Vibrio cholera pacini O1 biovar eltor str. N16961 Agent Information Sheet

Boston University
Research Occupational Health Program (ROHP)
617-358-7647

Agent

Vibrio cholerae is a gram negative, non-spore forming, curved rod bacterium that contains a motile flagellum. It is a facultative anaerobe and part of the Vibronaceae family. There are over 200 subtypes, and the O1 and O139 serotypes cause epidemic cholera in humans. Vibrio cholera pacini O1 biovar eltor str. N16961 is an epidemic serogroup of Vibrio cholerae isolated in 1971 in Bangladesh and is distinguished from the classical biotype due to hemolysin production

Disease/Infection

Causes limited gastrointestinal illness or can cause severe cholera gravis infection.

Pathogenicity

Pathogenic Vibrio serogroups produce cholera toxin while non-pathogenic strains may or may not produce this toxin but can still cause illness in humans. Symptoms often depend on the strain and severity of illness. N16961 is a pathogenic strain. In serious cases of cholera involving severe dehydration, up to 60% of patients can die. However, with rehydration therapy, less than 1% of cases are fatal. The disease typically lasts from 4-6 days depending on treatment.

In 2002, the World Health Organization announced the fatality ratio for cholera was about 4%.

• Special Populations at Risk
  In untreated children, death secondary to dehydration can happen in a matter of hours or days. In addition, cholera infection in pregnant women and their fetuses may lead to premature labor and fetal death.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety Level 2 Practices

Modes of Transmission

Host Range/Reservoir
Humans, water birds, shellfish, fish, and herbivores have been found to contain the infectious agent.

Symptoms
Vibrio cholera can cause asymptomatic or mild disease, or result in more severe clinical symptoms. Symptoms of vibrio cholera include the hallmark of the abrupt onset of watery diarrhea, occasional vomiting and abdominal cramps. Severe dehydration usually happens, and signs may include extreme thirst, dry mucous membranes, decreased skin turgor, hypotension, weak or absent pulses, tachycardia, oliguria, renal failure, seizures, somnolence, and death.

Incubation Period
Incubation period can range from a few hours to 5 days.

Viability
Susceptible to 2-5% phenol, 1% sodium hypochlorite, 4% formaldehyde, 2% glutaraldehyde, 70% ethanol, 70% propanol, 2% peracetic acid, 3-6% hydrogen peroxide, and 0.16% iodine.

Survival Outside Host
Cholera can survive in well water from 6-10 days. Vibrio can survive in a wide variety of foods and drinks for 1-14 days at room temperature and 1-35 days on ice.

Information for Lab Workers

Laboratory PPE

Personal protective equipment includes but is not limited to gowns with tight wrists and ties in back, disposable gloves, combination safety glass and mask or a face shield. Facilities for washing and changing clothing after work should be available.

Containment

BSL-2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. Procedures that are likely to generate aerosols should be conducted in a biosafety cabinet. Practices may be enhanced based on risk assessment.

In Case of Exposure/Disease

• For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
  • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
  • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
    You will be referred to or transported to the appropriate health care location by the emergency response team.
• For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
• Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
• Provide the wallet-size agent ID card to the physician.

Vaccination

Vaccination is not available in the United States

Information for First Responders/Medical Personnel

Public Health Issues

Good hand hygiene should be practiced and standard precautions should be observed. Contact Precautions can be used for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.

Diagnosis/Surveillance

Clinically, cholera should be suspected in all patients with watery diarrhea, vomiting, and rapid dehydration, but it is not possible to distinguish cholera against other gastroenteritis diseases based on clinical suspicions alone.

Laboratory diagnosis via Gram stain / culture, and dark field microscopy are the standard for diagnosis. In addition, PCR and monoclonal antibody based stool tests are used.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

No prophylaxis has been shown to be effective.

Treatment

Treatment of cholera involves aggressive oral and intravenous rehydration. Tetracyclines such as doxycycline are usually first line for antibiotic therapy. For those strains with resistance, other agents that can be used include fluoroquinolones and macrolides.

References

Pathogen Safety Data Sheet. Vibrio cholera. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/vibrio-cholerae-eng.php

Overview of Vibrio Cholerae Infection. UpToDate. 2012. http://www.uptodate.com/contents/overview-of-vibrio-cholerae-infection?source=search_result&search=vibrio+cholera+pacini&selectedTitle=1~88

Hugh, Randolph. “A comparison of Vibrio cholerae Pacini and Vibrio eltor Pribram.” IJSEM (International Journal of Systematic and Evolutionary Microbiology). January 1965 vol. 15 no. 1 61-68.

Revised: 11/20/2012