HLTH 642 LIBERTY UNIVERSITY Case Study Cruise Ship Analysis _2024.pdf

Case Study: Cruise Ship Analysis

Liberty University

Master of Science in Nutrition

HLTH 642: Food-Borne Illness Prevention

Case Study: Cruise Ship Analysis

Case Study: Cruise Ship Analysis

Introduction

event to the Vessel Sanitation Program (VSP).

The ship had made ports of call at Key West, Ocho Rios, Jamaica, Cozumel, Mexico,

Belize, and the Grand Cayman Islands. As the cases continued to increase, medical staff became

concerned that they may not be able to meet the growing patient needs. Medical staff decided to

cancel all ports of call after Grand Cayman and go directly to Miami.

Comprehensive Analysis of the Data

According to the data provided, there were no cases reported on day one. The first case

occurred on the second day, four hours after a stop at Ocho Rios. The patient was a 26-year-old

Caucasian woman who was on her honeymoon. Her husband experienced no symptoms. Their

wedding occurred after their departure from Philadelphia. They ate one meal that day which was

Case Study: Cruise Ship Analysis

ship, they were some of the first passengers to eat at the buffet (see Appendix A ). After eating at

the buffet, the woman felt ill and wanted to retire early.

The following morning after eating at the buffet, the newlyweds had a light breakfast

consisting of fruit, yogurt, toast, and coffee aboard the ship prior to the port of call in Jamaica.

The wife stated that she had no appetite at breakfast and only sipped on a water she obtained

from the ship while she was ashore. She did not eat in Ocho Rios, but her husband had a cola and

salt fish.

Detailed food diaries were not available for each victim, but experts found that only the

passengers and crew who consumed food from the buffet became ill. Appendix C is a working

spreadsheet of the food consumed from the buffet by passengers and crew. The newlywed was

the only specific food log provided.

Ten additional cases were diagnosed on day four, and seventy cases were diagnosed on

the fifth day (see Appendix B). The predominant symptoms of the illness were diarrhea and

passion fruit, kiwi, papaya, hamburger, apple juice, prime rib, Hawaiian ham, green beans,

carrots, creamed corn, broccoli, tossed salad, boiled potato, cole slaw, tomato slices, white bread,

ice cream, apple pie, and cheesecake. Once she became ill, she was placed on a BRAT (bananas,

Case Study: Cruise Ship Analysis

rice, apples, toast) diet. Ten new cases were reported on day four. Fifty-nine new cases were

reported on day five.

Based on the limited information, it is difficult to determine the exact cause of the

illness outbreak. In order to rule out possible culprits of illness, it is important to note what the

newlywed did not eat. On days one and two she did not consume hot tea, iced tea, fountain

drinks, therefore, these items can safely be ruled out.

The statistics calculated for this study are the overall attack rate and the food specific

attack rate. The overall attack rate is the number of new cases divided by the population of the

setting. The food-specific attack rate involves the number of persons who ate a specific food and

became ill divided by the total number of persons who ate the specific food.9 (see Appendix D).

Overall attack rate9

The overall attack rate is 1.8% (70 cases/3700 passengers).

Food Specific Attack Rate

watermelon, cantaloupe, and hamburger. The food-specific attack rate for watermelon was 5.8%

(day 1), 7.2 % (day 2), 12.2% (day 3), and 8.5 % (day 4). The food-specific attack rate for

cantaloupe was 3.5% (day 1), 3.5% (day 2), 3.3% (day 3), 2.6% (day 4). The food-specific attack

rate for hamburger was 2.6% (day 1), 2.9% (day 2), 3.0% (day 3), 2.5% (day 4).

Likely Source of Outbreak

Based on the data, it appears that watermelon is the likely source of the outbreak. The

data showed an increase over the four days. There is no information provided regarding how the

Case Study: Cruise Ship Analysis

There is no information provided regarding kitchen protocol, handling procedures, or

worker hygiene. There is no information regarding where the watermelon or other fresh fruits

were purchased from. Therefore, it would be difficult to determine how the watermelon became

infected.

According to the U.S. Centers for Disease Control and Prevention (CDC), staphylococcus

aureus is common to foods that are not cooked after they are handled.7 After exposure, illness

can develop within 30 minutes to 8 hours. Salmonella can also be found on raw fruits and

vegetables and can cause illness between 6 hours to 6 days after exposure.7 Fresh fruits and

vegetables can also develop norovirus and cause illness between 12 to 48 hours after exposure.7

Cyclospora and listeria are other common bacteria but illness does not occurs until one to two

weeks after exposure.7 Illnesses from these types of bacteria cause gastrointestinal problems such

as nausea, vomiting, and diarrhea.10

Other possibilities regarding probable causes of the outbreak could be food worker

commonly the primary and secondary sources of pathogenic or toxigenic bacteria.5 Humans

beings are carriers of enteric illness and can transmit pathogens by direct or indirect contact with

food.2 Food workers can also cause cross-contamination from unsanitary food handling practices,

such as using the same knife to cut different food items.1 For example, the knife used to cut

infected watermelon may have been used to cut other fruits and vegetables, therefore, the

Another potential cause could be unclean food surfaces that may cause contamination

that can easily affect all of the food on the buffet. This could occur through improper cleaning of

Case Study: Cruise Ship Analysis

hold bacteria through scratches in the surface or other damage to surfaces and equipment that can

hold bacteria even though it has been cleaned.2

source of the contamination. An investigation of the watermelon should commence. This

includes how it was prepared, how it was stored, how it was transported, and where the

watermelon came from. Food worker hygiene and handling methods should be thoroughly

reviewed. The cruise ship management should continue to follow all directives made by the

Vessel Sanitation Program.

Educational Program for Food Handlers

The CDC provides educational material to assist in preventing foodborne illness. The

National Restaurant Association Educational Foundation (NSEAF) provides the SERV Safe

program and certification.3 This program educates food workers and provides certification for

meeting high standards of food safety. SERV Safe provides specific certification programs for

Case Study: Cruise Ship Analysis

dairy producers, storage and distribution programs, food workers, and other important pieces of

the food distribution process.4 This and SERV Safe are lower cost programs that would fit into

any organization's budget. This certification also meets standards of the FDA, FSIS/USDA, and

GFSI (Global Food Safety Initiative).4

The CDC also provides education regarding cruise ship safety for passengers. There are

recommended foods to consume or avoid while traveling.11 Some foods to consume are bottled

waters, canned drinks, and dry packaged foods such as potato chips.6 Caution is recommended

regarding tap water, raw vegetables, fresh fruits, and freshly squeezed juices.6

Foodborne illness affects people worldwide and can cause illness, disease, or death.5,7 In

cases of foodborne outbreaks, quick action needs to be taken. In this case study, a cruise ship

experienced a foodborne illness outbreak at their buffet. The cruise ship treated the afflicted

environment. Each of these steps can prevent future foodborne outbreaks.

Case Study: Cruise Ship Analysis

Appendix A

Female Newlywed Food Diary/Buffet Meal

F Eaten D 1 D 2 D 3 D 4 D 5

Coffee

Yes Yes No No No

Hot Tea No No Yes Yes Yes

Iced Tea No No Yes Yes Yes

Fountain Drink No No Yes Yes Yes

Ice Yes Yes Yes Yes Yes

Watermelon Yes Yes No No No

Banana No Yes Yes Yes Yes

Hamburger Yes Yes No No No

Apple Juice Yes Yes No No No

Prime Rib Yes No No No No

Hawaiian Ham Yes No No No No

Case Study: Cruise Ship Analysis

Green Beans Yes No No No No

Carrots Yes No No No No

Creamed Corn Yes Yes No No No

Broccoli Yes No No No No

Tossed Salad Yes No No No No

Applesauce No Yes Yes Yes No

Ice Cream Yes No No No No

Apple Pie Yes No No No No

Cheesecake Yes No No No No

Total 998 908 90

Case Study: Cruise Ship Analysis

References