9/11/23 Health Advisory: reports of fatal Vibrio vulnificus (V. vulnificus) infections

The Centers for Disease Control and Prevention (CDC) recently issued a Health Alert Network (HAN) Health Advisory to:

  • Notify healthcare providers, laboratories, and public health departments about recent reports of fatal Vibrio vulnificus (V. vulnificus)infections, including wound and foodborne infections.
  • Urge healthcare professionals to consider V. vulnificus as a possible cause of infected wounds that were exposed to coastal waters, particularly near the Gulf of Mexico or East Coast, and during periods with warmer coastal sea surface temperatures.

Recommendations for Healthcare Professionals
This guidance pertains to managing severe V. vulnificus wound infections.


  • Consider V. vulnificus as a possible cause of infection in wounds that were exposed to coastal waters, especially in patients at higher risk for Vibrio infection, including those with underlying health conditions such as liver disease (including alcohol-associated liver cirrhosis), diabetes, and immunocompromising conditions [3].
  • If V. vulnificus infection is suspected,
    • Obtain wound or hemorrhagic bullae cultures and send all V. vulnificus isolates to a local, state, territorial, or tribal public health laboratory.
      • Blood cultures are recommended in addition to wound and hemorrhagic bullae cultures if the patient is febrile, has hemorrhagic bullae, or has signs of sepsis.
    • Ask the patient or family about relevant exposures, including whether they entered coastal water with an open wound; acquired a scratch or a cut while in coastal water; or had open-wound contact with raw or undercooked seafood.

Clinical Management

  • Initiate treatment promptly. Early antibiotic therapy and early surgical intervention improve survival. Do not wait for consultation with an infectious disease specialist or laboratory confirmation of V. vulnificus infection to initiate treatment.
  • Antibiotic therapy
    • Doxycycline (100mg orally or intravenously twice a day for 7–14 days) and a third-generation cephalosporin (e.g., ceftazidime 1–2g intravenously or intramuscularly every 8 hours) are recommended. [7]
    • Alternate regimens include a third-generation cephalosporin with a fluoroquinolone (e.g., 500mg ciprofloxacin orally twice a day) or a fluoroquinolone given alone. [8,9].
    • Children may also be treated with a combination regimen of a third-generation cephalosporin plus doxycycline or ciprofloxacin, or with an alternative regimen of trimethoprim-sulfamethoxazole plus an aminoglycoside [10]. In selecting a regimen, clinicians should be aware of guidance from the American Academy of Pediatrics:
      • Fluoroquinolones should not be used routinely as first-line agents in children younger than 18 years except when specific indications exist or in specific conditions for which there are no alternative agents (including oral agents) and the drug is known to be effective for the specific situation. [11]
      • Use of tetracyclines as a class of drugs in pediatric patients historically has been limited because of reports that this class could cause permanent dental discoloration in children younger than 8 years. More recent data suggest that doxycycline can be administered for short durations (i.e., 21 days or less) without regard to the patient’s age. [12]
    • Doses should be appropriately adjusted for renal and hepatic function.
    • If appropriate, consult a microbiologist or infectious disease specialist.
  • Give careful attention to the wound site. Necrotic tissue should be debrided. Severe cases might require aggressive debridement, fasciotomy, or amputation of the infected limb.

Clinician Reporting

  • Vibriosis is a nationally notifiable disease. Healthcare professionals and clinical laboratories should report all cases to their local, state, territorial, or tribal health department.
  • Healthcare professionals should consult their health department for guidance on when patients may return to childcare, school, or work.

Recommendations for the Public
Taking the following steps can help keep you safe:

  • Stay out of salt water and brackish water if you have an open wound or cut. If you get a cut while you are in the water, leave the water immediately.
    • If your open wounds and cuts could come in contact with salt water, brackish water, or raw or undercooked seafood, cover them completely with a waterproof bandage.
    • Wash open wounds and cuts thoroughly with soap and clean, running water after they come in contact with salt water, brackish water, or drippings from raw or undercooked seafood.
  • Cook raw oysters and other shellfish before eating.
  • Always wash your hands with soap and water after handling raw shellfish.
  • Seek medical attention right away for infected wounds.

Contacting Whatcom County Health and Community Services.

360-778-6100 Main Call Line – available M-F 8:30am to 4:30pm
360-778-6100 Follow prompts to Afterhours Answering Service – available after 4:30pm and weekends
360-778-6150 Communicable Disease Report Line – 24 hours a day 7 days a week
360-778-6103 Confidential Communicable Disease Fax – 24 hours a day 7 days a week