[Is Vibrio cholerae serotype 0139 a potential cause of a new pandemic?]

Vibrio cholerae O139, a new V. cholerae serotype that does not react with the 138 so far known antisera, was first isolated in 1992 in Madras, India. Although a V. cholerae non-O1, it behaved quite differently from this particular group of organisms by its clinical appearance in causing epidemic cholera-like disease. The organism possessed the same register of virulence factors as V. cholerae O1. Biochemical and genetic analyses have shown that V. cholerae O139 was closely related to the El Tor biotype and it has been suggested that it might be a mutant of this biotype. Despite the fact that V. cholerae O139 isolates were very homologous in many respects, ribotyping of Thai isolates showed a certain degree of genetic diversity. From its rapid spread in populations, pattern of infection and ability to survive in aquatic environments, it may be suggested that we are dealing with a more infectious, more virulent and in an ecological sense more robust organism, whose pandemic potential appears significant. Commercial cholera vaccines offer no or only limited protection. Treatment comprises an adequate rehydration and use of effective antibiotics--at present tetracycline, ampicillin, erythromycin and ciprofloxacin. Tourism and perhaps the import of foods from Third World countries may excert a potential risk for the Danish population.