An epidemiological description of illness in passengers and crew at the Bridgetown Barbados port and cruise terminal

OBJECTIVE: To describe and analyse the epidemiology of illnesses experienced by passengers and crew arriving at the Bridgetown Port, Barbados between 2009 and 2013. DESIGN AND METHODS: Data were extracted from the passenger and crew arrival registers and passenger and crew illness logs. This was done for all vessels arriving at the Bridgetown Port between January 2009 and December 2013. Data were entered into an Epi Info database and analysis done using Epi Info Version 7. RESULTS: There were 1031 cases of illness from over 3 million passenger visits and 1 million crew. The overall event rate for communicable illnesses was 15.7 (95% CI 14.4 - 17.1) per 100,000 passengers, and for crew was 24.0 (21.6 - 26.6) per 100, 000 crew. Gastroenteritis was the predominant illness experienced by passengers and crew followed by influenza. The event rate for gastroenteritis among passengers was 13.7 (12.5 -15.0) per 100,000 and 14.4 (12.6, 16.5) for crew. The event rate for non-communicable illnesses was 3.4 per 100,000 passengers with myocardial infarction being the main diagnosis. The event rate for non-communicable illnesses among crew was 2.1 per 100,000, the leading cause being injuries. CONCLUSIONS: The predominant illnesses reported were gastroenteritis and influenza similar to previous published reports from around the world, but gastroenteritis was the predominant illness, unlike most other published studies. There is a role for Port Health Officers to assist the food safety and sanitation efforts on cruise liners and more frequent inspections and investigations of diseases outbreaks may be helpful.

Ethnic and gender disparities in premature adult mortality in Belize 2008-2010

OBJECTIVE: To determine if differences exist in premature adult mortality between the four main ethnic groups in Belize, by men and women aged 15-59 years. DESIGN AND METHODS: The analysis used 2008 to 2010 mortality data (Ministry of Health, Belize) and census data (2010) stratified by age, sex, and ethnicity (Statistical Institute of Belize). Underlying cause of death was classified using ICD10, then into 3-groups: communicable diseases, non-communicable diseases and injuries. We calculated the probability of death at 5-year intervals, 15-59 years (45q15) for all deaths and for the 3-broad (and competing) mortality causes. RESULTS: The probability of death among the population 15-59 years was 18.1%, and was higher in men than in women (women 13.5%, men 22.7%). Important ethnic variation existed, with Creole and Garifuna ethnic groups having three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%). This ethnic disparity pattern existed in both sexes but was greater in men. The female probability of death in the Creole and Garifuna groups was roughly twice that of the Mayan and Mestizo groups. For males it was between three and four times higher. Violent death contributes to this difference, particularly in Creole men, where roughly 1 in 7 can expect to die a violent death before their 60th birthday. CONCLUSIONS: This study starts to identify health inequities. Targeted work to identify potential interventions aimed at reducing the excess adult mortality in the Garifuna and Creole groups is needed.