Etiology of travelers' diarrhea on a Caribbean island

Background: Between December 6, 1994 and March 10, 1996, a study of the eti ology 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 laborat ory 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%) ca ses. Enterotoxigenic E. coli(ETEC) were the most commonly identified pathog en (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clust ering of etiologically defined cases was studied at each hotel. A cluster w as 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 d iarrhea, enteropathogens were part of a duster 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 detect ed at the five hotels during the study period. Seventeen of 25 (68%) ETEC i solations occurred as part of a clustering of diarrhea cases. The largest o utbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC produc ing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels w ith all inclusive meal packages most diarrhea cases occurred as small clust ers, presumably as the result of foodborne outbreaks.