Cholera on Guam, 1974: Epidemiologic findings and isolation of non-toxinogenic strains

Michael H. Merson, William T. Martin, John P. Craig, George K. Morris, Paul A. Blake, Gunther F. Craun, John C. Feeley, Joaquin C. Camacho, Eugene J. Gangarosa

Research output: Contribution to journalArticlepeer-review


In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains emptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of different V. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.

Original languageEnglish (US)
Pages (from-to)349-361
Number of pages13
JournalAmerican Journal of Epidemiology
Issue number4
StatePublished - Apr 1977


  • Cholera
  • Fermentation, sucrose
  • Fish
  • Outbreaks
  • Sewage
  • Toxins
  • Vibrio cholerae

ASJC Scopus subject areas

  • Epidemiology


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