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Journal of Clinical Microbiology, March 1999, p. 734-741, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Cholera in Vietnam: Changes in Genotypes and Emergence of Class I Integrons Containing Aminoglycoside Resistance Gene Cassettes in Vibrio cholerae O1 Strains Isolated from 1979 to 1996

A. Dalsgaard,1,* A. Forslund,1 N. V. Tam,2 D. X. Vinh,3 and P. D. Cam4

Department of Veterinary Microbiology, Royal Veterinary and Agricultural University, DK-18070 Frederiksberg C, Denmark,1 and Department of Microbiology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City,2 Department of Microbiology, Regional Institute of Hygiene and Epidemiology, Ban Me Thuot, Dak Lak,3 and Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi,4 Vietnam

Received 27 July 1998/Returned for modification 13 October 1998/Accepted 1 December 1998

The number of cholera cases and the mortality rates reported from different regions of Vietnam varied considerably in the period from 1979 to 1996, with between 2,500 and 6,000 cases reported annually from 1992 to 1995. Annual mortality rates ranged from 2.0 to 9.6% from 1979 to 1983 to less than 1.8% after 1983. Major cholera outbreaks were reported from the High Plateau region for the first time in 1994 and 1995; this is an area with limited access to health services and safe drinking-water supplies. All cases were associated with Vibrio cholerae O1. Using ribotyping, cholera toxin (CT) genotyping, and characterization of antibiotic susceptibility patterns and antibiotic resistance genes by PCR, we show that strains isolated after 1990 were clearly different from strains isolated before 1991. In contrast to strains isolated before 1991, 94% of 104 strains isolated after 1990 showed an identical ribotype R1, were resistant to sulfamethoxazole and streptomycin, and showed a different CT genotype. Furthermore, PCR analysis revealed that sulfamethoxazole-resistant strains harbored class I integrons containing a gene cassette ant(3")-1a encoding resistance to streptomycin and spectinomycin. This is, to our knowledge, the first report of class I integrons in V. cholerae. The development of cholera and the changes in the phenotypic and genotypic properties of V. cholerae O1 shown in the present study highlight the importance of monitoring V. cholerae O1 in Vietnam as in other parts of the world. In particular, the emergence of the new ribotype R1 strain containing class I integrons should be further studied.

* Corresponding author. Mailing address: Department of Veterinary Microbiology, The Royal Veterinary and Agricultural University, Bülowsvej 13, 1870 Frederiksberg C, Denmark. Phone: 45-35-282720. Fax: 45-35-282757. E-mail: ad{at}kvl.dk.

Journal of Clinical Microbiology, March 1999, p. 734-741, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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