September 3, 2009

TO: Healthcare Providers, Hospitals, Laboratories, Local Health Departments

FROM: NYSDOH Bureau of Communicable Disease Control

HEALTH ADVISORY: VIBRIO PARAHAEMOLYTICUS

 

INFECTIONS INCREASE

Please distribute to all staff in the Departments of Emergency Medicine, Internal Medicine, Infectious Disease, Family Medicine, Pediatrics, Infection Control, and Laboratory Medicine

• Since June 1, 2009, there has been an increase in laboratory-confirmed cases of Vibrio parahaemolyticus in New York State (NYS) and New York City (NYC).

• Vibrio species (sp.) infections should be considered in the differential diagnosis of any patient presenting with gastrointestinal illness and a history of consuming seafood. If suspected, providers must specifically request testing for Vibrio sp. bacteria.

• Providers should report any suspected or confirmed cases of Vibrio sp. infection to the local health department (LHD) where the patient resides.

• Laboratories should submit all positive Vibrio sp. isolates to the New York State Department of Health (NYSDOH) Wadsworth Center or the New York City Department of Health and Mental Hygiene (NYCDOHMH) Public Health Laboratory for confirmation and molecular typing.

• Certain patients are at higher risk and should be reminded about the hazards of consuming or handling raw seafood.

 

Between June 1 and August 28, 2009, there has been an increase in Vibrio parahaemolyticus (Vp) cases reported to the NYSDOH in comparison to the same time periods in 2007 and 2008. A similar increase in Vp has been noted in NYC and other states. Therefore, health care providers are reminded to consider Vibrio-related infection when evaluating patients with gastroenteritis. Since June 1, 2009, 25 cases of Vp were reported in 10 counties of NYS, outside of NYC (Dutchess-1, Franklin-1, Monroe-1, Montogomery-1, Nassau-4, Onondaga-1, Saratoga-1, Suffolk-11, Tompkins-1, and Westchester-3) with onsets of illness between 6/1/09 and 8/10/09. Of the reported Vp cases, ages range from 8 to 83 years of age, with a median age of 46; 72% are male. Twelve of the 15 cases for which we have exposure information indicate consumption of raw clams.

The diagnosis of Vibrio sp. infections should be considered in any patient presenting with gastrointestinal symptoms and a recent history of consumption of raw or undercooked seafood. Onset of illness may occur within hours to five days after exposure. Most episodes of illness are self-limited and do not require treatment other than oral or intravenous hydration. Elderly and very young patients, pregnant women, and patients with underlying illness such as liver disease, diabetes and those with immune disorders may be at increased risk of sepsis and other complications.

Providers are encouraged to remind such at-risk patients that consumption and improper handling of raw or undercooked seafood can result in serious illness, including death. Since Vibrio sp. require selective culture media for isolation, testing for Vibrio sp. must specifically be requested when submitting stool for bacteriologic examination. The medium of choice for isolation is selective thiosulfate citrate bile salts sucrose (TCBS) agar, on which it appears as a distinct opaque green colony. All clinical Vibrio sp. isolates from outside NYC should be forwarded for confirmation and molecular typing to the NYSDOH Wadsworth Center Bacteriology Laboratory to the attention of Nellie Dumas at the appropriate address below:

If sent via overnight courier:

120 New Scotland Avenue Empire State Plaza

Albany, New York 12208

 

If sent through USPS:

P.O. Box 509

Albany, New York 12201

 

Foodborne illnesses, including Vibrio sp. infections, are reportable diseases in NYS. Prompt notification to your LHD is imperative to ensure that outbreaks are promptly recognized and control measures are implemented. If you have any general questions about Vibrio-related infections, please contact your LHD.

For questions about laboratory testing, please contact the NYSDOH Wadsworth Center at 518-474-177. Your cooperation is appreciated.