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After two Brevard County men recently recovered from skin infections caused by a deadly flesh-eating bacteria in the Indian River Lagoon, health officials Thursday urged residents to avoid exposure of open wounds or broken skin to warm, salty outdoor waters, or to raw shellfish harvested there.

Both men were infected after fishing in the lagoon.

On Aug. 26, health officials confirmed that a 62-year-old Rockledge man was infected by Vibrio vulnificus bacteria while fishing. Then on Monday, officials confirmed that a 74-year-old Melbourne man also had been infected.

They were among 27 reported cases of infections from the bacteria, which has killed nine people so far this year in Florida, most recently a 59-year-old Flagler County man.

Henry Konietzsky, 59, died Sept. 23 after walking knee deep while crabbing in the Halifax River near Ormond Beach on Sept. 21.

Health officials warn those with open wounds or certain health conditions to stay out of the Indian River Lagoon and other warm, salty waters.

"Vibrio vulnificus bacteria naturally live in the river," Brevard County Health Department Director, Heidar Heshmati, said in a release. "Every year we have a few cases of infection in humans due to water exposure."

While infections are rare, individuals should take precautions, health officials said.

"People should be aware of their risk. Boating and other sporting activities in the Indian River Lagoon are fine," Heshmati said. "However, I recommend people not eat raw seafood and/or expose their self to the lagoon water if they have an open wound, especially if they have liver or immune system problems."

Infections in people with those types of conditions have a 50 percent fatality rate.

When it infects the skin via open wounds, Vibrio vulnificus can cause skin breakdown and ulcers.

Ingestion of the bacteria can trigger vomiting, diarrhea and abdominal pain.

People with weakened immune systems, especially those with chronic liver disease, are the most at risk when they eat raw shellfish, especially oysters, health officials said, because oysters filter the bacteria from the water. Eating a single contaminated oyster can kill.

States in the Gulf Coast region average about 50 cases, 45 hospitalizations and 16 deaths annually, according to the Florida Department of Health. Most of the cases are in Florida, which has averaged about 27 cases annually over the past five years. Between 1988 and 2006, the Centers for Disease Control and Prevention documented more than 900 Vibrio vulnificus infections from the Gulf Coast states, where most infections happen. Before 2007, no national surveillance system existed for Vibrio vulnificus, but CDC collaborated with Florida, Alabama, Louisiana, Texas and Mississippi to monitor the number of cases in the Gulf Coast region.

Of this year's nine deaths in Florida, four were likely from exposure to water, three from eating raw oysters, and in two of the deaths the exposure couldn't be determined, according to state health officials.

The bacteria rarely cause serious disease, and as a result is underreported, according to the CDC. Illness usually begins within one to three days of exposure, but up to a week later for a small percentage of cases. Symptoms include fever, swelling and redness of skin on arms or legs, with blood-tinged blisters, low blood pressure and shock.

Even an ant bite or any tiny wound can allow an entry point for the bacteria.

Vibrio vulnificus belongs to the same family of bacterium as those that cause cholera. It inhabits warm, salty water and is part of a group of bacteria called "halophilic" because they require salt.

It dies at salt levels typical of the ocean but thrives at lower to moderate salt concentrations, such as those found in the lagoon.

Tips for preventing Vibrio vulnificus infections include:

-- Do not eat raw oysters or other raw shellfish.

-- Cook shellfish (oysters, clams, mussels) thoroughly.

-- For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375°F.

-- Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood.

-- Eat shellfish promptly after cooking and refrigerate leftovers.

-- Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters.

-- Wear protective clothing (e.g., gloves) when handling raw shellfish.

Source: Brevard County Health Department

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