Vibrio cholerae O1 El Tor cluster in Sydney linked to imported whitebait

Three cases of cholera in women aged 71, 72 and 84 years were notified in November 2006 in Sydney, New South Wales. This is the first reported cluster of cholera in Australia for over 30 years, and was an unusual outbreak in patients with no history of recent travel to cholera-endemic areas. A food trace-back investigation found that the only exposure common to all cases was consumption of raw whitebait imported from Indonesia. This outbreak demonstrates that the practice of eating raw whitebait does occur in Australia, albeit in the process of taste-testing uncooked fritter batter. All three patients were undergoing long-term therapy with proton-pump inhibitors, which may have contributed to their susceptibility to the disease. A review of importation practices of food from cholera-endemic regions may be required to prevent future transmission.