Case Study: Cruise Ship Analysis Assignment InstructionsOverviewA 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.InstructionsYou 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 1onboard food consumption by index casefoods eatenday 1day 2day 3day 4day 5coffeeyesyesnononohot teanonoyesyesyesiced teanonoyesyesyesfountain drinknonoyesyesyesiceyesyesyesyesyeswatermelonyesyesnononopineappleyesyesnononocantaloupeyesyesnononograpefruityesyesnononopassion fruityesyesnononokiwiyesyesnononopapayayesyesnononobanananoyesyesyesyeshamburgeryesyesyesnonoapple juiceyesyesnononoprime ribyesnonononoHawaiian hamyesnonononogreen beansyesnonononocarrotsyesnonononocreamed cornyesyesnononobroccoliyesnonononotossed saladyesnonononowhite ricenoyesyesyesyesboiled potatoyesnonononocole slawyesnonononotomato slicesyesyesnononoyogurtnoyesnononowhite breadyesnonononoapple saucenoyesyesyesnoice creamyesnonononoapple pieyesnonononocheese cakeyesnonononoTen 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 2onset of cases aboard cruise shipday 1day 2day 3day 4day 5new passenger cases010759new crew cases00030total new cases0101059total cumulative cases0111170non ill37003699369936893630Detailed 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 Imaginationafflicted passengers and crewnon-afflicted passengers and crewfoods eatenday 1day 2day 3day 4day 5day 1day 2day 3day 4day 5bacon43***37***34***10030002763287925562865sausage24120120128715341302698779fried ham12171270615863827793654pancakes28632724013773312174317521297French toast34122618023001389147615761681scrambled eggs47***43***39***37025482334208921922212cold cereal151512100800778731803768skim milk66666657034783478347834783478whole milk33300175175175175175coffee70***70***69***59**034973512361235973581hot tea40404147***70***20692109221120752075iced tea4040414770***20811056211223332100fountain drink49***53***54***63***61***22172749275725662239ice70***70***70***70***70***36303618362436303630oatmeal12110122103997661watermelon60***60***60***500968763428534677pineapple45*454030024132425245123122433cantaloupe47***47***45***35012871286129013011287grapefruit1215*15110778779783775715passion fruit30354543015631823234523302312kiwi30353535015471837183218151821papaya46474439024012412239720762073banana50***53***59***49***70***25932852311230182987apple juice55544947*65**28532853259725402543grapefruit juice0000012381227119913281213hamburger70***70***70***59025672312221422372412fried chicken23141230012967697561612987prime rib70***695843036303627320023002413Hawaiian ham59533638030852714186920782217green beans68**606053035303121310831233119carrots63603841032693114199921332210creamed corn3538***343101036667623519543broccoli33452728018132334155415631567tossed salad41634032022323278320621112328white rice53***48***43***70***70***27502599231925262417mashed potatoes69***67*6554036023526341835153591boiled potatoes52*505436027042594285225982419potato salad4337*4013023332071207521402167cole slaw34333312017281823187318561917tomato slices70***70***69**59033871292172113121097asparagus331225001847178312991717787yogurt4012180020471555111317191982leaf lettuce1533392608631888207713501613cheddar cheese25252723033121543139711922109white bread3535353570***17631918201918151772apple sauce13171411***70***694893771663894ice cream20232421010671284128110931123apple pie56*53*49*48029882748258725542548chocolate cake66**67*56*43034233478300533973414cheese cake6160*58*48034003200301031113093* indicates food consumed by a sickened crewmember
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