Vulnerable To Vibrio

Credit Florida DOH

 

 

# 8758

 

While it is not always appreciated by tourists (and even some locals) here in Florida - once you step out of the tightly controlled environs of our mega-amusement parks - some of our best attractions can carry with them some unexpected hazards.

 

Parts of Florida remain as wild, and potentially dangerous, as it was a hundred years ago.

 

Hence admonitions not to feed, taunt, or otherwise engage our sizable population of alligators, warnings to beachgoers to shuffle your feet while wading to ward off horseshoe crabs, and caveats about ours being the lightning capital of the United States (4 lightning related deaths already in 2014).

 

Not all of our local hazards are as vicious as alligators, or as vivid as lightning bolts.  Some are microscopic, and can hide in  the warm waters of the Gulf coast and in contaminated seafood. 

 

Such is a bacteria called Vibrio Vulnificus.  

 

Ingestion of Vibrio vulnificus can cause gastrointestinal symptoms, but for healthy people, rarely causes serious illness.  The State of Florida warns, however: Vibrio vulnificus infections can be a serious concern for people who have weakened immune systems, particularly those with chronic liver disease

 

The most common route of infection is by eating raw or undercooked shellfish (oysters, mainly). Which is why I’ll take my oysters deep fried or steamed, thank you.

 

It is also possible to contract this infection from swimming, or wading, in contaminated waters.  From the CDC’s Vibrio Vulnificus website:

 

V. vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulceration. Persons who are immunocompromised are at higher risk for invasion of the organism into the bloodstream and potentially fatal complications.

 

These skin infections can prove quite nasty, and the press often refers to it as a `flesh eating bacteria’.   Antibiotics and extensive debridement of necrotic tissue are the standard treatments, and in some instances amputation is required.

 

It should be noted that millions of people swim in the Gulf and Atlantic waters off Florida every year, and only a small handful are affected. Frankly, you have a far better chance of drowning than acquiring this bacterial infection.

 

Nevertheless . . . . a handful of people do each year.

 

In order to remind the public of the dangers and to reduce the incidence of infection, yesterday Florida’s Department of Health released the following announcement:

 

FOR IMMEDIATE RELEASE          Contact: DOH Communications June 17, 2014            (850) 245-4111

HEALTH OFFICIALS ENCOURAGE AWARENESS OF POTENTIAL BACTERIA IN COASTAL WATERS

TALLAHASSEE – The Florida Department of Health urges Floridians with certain health conditions to avoid eating raw oysters and exposing open wounds to seawater and estuarine water, which may harbor bacteria called Vibrio vulnificus. Occurring naturally in the warm coastal waters, particularly during the summer months, Vibrio vulnificus has the potential to cause serious illness.

Persons who have wounds, cuts or scratches and wade in estuarine areas or seawater where the bacteria might be present can become ill. Symptoms of Vibrio vulnificus in wound infections typically include swelling, pain and redness at the wound site.

Other symptoms of Vibrio vulnificus infection include; nausea, vomiting, abdominal pain, diarrhea, fever, chills, and the formation of blistering skin lesions. Individuals experiencing these symptoms should contact a physician immediately for diagnosis and treatment.

Individuals with liver disease, including Hepatitis C and cirrhosis, are most at risk for developing serious illness from Vibrio vulnificus obtained from eating raw oysters. Others who should avoid consuming raw shellfish are those with hemochromatosis (iron overload), diabetes, cancer, stomach disorders or any illness or treatment that weakens the immune system. Thoroughly cooking oysters, either by frying, stewing, or roasting eliminates harmful bacteria and viruses in the meat. Consuming raw oysters that have undergone a post-harvest treatment process to eliminate the bacteria can also reduce the risk of illness.

A total of 41 cases of Vibrio vulnificus were reported during 2013 and to date this year there have been six cases, four due to the infection of an open wound and two from consuming raw shellfish.  For more information, please view this

Vibrio vulnificus fact sheet:  

 

 

Despite the dangers, and considering we have 80 million yearly visitors, and 20 million residents, surprisingly few run afoul of our natural hazards.  For that, public education and awareness is probably the biggest mitigating factor, something actively pursued by both the Florida Department of Health and Florida’s Division of Emergency Management.

For some of my earlier posts on Vibrio, you may wish to revisit:

Vibrio Vulnificus: Rare, But Sometimes Deadly

Flood Dangers Run Deep

Vibrio Vulnificus: Rare, But Sometimes Deadly

Credit Florida DOH

 

# 7830

 

As a native Floridian who has lived a good deal of his life aboard boats or near the ocean, I’m quite aware of both the lure - and the hazards - of Florida’s waters.  Like anyplace else, we have our fair share of local dangers.  But the ones that tourists tend to worry about;  alligator or shark attacks are actually quite rare.

 

A bit more common – but not well appreciated - are some of the naturally occurring pathogens that can be found in our local salt and fresh waters (but not restricted only to Florida). 

 

While exceeding rare, the `killer amoeba’  called Naegleria Fowleri gets a lot of press attention each summer, as its victims are usually children, and the outcome is almost always fatal.  We generally see 2 or 3 cases a year across the southern states each year, usually linked to swimming in stagnant freshwater lakes or ponds.  

 

In mid-August, in Florida Reports Naegleria fowleri Infection we learned of an 12-year-old boy with the infection, in July (see Arkansas: Naegleria fowleri Shuts Water Park) the victim was a 12-year-old girl, while just last month, in Louisiana: St. Bernard Parish Water Supply Tests Positive For Naegleria Fowleri  we saw the rare acquisition of the parasite from tap water.

 

But there is another waterborne pathogen, called Vibrio vulnificus, that is a naturally occurring bacteria that can be found in the warm coastal waters of the gulf coast states (Alabama, Florida, Louisiana, Texas and Mississippi). Over the past week, local and national media have reported on  26 infections, and 9 fatalities this year in Florida. 

 

An active year, but hardly a record.  As in 2011 Florida reported 35 cases, and 13 deaths.

 

Ingestion of Vibrio vulnificus can cause gastrointestinal symptoms, but for healthy people, rarely causes serious illness.  The State of Florida warns, however: Vibrio vulnificus infections can be a serious concern for people who have weakened immune systems, particularly those with chronic liver disease

 

The most common route of infection is by eating raw or undercooked shellfish (oysters, mainly).  Between 1988 and 2003, Florida reported 157 Vibrio infections from oyster consumption. Of those,  nearly half (45%) died.  

.

Which is why I’ll take my oysters deep fried or steamed, thank you.

 

It is also possible to contract this infection from swimming, or wading, in contaminated waters.  From the CDC’s  Vibrio Vulnificus website:

 

V. vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulceration. Persons who are immunocompromised are at higher risk for invasion of the organism into the bloodstream and potentially fatal complications.

 

These skin infections can prove quite nasty, and the press often refers to it as a `flesh eating bacteria’.   Antibiotics and extensive debridement of necrotic tissue are the standard treatments, and in some instances amputation is required.

 

It should be noted that millions of people swim in the Gulf and Atlantic waters off Florida every year, and only a small handful are affected. Frankly, you have a far better chance of drowning than acquiring this bacterial infection.   Nevertheless . . . .

 

In 2007, V. vulnificus became a reportable illness to the CDC, and so surveillance and reporting has become more detailed.  Here, from the State of Florida Department of Health, is a breakdown of V. vulnificus infections in the state over the past 6 years.

 

Below is a breakdown of cases in Florida since 2008:

2008 = 15 cases, 5 deaths

2009 = 24 cases, 7 deaths

2010 = 32 cases, 10 deaths

2011 = 35 cases, 13 deaths

2012 = 27 cases, 9 deaths

2013 = so far 26 cases, 9 deaths and of those deaths:

• 2 – unable to determine exposure history
• 3 – consumed raw oysters
• 4 – likely exposure to seawater

2013 deaths occurred in the following counties:

• Broward (2 qty.)  Flagler  Glades  Lee  Leon  Monroe  Okaloosa  Walton

 

This from the Florida’s DOH press release of October 1st, 2013.

 

How common is Vibrio vulnificus infection?

Vibrio vulnificus is a rare cause of disease, but it is also underreported. Between 1988 and 2006, the Centers for Disease Control and Prevention (CDC) received reports of more than 900 Vibrio vulnificus infections from the Gulf Coast states, where most cases occur.  Before 2007, there was no national surveillance system for Vibrio vulnificus, but CDC collaborated with Alabama, Florida, Louisiana, Texas and Mississippi to monitor the number of cases in the Gulf Coast region.  In 2007, infections caused by Vibrio vulnificus and other vibrio species became nationally notifiable.

What are some tips for preventing Vibrio vulnificus infections?

• Do not eat raw oysters or other raw shellfish.
• Cook shellfish (oysters, clams, mussels) thoroughly.
• For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375°F.
• Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood.
• Eat shellfish promptly after cooking and refrigerate leftovers.
• Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters.
• Wear protective clothing (e.g., gloves) when handling raw shellfish.

 

And as a final note, with a tropical system trying to wind up in the Gulf of Mexico this weekend, V. vulnificus infections are a particular concern after a hurricane or tropical storm,  as salt or brackish waters can be forced up onto land, and people may be wading through it during the recovery effort.    

 

The follow excerpt is  from the CDC’s Vibrio vulnificus After a Disaster webpage.

 

Concerns in hurricane-affected areas

Persons with immunocompromising conditions and especially those with chronic liver disease should avoid exposure of open wounds or broken skin to warm salt or brackish water, and avoid consuming undercooked shellfish harvested from such waters. More information on caring for wounds may be found in the fact sheet Emergency Wound Care After a Natural Disaster available on the CDC Hurricane website.

After a coastal flood disaster, large numbers of persons with illnesses that affect their resistance to infection may be exposed to seawater. Injury prevention is especially important for high-risk persons. Wounds exposed to seawater should be washed with soap and water as soon as possible, infected wounds should be seen by a doctor, and clinicians should aggressively monitor these wounds.

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Further information about Vibrio vulnificus can be found in Management of Vibrio vulnificus Wound Infections.