1. Ms. Anna Newton Surveillance Epidemiologist Centers for Disease Control and Prevention Cholera in the United States Emerging Infectious Diseases National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases November 2011 Based on the article Cholera in United States Associated with Epidemic in Hispaniola Anna E. Newton, Katherine E. Heiman, Ann Schmitz, Tom Török, Andria Apostolou, Heather Hanson, Prabhu Gounder, Susan Bohm, Katie Kurkjian, Michele Parsons, Deborah Talkington, Steven Stroika, Lawrence C. Madoff, Franny Elson, David Sweat, Venessa Cantu, Okey Akwari, Barbara E. Mahon, and Eric D. Mintz

2. What was the study about?  The study summarized the United States’ cases of cholera between October 2010 and April 2011 that were associated with the cholera epidemic in Haiti and the Dominican Republic, a region which is also known as Hispaniola.  Because of epidemic, the United States enhanced monitoring and notification for cholera.

3. Why was the study done?  Cholera is a major cause of epidemic diarrhea throughout the developing world.  However, cholera is rare in the United States.  During 2000-2009, 1-8 cases of cholera were diagnosed each year among people returning or coming from cholera-affected countries.  When cholera breaks out in an area, people who travel there from the United States can get infected. Back in the 1990s, over 100 people in the US became ill with cholera after traveling to Latin America during a cholera outbreak there.

4. What was found in the study?  23 cases of cholera in the United States from October 2010 to April 2011  13 patients reported travel to Haiti, and 9 to the Dominican Republic. The main reason for travel was to visit friends and family.  1 patient reported eating conch, a type of shellfish, brought back by a family member from Haiti.

5. What importance do the findings have for people living in the United States?  People traveling to areas where cholera is occurring may be exposed to the cholera bacteria and should take appropriate prevention measures while abroad so they don’t get diarrhea  People with severe diarrhea who have just come back from traveling to an area with cholera should be sure to tell their doctor they have been in a country where they could have gotten cholera

6. How can people protect themselves from getting cholera when traveling?  Cholera is transmitted through contaminated food and water  Prevention measures for travelers  Drink safe water Safe water is water that has been boiled, carbonated, or disinfected. This includes only using ice that is made from safe water  Wash hands often with soap and safe water  When consider what food to eat, a good rule of thumb: ‘boil it, cook it, peel it, or forget it’ People should cook food well, keep it covered, and eat it hot  When preparing food, wash (using safe water) and peel fruits and vegetables  Avoid eating fresh salads or raw seafood  Don’t bring back food in luggage, especially seafood  These same measures will also help to protect travelers form getting other types of diarrhea

7. For more information, please contact: Emerging Infectious Diseases Centers for Disease Control and Prevention 1600 Clifton Road NE, Mailstop D61, Atlanta, GA 30333, USA Telephone: 1-404-639-1960/Fax: 1-404-639-1954 E-mail: eideditor@cdc.gov Web: http://www.cdc.gov/eid/ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases Thank you to all authors Anna E. Newton, Katherine E. Heiman, Ann Schmitz, Tom Török, Andria Apostolou, Heather Hanson, Prabhu Gounder, Susan Bohm, Katie Kurkjian, Michele Parsons, Deborah Talkington, Steven Stroika, Lawrence C. Madoff, Franny Elson, David Sweat, Venessa Cantu, Okey Akwari, Barbara E. Mahon, and Eric D. Mintz