Lew J F, Swerdlow D L, Dance M E, Griffin P M, Bopp C A, Gillenwater M J, Mercatante T, Glass R I
Viral Gastroenteritis Unit, Centers for Disease Control, Atlanta, GA 30333.
Am J Epidemiol. 1991 Aug 15;134(4):413-20. doi: 10.1093/oxfordjournals.aje.a116103.
From October 23 to October 27, 1989, an outbreak of gastroenteritis occurred aboard a cruise ship in the Caribbean. The 818 passengers and 518 crew members were surveyed for gastrointestinal symptoms; 72 (14%) of 512 passengers and 12 (3%) of 388 crew members who answered the survey reported having a diarrheal illness. Multiple-antibiotic-resistant Shigella flexneri 4a was isolated from 19 ill passengers and two ill crew members. Thirteen people were hospitalized, and prolonged duration of illness was associated with taking an antibiotic to which the isolated strain of Shigella was resistant. A case-control study of food items implicated German potato salad as the vehicle of transmission. It was prepared and probably infected by a food handler from a country where multiple-antibiotic-resistant Shigella is common. Spread may have been facilitated by the limited availability of toilet facilities for the galley crew. This outbreak demonstrates how antibiotic-resistant strains can be introduced into the United States, where they can pose treatment problems. The continuing problem of foodborne gastrointestinal disease in settings such as cruise ships underscores the need for basic hygienic control for food handlers and food preparation areas. In addition, the availability of adequate working conditions for crew members, including appropriately furnished toilet facilities, may be important issues that must be addressed in order to decrease the frequency of diarrhea outbreaks aboard cruise ships.
1989年10月23日至10月27日，加勒比海一艘游轮上爆发了肠胃炎疫情。对818名乘客和518名船员进行了胃肠道症状调查；在512名回复调查的乘客中，有72人（14%）报告患有腹泻疾病，在388名回复调查的船员中，有12人（3%）报告患有腹泻疾病。从19名患病乘客和2名患病船员身上分离出多重耐药性福氏志贺菌4a。13人住院治疗，病程延长与使用分离出的志贺菌菌株耐药的抗生素有关。一项针对食品的病例对照研究表明，德国土豆沙拉是传播媒介。它是由一名来自多重耐药性志贺菌常见国家的食品处理人员制作并可能受到污染的。厨房工作人员厕所设施有限可能助长了疫情传播。这次疫情表明耐药菌株是如何传入美国的，在美国它们可能会带来治疗问题。游轮等场所食源性胃肠道疾病持续存在的问题凸显了对食品处理人员和食品制备区域进行基本卫生控制的必要性。此外，为船员提供充足的工作条件，包括配备适当的厕所设施，可能是为减少游轮上腹泻疫情发生频率而必须解决的重要问题。
