During the first quarter of 1998, CAREC provided technical assistance in the area of outbreak investigation for the following:

In response to a preliminary December 1997 assessment which indicated a significant increase in reported morbidity due to tuberculosis, a CAREC team visited the Turks and Caicos Islands in early January 1998 to assist the Ministry of Health with the conduct of an investigation of this epidemiologic situation. Twenty suspected/confirmed cases as well as 19 of 37 potential contacts and 31 health workers were reviewed as part of this investigation.

Of the cases investigated, 14 were confirmed as having pulmonary tuberculosis. Of these, one had been inadequately treated for previously diagnosed tuberculosis, while another had defaulted and a third had stopped treatment after two months. Of the contacts traced, two were found to be Mantoux test positive, while another two had clinical and radiologic evidence of tuberculous disease. Although eight of the screened health workers were found to be Mantoux test positive, no interpretation of these results could be made in the absence of their BCG vaccination histories.

This outbreak exemplified the potential for the re-emergence of tuberculosis through the migration of infected persons from hyper-endemic areas to other territories within the region. It also brought into focus the urgent need for the following:

In February 1998, a fatal case of Plasmodium falciparum malaria was notified from the Bahamas. This patient was a 45 year old male Bahamian, whose infection has been classified as imported by the national health authorities. As part of the outbreak investigation, extensive screening surveys, utilising thick and thin blood film microscopy and immunofluorescent antibody techniques, were undertaken in populations living in close proximity to this index case. This exercise subsequently yielded four additional cases, all of which have been classified as indigenous.

We wish to emphasis that the potential is real for re-introduction of malaria with local transmission in those countries from which it had been previously eradicated as a number of facilitating conditions still obtain. These include, inter alia,

In February 1998, CAREC’s Epidemiology and Laboratory Divisions supported the Ministry of Health, Bermuda, with the conduct of an extensive epidemiologic and environmental investigation of an outbreak of gastrointestinal illness at one the country’s large hotels. Over four hundred cases of gastroenteritis were documented in this outbreak and these included hotel staff, hotel guests as well as other hotel patrons who were not in-house guests. The hotel’s drinking/potable water supply had become contaminated with sewage, and a Norwalk-like virus was identified as the aetiologic agent in both clinical specimens as well as water samples tested by the US Centers for Disease Prevention and Control.