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Salmonellosis at a Resort Hotel -- Puerto Rico

Several state health departments and CDC have received reports of salmonellosis in travelers returning from the Hotel Cerromar, Vega Alta, Puerto Rico. Earlier, in July 1986, CDC received reports about travelers returning from this hotel with Salmonella enteritidis infections. The Puerto Rico Department of Health investigated, and no additional cases were reported until November. At present, several state health departments have obtained preliminary epidemiologic information about additional cases from recently returning groups.

A New Jersey trade association held a convention at the hotel during the period November 1-8. At least 23 of 141 travelers (16%) complained of acute diarrhea. Two were hospitalized for a week in Puerto Rico, and three were hospitalized upon returning. S. enteritidis was isolated from two of these cases. A week later, during the period November 9-19, a New Jersey professional association hosted a convention of 1,400 members and their families at the hotel. The New Jersey State Department of Health contacted a representative sample of the group after receiving a report of four cases in one returning family. The attack rate is estimated to be 10% to 15%; onset dates ranged from November 12 to 22. Eight stool cultures have yielded Salmonella Group D, and six of these have been serotyped as S. enteritidis. A questionnaire followup is underway to determine whether or not further cases have occurred.

A convention of 800 food distributors, primarily from Connecticut and Massachusetts, was held at the same hotel, in two successive groups, during the period November 2-12. Among the 220 Connecticut residents, 16 (7%) reported diarrheal illness within several days after their visit. The Connecticut State Department of Health Services confirmed nine cases of S. enteritidis infection in this group. Followup is underway to more fully evaluate the extent of illness. The Massachusetts Department of Public Health has identified 42 cases (10%) of diarrheal illness among 442 state residents who had attended the same convention. S. enteritidis has been isolated from nine of these. Other possible cases are being investigated.

Most recently, CDC has received a report of eight cases of diarrheal illness among attendees of a Puerto Rican trade convention at the hotel during the period November 28-30. Thus far, two of five cultures obtained have yielded Salmonella Group D. Reported by JL Hadler, MD, MPH, State Epidemiologist, Connecticut State Dept of Health Svcs; KM Gallagher, MPH, LM Mofenson, MD, GF Grady, MD, State Epidemiologist, Massachusetts Dept of Public Health; CH Turner, H Rosenfeld, DVM, JW Farrell, MSW, WE Parkin, DVM, State Epidemiologist, New Jersey State Dept of Health; JG Rigau, MD, Commonwealth Epidemiologist, Puerto Rico Dept of Health; Div of Field Svcs, Epidemiology Program Office, Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Laboratory studies are in progress to determine whether or not the same strain of S. enteritidis caused all of the outbreaks. Reports in both July and November of S. enteritidis gastroenteritis among persons visiting the same hotel suggest a recurrent source. Measures to control the outbreak are being implemented by the hotel management and the Puerto Rico Department of Health. Cases of salmonellosis developing in persons within 1 week after staying at this hotel should be reported to local and state health departments. State health departments are requested to report such cases to the Enteric Diseases Branch, Division of Bacterial Diseases, CDC. Information about the current status of the outbreak can be obtained by calling the Commonwealth of Puerto Rico, Department of Health, (809) 766-2240.

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