Case Study: Cruise Ship Analysis Assignment

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Case Study: Cruise Ship Analysis Assignment Instructions

Overview

A case study is an in-depth investigation of a group, event, or community. For this assignment, students will be asked to review the cruise ship outbreak information, analyze the data, determine attack rates, and perform the statistical calculations necessary to determine a likely source of the outbreak. In addition, students will be asked to develop a plan to stop the outbreak and an educational program for food handlers to assist them in outbreak prevention. Completing this analysis will grant students to the opportunity to utilize critical thinking skills. In addition, students will be able to apply their knowledge of epidemiology and the outbreak investigative process. 

Instructions

You will assume the role of the investigator for the following foodborne illness outbreak. You should ensure that all practices and recommendations are in accordance with the regulations of the governing agency. The case study analysis should include the following components: Comprehensive Analysis of the Data, Statistical Calculations that demonstrate an association with disease and determine the likely source of the outbreak (Specifically focus on the food specific attack rate.), Identification of Probable Source of the outbreak, Actions to Stop the outbreak, and the Educational Program for Food Handlers that highlights outbreak prevention. The required length of this case study is 8 double-spaced pages. The case study should include a title page and reference page. The title page and reference page are not included in the 8-page minimum requirement. You should include a minimum of 5 sources from government publications. You are welcome to use more sources, but at least 5 sources must be from government publications. The formatting should be consistent with the AMA style guide. 

Case: You have just finished your MPH at Liberty University and have taken a position with the Centers for Disease Control and Prevention (CDC) in the Vessel Sanitation Program (VSP). Today, you have been asked to participate in an investigation of the outbreak of a diarrheal illness aboard the cruise ship Warped Imagination bound to Miami from a Caribbean voyage. 

In accordance with VSP protocol, the chief medical officer on board the ship has kept a log of illness among the crew and passengers. Sick passengers and crew were instructed to begin a BRAT diet (bananas, rice, apple sauce, tea, and toast). Normally a formal count would be presented to the VSP 36 hours prior to arrival in the US; however, on the fifth day of the trip a total of 67 cases of diarrheal illness had been recorded among the 2500 passengers and 3 cases of a similar illness among the 1200 crew. Afflicted crew members and all food handlers have been removed from duty. It is now the 6th day of the trip and, since the case load has reached the 2% threshold for passengers, the medical staff has filed the mandatory report of the situation to the VSP. 

The ship has made ports of call at Key West; Ocho Rios, Jamaica; Cozumel, Mexico; Belize; and Grand Cayman. The remaining ports of call have been canceled and the ship is en route to Miami as the capacity of the medical staff to provide care may soon be exceeded by the case load of victims requiring IV therapy. The captain expects to make it to Miami within about 48 hours provided the weather cooperates.

The first case of the illness was logged on the second day of the cruise about 4 hours after departing from Ocho Rios. The index case is a 26 year-old newlywed white female from Philadelphia. Her husband has not experienced any symptoms. The wedding was the day prior to their departure from Philadelphia. Their only meal the day of the wedding was a catered dinner of chicken and beef barbeque, mashed potatoes, mixed steamed vegetables, a tossed salad, wedding cake, fruit punch and a glass of champagne. The caterer also provided a box of leftovers which the couple snacked on that evening and again just prior to leaving for the airport on the day the cruise began. They consumed only the complimentary Coke and pretzel snacks during their flight between the time they left home and the time when they had boarded the ship went to the buffet as soon as they could. The couple disembarked at Key West, the first port of call, where they ate Key Lime Pie and coffee. They had no water, alcoholic beverages or other food while ashore. That evening they were among the first passengers to eat from the buffet on the ship (See Table 1 for her food diary). The woman was feeling a bit of malaise and wanted to retire early. The following day, the couple had a light breakfast of fruit, yogurt, toast and coffee aboard ship just before making the port of call in Jamaica. The woman claims to have had no appetite that morning and while ashore only sipped a bottle of water acquired from the ship. She consumed no food in Ocho Rios. Her husband had a cola and salt fish.

  

TABLE 1


onboard food consumption by index   case

 

foods eaten


day 1


day 2


day 3


day 4


day 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

 

pineapple


yes


yes


no


no


no

 

cantaloupe


yes


yes


no


no


no

 

grapefruit


yes


yes


no


no


no

 

passion fruit


yes


yes


no


no


no

 

kiwi


yes


yes


no


no


no

 

papaya


yes


yes


no


no


no

 

banana


no


yes


yes


yes


yes

 

hamburger


yes


yes


yes


no


no

 

apple juice


yes


yes


no


no


no

 

prime rib


yes


no


no


no


no

 

Hawaiian ham


yes


no


no


no


no

 

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

 

white rice


no


yes


yes


yes


yes

 

boiled potato


yes


no


no


no


no

 

cole slaw


yes


no


no


no


no

 

tomato slices


yes


yes


no


no


no

 

yogurt


no


yes


no


no


no

 

white bread


yes


no


no


no


no

 

apple sauce


no


yes


yes


yes


no

 

ice cream


yes


no


no


no


no

 

apple pie


yes


no


no


no


no

 

cheese cake


yes


no


no


no


no

Ten additional cases were diagnosed by the medical staff the fourth day of the voyage and a total of 70 cases was either diagnosed or self-reported by the fifth day (Table 2). The predominant symptoms reported are vomiting and diarrhea. A low grade fever is variable.  Everyone afflicted, including the index case, continued to have intermittent diarrhea and loss of appetite when the initial report was made to VSP.

  

Table 2


onset of cases aboard cruise ship

 


day 1


day 2


day 3


day 4


day 5

 

new passenger cases


0


1


0


7


59

 

new crew cases


0


0


0


3


0

 

total new cases


0


1


0


10


59

 

total cumulative cases


0


1


1


11


70

 

non ill


3700


3699


3699


3689


3630

Detailed food diaries during port of calls for each victim are not available; however, only passengers and crew who have consumed food from the ship’s buffet have become ill. Table 3 is a working spreadsheet of foods consumed by the passengers and crew from the buffet while on board the ship comparing afflicted and non-afflicted individuals.

  

TABLE 3: Food Consumption from Buffet   Aboard Warped Imagination

 


afflicted passengers and crew 


non-afflicted passengers and crew

 

foods eaten


day 1


day 2


day 3


day 4


day 5


day 1


day 2


day 3


day 4


day 5

 

bacon


43***


37***


34***


10


0


3000


2763


2879


2556


2865

 

sausage


24


12


0


12


0


1287


1534


1302


698


779

 

fried ham


12


17


12


7


0


615


863


827


793


654

 

pancakes


28


63


27


24


0


1377


3312


1743


1752


1297

 

French toast


34


12


26


18


0


2300


1389


1476


1576


1681

 

scrambled eggs


47***


43***


39***


37


0


2548


2334


2089


2192


2212

 

cold cereal


15


15


12


10


0


800


778


731


803


768

 

skim milk


66


66


66


57


0


3478


3478


3478


3478


3478

 

whole milk


3


3


3


0


0


175


175


175


175


175

 

coffee


70***


70***


69***


59**


0


3497


3512


3612


3597


3581

 

hot tea


40


40


41


47***


70***


2069


2109


2211


2075


2075

 

iced tea


40


40


41


47


70***


2081


1056


2112


2333


2100

 

fountain drink


49***


53***


54***


63***


61***


2217


2749


2757


2566


2239

 

ice


70***


70***


70***


70***


70***


3630


3618


3624


3630


3630

 

oatmeal


1


2


1


1


0


122


103


99


76


61

 

watermelon


60***


60***


60***


50


0


968


763


428


534


677

 

pineapple


45*


45


40


30


0


2413


2425


2451


2312


2433

 

cantaloupe


47***


47***


45***


35


0


1287


1286


1290


1301


1287

 

grapefruit


12


15*


15


11


0


778


779


783


775


715

 

passion fruit


30


35


45


43


0


1563


1823


2345


2330


2312

 

kiwi


30


35


35


35


0


1547


1837


1832


1815


1821

 

papaya


46


47


44


39


0


2401


2412


2397


2076


2073

 

banana


50***


53***


59***


49***


70***


2593


2852


3112


3018


2987

 

apple juice


55


54


49


47*


65**


2853


2853


2597


2540


2543

 

grapefruit juice


0


0


0


0


0


1238


1227


1199


1328


1213

 

hamburger


70***


70***


70***


59


0


2567


2312


2214


2237


2412

 

fried chicken


23


14


12


30


0


1296


769


756


1612


987

 

prime rib


70***


69


58


43


0


3630


3627


3200


2300


2413

 

Hawaiian ham


59


53


36


38


0


3085


2714


1869


2078


2217

 

green beans


68**


60


60


53


0


3530


3121


3108


3123


3119

 

carrots


63


60


38


41


0


3269


3114


1999


2133


2210

 

creamed corn


35


38***


34


31


0


1036


667


623


519


543

 

broccoli


33


45


27


28


0


1813


2334


1554


1563


1567

 

tossed salad


41


63


40


32


0


2232


3278


3206


2111


2328

 

white rice


53***


48***


43***


70***


70***


2750


2599


2319


2526


2417

 

mashed potatoes


69***


67*


65


54


0


3602


3526


3418


3515


3591

 

boiled potatoes


52*


50


54


36


0


2704


2594


2852


2598


2419

 

potato salad


43


37*


40


13


0


2333


2071


2075


2140


2167

 

cole slaw


34


33


33


12


0


1728


1823


1873


1856


1917

 

tomato slices


70***


70***


69**


59


0


3387


1292


1721


1312


1097

 

asparagus


33


12


25


0


0


1847


1783


1299


1717


787

 

yogurt


40


12


18


0


0


2047


1555


1113


1719


1982

 

leaf lettuce


15


33


39


26


0


863


1888


2077


1350


1613

 

cheddar cheese


25


25


27


23


0


3312


1543


1397


1192


2109

 

white bread


35


35


35


35


70***


1763


1918


2019


1815


1772

 

apple sauce


13


17


14


11***


70***


694


893


771


663


894

 

ice cream


20


23


24


21


0


1067


1284


1281


1093


1123

 

apple pie


56*


53*


49*


48


0


2988


2748


2587


2554


2548

 

chocolate cake


66**


67*


56*


43


0


3423


3478


3005


3397


3414

 

cheese cake


61


60*


58*


48


0


3400


3200


3010


3111


3093

  

* indicates food consumed by a   sickened crewmember

  • 6 days ago
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