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

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiologia--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.

Waterborne outbreak of tularemia associated with crayfish fishing

In 1997, an outbreak of human tularemia associated with hare-hunting in central Spain affected 585 patients. We describe the identification of Francisella tularensis biovar palaearctica in a second outbreak of ulceroglandular tularemia associated with crayfish (Procambarus clarkii) fishing in a contaminated freshwater stream distant from the hare-associated outbreak. The second outbreak occurred 1 year after the first.

Impact of rotavirus disease in Spain: an estimate of hospital admissions due to rotavirus

The epidemiology of rotavirus infection in Spain was investigated using information from existing surveillance systems. Reports from laboratories and data on hospital admissions were used to estimate the number of hospital admissions due to rotavirus infection. Between January 1989 and December 1995 there were 8265 reports of rotavirus identification in the Sistema de Información Microbiológica, a voluntary national laboratory surveillance system. Where age was reported, 89.2% were in children under 5 y old. This represents 21.8% of all pathogens identified in faecal specimens in children of this age group. Between January and December 1994 there were 5639 admissions coded as "infectious intestinal disease" and 8225 as "non-infective gastroenteritis" in children under 5 y of age in the Conjunto Mínimo Básico de Datos, an obligatory hospital admissions surveillance system which covers 83% of public hospitals. Using regression analysis of admission data and laboratory reports it was estimated that rotavirus infection accounted for 3519 (25.3%) of the hospital admissions. We estimate that 4239 admissions attributable to rotavirus occurred in children under 5 y of age in Spain in 1994, a rate of 2.5/1000 population in this age group. These estimates are lower than those published for other countries, where the burden of disease is considered high enough to warrant a national vaccination programme. A cost-effectiveness study with Spanish information is essential before embarking on a national vaccination programme.