Twentieth

To evaluate recent trends in cholera in the United States, surveillance data from all cases of laboratory-confirmed toxigenic Vibrio cholerae O1 and O139 infection reported to the Centers for Disease Control and Prevention between 1995 and 2000 were reviewed. Sixty-one cases of cholera, all caused by V. cholerae O1, were reported. There was 1 death, and 35 (57%) of the patients were hospitalized. Thirty-seven (61%) infections were acquired outside the United States; 14 (23%) were acquired through undercooked seafood consumed in the United States, 2 (3%) were acquired through sliced cantaloupe contaminated by an asymptomatically infected food handler, and no source was identified for 8 (13%) infections. The proportion of travel-associated infections resistant to trimethoprim-sulfamethoxazole, sulfisoxazole, streptomycin, and furazolidone increased from 7 (8%) of 88 in 1990 1994 to 11 (31%) of 35 in 1995 2000. Foreign travel and undercooked seafood continue to account for most US cholera cases. Antimicrobial resistance has increased among V. cholerae O1 strains isolated from ill travelers. Cholera remains one of the most feared epidemic diseases throughout much of the world. Persons living in the United States most often acquire cholera through travel to cholera-endemic areas or through consumption of undercooked seafood from the Gulf Coast or foreign waters. The following case reports illustrate these 2 mechanisms