Gastroenteritis outbreaks on two Caribbean cruise ships

Outbreaks of gastrointestinal illness on cruise vessels have been caused in the past by contaminated water and by food consumed on the ships or on shore visits. Person-to person transmission has also been strongly suspected on some occasions-in one case, in the setting of repeated outbreaks on consecutive cruises. Laboratory findings implicated Norwalk virus as the pathogenic agent on the first of the Holiday outbreaks. However, all three outbreaks had epidemiologic features characteristic of epidemics of Norwalk virus gastroenteritis. These include: (1) a high attack rate in adults; (2) a high frequency of vomiting; (3) short duration of illness; and (4) absence of identified bacterial pathogens. It is not yet clear whether food or water were vehicles of infection in these outbreaks or whether sanitary deficiencies contributed to the risk of outbreaks of viral enteric disease on these cruise ships. (AU)

Missionary anesthesia

Missionary anesthesiologists are needed for developing areas around the world. Missionary work has both rewarding and frustrating aspects. Rewards include adventures in living and medicine and the chance to aid less fortunate people. The frustrations include separation from family, uncomfortable living conditions, language barriers, and inability to change medical practices that seem improper. (AU)