Blake P A
Enteric Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Gastroenterol Clin North Am. 1993 Sep;22(3):639-60.
A persisting reservoir of the Gulf Coast strain of toxigenic V. cholerae O1 in Louisiana and Texas marshes and the shipment of seafood from these areas throughout the United States means that sporadic cases and outbreaks of cholera may occur anywhere in the country for the foreseeable future. Such cases are most likely to occur during warm months, especially between July and October. Physicians should think of cholera when consulted for severe watery diarrhea, even when the patient has no history of travel, and alert the laboratory. Experience has shown that US food and water sanitation is good enough to make either secondary transmission or large outbreaks unlikely; however, as long as we have foodborne and waterborne outbreaks of bacterial enteric diseases, the Gulf Coast strain may appear in a situation in which it can multiply and be ingested in large numbers by many people. The Latin American cholera epidemic has caused more cases of cholera in the United States in 2 years than the total of Gulf Coast strain cases identified during the past 20 years. The epidemic's future is uncertain. Despite knowing a great deal about cholera epidemiology, we cannot fully explain the ebb and flow of cholera epidemics. We do not know why cholera was apparently eliminated from the Western Hemisphere by 1900, nor can we predict which areas will be affected next or whether cholera will remain in a given area transiently or become endemic. The fact that cholera disappeared from the Western Hemisphere in the last century does not necessarily mean that it will disappear again. The situation is different now in several ways. The current pandemic is caused by the El Tor biotype, which persists better in the environment than does the classical biotype. Travel is now more frequent and more rapid. Finally, the population of the Western Hemisphere is about 14 times larger now than it was in 1850 and produces about 80,000 metric tons of human feces each day, of which only a fraction is treated. Thus, cholera will probably become endemic in Latin America and persist indefinitely.
产毒霍乱弧菌O1型海湾沿岸菌株持续存在于路易斯安那州和得克萨斯州的沼泽地，且来自这些地区的海鲜运往美国各地，这意味着在可预见的未来，霍乱的散发病例和疫情可能在该国任何地方发生。此类病例最有可能在温暖月份出现，尤其是在7月至10月之间。医生在遇到严重水样腹泻患者前来咨询时，即使患者没有旅行史，也应考虑霍乱，并通知实验室。经验表明，美国的食品和饮用水卫生状况良好，足以使二次传播或大规模疫情不太可能发生；然而，只要存在细菌性肠道疾病的食源性和水源性疫情，海湾沿岸菌株就可能出现在能够大量繁殖并被许多人摄入的环境中。拉丁美洲的霍乱疫情在两年内导致美国的霍乱病例比过去20年中确认的海湾沿岸菌株病例总数还多。该疫情的未来尚不确定。尽管我们对霍乱流行病学了解很多，但仍无法完全解释霍乱疫情的起伏。我们不知道为什么霍乱在1900年时显然已从西半球消除，也无法预测下一个受影响的地区，或者霍乱是否会在某个特定地区短暂停留或成为地方病。霍乱在上个世纪从西半球消失这一事实并不一定意味着它会再次消失。现在的情况在几个方面有所不同。当前的大流行是由埃尔托生物型引起的，它在环境中的存活能力比古典生物型更强。现在旅行更加频繁和迅速。最后，西半球目前的人口约是1850年的14倍，每天产生约80000公吨人类粪便，其中只有一小部分得到处理。因此，霍乱可能会在拉丁美洲成为地方病并无限期持续存在。
