title: Etiology of travelers' diarrhea on a Caribbean island.
abstract: BACKGROUND
  Between December 6, 1994 and March 10, 1996, a study of the etiology of diarrhea was carried out among 332 travelers to five all-inclusive hotels in Negril, Jamaica.
  
  
  METHODS
  Stool specimens were collected and sent to Montego Bay for laboratory analysis. Escherichia coli strains isolated at the Jamaican laboratory were sent to Houston for toxin testing.
  
  
  RESULTS
  A recognized enteropathogen was found in 118 of the 332 (35.5%) cases. Enterotoxigenic E. coli (ETEC) were the most commonly identified pathogen (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clustering of etiologically defined cases was studied at each hotel. A cluster was defined as 2 or more cases with the same pathogen identified in the same hotel within 7 days. In the 3 hotels with the highest number of cases of diarrhea, enteropathogens were part of a cluster in 65 of 99 cases (65.7%) of diarrhea of which an etiologic agent was identified. In the other 2 hotels, only 4 of 20 cases (20%) occurred in clusters.
  
  
  CONCLUSIONS
  A total of 25 clusters of travelers' diarrhea cases was detected at the five hotels during the study period. Seventeen of 25 (68%) ETEC isolations occurred as part of a clustering of diarrhea cases. The largest outbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC producing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels with all inclusive meal packages most diarrhea cases occurred as small clusters, presumably as the result of foodborne outbreaks.
authors.affiliation: Center for Infectious Diseases, The University of Texas-Houston, Houston, Texas, USA.
authors.forename: P
authors.initials: P
authors.lastname: Paredes
authors.forename: S
authors.initials: S
authors.lastname: Campbell-Forrester
authors.forename: J J
authors.initials: JJ
authors.lastname: Mathewson
authors.forename: D
authors.initials: D
authors.lastname: Ashley
authors.forename: S
authors.initials: S
authors.lastname: Thompson
authors.forename: R
authors.initials: R
authors.lastname: Steffen
authors.forename: Z D
authors.initials: ZD
authors.lastname: Jiang
authors.forename: A M
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: H L
authors.initials: HL
authors.lastname: DuPont
mesh_terms: D002169:Campylobacter Infections / Q000453:epidemiology; D016123:Campylobacter jejuni / Q000302:isolation & purification; D016000:Cluster Analysis; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology* / Q000469:parasitology; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000453:epidemiology; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology / Q000469:parasitology; D005873:Giardiasis / Q000453:epidemiology; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D012480:Salmonella Infections / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014195:Travel