16 July 2012

Acute watery diarrhoea and cholera: Cuba

This updates the Clinical Update 5 July, 2012

As of 14 July, 2012 The Ministry of Public Health of Cuba reported 158 confirmed cases of toxigenic Vibrio Cholerae El Tor (serotype O1, Ogawa) in the outbreak of acute watery diarrhoea (AWD) first reported 2 July, 2012 [1, 2].

In recent weeks 1,000 cases of AWD including three deaths have been reported. The province with the highest incidence is Granma, with most cases reported from the municipality of Manzanillo.  Public health measures, including surveillance, have been implemented; isolated cases of AWD occuring elsewhere in Cuba, associated  with this outbreak, have been identified promptly and treated [1, 2].

Advice for travellers

Cholera is an acute diarrhoeal disease caused by the Gram negative bacillus Vibrio cholerae serogroup O1 or O139.  Vibrio cholerae is transmitted through contaminated water or food in areas of poor sanitation.

Most travellers are at very low risk, but should practise food and water hygiene precautions. Cholera vaccine is not routinely recommended for travellers, but may be considered for those at higher risk of the toxigenic O1 strain of V. cholerae travelling to affected areas such as humanitarian aid workers and those who will have limited access to safe drinking water [3-4]. Country recommendations for Cuba have been updated.

Advice specific to countries that have consistently reported toxigenic V. cholerae outbreaks in recent years, can be found on NaTHNaC Country Information Pages and Outbreak Surveillance Database.

References

1. InfoMed Red du Salud de Cuba. Nota informativa del Ministerio de Salud Pública [In Spanish]. 14 de jullio, 2012. [Accessed 16 July, 2012], Available at: http://www.sld.cu/

2. Centro Nacional de Información de Ciencias Médicas, Nota Informativa. 2 de jullio, 2012 [In Spanish]. [Accessed 16 July 2012]. Available at: http://www.sld.cu/verpost.php?blog=http://articulos.sld. cu/editorhome&post_id=10261&c=226&tipo=2&idblog=

60&p=1&n=z

3. Hill DR, Ford L, Lalloo DG. Oral cholera vaccines: use in clinical practice. Lancet Infect Dis 6:361-73, 2006.

4. Cholera. In Salisbury D, Ramsay M, Noakes K [eds]. Immunisation against infectious disease.2006. [Accessed 5 July 2012]. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalas

sets/documents/digitalasset/dh_078541.pdf

Links

Health Protection Agency: Fact sheet on Cholera

NaTHNaC Health Information Sheet: Cholera

NaTHNaC Health Information Sheet: Prevention of food and water borne diseases