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An outbreak of cholera in Maryland associated with imported commercial frozen fresh coconut milk.

In August 1991, the first outbreak of cholera associated with an imported commercial food product occurred among persons attending a private picnic. An epidemiologic investigation showed infection with toxigenic Vibrio cholerae O1, biotype El Tor, serotype Ogawa, in 4 of 6 persons who had consumed coconut milk imported from Thailand. In addition, the US Food and Drug Administration recovered toxigenic V. cholerae O1, biotype El Tor, serotype Ogawa, from 1 of 6 unopened bags of the same brand (but different shipment) of coconut milk as that consumed by infected persons. Investigation in Thailand of the manufacturing process of the implicated coconut milk showed several sanitary violations, suggesting that contamination had occurred during production. This outbreak suggests a model of entrance of V. cholerae into a population and shows the need to evaluate current methods of maintaining the safety of imported foods in the United States.