Waterborne outbreak among Spanish tourists in a holiday resort in the Dominican Republic, August 2002

Abstract

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiología - CNE) was alerted to a high number of gastroenteritis cases in Spanish tourists who had travelled to a hotel in Punta Cana on different days during august 2002. Entamoeba hystolitica cysts have been visualised by microscopy in the stools of several patients that sought medical attention in the Dominican Republic. The CNE informed the health authorities in the Dominican Republic and conducted in conjunction an epidemiological investigation. A descriptive study of the 76 initial cases estimated a mean illness duration of 5.1+2.9 days and a exposure period of 3.6+2.2 days. Following a retrospective cohort study, the attack rate was found to be 32.4%. Consequently, 216 (95% CI=114.75-317.25) spanish tourists had probably developed the illness. Stool samples were collected in Spain from untreated patients who still felt unwell. None of the samples were positive for E.hystolitica. On 10 September, a hygiene inspection was undertaken at the hotel. Samples of the ice and meals served at the buffet that day, yielded coliform bacteria. Consumption of water from the resort water system was the only risk factor associated with the symptoms (RR= 3.55; 95% CI =1.13-10.99). To avoid similar outbreaks occurring again at the hotel, it is essential to regularly monitor the water quality and to improve food handling hygiene standards. Basic food hygiene training for food handlers should be mandatory. An international guideline for the management foodborne and waterborne outbreaks among tourists in holiday resorts should be drawn up, involving all competent authorities of both destination and tourist origin countries.

Systematic mapping of food safety outbreaks in the hospitality sector in the Dominican Republic

“…, 1992; Martínez et al. , 2011; Ministerio de Salud Pública, 2016; Páez Jiménez et al. , 2004; Szakacs and McCarthy, 2007), dining, wedding banquet (Blume et al.…”

“…The systematic mapping used seven articles that reported FBDOs in food premises such as all-inclusive hotel restaurants (Develoux et al, 2008;Gupta et al, 2007;Lange et al, 1992;Mart ınez et al, 2011;Ministerio de Salud P ublica, 2016;P aez Jim enez et al, 2004;Szakacs and McCarthy, 2007), dining, wedding banquet (Blume et al, 1999;Jim enez et al, 2011), and a guest house (Perez et al, 2001). However, eight articles did not report the food premises.…”

“…None of the sources reported how many locals, staff or workers were affected. During the collection of data, the systematic mapping revealed that few articles provided any information about the implemented control measures in the hotel premises (Dom enech-S anchez et al, 2011;Jimenez et al, 2004;Jim enez et al, 2011;Loharikar et al, 2015).…”