On September 18, 2012, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s first two cases of locally acquired cholera infection in a 75-year-old couple who reside in central Taiwan. Both of them have no international travel history and they consume mostly food they grow, including poultry, vegetables, fish and shell fish. The husband has history of chronic diseases, including high blood pressure and diabetes. Towards the end of August and early September, the couple respectively developed symptoms such as watery stool and vomiting. Currently, they are both hospitalized for medical treatment. Toxigenic V. cholerae O1 serotype Ogawa was isolated from the specimens collected from both cases by Taiwan CDC. According to the epidemiological investigation, none of the family members residing in the same household has developed suspected symptoms and the specimens collected from them were tested negative for cholera. Taiwan CDC continues to closely monitor the health of the family members. Additionally, Taiwan CDC has interviewed neighboring hospitals and clinics and no patient with suspected symptoms has sought medical attention at any of the hospitals and clinics. Further, a total of 13 environmental specimens were collected for the epidemiological investigation, including cookware at the cases’ residence, underground water, and fish pond water. Of all the 13 environmental specimens, only the toilet water was tested positive for cholera while all the other specimens were tested negative for the virus. The health authority has already assisted the cases in disinfecting their residence. On the other hand, food specimens have been submitted to the Food and Drug Administration (FDA) for laboratory testing. Between 2009 and 2011, 3, 5, and 2 locally acquired cholera cases were respectively confirmed. Of these cases, one death associated with cholera was reported in 2011 in an 86-year-old female who had cancer.

Cholera is an acute bacterial enteric disease with sudden onset of profuse watery diarrhea, vomiting, rapid loss of body fluids that leads to dehydration, acidosis, and circulatory collapse. The incubation period can vary from a few hours to five days with an average of 2-3 days. Transmission of cholera typically occurs by eating food or drinking water that is undercooked and contaminated with the feces of an infected person or carrier. The onset of cholera is related to the number of bacteria ingested and the host immunity. People at increased risk of cholera include elderly, patients with chronic diseases, cancer, weakened immune system, gastric hypoacidity, and people who have had gastrectomy. 

Taiwan CDC urges the public to pay attention to food and water hygiene. To prevent cholera, people are advised to take the following steps: consume thoroughly cooked food, store food safely and refrigerate when necessary, avoid cross-contamination-mixing raw food with cooked food, and drink only boiled or bottled water. In addition, high risk groups should avoid eating raw fish and vegetables to reduce the chance of infection.  Physicians are urged to report suspected case within 24 hours of diagnosis.If suspected symptoms develop, please seek immediate medical attention.  For any questions or further information on cholera, please call the toll-free Communicable Disease Reporting and Consultation Hotline 1922, or visit the Taiwan CDC’s website at http://www.cdc.gov.tw.