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2d cholera case confirmed

4 others in Bay State suspected of having disease

By Stephen Smith
Globe Staff / January 29, 2011

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The destination was shimmering: a five-star, palm tree-studded resort in the Caribbean. The occasion was joyous: a lavish wedding with a guest roster stretching more than 400 names long.

But attendees left the fete in the Dominican Republic with an unwanted reminder of the nuptials: the germ that causes cholera.

At least two of those who became ill hail from Massachusetts. First, there was a 30-year-old man who sought treatment Tuesday in the emergency room at Massachusetts General Hospital. Then there were more: Disease trackers said yesterday that a second Massachusetts resident had been diagnosed with the intestinal ailment and four others in the state are suspected of having it.

All are recovering, and there is no evidence the disease is spreading in Massachusetts, said Dr. Larry Madoff, a top epidemiologist at the Massachusetts Department of Public Health.

The emergence of cholera in Boston, 1,700 miles from the origin of an outbreak moving across the island of Hispaniola, il lustrates the swift, relentless migration of infectious diseases in an era of widespread jet traffic.

“We fully expected this,’’ said Dr. Jordan Tappero, incident manager for the cholera outbreak response at the US Centers for Disease Control and Prevention in Atlanta. “We’re not at all surprised that this would happen, given all the travel.’’

Guests flew to the Dominican Republic from distant points for the extravagant wedding last weekend. There were visitors from Venezuela and Spain — and Boston. By the dozens, they became sick after returning home, stricken with the hallmark symptoms of cholera: diarrhea and vomiting.

The man treated at Mass. General endured multiple bowel movements for a day and a half, although he had neither a fever nor bloody stool, both symptoms of more severe infection. He was given oral rehydration and antibiotics and sent home.

A young woman arrived at the Brigham and Women’s Hospital emergency room on Wednesday. She, too, was rehydrated and sent home, said Erin McDonough, spokeswoman for the Brigham. Preliminary testing found that the woman, who was not identified because of patient confidentiality laws, had cholera.

“The physician I spoke with said there’s very little concern with cholera cases in the US because of the availability of medications and clean water,’’ McDonough said. “It’s unlikely there would be any transmission.’’

A father and his three children are also suspected of having the bacterial condition, said Madoff, adding that disease specialists are awaiting laboratory tests on at least one member of that family before a firm diagnosis can be made.

“We’re certainly very suspicious that one or more of the family members may turn out to be positive,’’ Madoff said. That family, he said, was “in the same setting where we know everybody else acquired it.’’

That setting was the Casa de Campo resort, a popular Caribbean destination. The timing of symptoms among wedding guests suggested they caught the germs in the Dominican Republic.

The source of the outbreak is unknown. It has been reported that guests dined on lobster, and shellfish can harbor the germs. But if food is cooked thoroughly, the risk of infection should be mitigated. Cholera most often spreads through tainted water or sewage but can be conveyed by contaminated food.

The resort issued a statement saying that while it “deeply regrets the food poisoning/cholera cases that recently occurred during an exclusive wedding party in a private villa residence within our resort,’’ the food, drinks, and ice were provided by an outside catering company hired by the party’s hosts.

The cholera strain circulating in the Dominican Republic has been linked to an epidemic in Haiti that has killed more than 3,000 since October. Before the cluster of patients in Massachusetts, federal disease detectives had identified 10 cholera cases in the United States they believe are linked to the island of Hispaniola, shared by Haiti and the Dominican Republic.

Stephen Smith can be reached at stsmith@globe.com.

SAFETY TIPS
Experts say take precautions when traveling to an area with a cholera risk.
■ Drink only bottled water or boiled water cooled to room temperature.
■ Avoid eating raw vegetables and undercooked shellfish.