The Caribbean Amblyomma Program has been operational for 8 years. However, owing to funding availability, some islands did not commence eradication activities until late 1997. During the past 2 years, 6 of the 9 islands (St. Kitts, St. Lucia, Anguilla, Montserrat, Barbados, and Dominica) under the program have attained the status of provisional freedom from the tropical bont tick (TBT). There are several administrative and technical reasons why the attainment of the program goals took longer than originally anticipated. This paper examines some of the ecologic factors that necessitated the prolongation of the treatment period and the recrudescence of TBT infestation in some islands. The introduction and subsequent spread of the cattle egret, Bulbucus ibis, in the 1960s and 1970s was most likely closely associated with the dissemination of the TBT in the region. At the national or island level, variations in land use are believed to have had a major impact on the eradication efforts in the different islands. Two islands, Antigua and Nevis, both opted out of sugar production several decades ago for economic reasons. Unfortunately, however, land from former sugar estates was not developed for other agricultural purposes and it became "unimproved free-grazing" areas for livestock. Thus, in both Antigua and Nevis, large numbers of livestock tend to become feral or free-ranging, making compliance with the mandatory treatment schedules impossible. In contrast, St. Lucia has large tracts of land allocated to banana plantations and St. Kitts to sugar plantations. Thus, feral or free-ranging livestock were rarely a problem in these islands. These differences in land use management are compared and discussed in relation to their perceived profound impact on TBT eradication efforts in the region.

In 2009, the burden of illness study for acute gastroenteritis in Trinidad and Tobago highlighted that ~10% of stool samples tested were positive for a foodborne pathogen. The study also noted that limited laboratory screening for pathogens contributed to a lack of etiology as public health hospitals only routinely tested for Salmonella and Shigella, and sometimes for Escherichia coli and Campylobacter. To better understand the foodborne pathogens responsible for acute gastroenteritis, enhanced testing using the BioFire® FilmArray® Gastrointestinal PCR panel was used to screen diarrheal stool samples for 22 pathogens from patients in 2018. The five general public health hospitals (San Fernando, Mt. Hope, Port of Spain, Sangre Grande, and Tobago) were notified of research activities and diarrheal stool samples were collected from all acute gastroenteritis patients. A total of 66 stools were screened and ~30% of samples tested positive for a foodborne pathogen. The current study showed that a much wider range of enteric pathogens were associated with acute gastroenteritis in Trinidad and Tobago than previously reported in 2009. These findings can be used by health officials to guide appropriate interventions, as well as to provide evidence for adoption of the PCR panel detection method at public health hospitals to benefit patient care.

ObjectiveThe Regional Tourism and Health program (THP) is a novel program, comprising of a tourism surveillance system, training, standards and multisectoral partnerships. The objective was to develop regional mandate and policy to support this new program and its non-traditional surveillance system.IntroductionIn January 2016, the Caribbean Public Health Agency (CARPHA), serving 24 Member States(MS), began executing a regional Tourism and Health program (THP), recognizing that the health of Caribbean economies is closely related to the health of its tourism industry since the Caribbean is most tourism-dependent region in the world; that tourism is vulnerable to health, safety and environmental (HSE) threats; and that travel and tourism impacted on global health security. High and increasing visitors to the Caribbean can increase the health, safety and security risks by the introduction and spread of diseases, by both residents and visitors. This was exemplified by the H1N1 pandemic (2009), Chikungunya (2013), and the recent Zika epidemic. However, even though more people visit the Caribbean than reside, there is no regional visitor/tourism surveillance system. There is also no regional mandate and policy for the reporting of visitor/tourism illnesses. This coupled with inadequate training, lack of standards and collaboration between tourism health stakeholders have contributed to disease spread.The THP is an innovative, multifaceted, integrated, regional program with components of a web based real time Tourism and Health Information Surveillance and Response system (THiS), food safety and environmental sanitation training, standards and multisectoral health and tourism partnerships. It aims to promote the health, safety and security of Caribbean visitors and residents. The THP is novel in that it involves the implementation of a non- traditional, health information and surveillance system (visitor based illnesses), new data users (private sector, hotels, passenger ships, visitors), new partners (tourism sector) and at regional level. Given the novelty and the multisectoral nature of the THP, a critical factor to support its implementation and sustainability was the development of regional mandate and policy to facilitate real time surveillance and response to detect and reduce the spread of illness.MethodsA multiprong approach was used to develop regional mandate and policy for the unique multisectoral THP program, from January 2016 to October 2017. This consisted of (i) weekly advocacy meetings with national and regional tourism and health public and private stakeholders to gain buy-in, recognition and support (ii) requesting letters of commitment from MS (iii) seeking support from the Caribbean Chief Medical Officers of Health (CMOs), who advises the Ministers of Health, at their annual meeting and convening a special CMO meeting on the THP (iv) seeking Ministers of Tourism support through the Caribbean Tourism Organization(CTO) forum (v) inclusion of tourism and health as a priority in the Caribbean Cooperation in Health (CCH4) strategy (which sets health priorities for the Caribbean region) (vi) presenting the THP to the Council for Human and Social Development (COHSOD), consisting of Caribbean Ministers of Health requesting approval to develop a regional THP policy (September 2017) and (viii) convening of a regional THP stakeholders meeting (October 2017) with high level decision makers from national, regional and international health and tourism sectors.ResultsA multiprong approach was used to develop regional mandate and policy for the unique multisectoral THP program, from January 2016 to October 2017. This consisted of (i) weekly advocacy meetings with national and regional tourism and health public and private stakeholders to gain buy-in, recognition and support (ii) requesting letters of commitment from MS (iii) seeking support from the Caribbean Chief Medical Officers of Health (CMOs), who advises the Ministers of Health, at their annual meeting and convening a special CMO meeting on the THP (iv) seeking Ministers of Tourism support through the Caribbean Tourism Organization(CTO) forum (v) inclusion of tourism and health as a priority in the Caribbean Cooperation in Health (CCH4) strategy (which sets health priorities for the Caribbean region) (vi) presenting the THP to the Council for Human and Social Development (COHSOD), consisting of Caribbean Ministers of Health requesting approval to develop a regional THP policy (September 2017) and (viii) convening of a regional THP stakeholders meeting (October 2017) with high level decision makers from national, regional and international health and tourism sectors.ConcludsionsDeveloping regional mandate and policy is a complex and long, but critical necessity for the implementation and the sustainability of this novel, multisectoral, non-traditional, multi-country tourism and health surveillance and response program. While the regional policy will take time to finalize, CARPHA and MS now have regional mandate to support the implementation of the THP, to strengthen capacity to prepare for, mitigate and respond to public health threats, which can transcend national boundaries.

No abstract

Objective: The new Tourism and Health Information System (THiS) was implemented for syndromic surveillance in visitor accommodations in the Caribbean region. The objective was to monitor for illnesses and potential outbreaks in visitor accommodations (hotels/guest houses) in the Caribbean in real-time using the web-based application.Introduction: Travel and tourism pose global health security risks via the introduction and spread of disease, as demonstrated by the H1N1 pandemic (2009), Chikungunya (2013), and recent Zika virus outbreak. In 2016, nearly 60 million persons visited the Caribbean. Historically no regional surveillance systems for illnesses in visitor populations existed. The Tourism and Health Information System (THiS), designed by the Caribbean Public Health Agency (CARPHA) from 2016-2017, is a new web-based application for syndromic surveillance in Caribbean accommodation settings, with real-time data analytics and aberration detection built in. Once an accommodation registers as part of the surveillance system, guests and staff can report their illness to front desk administration who then complete an online case questionnaire. Alternatively guests and staff from both registered and unregistered accommodations can self-report their illness using the online questionnaire in the THiS web application. Reported symptoms are applied against case definitions in real-time to generate the following syndromes: gastroenteritis, fever & respiratory symptoms, fever & haemorrhagic symptoms, fever & neurologic symptoms, undifferentiated fever, and fever & rash. Reported data is analyzed in real-time and displayed in a data analytic dashboard that is accessible to hotel/guest house management and surveillance officers at the Ministry of Health. Data analytics include syndrome trends over time, gender and age breakdown, and illness attack rates.Methods: Visitor accommodations from the following countries participated: Bahamas, Barbados, Belize, Bermuda, Guyana, Jamaica, Trinidad & Tobago, and Turks & Caicos Islands. National staff from the Ministry of Health, Ministry of Tourism, and/or Tourism Authority/Board engaged accommodations to participate. Participating accommodations were provided with training by national staff on how to report cases and use data analytic functions. They were asked to provide registration information to CARPHA, such as contact information to create login credentials, and data on occupancy rates for low/high seasons, number of staff, and number of lodging rooms to calculate illness attack rates. Weekly email reminders to accommodations to report cases of illness in the THiS web application, or to confirm 'nil' cases by email were sent by CARPHA staff.Results: Of the 105 accommodations engaged by national staff, 39.1% (n=41) registered to participate, accounting for 3738 lodging rooms. From epidemiological week 24-39, five cases of syndromes from three accommodations in two countries were reported in the THiS web application (Table). A case of gastroenteritis and fever & respiratory symptoms were self-reported from an unregistered accommodation. Three cases of gastroenteritis were reported by hotel administration from two registered accommodations. The average response rate to weekly emails confirming 'nil' cases was 32.1% (range: 10.5-83.3%). One accommodation reported by email a cluster of 7 cases with possible conjuctivitis. No outbreaks or aberrations were detected in the THiS web application.Conclusions: Engagement of Caribbean visitor accommodations in public health surveillance is a novel but critical undertaking for promoting health, safety, and security for both visitors and locals in the tourism dependent Caribbean region, but it will take time to establish. Confirming the absence of illness is an important public health endeavor for visitor accommodations. Preliminary results have demonstrated that it is possible for public health to work in a voluntary basis with the private accommodation sector. To establish more consistent and reliable reporting public health legislation and policies will need to be explored. As more data is gathered, assessments of the validity and sensitivity of the system will need to be conducted.