<i>Vibrio vulnificus</i> epidemiology and risk factors for mortality in the United States, 2000–2022
Marisa Hast, Craig Baker‐Austin, Iain Lake, Pritiza Paromita, Zhaohui Cui, Natalia R. Jones, Paulette Posen, Michael Hughes
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 characterized U.S. V. vulnificus epidemiology and identified risk factors for mortality.Methods For all culture-confirmed V. vulnificus cases reported to the Cholera and Other Vibrio Illness Surveillance (COVIS) system from 2000 to 2022, patient characteristics and medical outcomes were described by foodborne vs. non-foodborne transmission routes. Risk factors for mortality were identified using multivariate logistic regression.Results Two thousand nine hundred and eighty-nine V. vulnificus cases were reported from 2000 to 2022, including 656 (22%) foodborne and 1,619 (54%) non-foodborne cases. Five-year case total increased 70% from 2000–2004 (n = 487) to 2018–2022 (n = 827). Most patients were male, older and White, with reported underlying health conditions; 2,493 (83%) patients 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. Antibiotic use was protective (OR = 0.33, p = 0.001). Liver disease associated with diabetes had lower mortality than other forms of liver disease (interaction OR = 0.5, p = 0.04).Conclusions V. vulnificus infections confer a substantial and increasing public health burden in the United States. Non-foodborne transmission caused 2.5 times more cases, and foodborne transmission caused 30% more deaths and had >3 times higher fatality rate. Identifying risk factors for mortality can inform public health and medical interventions.