Publication Abstract

Background: Vibrio vulnificus is a foodborne and waterborne pathogen causing substantial morbidity and mortality, however its epidemiology remains poorly understood. To inform prevention and control efforts, we aimed to characterize V. vulnificus epidemiology and identify correlates of mortality.

Methods: For all culture-confirmed V. vulnificus cases reported to the U.S. Cholera and other Vibrio Surveillance (COVIS) system from 2000-2022, patient characteristics and medical outcomes were described by transmission route. Risk factors for mortality were identified using multivariate logistic regression models.

Findings: 2,989 V. vulnificus cases were reported to COVIS from 2000-2022, including 656 (22%) foodborne and 1,619 non-foodborne (54%) cases. Five-year case total increased 70% from 2000-2004 (n=487) to 2018-2022 (n=827). Patients were largely male, older, and White, with reported underlying conditions; 2,493 (83%) cases were hospitalized and 692 (23%) died. Number of deaths (260 vs. 200) and fatality rate (40% vs. 12%) were higher among foodborne vs. non-foodborne cases. Mortality was associated with history of liver disease/alcoholism (odds ratio [OR]=6.5, P<0.001), age 45-59 (OR=11.3, P=0.001), foodborne transmission (OR=1.3, P=0.006), and Black (OR=1.8, P=0.03) or Asian (OR=2.5, P=0.009) race/ethnicity. Antibiotic use was protective (OR=0.33, P=0.001). Diabetic liver disease was associated with lower mortality than other forms of liver disease (interaction OR=0.5, P=0.04).

Interpretation: V. vulnificus infections confer a substantial and increasing public health burden. Non-foodborne transmission caused 2.5 times more cases, and foodborne transmission caused 30% more deaths and had >3 times higher fatality rate. Identification of risk factors for mortality can inform public health and medical interventions.

Marisa Hast, Craig Baker-Austin, Iain Lake, Pritiza Paromita, Zhaohui Cui, Michael Hughes