National Enteric Disease Surveillance : COVIS annual summary, 2012
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      Summary of human Vibrio cases reported to CDC, 2012.

      The Cholera and Other Vibrio Illness Surveillance (COVIS) system is a national surveillance system for human infection with pathogenic species of the family Vibrionaceae, which cause vibriosis and cholera. The Centers for Disease Control and Prevention (CDC) maintains COVIS. Information from COVIS helps track Vibrio infections and determine host, food, and environmental risk factors for these infections.

      CDC initiated COVIS in collaboration with the Food and Drug Administration and four Gulf Coast states (Alabama, Florida, Louisiana, and Texas) in 1989. Using the COVIS report form (available at nationalsurveillance/PDFs/CDC5279_COVISvibriosis.pdf ), participating health officials report cases of vibriosis and cholera. The case report includes clinical data, including information about underlying illness; detailed history of seafood consumption; detailed history of exposure to bodies of water, raw or live seafood or their drippings, or contact with marine life in the seven days before illness onset; and traceback information on implicated seafood.

      Before 2007, only cholera, which by definition is caused by infection with toxigenic Vibrio cholerae serogroup O1 or O139, was nationally notifiable. In January 2007, infection with other serogroups of V. cholerae and other species from the family Vibrionaceae also became nationally notifiable, as vibriosis.

      CDC requests that all State Health Departments send all Vibrio cholerae and Vibrio mimicus isolates to CDC for additional characterization. For V. cholerae, CDC identifies serogroups O1, O75, O139, and O141 and determines whether the isolate produces cholera toxin. For all Vibrio species (excluding V. cholerae), CDC accepts isolates for antimicrobial resistance testing and all outbreak isolates for identification. Although all Vibrio infections are nationally notifiable, many cases are likely not recognized because Vibrios are not easily identified on routine enteric media. A selective medium, such as thiosulfate citrate bile salts sucrose agar (TCBS), should be used.

      This report summarizes human Vibrio infections occurring during 2012 reported to COVIS. Results are presented in two categories: (1) infection with pathogenic species of the family Vibrionaceae (other than toxigenic Vibrio cholerae serogroups O1 and O139), which cause vibriosis; this category includes infection with toxigenic V. cholerae of serogroups other than O1 and O139, and (2) infection with toxigenic V. cholerae serogroups O1 and O139, which cause cholera. While many Vibrio species are well-recognized human pathogens, the status of some species (including Photobacterium damselae subsp. damselae (formerly V. damsela), V. furnissii, V. metschnikovii, and V. cincinnatiensis) as human enteric or wound pathogens is less clear.

      Understanding the routes by which infection is transmitted is essential for control. For vibriosis, cases are summarized by place of exposure (travel-associated vs. domestically acquired). Travel- associated cases are defined as infections in persons who reported international travel in the seven days before illness began; all other infections were defined as domestically-acquired cases. For domestically acquired vibriosis, transmission routes (foodborne, non- foodborne, and unknown) are determined based on reported patient exposures and specimen sites (see Appendix for classification method). For toxigenic V. cholerae (all serogroups), exposures are summarized by place of exposure (travel-associated vs. domestically acquired) and then, if information is available, by source (such as consumption of contaminated seafood).

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