EP1401:                Issues and Challenges: Investigation of Foodborne Illness Outbreak in Jamaica / Investigation of Foodborne Illness Outbreak in Toronto, Canada

Speaker:              Taraleen Malcolm, PhD, MPH, CP-FS; Sylvanus Thompson, MS, PhD, CPHI

This session reviews an outbreak investigation conducted in a mega hotel in Jamaica. Along the way, we discover gaps in the investigation process, describe challenges in disease surveillance, and determine the barriers to effective outbreak prevention and control.

See how the existing regulations stack up against changing trends in the tourism sector and possible remedies for the shortcomings.  Use this case study to identify the emerging challenges and possible solutions in your outbreak investigation process before they happen.


Issues and Challenges: Investigation of Foodborne Illness Outbreak in Jamaica

Objectives: In 1996-1997, a study indicated that the attack rate for diarrhea among travelers in Jamaica was found to be approximately 24%. The findings resulted in the enactment of new regulations in 1998 to reduce the incidence of travel related diarrhea. Outbreak investigation within all-inclusive resorts in Jamaica has always proven to be challenging. This has been compounded by the advent of the mega hotel.  The objective of this paper is to review a diarrheal outbreak investigation conducted in a mega hotel to determine the barriers to effective prevention and control.

Method:   A review of the epidemiological, environmental and laboratory assessment were conducted to determine the adherence to existing outbreak investigation standards. A gap analysis was then conducted to determine the factors affecting the outcome of the outbreak.

Results:   The review revealed that the investigation adhered to the existing standards for the most part. However there were significant gaps identified. These included the late identification of the outbreak, incomplete case history forms and inadequate food samples. There were 80 suspected cases identified. Salmonella enteritidis was isolated from 21 stool samples and phage types were available for 2.

Conclusion:   No conclusive epidemiological link could be identified between the cases as there was insufficient evidence. The team was also unable to conclusively identify the source of the organism. The issues identified highlighted the need to reevaluate the existing Public Health Tourist Establishment regulations to address the changing trends in the tourism sector.

Investigation of Foodborne Illness Outbreak in Toronto, Canada

In the August 2013, the organizers of a large public event received a number of complaints of gastrointestinal symptoms related to the consumption of a specific food served by one of their vendors. The food item was a popular new burger and the potential outbreak gained immediate media attention. The organizers instructed the specific food vendor to close the food outlet and notified the local public health agency. The outbreak investigation included inspections of three food establishments, active surveillance for cases, microbiological testing of human specimen and food samples, and an epidemiological analysis. The outbreak management was performed using an Incident Management System and involved environmental controls and regular communication to the media and the public.

In total, 257 reports were investigated in association with this outbreak of which 144 (56%) met the case definition. Of the 144 cases, 93% reported eating the implicated food item within 10 hours of symptoms. Several food samples collected from different locations tested positive for high levels of S. aureus and the presence of the enterotoxin. The same PFGE pattern was detected in all but two of the samples.


This presentation outlines the investigation and management of a foodborne illness outbreak associated with the consumption of a new popular food item that was contaminated with Staphylococcus aureus enterotoxin. Challenges and lessons learned related to logistics, the development of the case definition, the environmental inspection, the multi-jurisdictional nature of the outbreak and communications will be described.