The Connecticut Department of Health (DPH) issued a Press Release on July 28, 2023, warning residents about a severe Vibrio infection outbreak detected in the state that has sickened at least 3 and caused 1 death so far.

The Outbreak

According to the report, 3 cases of Vibrio vulnificus infection have been reported to DPH since July 1, 2023. All three patients were between the ages of 60 and 80 years. All three patients were hospitalized. One died.

The Common Link

The common link seems to be consuming raw shellfish and exposure to salt or brackish water along the Long Island Sound.

According to reports, one patient indicated consuming raw oysters from an out-of-state establishment. The other two patients had pre-existing open cuts or wounds or sustained new wounds, leaving them susceptible to infections.

“The identification of these severe cases, including one fatality, due to V. vulnificus is concerning. People should consider the potential risk of consuming raw oysters and exposure to salt or brackish water and take appropriate precautions. Particularly during the hottest months of the summer, bacteria are more likely to overgrow and contaminate raw shellfish. Given our current heat wave, this may be a time to exercise particular caution in what you consume.”

DPH Commissioner Manisha Juthani, MD

Extremely Rare Infection

2022. vulnificus is an extremely rare bacterial infection. So rare that only five cases in all of Connecticut were reported in 2020 and not a single case in either 2021 or 2022. Commissioner Juthani describes this recent uptick in cases, “concerning.”

The Center for Disease Control and Prevention (CDC) estimates that vibriosis, the illness associated with Vibrio infection, causes 80,000 illnesses in the United States each year. Most of these (around 52,000) are estimated to be associated with eating a contaminated food. About 80% of Vibrio infections occur when water temperatures are warmer. Generally, this falls between the months of May and October.

Vibrio vulnificus is just one strain of Vibrio bacteria that can cause illness in humans.

Extremely Serious Infection

While rare, this type of infection is extremely serious. An infected wound could lead to serious blood stream infections requiring intensive care or limb amputation. About 1 in five people with V. vulnificus infection die. The elderly and those with a weakened immune system are at greatest risk for serious illness, but there are other susceptible groups as well.

Risk Factors

Anyone can become sick from Vibrio exposure, but certain groups are at higher risk of complications. People with certain health conditions such as liver disease, cancer, diabetes, HIV, thalassemia, or had part of the stomach removed are at greater risk. As are those taking certain medications such as those to decrease stomach acid levels or people receiving immune-suppressing therapy.

Reduce Your Chance of Infection

Avoidance is the best policy when it comes to Vibrio exposure. There are several ways to reduce your chance of getting a Vibrio infection. These small precautions can go a long way.

Don’t eat raw or undercooked oysters or other shellfish

Cooking oysters and other shellfish can kill the harmful bacteria potentially lurking inside. Eating them raw or undercooked can allow that bacteria to enter your body and cause infection.

Avoid saltwater or brackish water if you have a wound

If you have a wound, whether from a sore, cut, recent surgery, piercing, or even tattoo, stay out of saltwater or brackish water. This even includes wading that the beach or hanging out by the shore of a river.

Cover wounds

Cover any wound with a waterproof bandage if there is a chance that it may come into contact with saltwater, brackish water, or marine life. This precaution is also a good idea if you are in contact with raw or undercooked seafood and its juices in such situations as cooking or preparing the product.

Thoroughly wash wounds

If you happen to come in contact with saltwater, brackish water, marine life, raw seafood, or its juices, be sure to thoroughly wash the wounds with soap and water.

Narrowing Down the Source

Could the recent Vibrio infection cases be happenstance exposure in the warm brackish waters of the Long Island Sound, or are there other overlapping factors linking these patients? Connecticut DPH continues to investigate.

Symptoms

Symptoms will vary based on the type of exposure. Ingested Vibrio infection presents very different symptoms to that of wound exposure.

Ingestion Symptoms

Symptoms of ingested Vibrio vulnificus often begin within 24 hours and generally last about 3 days. A key trait of infection is watery diarrhea that is accompanied by abdominal cramping, nausea, vomiting, fever, and/or chills. In more susceptible cases, such as those with a weakened immune system, illness can be more severe.

Wound Exposure Symptoms

Symptoms of vibrio vulnificus wound exposure often include large, spreading blisters, sepsis, and shock. Symptoms generally appear quickly and become fatal within a day or two of becoming ill.

This type of illness is often referred to as necrotizing fasciitis, or what is more commonly called “flesh-eating bacteria. Vibrio vulnificus bacteria is not the only type of bacteria that can cause this type of illness where the flesh around an open wound dies.

Diagnosis

Vibrio infection is diagnosed through laboratory tests. Common samples include wound swabs, blood, or stool samples of the sick individual. These samples are screened and analyzed for growth on specific culture media. Growth indicates a positive result. Further testing is necessary to determine the exact strain.

Treatment

For ingestion exposure, mild cases may not require treatment. The patient is advised to drink plenty of liquids to replace those lost through diarrheal symptoms. In severe or prolonged illness, antibiotic treatment may be prescribed.

For wound exposure, treatment may range from removing the dead tissue from around the wound to amputating the affected limb to prevent further spread throughout the body.

Have You Been Exposed?

If you believe you have been exposed to Vibrio vulnificus, you should seek medical attention immediately. You do not want to incorrectly assume you will have a mild case, particularly if you have experienced wound exposure and have symptoms of necrotizing fasciitis.

There are a few other activities that can help investigators determine a source.

• Make a list – Make a list of the foods and drinks you have consumed and where you got them. Creating this list as early as possible helps ensure a more accurate accounting. This patient interview data is used to identify overlapping details between outbreak patients.
• Inspect your body – Check your body for other lesions that may have been exposed. Close monitoring and documenting changes will help healthcare providers with your treatment.
• Reach out to a Vibrio lawyer – If you have been exposed due to negligence, such as consuming undercooked food, a Vibrio lawyer may be able to help you navigate the aftermath of the illness. The Lange Law Firm, PLLC is experienced and offers a complementary consultation to help answer questions that you may have. Call (833) 330-3663 or click here for email.

By: Heather Van Tassell