Interventions to prevent and control food-borne diseases associated with a reduction in traveler's diarrhea in tourists to Jamaica.

BACKGROUND: In 1996 a study found that approximately one in four tourists to Jamaica were affected with traveler's diarrhea (TD) during their stay. That year the Ministry of Health initiated a program for the prevention and control of TD. The aim of this ongoing program was to reduce attack rates of TD from 25% to 12% over a 5-year period by improving the environmental health and food safety standards of hotels. METHODS: Hotel-based surveillance procedures for TD were implemented in sentinel hotels in Negril and Montego Bay in 1996, Ocho Rios in 1997, and Kingston in 1999. A structured program provided training and technical assistance to nurses, food and beverage staff, and environmental sanitation personnel in the implementation of Hazard Analysis Critical Control Point principles for monitoring food safety standards. The impact of interventions on TD was assessed in a survey of tourists departing from the international airport in Montego Bay in 1997-1998 and from the international airport in Kingston in 1999-2000. The impact of the training and technical assistance program on food safety standards and practices was assessed in hotels in Ocho Rios as of 1998 and in Kingston from 1999. RESULTS: At the end of May 2002, TD incidence rates were 72% lower than in 1996, when the Ministry of Health initiated its program for the prevention and control of TD. Both hotel surveillance data and airport surveillance data suggest that the vast majority of travelers to Kingston and southern regions are not afflicted with TD during their stay. The training and technical assistance program improved compliance to food safety standards over time. CONCLUSION: Interventions to prevent and control TD in visitors to Jamaica are positively associated with a reduction in TD in the visitor population and improvements in food safety standards and practices in hotels.

Incidence of health crises in tourists visiting Jamaica, west indies, 1998 to 2000.

BACKGROUND: Tourism is important to the Jamaican economy accounting for approximately 25% of the gross domestic product. Health problems in tourists could have significant impact on the health of the local population, the scarce health service resources, and the tourist industry. This study was conducted to identify health problems most commonly occurring in tourists visiting Jamaica and examine how these problems are managed. METHODS: Records of health problems occurring in tourists who visited principal tourist areas on the north coast from June 1998 to June 2002 were reviewed for the type of illness and how the problem was handled. The data were analyzed using Epi-Info software (Centers for Disease Control and Prevention, Atlanta, GA) and Statistical Analysis System software (SAS Institute, Cary, NC). RESULTS: Accidents were the most common health crises reported by tourists. Gastrointestinal, respiratory, and cardiovascular problems occurred less frequently. Those less than 40 years of age more frequently reported accidents or injury, gastrointestinal problems, and drug abuse, whereas respiratory and cardiovascular problems were more common among those above 40 years of age. Cardiovascular problems, drug abuse, and death were more common in men than in women. Hotel nurses handled most of the cases and were more likely to refer patients to private physicians or hospitals than to public hospitals (p <.05). Factors influencing the way the crisis was handled were age (p =.0441); who handled the crisis (p <.0001); and the method of payment (p =.0072). The factors that influenced hospitalization were gender (p =.0615); who handled the crisis at the onset (p =.0497); how the crisis was dealt with (p =.0336); and previous health problems (p =.0056). Men were more likely to be hospitalized and to be referred to a public hospital than women. Medical insurance covered the costs for 11% of tourists, and 75% paid out of pocket. CONCLUSION: The information provided by this study can be used to implement changes to reduce health problems in tourists and improve emergency health services in tourist areas.

Enteroaggregative Escherichia coli as a cause of traveler's diarrhea: clinical response to ciprofloxacin

The purpose of this study was to determine the role of enteroaggregative Escherichia coli (EAEC) in the development of traveler's diarrhea and the clinical response of patients with EAEC diarrhea following treatment with ciprofloxacin. Sixty-four travelers with diarrhea and no other recognized enteropathogen were enrolled in treatment studies in Jamaica and Mexico from July 1997 to July 1998. EAEC was isolated from 29 travelers (45.3 percent). There was a significant reduction in the duration of posttreatment diarrhea in the 16 patients treated with ciprofloxacin, as compared with that in the 13 patients who received placebo (mean of 35.3 versus 55.5 hours; P= .049). There was a nonsignificant reduction in the mean number of unformed stools passed during the 72 hours after enrollment in the ciprofloxacin-treated group (7.5) (P= .128). This study provides additional evidence that EAEC should be considered as a cause of antibiotic-responsive traveler's diarrhea. (AU)

Epidemiology, etiology, and impact of traveler's diarrhea in Jamaica

CONTEXT: Traveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD. OBJECTIVE: To determine epidemiology, etiology, and impact of TD in Jamaica. DESIGN: Two-armed, cross-sectional survey conducted between March 1996 and May 1997. SETTING: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. MAIN OUTCOME MEASURES: Attack and incidence rates of reported diarrhea and of classically defined TD (> or = 3 unformed stool samples in 24 hours and > or = 1 accompanying symptom), incapacity, risk factors, and etiology. RESULTS: The attack rate for diarrhea was 23.6 percent overall, with 11.7 percent having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9 percent (all TD) and 10.0 percent (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3 percent of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species. CONCLUSIONS: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal (Au)

Informing maternal and child health (MCH) policy through research

Maternal and Child Health (MCH) policy over the past two decades has been strongly influenced by research. The paper presents examples of some of the research undertaken and its significant influence in shaping health service delivery. Research in child health has focussed on oral rehydration therapy, immunization and perinatal morbidity and mortality. On the maternal side, morbidity and mortality have been examined with particular focus on problems which contribute to maternal and perinatal morbidity and mortality. Policies arising out of the outcome of these studies have influenced organization of service delivery, information system development, manpower development and deployment, maternal education, surveillance/auditing, quality of care, design of physical facilites and selection of equipment. The results of these studies have also led to the identification of areas requiring further study and testing of intervention to correct the deficiencies identified. These studies demonstrate that research can and does influence health policy, and has impacted positively on the quality and cost of care provided through our health services.(AU)

Hotel based surveillance of health conditions amongst travellers to Jamaica

Pursuant of the goal to implement a strategy for prevention and control of travellers' diarrhoea (TD), a programme for the surveillance of selected health conditions amongst visitors and staff was pilot tested in 5 resort hotels in Jamaica. Surveillance reports submitted on a weekly basis by the hotel nurses were analyzed for usage of hotel medical facilities; cases due to accidents, diarrhoea and associated symptoms; and acute respiratory tract infections (ARIs). Diarrhoea visits accounted for the lowest number of visits to the nurses' station of all properties, ARIs for the highest. Highest frequency of diarrhoea visits occurred in hotels 4 and 5 being 9.3 and 7.3 percent of all visits to the nurses' station. 70 percent of guest TD cases and 26 percent of staff reported with more than 6 evacuations per day. Abdominal cramps was the most frequent complaint, being present in 38 percent and 43 percent of staff. Vomiting was an associated symptom in 17.6 percent of guest cases and in 26.4 percent of staff cases. A hotel 1, fever was an associated symptom in 23.6 percent and blood in stool in 4.9 percent of guest cases. At hotel 4, fever was present in 14.1 percent and blood in stool of 1.5 percent of guest cases. Amongst staff at hotels 1 and 4, 22.2 percent and 3.8 respectively, and fever. Blood in stool was infrequent amongst staff. These data confirm the usefulness of the surveillance tool for the analysis of TD in hotels.(AU)

The aetiology of diarrhoea in five hotels in Jamaica

Diarrhoea is a self-limited disease which commonly affects tourists traveling from low risk to high risk destinations. It is estimated to affect 20-50 percent of the residents of industrialized countries who visit a developing country each year. Jamaica and other countries of the Caribbean, Latin America, Sub-Saharan African and South East Asia are considered to be intermediate to high risk tourist destinations. Data generated between 1979 and 1981 estimated that approximately 20 percent of European visitors to the Caribbean are afflicted with travellers' diarrhoea (TD) during their stay. Since the time, tourist arrivals to Jamaica have increased from 0.4 to 1.2 millions. To meet the challenges faced by this rapid growth, significant changes have been made to the tourism product, which may have impacted on the health visitors. Immediately following Jamaica's citation by the US Travel Advisory after an outbreak of typhoid in the parish of Westmoreland in 1991, the country was faced by a threat of a cholera epidemic in neighbouring Latin America. With a view to implementing a strategy for cholera prevention and control of cholera and other foodborne diseases, the Ministry of Health initiated a study of epidemiology and aetiology of TD in Jamaica. The first phase of the study was designed to assess the magnitude of TD amongst travellers to Jamaica, by region and by hotel. Those data have been reported elsewhere. Bacterial enteropathogens cause 80 percent of TD.(AU)