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A Prevention Quandary

Nicholas A. Daniels, MD, MPH; Beverly Ray, RN; Alyssa Easton, PhD, MPH; Nina Marano, DVM, MPH; Emily Kahn, PhD, MPH; André L. McShan II; Lamuels Del Rosario; Tamara Baldwin; Monica A. Kingsley; Nancy D. Puhr; Joy G. Wells, MS; Frederick J. Angulo, DVM, PhD

JAMA. 2000;284:1541-1545.

Context  In May and June 1998, reported Vibrio parahaemolyticus infections increased sharply in Texas.

Objective  To determine factors that contributed to the increase in V parahaemolyticus infections.

Design, Setting, and Participants  Cross-sectional survey of persons reporting gastroenteritis after eating seafood in Texas; survey of environmental conditions in Galveston Bay.

Main Outcome Measures  Traceback of oysters, water quality measures in harvest areas, presence of V parahaemolyticus in stool cultures; comparison of median values for environmental conditions before and during the outbreak compared with during the previous 5 years.

Results  Between May 31 and July 10, 1998, 416 persons in 13 states reported having gastroenteritis after eating oysters harvested from Galveston Bay. All 28 available stool specimens from affected persons yielded V parahaemolyticus serotype O3:K6 isolates. Oyster beds met current bacteriologic standards during harvest and fecal coliform counts in water samples were within acceptable limits. Median water temperature and salinity during May and June 1998 were 30.0°C and 29.6 parts per thousand (ppt) compared with 28.9°C and 15.6 ppt for the previous 5 years (P<.001).

Conclusions  This is the first reported outbreak of V parahaemolyticus serotype O3:K6 infection in the United States. The emergence of a virulent serotype and elevated seawater temperatures and salinity levels may have contributed to this large multistate outbreak of V parahaemolyticus. Bacteriologic monitoring at harvest sites did not prevent this outbreak, suggesting that current policy and regulations regarding the safety of raw oysters require reevaluation. Consumers and physicians should understand that raw or undercooked oysters can cause illness even if harvested from monitored beds. In patients who develop acute gastroenteritis within 4 days of consuming raw or undercooked oysters, a stool specimen should be tested for Vibrio species using specific media.

Author Affiliations: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Drs Daniels, Marano, and Angulo and Mss Puhr and Wells), Epidemic Intelligence Service, Epidemiology Program Office (Drs Daniels, Easton, and Kahn), and the Epidemiology Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (Dr Easton), Centers for Disease Control and Prevention, Atlanta, Ga; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (Dr Daniels); Texas Department of Health, Austin (Mss Ray, Baldwin, and Kingsley, Dr Kahn, and Mr Del Rosario); and Meharry Medical College, Nashville, Tenn (Mr McShan).

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