A Cluster of Diarrhea in a Tourist Group to Bali, Indonesia, 2010

Huai-Te Tsai1, 2, Donald Dah-Shyong Jiang1, 2 , Hsiao-Ping Tung3 ,Chia-Ping Su1, 2 , Yu-San Chien1, 2 , Jen-Hsiang Chuang1

2010 Vol.26 NO.20

Correspondence Author: Huai-Te Tsai


Diarrhea during travelling has become a common health problem in Taiwan due to increasing international travel. On January 22, 2010, Fever Screening Station at the Taoyuan International Airport found 4 febrile nationals among the 10 members of a tourist group coming back from Bali, Indonesia. Investigation showed that the 10 people all had diarrhea during travelling. Epidemiological investigation showed that all members were fine prior to the trip and started to have symptoms after 4 to 6 days in Indonesia. Laboratory examinations showed that rectal swabs from 3 of the 10 members yielded S. flexneri group B and hence confirmed an outbreak of shigellosis. After treatment, the culture-positive cases were negative for the bacteria after two follow-up examinations. Health education and monitoring were done for all members and their close contacts. No secondary outbreaks were seen. The outbreak ended on February 13.
The epidemic curve showed that the outbreak had a single peak suggestive of a common source infection. We suspected that environment encountered during that trip, utensils, foods, or drinking water might be the source of infection. According to the menus during the trip and memory of the members, ice, bottle water or incompletely heated foods might be the risk factors of the cluster. Hence, food hygiene during travels should be emphasized. Disease symptoms should be reported and treated promptly.