MMWR Weekly for May 4, 2012

The MMWR Weekly for May 4, 2012 / Vol. 61 / No. 17 includes:

Imported Human Rabies in a U.S. Army Soldier — New York, 2011

Comparison of Meningococcal Disease Surveillance Systems — United States, 2005–2008

Notes from the Field: Identification of Vibrio cholerae Serogroup O1, Serotype Inaba, Biotype El Tor Strain — Haiti, March 2012
On October 20, 2010, an outbreak of cholera was confirmed in Haiti for the first time in more than a century. As of April 10, 2012, a total of 534,647 cases, 287,656 hospitalizations, and 7,091 deaths have been reported in Haiti as a result of the outbreak (1). The Vibrio cholerae strain that caused the Haiti epidemic has been characterized as toxigenic V. cholerae, serogroup O1, serotype Ogawa, biotype El Tor (2).

Recently, two V. cholerae isolates collected on March 12 and 13, 2012, in Anse Rouge, Artibonite Department, were characterized at the National Public Health Laboratory in Haiti as non-Ogawa serotypes. The isolates subsequently were confirmed by CDC to belong to the Inaba serotype. By molecular analyses (pulsed-field gel electrophoresis, multilocus variable number of tandem repeat analysis, and virulence gene sequencing [ctxB and tcpA]), these two isolates are indistinguishable from the currently circulating V. cholerae serotype Ogawa strain in Haiti. The molecular analyses conducted to date suggest that they arose from serotype switching, which is a commonly observed phenomenon in cholera epidemics, often driven by population immunity to the circulating serotype. Further characterization efforts are ongoing.  Finding these two isolates does not change current clinical management guidelines (3)…

…The two World Health Organization prequalified vaccines provide protection against the Ogawa and Inaba serotypes. In addition, the cholera rapid diagnostic tests detect all O1 serogroup infections, including Ogawa and Inaba serotypes.

This serotype conversion illustrates the increasing diversity of V. cholerae in Haiti (2) and emphasizes the importance of continued public health surveillance by the National Public Health Laboratory and CDC, which are partnering to establish a laboratory-enhanced sentinel surveillance system for a range of infectious diseases, including cholera and other diarrheal diseases. The system will provide data to determine the burden of diarrheal disease attributable to cholera and to help direct prevention efforts and programs to reduce morbidity and mortality from cholera in Haiti