title: Interventions to prevent and control food-borne diseases associated with a reduction in traveler's diarrhea in tourists to Jamaica.
abstract: BACKGROUND
  In 1996 a study found that approximately one in four tourists to Jamaica were affected with traveler's diarrhea (TD) during their stay. That year the Ministry of Health initiated a program for the prevention and control of TD. The aim of this ongoing program was to reduce attack rates of TD from 25% to 12% over a 5-year period by improving the environmental health and food safety standards of hotels.
  
  
  METHODS
  Hotel-based surveillance procedures for TD were implemented in sentinel hotels in Negril and Montego Bay in 1996, Ocho Rios in 1997, and Kingston in 1999. A structured program provided training and technical assistance to nurses, food and beverage staff, and environmental sanitation personnel in the implementation of Hazard Analysis Critical Control Point principles for monitoring food safety standards. The impact of interventions on TD was assessed in a survey of tourists departing from the international airport in Montego Bay in 1997-1998 and from the international airport in Kingston in 1999-2000. The impact of the training and technical assistance program on food safety standards and practices was assessed in hotels in Ocho Rios as of 1998 and in Kingston from 1999.
  
  
  RESULTS
  At the end of May 2002, TD incidence rates were 72% lower than in 1996, when the Ministry of Health initiated its program for the prevention and control of TD. Both hotel surveillance data and airport surveillance data suggest that the vast majority of travelers to Kingston and southern regions are not afflicted with TD during their stay. The training and technical assistance program improved compliance to food safety standards over time.
  
  
  CONCLUSIONS
  Interventions to prevent and control TD in visitors to Jamaica are positively associated with a reduction in TD in the visitor population and improvements in food safety standards and practices in hotels.
authors.affiliation: Health and Tourism, Ministry of Health, Kingston, Jamaica.
authors.forename: David V M
authors.initials: DV
authors.lastname: Ashley
authors.forename: Christine
authors.initials: C
authors.lastname: Walters
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dockery-Brown
authors.forename: André
authors.initials: A
authors.lastname: McNab
authors.forename: Deanna E C
authors.initials: DE
authors.lastname: Ashley
mesh_terms: D000293:Adolescent; D000328:Adult; D003140:Communicable Disease Control / Q000379:methods*; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005511:Food Handling; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance / Q000379:methods; D011795:Surveys and Questionnaires; D014195:Travel