Case Study 2 1
Case Study 2
Jenna Mrozinski
Liberty University
Case Study 2 2
In this study, we have to look at whether there is an association between the
afflicted passengers and non-afflicted passengers and the different types of food eaten by
these passengers. Therefore, it would be beneficial to use descriptive statistics, which
uses data to provide descriptions of the population, along with inferential statistics, which
makes inferences and predictions based on sample data, to determine the source of the
outbreak in this investigation. (Ltd, 2013) By using these approaches we would be able to
get an overall idea about the situation and if there is a correlation between the passengers
and the food being served at the buffet. After calculating the sum for the afflicted
passengers and non-afflicted passengers for the different foods consumed, descriptive
In this case study, the investigation of a foodborne illness outbreak is investigated.
The outbreak began aboard a cruise ship Warped Imagination departing from Miami
heading to the Caribbean including ports of call at Key West; Ocho Rios, Jamaica;
Cozumel, Mexico; Belize; and Grand Cayman. The first illness was discovered on the
second day of the cruise about 4 hours after departing from Ocho Rios in a 26-year-old
female who was accompanied by her husband. They were among the first passengers to
consume food at the buffet. By the 4th day 10 additional cases were diagnosed by health
professionals and by the 5th day 70 cases were diagnosed or self-reported and the
predominate symptoms were vomiting, diarrhea and loss of appetite. Although detailed
information is not documented on all the victims’ food consumption, all the passengers
and crew afflicted had consumed food in the past from the ships buffet revealing that this
problem is resulting from a foodborne illness outbreak.
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statistics can be created and shown through tables and graphs. The table below reveals the
descriptive statistics for the afflicted total based on the sum of the food consumed. After
calculations are completed, the minimum amount of afflicted passengers due to food
consumption abroad the cruise ship was 0 and the maximum was 350. The average
number or mean of afflicted passengers was approximately 166, and the standard
deviation was 86 when rounded.
Afflicted total by food consumed
Mean 165.88
Median 170
Mode 48
Min0
Max 350
To see the difference between the two groups of afflicted and non-afflicted
passengers and how food affected them, we now have to determine the descriptive
statistics for non-afflicted passengers as well. By completing the calculations, the table
below shows that the minimum number of non-afflicted passengers from food consumed
is 461 while the maximum is 18132. Therefore, the average number or mean of non-
afflicted passengers is approximately 10065 with an approximate standard deviation of
4561.
Non-afflicted total by food eaten
Mean 10064.34
Median 10027.5
ModeNo Mode
Min 461
Max 18132
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non-afflicted total
4
The next step would be to see if there is a positive or negative correlation between
the afflicted and non-afflicted total passengers for the different food items consumed on
the cruise. To do so, a scatter plot can be created to show this correlation. After creating
this scatter plot below, it is revealed that there is a positive correlation existing between
the afflicted and non-afflicted passengers for the different food items consumed.
These statistical calculations demonstrate an association with disease and helped
determine a likely source of outbreak for this investigation. Seeing that there is a positive
correlation in the scatter plot, it reveals that the different food items consumed on the
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
050 100 150 200 250 300 350 400
Non-afflicted total
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cruise ship Warped Imagination was most likely the probable cause of the symptoms seen
in many of the passengers. For example, as the number of people who consumed a
specific food product increased so did the amount of food borne illnesses seen in the
afflicted passengers from the specific food product. Another example can go either more
in depth by revealing that the largest number of passengers afflicted by a specific food
item was ice and it just so happens that this was also the most consumed product on the
cruise ship.
When an outbreak occurs, many important steps need to be taken to avoid further
contamination and an increase in the foodborne illness outbreak. When dealing with a
foodborne illness outbreak on a cruise ship it is important to not only include passengers
in actions to stop the outbreak, but employees as well, especially food handlers. When it
comes to the passengers who are ill, the staff must enforce isolation of the ill for a
minimum of 24 hours. According to the CDC, this can be encouraged by providing
activities and delivering food to the cabins. (CDC) Another tactic is to provide the
individual with proper hygiene procedures and hand washing tips. This would be
beneficial in stopping the outbreak, once the individual returns from isolation. When it
comes to dealing with food handlers working on the ship, it is important to assess their
signs and symptoms. However, this should be done on a daily basis and not only when an
outbreak suddenly occurs. By examining their signs and symptoms we can then prevent
contamination from their hands and other vectors such as airborne illnesses from
coughing or sneezing. If a food employee is suspected of symptoms, they are to be
restricted from work and in order to return they must be examined by a health
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In order to prevent foodborne illnesses from spreading, the most important step is
to educate and train food handlers about how and why we need to prevent disease from
occurring in facilities that deal with food products. Therefore, an educational program
can be created to educate them on the important topics of foodborne illness prevention to
stop similar outbreaks from occurring. The first step in educating food handlers is to
decide on a method of teaching the material and for this topic to reach several individuals
effectively it would be beneficial to have a PowerPoint demonstration with handouts
provided showing the most important points of the educational program.
To begin the program, the first place to start would be the ways a foodborne
illness could spread ending with techniques on how to stop and control the spread of
these organisms. Therefore, the first part of the program would talk about the carriers of
professional and be free of symptoms for 48 hours. After isolating all the ill passengers
and afflicted crewmembers aboard the ship, it would be beneficial to increase cleaning
and disinfection procedures throughout the ship. This would help eliminate harmful
organisms lingering on the ship. (CDC, 2017) Other actions that should be put in place to
stop the outbreak would to keep track of the cases of illness on a daily basis, discontinue
high risk activities or activities during the cruise (CDC, 2016), monitor sanitation of food
production and food temperatures and lastly, cancel the remaining destinations of the
cruise ship and return to the port as soon as possible where it can be properly investigated
by the CDC and sanitized by the Vessel Sanitation Program which assists the cruise ship
industry to prevent and control the introduction, transmission, and spread of
gastrointestinal illnesses on cruise ships. (CDC, 2016)
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the illness. One aspect of illness that is important to understand is that there are
individuals who can spread illness without showing any symptoms. (CDC) Therefore, it
is important for food handlers to “speak up” when they have been in close contact of an
individual experiencing any type of symptomatic signs of illness. The next topic of
concern would be the cause and transmission of foodborne illnesses because according to
the CDC, in order to prevent pathogens from spreading, it is important to understand the
various routes of transmission. (CDC) With this being said, pathogens such as viruses,
bacteria and parasites are the categories of foodborne illness causes. The pathogens are
then created or transmitted through one of many steps which could include “improper
holding temperatures, either hot or cold holding, improper cooling, either the required
minimum temperature danger zone too long, improper cooking or reheating, infected
employees, poor personal hygiene” (CDC) and lastly cross contamination.
Demonstrations and proper training would then follow this part of the program to ensure
that the food handlers are aware of proper cooking and storing temperatures and
knowledge on how to avoid cross contamination. To give further instructions on how to
practice these prevention methods, the educational program would provide several
handouts including demonstrations on proper hand washing techniques, how to avoid
cross contamination, and how to practice good hygiene. Overall, to conclude the program
the food handlers should understand the four most important parts of preventing
foodborne illness which includes cleaning, which stands for washing hands and surfaces
often, separating, which means to prevent cross contamination, cooking, which involves
cooking to the right temperature and chilling which means to refrigerate promptly.
(USDA, 2015)
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References
Overall, foodborne illness outbreaks on cruise ships can be prevented and stopped
if individuals take proper precautions to do so. However, if these rules and regulations are
not followed, especially by food handlers, foodborne illness outbreaks can occur resulting
in many people getting sick with a number of possible illness. In order to stop these
outbreaks, more awareness, education and training needs to be implemented before
passengers crowd onto a cruise ship and before employees, especially food handlers
begin their job and workday.
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1.CDC. Health Practices on Cruise Ships: Training for Employees Transcript.
Retrieved from
http://1.https://www.cdc.gov/nceh/vsp/training/videos/transcripts/foodborne.pdf
2.CDC. (2017). Outbreak Updates for International Cruise Ships. Retrieved March
1, 2017, from https://www.cdc.gov/nceh/vsp/surv/gilist.htm
3.CDC. (2016, August 16). Frequently Asked Questions. Retrieved from
http://3.https://www.cdc.gov/nceh/vsp/pub/faq/faq.htm
4.CDC. (2016, September 6). Vessel sanitation program. Retrieved from
https://www.cdc.gov/nceh/vsp/
5.USDA. (2015, March 24). Basics for Handling Food Safely. Retrieved from
http://5.https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-
education/get-answers/food-safety-fact-sheets/safe-food-handling/basics-for-
handling-food-safely/ct_index
6.Ltd, L. R. (2013). Descriptive and inferential statistics. Retrieved from
https://statistics.laerd.com/statistical-guides/descriptive-inferential-statistics.php
