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.
Disclaimer
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