Pathogenic Vibrio species in Florida - Florida Department of Health

Pathogenic Vibrio species in Florida: Vibrio cholera O1 & O139,
Vibrio cholera non-O1 non O1 & non-O139, non O139, Vibrio parahaemolyticus and
Vibrio vulnificus
Kathleen Ward, RS, MSEH, Bureau of Community Environmental Health, Division of Environmental Health, Department of Health
Introduction
The Vibrio species of bacteria occur naturally in the marine and estuarine waters of Florida unlike other bacterial
pathogens of Public Health concern, which are introduced to Florida waters by polluting fecal contamination. As
expected, seafood consumption is consistently associated with Vibrio infection. Oysters, Blue crabs, clams,
shrimp and fish will harbor the Vibrio bacteria naturally and without ill effect to themselves.
Vibrio cholera, vulnificus and parahaemolyticus are three species of primary Public Health concern in Florida.
Infections by these pathogens are acquired by consumption of seafood, exposure to contaminated water and
directly through wounds. Clinical manifestations may range from gastroenteritis to septicemia to death. Vibrio
cholera O1 and O139 infections are rare in Florida. The presence of this Vibrio in Florida waters has been
associated with the release of contaminated ballast water from ships traveling from polluted areas outside The
United States.
Vibrio parahaemolyticus infection may occur as single cases or in large outbreaks. Oyster consumption has been
implicated in multi-state outbreaks. Smaller outbreaks are caused by consumption of cross-contaminated cooked
blue crabs. This illness is characterized by abdominal cramps and watery dysenteric diarrhea. Systemic infection
and death is rare.
Vibrio vulnificus infections occur as single cases when immune compromised persons consume raw or lightly
cooked oysters or through infected wounds. The clinical symptoms include gastroenteritis, septicemia, coma and
death. The mortality rate among at risk persons is as high as 50% of all reported cases.
The Florida Department of Health conducts active surveillance of all Vibrio cases in partnership with the Florida
Department of Agriculture and Consumer Services Division of Aquaculture.
Vibrio species:
V. cholera 01, O139
V. cholera non-01,
nonO139
V. parahaemolyticus
V. vulnificus
V. alginolyticus
V. fluvialis
V. hollisae
V. mimicus
V. carchariae
V. cincinnatiensis
V. damsela
V. furnissii
V. hollisae
V. metschnikovii
V. vulnificus
V. parahaemolyticus
V. cholera
• Pathogenic Vibrio species are ubiquitous in the Gulf Coast waters and are indigenous flora of
brackish water, estuaries and salt marshes of the temperate coastal areas.
• The levels of pathogenic Vibrio spp. in coastal waters do not correlate with fecal coliform
levels.
• The Vibrio levels decrease as water temperatures fall and increase again with rising water
temperatures.
• The ability of pathogenic Vibrio species to produce chitinase or to be chitinoclastic also
correlates to the rise in Vibrio numbers with the increase of chitin producing marine life in
warmer waters.
• Vibrios are found in the water column during warm months and will survive the colder
temperatures by attaching to chitinous marine life in the sediment.
• May to October increases of Vibrio infections also correlate to warmer water temperatures.
• Pathogenic Vibrios are associated with molluscs and crustaceans and human infection occurs
through their consumption or by wound exposures.

Vibrio cholera 01 And 0139
•Vibrio cholera O1 and O139 produce the cholera toxin. Infections are very rare in the United States
with usually no more that 0-5 cases per year.
•Transmission occurs through consumption of contaminated foods and drinking water, as well as raw
or undercooked shellfish.
•Incubation periods ranges from hours to 5 days, usually average 2-3 days.
•Many infections are asymptomatic or have milder diarrhea. Serious infections exhibit profuse watery
diarrhea, vomiting, circulatory collapse and shock. 25-50% are fatal if untreated.
•Treatment includes; aggressive rehydration therapy, administration of effective antibiotics (which
also helps to shorten the period of communicability) and treatment of complications
Vibrio cholera non-01 non 01 and non-0139 non 0139
•Vibrio cholera non-O1 and non-O139 strains rarely produce the cholera toxin and do not cause
epidemic disease.
•Transmission also occurs through consumption of raw, undercooked or cross-contaminated shellfish
such as oysters and blue crabs. Wound related infections may also occur.
•Incubation periods range from 5 -96 hours but usually average 10 hours.
•Infection usually causes a mild self-limiting gastroenteritis. Although persons with preexisting health
problems are at greater risk for life threatening infection.
•Serious infections require aggressive and prompt antibiotic therapy.
Vibrio parahaemolyticus
Vibrio parahaemolyticus is responsible for an estimated 3000 cases, an average of 190 culture
confirmed cases, 40 hospitalizations and 7 deaths in the United States each year.
Transmission is most commonly associated with consumption of raw, undercooked or crosscontaminated
shellfish and crustaceans. There are also infections through wound or soft
tissue exposures.
Large outbreaks of Vibrio parahaemolyticus infections are often associated with raw oyster
consumption. Smaller outbreaks or individual cases are commonly associated with
consumption of cooked Blue crab that has been mishandled.
Vibrio parahaemolyticus is a relatively fragile microbe and is readily destroyed by normal cooking
temperatures. Live Vibrio parahaemolyticus organisms are reintroduced to susceptible
foods such as cooked Blue crabs by cross contamination from Live crabs or contaminated
surfaces. Also improper temperature management such as failure to maintain hot holding
temperatures or too rapidly chill cooked crabs is often implicated in outbreaks.
Incubation periods for Vibrio parahaemolyticus range from 4-30 hours and usually average 12-24
hours.
Symptoms include nausea, vomiting, cramps, fever and watery, sometimes bloody diarrhea.
Duration of the illness usually only lasts 2-3 days with no long term health effects. Immunecompromised
persons are at greater risk for more serious illness and complications.

Vibrio parahaemolyticus and blue crabs, Duval County, 1995, 1997,1999, 2000,
2003 and 2004
•3 Jacksonville seafood markets also operating as take out restaurants have multiple Vibrio
parahaemolyticus outbreaks between 1995-2004:
•Cross Contamination Nightmare: Crabs contaminated after cooking by; contact with Live crabs in
the display cooler, food contact surfaces (sheet pans) contaminated with raw crab water and
being stored in baskets that held live crabs.
•Temperature Abuse Nightmare: Hot cooked crabs are packed in styrofoam boxes instead of being
rapidly chilled before packaging. Boxes of Hot product are stacked top to bottom and front to rear
of an old display cooler.
•Overloaded display cooler unable to accomplish rapid chilling to safe temperatures. Temperature
checks during investigation showed that boxes in the middle of the stacked products were still
above 50f after 24 hours in the cooler.
•Leftover cooked crabs from consumers and stool samples were positive for Vibrio parahaemolyticus.
2004 outbreak samples results from crab and stools were also positive for Vibrio alginolyticus and
suspected positive for Vibrio cholera nonO1.
Vibrio vulnificus
• Among the pathogenic Vibrio species, Vibrio vulnificus causes the most severe disease. The septicemia
and wound infections caused by this pathogen progress rapidly and are frequently fatal.
• An average of 50 culture-confirmed cases, 45 hospitalizations and 16 deaths are reported each year
from the Gulf Coast region. Nationwide there are 95 cases, 85 hospitalizations and 35 deaths.
• Consumption of raw oysters (as few as 3) is the predominant source of systemic Vibrio vulnificus
infection. Serious infections also occur through wound or soft tissue exposures to warm estuarine
waters.
• Incubation periods range from 12-72 hours after exposure.
• Symptoms in otherwise healthy persons include vomiting, diarrhea and abdominal pain. Persons with
underlying medical conditions experience fever, chills, decreased blood pressure, blistering skin lesions,
shock, and death.
• Individuals at highest risk for serious or fatal infections are those with cirrhosis, other liver disease,
hemochromatosis, chronic liver disease and those immunocompromised by underlying disease such as
diabetes or by medications.
• The typical case is a 40-75 year old male, heavy drinker, unaware of or in denial of dietary risks who
consumes raw or undercooked oysters and suffers septicemia with a 50% mortality rate.
Number of Cases/Deaths
18
16
14
12
10
8
6
4
2
0
1988
1989
Vibrio vulnificus Cases and Deaths Associated With Oyster
Consumption,
Florida, 1988-2003
1990
1991
1992
1993
1994
1995
1996
Year
1997
1998
1999
2000
2001
2002
From 1988-2003, 157 cases from oyster consumption, 71 deaths – 45% cases died.
References
• Tyson, David L., Vibrio 29: pp 497-506, Manual of Clinical Microbiology 7 th ed., 1999.
• Michael P. Doyle, ed. Foodborne Bacterial Pathogens, 1989, pp. 525-597.
• James Chin, ed. Control of Communicable Diseases Manual, 17 th edition, 2000 American
Public Health Association, pp. 100-115.
• CDC Diseases and Conditions: http://www.cdc.gov/az.do/id/0900f3ec8000e035#V
2003
Cases
Deaths