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Context: In May and June 1998, reported Vibrio parahaemolyticus infections increased sharply in Texas., Objective: To determine factors that contributed to the increase in V parahaemolyticus infections., Design, Setting, and Participants: Cross-sectional survey of persons reporting gastroenteritis after eating seafood in Texas; survey of environmental conditions in Galveston Bay., Main Outcome Measures: Traceback of oysters, water quality measures in harvest areas, presence of V parahaemolyticus in stool cultures; comparison of median values for environmental conditions before and during the outbreak compared with during the previous 5 years., Results: Between May 31 and July 10, 1998, 416 persons in 13 states reported having gastroenteritis after eating oysters harvested from Galveston Bay. All 28 available stool specimens from affected persons yielded V parahaemolyticus serotype O3:K6 isolates. Oyster beds met current bacteriologic standards during harvest and fecal coliform counts in water samples were within acceptable limits. Median water temperature and salinity during May and June 1998 were 30.0 degrees C and 29.6 parts per thousand (ppt) compared with 28.9 degrees C and 15.6 ppt for the previous 5 years (P<.001)., Conclusions: This is the first reported outbreak of V parahaemolyticus serotype O3:K6 infection in the United States. The emergence of a virulent serotype and elevated seawater temperatures and salinity levels may have contributed to this large multistate outbreak of V parahaemolyticus. Bacteriologic monitoring at harvest sites did not prevent this outbreak, suggesting that current policy and regulations regarding the safety of raw oysters require reevaluation. Consumers and physicians should understand that raw or undercooked oysters can cause illness even if harvested from monitored beds. In patients who develop acute gastroenteritis within 4 days of consuming raw or undercooked oysters, a stool specimen should be tested for Vibrio species using specific media. JAMA. 2000;284:1541-1545.

Context: Vibrio vulnificus-related disease caused by eating contaminated raw oysters prompted California to implement regulatory educational initiatives in 1991., Objective: To assess California guidelines and education efforts with regard to the prevention of V. vulnificus infections in Los Angeles County and to evaluate compliance with state regulations mandating posting of warning signs concerning risks of eating raw oysters., Design: Review of epidemiologic investigations of V. vulnificus infections in Los Angeles County between 1993 and 1995; telephone interviews of patients or surrogates; and a survey of restaurants serving raw oysters in Los Angeles County., Setting: General community., Main Outcome Measures: Prior warning of patients and posting of warning signs in restaurants., Results: Recent cases of V. vulnificus infections in Los Angeles County suggest that a unique, vulnerable group (uninsured Hispanic men with viral or alcoholic liver disease) has not been reached through education efforts. Of a total of 11 cases, information regarding being warned about the hazard of eating raw shellfish was available for 8; of these, only 1 case was reported as having been warned, but he had misunderstood the preventive message. Warning signs were not posted adequately in more than 50% of restaurants surveyed and one third of these establishments had signs in English only. Warnings were never located on dining tables and rarely included in menus., Conclusion: A more effective strategy is required to prevent V.vulnificus infections in Los Angeles County.

Marine Vibrio bacteria can cause illness and occasionally death to people who are exposed to seawater. These gram-negative bacteria can be found in ocean water and estuaries and in uncooked marine animals; they can cause primary sepsis, gastroenteritis, and soft-tissue infections. During a five-year period from 1981 to 1986, we encountered 51 patients with primary soft-tissue infections caused by marine vibrios. Thirty-nine patients developed cellulitis after direct exposure to ocean water, nine had eaten raw oysters, and three had no obvious exposure to seawater. Twenty-two patients (44%) had an underlying illness that might have made them compromised hosts and predisposed them to infection. Twelve patients developed necrotizing infections. Thirteen patients ultimately died. These infections are susceptible to many antibiotics. Débridement is necessary when tissue necrosis occurs. Surgeons should suspect a marine vibrio infection if cellulitis occurs in a patient who has been near ocean water or has eaten raw oysters. These infections may not become apparent until a traveler has returned home, a place that may be far from the ocean.