Vibrio cholerae consists of more than 200 serogroups. The classification of serogroups is based on the O antigen of the lipopolysaccharide (LPS) (1). The classical method of serogroup determination is based on the immune agglutination reaction between the O antigen and the corresponding specific antiserum. The molecular mechanisms of different serogroups are based on the variation in structure of O-antigen polysaccharide (O-PS) coding sequence (2). Therefore, the phenotype of O-antigen is correlated with the molecular type of O-PS coding sequence. Till now, only serogroup O1 and O139 V. cholerae caused cholera epidemics and pandemics (3). V. cholerae does not belong to serogroup O1 and O139 and is designated as “non-O1/non-O139” V. cholerae. Usually, these non-O1/non-O139 V. cholerae only cause sporadic infections and seldomly cause outbreaks (4). Several kinds of toxins, such as a heat-stable toxin, cholera toxin, and other enterotoxins, have been detected in the non-O1/non-O139 V. cholerae that caused an outbreak. Except for the toxins, secretion systems, for example type 3 secretion system (T3SS) and type 6 secretion system, have been detected in some V. cholerae strains that caused cholera outbreaks (5).
In China, toxigenic serogroup O1 and O139 V. cholerae strains were rarely isolated after 2010 (6). In contrast, sporadic cholera cases even small scale of outbreaks caused by non-O1/non-O139 V. cholerae were reported from time to time (4). Here we report successive cholera outbreaks caused by non-toxin-producing serogroup O5 V. cholerae in 2020 and 2021 in Guangdong Province, China.