Epidemiology of infections caused by four emerging Vibrio species of concern reported to the Cholera and Other Vibrio Illness Surveillance system (COVIS), United States, 1988-2024.

BACKGROUND: Incidence of vibriosis infections caused by several emerging Vibrio species has increased in the United States, including V. alginolyticus (Va), V. cholerae (Vc), V. fluvialis (Vf), and V. mimicus (Vm), which contribute substantially to overall vibriosis burden. The objective of this analysis was to characterize the epidemiology of these emerging Vibrio species using US national surveillance data. METHODS: We conducted an analysis of national Cholera and Other Vibrio Illness Surveillance (COVIS) data from 1988-2024. Splines regression was used to estimate trends. Counterfactual random forests were used to compare epidemiologic and clinical profiles across species. RESULTS: During 1988-2024, 4,350 Va, 2,856 Vc, 1,722 Vf, and 582 Vm infections were reported, and incidence increased for all species and varied by region. The largest relative increases were for Vf (+101%), Vc (+79%), and Va (+67%). Va had an epidemiologic profile distinct from Vc, Vf, and Vm; Va infections were associated with persons aged 1-17 years, waterborne transmission, and wound and ear infections. Vc, Vf, and Vm infections were more often foodborne and associated with gastrointestinal illness. Hospitalization was more common for Vc, Vf, and Vm (37-42%) compared with Va infections (13%). CONCLUSIONS: Va, Vc, Vf, and Vm infections represent a growing component of vibriosis infections in the United States and exhibited distinct epidemiologic profiles with substantial morbidity. Vibriosis prevention efforts should be tailored to include both foodborne and non-foodborne transmission in regions and populations at higher risk and clinicians should have increased awareness of emerging Vibrio species. PLAIN LANGUAGE: Vibrio are naturally occurring bacteria that can cause illnesses ranging from gastroenteritis to serious wound infections. Infections caused by four emerging Vibrio species of concern, namely V. alginolyticus (Va), V. cholerae (Vc), V. fluvialis (Vf), and V. mimicus (Vm), have been increasing in the United States. During 1988-2024, incidence of infections caused by these species increased. Va infections were distinct from the Vc, Vf and Vm infections. Va infections were more often associated with waterborne transmission, people aged 1-17 years, and ear and wound infections. Vc, Vf, and Vm infections were more often foodborne and linked to gastroenteritis and hospitalization. These species represent a growing component of vibriosis in the United States and have distinct clinical and epidemiologic profiles. Prevention efforts should be tailored to address foodborne and non-foodborne transmission in populations at higher risk for specific infection types.