A Family Outbreak of Cholera in Changhua County

Ying-Shu Liao1, Sung-Hsi Wei2, Hsiao-Lun Wei1, Chun-Hsing Liao1, Chi-Sen Tsao1, Hui-Chih Lo2, Du-Lin Ling2, Tsung-Chuan Sun3,Tsung-hsien Wu3,Yen-Po Yeh3, Chien-Shun Chiou1

2013 Vol.29 NO.22

Correspondence Author: Chien-Shun Chiou

  • 1.Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan
  • 2.Central Reginal Center, Centers for Disease Control, Ministry of Health and Welfare,Taiwan
  • 3.Changhua County Public Health Bureau


       In September 2012, two indigenous cholera cases occurred in Changhua County. An elderly couple in coastal areas was hospitalized due to vomiting, diarrhea and watery stools. Vibrio cholerae was isolated from the stool specimens. Toxigenic strains, biotype E1 Tor and serogroup O1 serotype Ogawa, were confirmed by Taiwan CDC. The investigation revealed that the clam farming couple had a simple diet, mostly home-made ingredients, rarely dined out. The same strain was isolated from family flush toilet. Non-O1 and non-O139 strains were isolated from residual clams and farm site. Non-toxigenic O1 Ogawa was isolated from two aquatic species. PFGE typing showed strains from two cases and the toilet have the same fingerprinting pattern, but obviously differ from non-toxigenic strains. The infection might due to the couple eat raw, not fully cooked or contaminated clams, along with high susceptibility. High diversity of V. cholerae was discovered in the aquaculture farming place, indicating V. cholerae (toxigenic strains) should have widely lived in waters and the surface of aquatic species in estuaries. The prevention control of cholera in Taiwan should emphasize on health education, clam and fish should be fully cooked, avoid eating raw food. Prevent cross-contamination of cooked and uncooked food. In addition, the leftover food should be refrigerated in case of V. cholerae contamination.