Distribution, Burden, and Impact of Acute Gastroenteritis in Dominica, 2009-2010

Acute gastroenteritis (AGE) is an important public-health issue in Dominica. To determine the burden of AGE in Dominica, a retrospective, cross-sectional population survey was conducted in March-April 2009 and October 2010 (low- and-high-AGE seasons) and a laboratory survey from April 2009 to March 2010. The overall monthly prevalence of self-reported AGE was 8.6 % (95% CI 7.0-10.6); the incidence rate was 1.1 episodes/person-year and 79,157.1 episodes of AGE for the total population/year. Monthly prevalence of AGE was the highest in the 1-4 year(s) age-group (25.0%), higher in females (10.8%) and also varied by health district, with the highest monthly prevalence of AGE being reported in the Portsmouth district (13.1%). This difference in gender and across the health region was statistically significant. The estimated underreporting of syndromic AGE to the Ministry of Health was 83.3%. Furthermore, for every reported laboratory-confirmed case of AGE and foodborne disease (FBD), there was an estimated underreporting factor of 280. Overall, 47% of AGE specimens tested were positive for FBD pathogens. The predominant pathogens isolated were norovirus, followed by Giardia , Salmonella , and Shigella . The total annual estimated cost of AGE was US$1,371,852.92, and the total cost per capita due to AGE was US$ 19.06, indicating an economic burden of AGE-related illness on a small island of Dominica

Burden and Impact of Acute Gastroenteritis and Foodborne Pathogens in Trinidad and Tobago

Objectives of this study were to determine the burden and impact of acute gastroenteritis (AGE) and foodborne pathogens in Trinidad and Tobago. A retrospective, cross-sectional population survey, based on selfreported cases of AGE, was conducted in November-December 2008 and May-June 2009 (high- and low- AGE season respectively) by face-to-face interviews. From 2,145 households selected to be interviewed, the response rate was 99.9%. Of those interviewed, 5.1% (n=110; 95% CI 4.3-6.2) reported having AGE (3 or more loose watery stools in 24 hours) in the 28 days prior to the interview (0.67 episodes/person-year). Monthly prevalence of AGE was the highest among children aged <5 years (1.3 episodes/year). Eighteen (16%) persons with AGE sought medical care (4 treated with oral rehydration salts and 6 with antibiotics), and 66% reported restricted activity [range 1-16 day(s)]. The mean duration of diarrhoea was 2.3 days (range 2-10 days). One case submitted a stool sample, and another was hospitalized. Overall, 56 (10%) AGE specimens tested positive for foodborne pathogens. It was estimated that 135,820 AGE cases occurred in 2009 (84% underreporting), and for every 1 AGE case reported, an additional 6.17 cases occurred in the community. The estimated economic cost of AGE ranged from US$ 27,331 to 19,736,344. Acute gastroenteritis, thus, poses a huge health and economic burden on Trinidad and Tobago

Determining the Community Prevalence of Acute Gastrointestinal Illness and Gaps in Surveillance of Acute Gastroenteritis and Foodborne Diseases in Guyana

Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. Objective of this study was to determine the community prevalence and true burden and economic impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Guyana. A cross-sectional population-based survey was conducted in 7 of the 10 regions in Guyana during August and November 2009 to capture the high- and low-AGE season respectively. Overall, 1,254 individual surveys were administered at a response rate of 96.5%. The overall monthly prevalence of self-reported cases of AGE was 7.7% (97 cases) (95% CI 6.3-9.3), and the yearly incidence was 1.0 episodes per person-year. The highest monthly prevalence of AGE was observed in region 4 (8.9%) and in children aged 1-4 year(s) (12.7%). Of the 97 AGE cases, 23% sought medical care; 65% reported spending time at home due to their illness [range 1-20 day(s), mean 2.7 days], of whom 51% required other individuals to look after them while ill. The maximum number of stools per 24 hours ranged from 3 to 9 (mean 4.5), and number of days an individual suffered from AGE ranged from 1 to 21 day(s) (mean 2.7 days). The burden of syndromic AGE cases in the population for 2009 was estimated to be 131,012 cases compared to the reported 30,468 cases (76.7% underreporting), which implies that, for every syndromic case of AGE reported, there were additional 4.3 cases occurring in the community. For every laboratory-confirmed case of FBD/AGE pathogen reported, it was estimated that approximately 2,881 more cases were occurring in the population. Giardia was the most common foodborne pathogen isolated. The minimum estimated annual cost associated with the treatment for AGE was US$ 2,358,233.2, showing that AGE and FBD pose a huge economic burden on Guyana. Underreporting of AGE and foodborne pathogens, stool collection, and laboratory capacity were major gaps, affecting the surveillance of AGE in Guyana

Population-based Estimates of Acute Gastrointestinal and Foodborne Illness in Barbados: A Retrospective Cross-sectional Study

The aim of this study was to determine the burden and impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Barbados through a retrospective, cross-sectional population survey and laboratory study in August 2010\u2013August 2011. Face-to-face interviews were conducted with one person from each of 1,710 randomly-selected households. Of these, 1,433 (84%) interviews were completed. A total of 70 respondents reported having experienced AGE in the 28 days prior to the interview, representing a prevalence of 4.9% and an annual incidence rate of 0.652 episodes per person-year. Age (p=0.01132), season (p=0.00343), and income (p<0.005) were statistically associated with the occurrence of AGE in the population. Norovirus was the leading foodborne pathogen causing AGE-related illness. An estimated 44,270 cases of AGE were found to occur during the period of the study and, for every case of AGE detected by surveillance, an additional 204 cases occurred in the community. Economic costs of AGE ranged from BD$9.5 million to 16.5 million (US$ 4.25-8.25) annually. This study demonstrated that the public-health burden and impact of AGE and FBD in Barbados were high and provided the necessary baseline information to guide targeted interventions

Estimating the Burden of Acute Gastrointestinal Illness: A Pilot Study of the Prevalence and Underreporting in Saint Lucia, Eastern Caribbean

Saint Lucia was the first country to conduct a burden of illness study in the Caribbean to determine the community prevalence and underreporting of acute gastroenteritis (AGE). A retrospective cross-sectional population survey on AGE-related illness was administered to a random sample of residents of Saint Lucia in 20 April\u201316 May 2008 and 6-13 December 2009 to capture the high- and low-AGE season respectively. Of the selected 1,150 individuals, 1,006 were administered the survey through face-to-face interviews (response rate 87.4%). The overall monthly prevalence of AGE was 3.9%. The yearly incidence rate was 0.52 episodes/person-year. The age-adjusted monthly prevalence was 4.6%. The highest monthly prevalence of AGE was among children aged <5 years (7.5%) and the lowest in persons aged 45-64 years (2.6%). The average number of days an individual suffered from diarrhoea was 3.8 days [range 1-21 day(s)]. Of the reported AGE cases, only seven (18%) sought medical care; however, 83% stayed at home due to the illness [(range 1-16 day(s), mean 2.5]; and 26% required other individuals to take care of them. The estimated underreporting of syndromic AGE and laboratory-confirmed foodborne disease pathogens was 81% and 99% respectively during the study period. The economic cost for treating syndromic AGE was estimated at US$ 3,892.837 per annum. This was a pilot study on the burden of illness (BOI) in the Caribbean. The results of the study should be interpreted within the limitations and challenges of this study. Lessons learnt were used for improving the implementation procedures of other BOI studies in the Caribbean

Estimating the Burden of Acute Gastrointestinal Illness in Grenada

This is the first study conducted in Grenada, with a population of approximately 108,000, to quantify the magnitude, distribution, and burden of self-reported acute gastroenteritis (AGE). A retrospective population survey was conducted in October 2008 and April 2009 and a laboratory survey from October 2008 to September 2009. The estimated monthly prevalence of AGE was 10.7% (95% CI 9.0-12.6; 1.4 episodes/ person-year), with a median of 3 days of illness. Of those who reported AGE, 31% sought medical care (stool samples were requested from 12.5%); 10% took antibiotics; 45% took non-prescribed medication; and 81% reported restricted activity. Prevalence of AGE was significantly higher among children aged <5 years (23.5%, p<0.001). Of the AGE stool samples submitted to the laboratory for analysis, 12.1% were positive for a foodborne pathogen. Salmonella enteritidis was the most common foodborne pathogen associated with AGE-related illness. The estimated percentage of underreporting of syndromic AGE to the Ministry of Health was 69%. In addition, for every laboratory-confirmed foodborne/AGE pathogen, it was estimated that there were 316 additional cases occurring in the population. The minimum estimated cost associated with treatment for AGE was US$ 703,950 each year, showing that AGE has a potentially significant economic impact in Grenada

A Novel Hotel-based Syndromic Surveillance System for the Caribbean Region

ObjectiveTo describe the Caribbean Public Health Agency’s (CARPHA)Tourism and Health Information System (THiS), a web-basedsyndromic surveillance system to increase the capacity of Caribbeancountries to monitor the health of visitors and staff in hotels, anddetect potential infectious disease outbreaks for early and coordinatedpublic health response.IntroductionThe tourism industry is highly vulnerable to Health, Safety, andEnvironmental Sanitation (HSE) threats. The Caribbean is the mosttourism dependent region in the world, with over 54.2 million stay-over and cruise ship arrivals in 2015, generating revenues of $US29.6billion and contributing to 15% of the Gross Domestic Product (GDP)and 2,255,000 jobs [1]. Tourists and staff are at an increased risk ofacquiring infectious diseases, given the mass-gathering of individualswith varying levels of susceptibility and often times in close quartersin hotels and cruise ships. To prevent the spread of infectious diseasesin these settings, early warning and response to potential publichealth threats is essential. To increase the capacity of countries in theCaribbean monitor and protect the health of tourists and staff in theirhotel establishments, THiS was designed as an early warning systemfor infectious disease outbreaks.MethodsCARPHA launched the Regional Tourism Health Information,Monitoring and Response System in 2016 with donor fundingreceived from the Inter-American Development Bank (IDB). Theoverall objective of THMRS project from 2016-2018 is to improveparticipating country’s capacity to provide cost-effective and qualityhealth, food safety and environmental solutions to HSE threats.As part of the THMRS project, the development of a hotel-basedsyndromic surveillance system for early warning and response toinfectious diseases was developed.THiS was developed in collaboration with six participating IDBcountries: Barbados, Bahamas, Belize, Guyana, Jamaica, Trinidadand Tobago. The implementation plan (2016-2018) with each countryinvolved three stages:1) Project Operations, Coordination, Management (includingAdvocacy, and Endorsement)2) Development of the project outputs: gap analysis and bestpractices; development of surveillance guidelines and trainingmodules, HSE Standards3) Implementation in participating countries (i.e. technical visits,ongoing technical coordination): Preparation, Buy-in, Training andLaunchThe web-based design of THiS enables the collection of real-time data which will inform health service delivery decisions/policies, strengthen national and regional health monitoring efforts,and trigger a rapid coordinated response to outbreaks, and preventescalation of tourism HSE incidents. The system involves a web-based questionnaire with a series of 11 short questions that ask theuser for basic non-identifiable demographic information as well assymptoms. The reported symptoms are used by the system to generatesix syndromes: Gastroenteritis, Undifferentiated Fever, HemorrhagicFever, Fever with Neurologic symptoms. Fever with Respiratorysymptoms, Fever with Rash.Data entry persons include hotel staff, physicians, and the case.Access to anlaytic dashboards of the aggregated data is limited toregistered hotel staff (i.e. Managers), the Ministry of Health of thecountry where the hotel reporting is located, and CARPHA.The limited level of baseline data for syndromes in the Caribbeanregion means that statistical aberration detection mechanisms formost syndromes will not be available until THiS collects at least oneyear’s worth of data. However, for acute gastroenteritis, until a moreaccurate threshold can be generated, a cut-off of 3% ill (staff andguests) will be used for alerting potential outbreaks. This is scheduledto be live and functional beginning in hotel facilities in Trinidad andTobago at the beginning of October 2016.By the end of 2016, THiS will be operating in facilities in all sixparticipating countries, allowing for the collection of baseline data forsyndromes occurring among tourists and staff in hotel-settings, andproviding a mechanism to detect and response to emerging publichealth threats early and efficiently.ConclusionsEstablishing this system is critical to improving countries’capacities to support the overall health surveillance system of thetourism-dependent Caribbean economies, enabling countries tocollect real-time data which will inform health service deliverydecisions/policies, strengthen national and regional health monitoringefforts to trigger a rapid coordinated response to outbreaks and othercrises and thus prevent tourism HSE incidents

A Novel Hotel-based Syndromic Surveillance System for the Caribbean Region

ObjectiveTo describe the Caribbean Public Health Agency’s (CARPHA)Tourism and Health Information System (THiS), a web-basedsyndromic surveillance system to increase the capacity of Caribbeancountries to monitor the health of visitors and staff in hotels, anddetect potential infectious disease outbreaks for early and coordinatedpublic health response.IntroductionThe tourism industry is highly vulnerable to Health, Safety, andEnvironmental Sanitation (HSE) threats. The Caribbean is the mosttourism dependent region in the world, with over 54.2 million stay-over and cruise ship arrivals in 2015, generating revenues of $US29.6billion and contributing to 15% of the Gross Domestic Product (GDP)and 2,255,000 jobs [1]. Tourists and staff are at an increased risk ofacquiring infectious diseases, given the mass-gathering of individualswith varying levels of susceptibility and often times in close quartersin hotels and cruise ships. To prevent the spread of infectious diseasesin these settings, early warning and response to potential publichealth threats is essential. To increase the capacity of countries in theCaribbean monitor and protect the health of tourists and staff in theirhotel establishments, THiS was designed as an early warning systemfor infectious disease outbreaks.MethodsCARPHA launched the Regional Tourism Health Information,Monitoring and Response System in 2016 with donor fundingreceived from the Inter-American Development Bank (IDB). Theoverall objective of THMRS project from 2016-2018 is to improveparticipating country’s capacity to provide cost-effective and qualityhealth, food safety and environmental solutions to HSE threats.As part of the THMRS project, the development of a hotel-basedsyndromic surveillance system for early warning and response toinfectious diseases was developed.THiS was developed in collaboration with six participating IDBcountries: Barbados, Bahamas, Belize, Guyana, Jamaica, Trinidadand Tobago. The implementation plan (2016-2018) with each countryinvolved three stages:1) Project Operations, Coordination, Management (includingAdvocacy, and Endorsement)2) Development of the project outputs: gap analysis and bestpractices; development of surveillance guidelines and trainingmodules, HSE Standards3) Implementation in participating countries (i.e. technical visits,ongoing technical coordination): Preparation, Buy-in, Training andLaunchThe web-based design of THiS enables the collection of real-time data which will inform health service delivery decisions/policies, strengthen national and regional health monitoring efforts,and trigger a rapid coordinated response to outbreaks, and preventescalation of tourism HSE incidents. The system involves a web-based questionnaire with a series of 11 short questions that ask theuser for basic non-identifiable demographic information as well assymptoms. The reported symptoms are used by the system to generatesix syndromes: Gastroenteritis, Undifferentiated Fever, HemorrhagicFever, Fever with Neurologic symptoms. Fever with Respiratorysymptoms, Fever with Rash.Data entry persons include hotel staff, physicians, and the case.Access to anlaytic dashboards of the aggregated data is limited toregistered hotel staff (i.e. Managers), the Ministry of Health of thecountry where the hotel reporting is located, and CARPHA.The limited level of baseline data for syndromes in the Caribbeanregion means that statistical aberration detection mechanisms formost syndromes will not be available until THiS collects at least oneyear’s worth of data. However, for acute gastroenteritis, until a moreaccurate threshold can be generated, a cut-off of 3% ill (staff andguests) will be used for alerting potential outbreaks. This is scheduledto be live and functional beginning in hotel facilities in Trinidad andTobago at the beginning of October 2016.By the end of 2016, THiS will be operating in facilities in all sixparticipating countries, allowing for the collection of baseline data forsyndromes occurring among tourists and staff in hotel-settings, andproviding a mechanism to detect and response to emerging publichealth threats early and efficiently.ConclusionsEstablishing this system is critical to improving countries’capacities to support the overall health surveillance system of thetourism-dependent Caribbean economies, enabling countries tocollect real-time data which will inform health service deliverydecisions/policies, strengthen national and regional health monitoringefforts to trigger a rapid coordinated response to outbreaks and othercrises and thus prevent tourism HSE incidents

Tourism and Health Information System (THiS) in the Caribbean, June-September 2017

Objective: The new Tourism and Health Information System (THiS) was implemented for syndromic surveillance in visitor accommodations in the Caribbean region. The objective was to monitor for illnesses and potential outbreaks in visitor accommodations (hotels/guest houses) in the Caribbean in real-time using the web-based application.Introduction: Travel and tourism pose global health security risks via the introduction and spread of disease, as demonstrated by the H1N1 pandemic (2009), Chikungunya (2013), and recent Zika virus outbreak. In 2016, nearly 60 million persons visited the Caribbean. Historically no regional surveillance systems for illnesses in visitor populations existed. The Tourism and Health Information System (THiS), designed by the Caribbean Public Health Agency (CARPHA) from 2016-2017, is a new web-based application for syndromic surveillance in Caribbean accommodation settings, with real-time data analytics and aberration detection built in. Once an accommodation registers as part of the surveillance system, guests and staff can report their illness to front desk administration who then complete an online case questionnaire. Alternatively guests and staff from both registered and unregistered accommodations can self-report their illness using the online questionnaire in the THiS web application. Reported symptoms are applied against case definitions in real-time to generate the following syndromes: gastroenteritis, fever & respiratory symptoms, fever & haemorrhagic symptoms, fever & neurologic symptoms, undifferentiated fever, and fever & rash. Reported data is analyzed in real-time and displayed in a data analytic dashboard that is accessible to hotel/guest house management and surveillance officers at the Ministry of Health. Data analytics include syndrome trends over time, gender and age breakdown, and illness attack rates.Methods: Visitor accommodations from the following countries participated: Bahamas, Barbados, Belize, Bermuda, Guyana, Jamaica, Trinidad & Tobago, and Turks & Caicos Islands. National staff from the Ministry of Health, Ministry of Tourism, and/or Tourism Authority/Board engaged accommodations to participate. Participating accommodations were provided with training by national staff on how to report cases and use data analytic functions. They were asked to provide registration information to CARPHA, such as contact information to create login credentials, and data on occupancy rates for low/high seasons, number of staff, and number of lodging rooms to calculate illness attack rates. Weekly email reminders to accommodations to report cases of illness in the THiS web application, or to confirm 'nil' cases by email were sent by CARPHA staff.Results: Of the 105 accommodations engaged by national staff, 39.1% (n=41) registered to participate, accounting for 3738 lodging rooms. From epidemiological week 24-39, five cases of syndromes from three accommodations in two countries were reported in the THiS web application (Table). A case of gastroenteritis and fever & respiratory symptoms were self-reported from an unregistered accommodation. Three cases of gastroenteritis were reported by hotel administration from two registered accommodations. The average response rate to weekly emails confirming 'nil' cases was 32.1% (range: 10.5-83.3%). One accommodation reported by email a cluster of 7 cases with possible conjuctivitis. No outbreaks or aberrations were detected in the THiS web application.Conclusions: Engagement of Caribbean visitor accommodations in public health surveillance is a novel but critical undertaking for promoting health, safety, and security for both visitors and locals in the tourism dependent Caribbean region, but it will take time to establish. Confirming the absence of illness is an important public health endeavor for visitor accommodations. Preliminary results have demonstrated that it is possible for public health to work in a voluntary basis with the private accommodation sector. To establish more consistent and reliable reporting public health legislation and policies will need to be explored. As more data is gathered, assessments of the validity and sensitivity of the system will need to be conducted

Direct outpatient cost per case of acute gastroenteritis in Trinidad and Tobago, 2021

The burdens associated with acute gastroenteritis involve billions of dollars in expenses, coupled with significant morbidity and mortality globally. To reduce these burdens, health officials and policymakers require up-to-date data (health and economic) to request and allocate resources in guiding the development and implementation of preventative strategies. In 2021, the estimate for one case of acute gastroenteritis was calculated using multiple sources of data: the 2009 national health burden survey on acute gastroenteritis; a 2021 telephone survey of five major private hospitals; a 2021 telephone survey of 30 private pharmacies; and the 2021 Minimum Wages Act of Trinidad and Tobago. For each case of illness, an average cost of $1614 TTD ($238 USD) was estimated. For residents who sought private health care, the average GP visit cost was $500–$700 TTD ($73–$103 USD), while costs for medication prescribed ranged between $327 and$1166 TTD ($48–$172 USD). Productivity losses amounted to almost $21.7 million TTD ($3.2 million USD) for residents who took time off from work or required caregiving services. The overall annual cost was estimated to be $204 million TTD ($30.1 million USD) and, therefore, warrants measures by health officials to reduce the economic and social burdens of acute gastroenteritis in Trinidad and Tobago