Challenges of Outbreak Investigation in Resort Settings: A Case of Foodborne Illness Among Hotel Conference Attendees in Urban Ghana

Abstract

Background: Foodborne illness is of major public health concern. Identifying foodborne outbreaks in resort settings among short-stay travelers is complex, as these persons often leave ill and seek medical care at home.
Objective: We report an outbreak investigation of diarrhoeal illness among attendees of a lunch banquet held for conference participants in a ‘first class’ hotel in Takoradi, Ghana.
Method: A case was defined as three or more loose stools within 24 hours occurring after 15 hours GMT of 26th November, 2018 to 28th November, 2018. A full list of food items and ingredients served at the banquet was reviewed with the participants using a questionnaire. A retrospective cohort study was then conducted. 
Results: A total of 49 attendees (all females) were present at the conference and 44 (90%) participated in the banquet. Approximately 36% (16) had illness that met the case definition and none of the five who were absent during the banquet developed illness. Vegetable
salad was the most likely source of illness (RR= 2.33; 95% CI: 1.16-4.69; p < 0.034). 
Conclusion: Although ‘first class’ hotels may have high sanitary standards; contamination of food may still occur. The short incubation period, mild and selflimiting nature of the illness suggest Staphylococcus aureus preformed toxins as the cause. Environmental
and laboratory investigations were not carried out due to late notification, low laboratory capacity and bureaucratic challenges at the site.