Epidemic cholera inGuatemala, 1993: transmission ofa newly introduced epidemic strain bystreet vendors*

SUMMARY Epidemic cholera reached Guatemala inJuly1991. Bymid-1993, Guatemala ranked third in thehemisphere inreported cases ofcholera. We conducted acase-control study withtwoage-, sex-, andneighbourhood-matched controls perpatient inperiurban Guatemala City. Twentysixpatients hospitalized forcholera and52controls wereenrolled. Seven (47%)of15stool cultures obtained after admission yielded toxigenic Vibrio cholerae 01.Allseven wereresistant tofurazolidone, sulfisoxazole, andstreptomycin, anddiffered substantially bypulsed-field gel electrophoresis fromtheLatin American epidemic strain dominant inthehemisphere since 1991. Inunivariate analysis, illness wasassociated withconsumption ofleft-over rice (odds ratio [OR]= 70,95% confidence interval [CI] = 1A-436), flavored ices ('helados') (OR= 3-6, CI= 11-12), andstreet-vended non-carbonated beverages (OR= 38,CI= 1-2-12) andfood items (OR= 110,CI=23-54). Street-vended fooditems remained significantly associated with illness inmultivariate analysis (OR=6-5, CI= 14-31). Illness wasnotassociated withdrinking municipal tapwater. Maintaining water safety isimportant, butslowing theepidemic in Guatemala Cityandelsewhere mayalso require improvement instreet vendor foodhandling andhygiene.