www.hcvadvocate.org a series of fact sheets written by experts in the field of liver disease HCSP FACT SHEET • H C V WEL L N E S S • Vibrio Vulnificus Written by: Alan Franciscus, Editor-in-Chief Foreword Vibrio are a family of bacteria that can cause mild to severe disease in people. Included in this family of bacteria are Vibrio cholerae (cholera), Vibrio parahaemolyticus and Vibrio vulnificus. The last Vibrio cholerae outbreak in the United States occurred in 19101911. In the last few years outbreaks of cholera have occurred in Iraq, India, Vietnam and some countries in Africa. Cholera is transmitted by ingesting fecal matter that contains the cholera bacterium. A less severe form of Vibrio is V. parahaemolyticus that can cause gastroenteritis (abdominal cramps, frequent diarrhea, nausea and vomiting, headache, fever and chills). V. parahaemolyticus resolves after a few days and it does not usually cause serious disease. V. parahaemolyticus is transmitted by eating raw or undercooked shellfish, wading in or swallowing contaminated water. Vibrio vulnificus or simply V. vulnificus is a common form of Vibrio that can cause serious illness and even death in certain populations. This fact sheet will focus on Vibrio vulnificus. V. vulnificus infection is mostly seen in areas with warm coastal waters although there have been reported cases in colder waters possibly due to global warming.1 According to the Centers for Disease Control in the United States as many as 95 cases occur yearly with 85 hospitalizations and 35 deaths a year. Transmission Transmission of V. vulnificus occurs from eating raw or undercooked oysters, clams and other shellfish. A person with an open cut or wound who wades, swims in or swallows contaminated water can also become infected with V. vulnificus. Transmission of V. vulnificus occurs most often in the summer months when the bacteria in the salt water are at their highest levels. There are no cases of V. vulnificus being transmitted from person to person. It’s important to know that Vibrio is not caused by pollution, but rather from naturally occurring bacteria. HCSP • VERSION 2.1 • April 2014 HCSP FACT SHEET A publication of the Hepatitis C Support Project EXECUTIVE DIRECTOR, EDITOR-IN-CHIEF, HCSP PUBLICATIONS Alan Franciscus DESIGN Leslie Hoex, Blue Kangaroo Design PRODUCTION C.D. Mazoff, PhD CONTACT INFORMATION Hepatitis C Support Project PO Box 15144 Sacramento, CA 95813 [email protected] The information in this fact sheet is designed to help you understand and manage HCV and is not intended as medical advice. All persons with HCV should consult a medical practitioner for diagnosis and treatment of HCV. This information is provided by the Hepatitis C Support Project a nonprofit organization for HCV education, support and advocacy Reprint permission is granted and encouraged with credit to the Hepatitis C Support Project. 1 © 2014 Hepatitis C Support Project HCSP FACT SHEET • HCV W E L L N E S S• a series of fact sheets written by experts in the field of liver disease Vibrio Vulnificus Vibro and HCV Safety Tips3 Since the Vibro virus and the hepatitis C virus infect the liver, people with hepatitis C should not eat raw or undercooked shellfish. Reports of people with hepatitis C dying from Vibrio Vulnificus are uncommon but do occur. • Cook shellfish (oysters, clams, mussels) thoroughly. Do not eat shellfish that do not open during cooking. Symptoms The initial symptoms of V. vulnificus usually occur within one day but can develop in 5 hours to 4 days and vary according to the type of infection. Symptoms and potential consequences include: • From eating raw/undercooked shellfish or swallowing water that contains Vibrio Gastrointestinal illness: Symptoms include watery diarrhea, stomach cramping, nausea or sick to the stomach, vomiting, fever, and chills. Severe gastrointestinal illness may require hospitalization especially in people with preexisting liver disease or a compromised immune system (HIV positive, diabetes, cancer). Reports of people with hepatitis C dying from swallowing V. vulnificus are uncommon but do occur. • Exposure from an open cut or wound Symptoms include fever, chills, decreased blood pressure, septic shock (major organ failure throughout the body), blistering skin legions or sores. In this type of infection immediate medical care is needed to prevent serious consequences. About 50% of people who contract vibrio from this type of infection die. • Exposure from a skin infection2 Symptoms from skin lacerations or abrasions (scraped skin, etc.) include ulceration (open sores) that leads to dead skin tissue that may require surgical removal of the affected area or in severe cases amputation. Death can occur when the infection spreads to the bloodstream. HCSP • VERSION 2.1 • April 2014 • Do not eat raw oysters or other raw shellfish. • Eat shellfish promptly after cooking and refrigerate leftovers immediately. • Avoid cross-contamination of uncooked seafood, including seafood juices, with other foods. • Avoid exposing an open cut, wound or broken skin in warm salt or brackish water, or to raw shellfish harvested from such waters. • Wear protective clothing such as gloves when handling raw shellfish especially if hands have any open cuts or wounds. Basic Food Handling Tips: • Wash surfaces including cutting boards thoroughly between and after use. • Always wash hands thoroughly with soapy water for at least 20 seconds before and after handling food. • Never put raw food on the same cutting board or dish without cleaning thoroughly between use. • Make sure food is cooked to the proper internal temperatures 4 • Do not leave any prepared or perishable foods at room temperature—make sure to refrigerate or freeze within two hours. • Thaw food in the refrigerator. • Dispose of any paper towels after use and wash any dish towels or sponges regularly to prevent cross-contamination. If you suspect that you have been exposed to V. vulnificus seek immediate medical care. Aggressive treatment with antibiotics can help to prevent death or amputation of an infected limb. 2 © 2014 Hepatitis C Support Project HCSP FACT SHEET • HCV W E L L N E S S• a series of fact sheets written by experts in the field of liver disease Vibrio Vulnificus Notes 1. "Vibrio Warning: Europe" http://hcvadvocate.blogspot.ca/2012/07/vibrio-warning-europe.html 2. “Rare flesh-eating bacteria kills man after fishing trip.” www.chron.com/disp/story.mpl/metropolitan/6579618.html 3. Adapted from Centers for Disease Control: www.cdc.gov 4. Food and Safety Inspection Service www.fsis.usda.gov/is_it_done_ yet/ For more information, please visit: • Centers for Disease Control: www.cdc.gov • Interstate Shellfish Sanitation Conference www.issc.org Related publications: • HCV Wellness: Managing Common Symptoms www.hcvadvocate.org/hepatitis/factsheets_pdf/symptoms.pdf • HCV Wellness: Hand Washing—A Primer www.hcvadvocate.org/hepatitis/factsheets_pdf/handwashing.pdf • HCV Wellness: Nutrition and Hepatitis C www.hcvadvocate.org/hepatitis/factsheets_pdf/nutrition.pdf For more information • Centers for Disease Control and Prevention www.cdc.gov • FoodSafety.Gov: www.foodsafety.gov • Mayo Clinic www.mayoclinic.com • The Original Memory Gym: www.memorise.org Visit our websites to learn more about viral hepatitis: www.hcvadvocate.org • www.hbvadvocate.org www.hepatitistattoos.org HCSP • VERSION 2.1 • April 2014 3 © 2014 Hepatitis C Support Project