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INTRODUCTIONThe World Health Organization (WHO) ranks foodborne illness as one of the most infectious communicable diseases, as illness results from eating contaminated food.1 A group of individuals feeding of the same contaminated food are likely to experience the symptoms of the disease shortly after the ingestion. Nevertheless, some factors may come into play like immunity and this influences the progress. In the case scenario, there is an outbreak of foodborne illness among passengers and the crew in a cruise ship. Most of the victims are presenting with symptoms of intermittent diarrhea and vomiting.1 Elements of fever were also reported among the passengers and crew onboard. The index case of in the outbreak is a 26-year old white female from Philadelphia. The index case has a history of contact with food one day ago in a wedding before the onset of symptoms. As the investigation team investigation of the outbreak is sensitive to stop the propagation. Education program for the food handlers will also be important in preventing the emergence of future cases of food contamination.2METHODSAccording to the records Vessel Sanitation Protocol (VSP), the log illness was kept as a track of the outbreak of the diarrheal illness. The symptoms of the disease were observable among passengers and crew. Out of 2,500 passengers, 67 cases of the illness were determined while 3 cases were reported among 1,200 members of the crew. This was a caseload of about 2%, as the condition of the identified cases continued to deteriorate on a daily basis while the ship continued in transit from one destination to another. The chief medical officer placed the individuals on IV Therapy to alleviate the symptoms, and as a way to control the outbreak, involved members of the crew and affected food handlers were removed from duty. The source of data was onsite diagnosis and self-report that changed consistently from the first day to the fifth day.Plan for Stopping the Propagation of the OutbreakIn investigating the outbreak of diarrheal illness, a plan template should be developed to act as a guide in the implementation process. Eradicating the propagation of epidemics is important in minimizing the risk of long-term illnesses and deaths resulting from the outbreak of the diarrheal illness. While implementing the plan, a group of outbreak management team will be involved in case management of the identified cases. The chief medical officer for VSP will guide other members in the case management process, while the plan for stopping any propagation of the diarrheal outbreak will be carried out as per the below plan rubric.The first step in the plan to stop the outbreak of the diarrheal illness will be establishing the existence of the disease. The chief medical officer in cooperation with other public health official should spearhead the process of establishing the existence of the disease, as the focus is on the number of identified cases and case definition. In this scenario, case definition will be the eligibility criterion for qualifying or disqualifying an individual as a non-case or case. This is the standard criterion for case definition in most outbreaks. About 67 passengers and 3 crew members were reported with dominant symptoms of diarrhea and vomiting with few cases of accompanying fever. The consistent diarrhea for about four days is a good inclusion criterion of an epidemic. The geographical restriction of the emerging illness among members who bordered the cruise ship is an indicator of a common area of epidemic. In the case scenario, an outbreak exists.2After a confirmation is made on the existence of an outbreak. The next step involves developing the outbreak response team and assigning of functions to the various members of the team.2 Every team will have defined functions and they are expected to approach the resolution of the outbreak as a team in enhancing coordination, every team will have a team leader to ensure that there is coordinated flow of activities. The outbreak response team includes multi-disciplinary approaches on professional practice with physicians, community health nurses, clinical officers, medical, laboratory technicians, and top leadership are all involved. A communication team should be developed to enhance coordination between the field and the offices or among the professionals in the field.3 Communication should be unified to avoid confusion as individuals communicates with other resources required about any emergencies on the ground. The team will participate in management of the presenting cases to minimize the incidence of the foodborne illness.3Data AnalysisIn data collection, a team will be developed to carry out interviews as a way of collecting information. This is crucial in getting the direction for the outbreak, especially the history of presenting illness. Information will be key in case management as well as the ultimate control of the outbreak. The information gathered should include the person name, place and time.4 In covering personal characteristics, include the age, presenting symptoms, immune status, and predisposing factors among other aspects. The time slot entails the onset, duration and the exact time for the symptoms.4 The place slot involves information related to where the person went before the illness. For instance, the index case of the 26-year old white female in the case scenario may have originated from contaminated food at the wedding. All persons reported to have the symptoms of the diarrheal disease will be identified. The team will inquire about the two classical characteristics of symptoms; onset and duration. The information on based on person, time and place will be helpful in case management of the outbreak.4The Attack Rate and Incidence rate was calculated as a means of exploring the statistical significance in the identified cases.Statistical Data Attack rateNumber of new cases identified * 100Number of individuals at risk 67+3 * 1000 = 1.89 %2500 + 1200Incidence Rate Number of new cases identified * 100Number of individuals at RiskNumber of passengers at risk = 2500 – 67 = 2493Incidence Rate = 67/2493 = 0.0269 = 2.69%Number of crew at risk = 1200 – 3 = 11973/1197 = 0.0025 * 100 = 0.25%The main aim of the statistical analysis is to define the statistical significance in the cases. In strategic control of epidemics, the Center for Disease Control (CDC) advocate for the need to use such data in making investigation decisions.2 the attack rate indicates how fast or slow is the epidemic. This is based on the number of new cases reported versus the time limit within which the cases are identified. In the case scenario, the attack rate of the diarrheal illness within the given days the cruise ship was on the journey was 1.89%. The incidence rate in epidemics indicates the disease burden; this is significant in determining the level of resource preparation and measures to control the developing cases as per the situation. In the case scenario, there is a caseload of about 2%, a figure tending towards threshold, this is an indicator and impending disease burden that deserves expeditious address.2Implementation of the control measures is the hallmark of stopping the propagation of outbreak, this should be done while other cases are being managed aggressively to prevent instances of outbreak propagated deaths. The Center for Disease Control (CDC) has about seven standard measures used in management of outbreaks.2 The main aim of using these measures is to stop the propagation of the outbreak while increasing the survival of the reported cases. The reported passengers and the crew with the symptoms of diarrheal illness will be put under IV Therapy and mineral supplementation. This will help replenish lost Zinc among other minerals and massive fluids lost through the intermittent diarrhea.The first measure involves contact tracing of the cases, in this step, the individual with the illness are identified. Contact tracing will be focused on the history of the presenting case. This will involve investigation of the foods they ate, places they visited as well as the persons they interacted with a few days before the outbreak. The main aim of contact tracing is to identify the source of the disease. The process may also reveal other undiagnosed cases that might have interacted with the sickling people. The medical laboratory technicians may take samples from the suspected individuals to investigate if there are traces of the given toxins in their body. Such early tracing allows early initiation of treatment before the cases become severe.As a control strategy, quarantine and isolation measures should be adopted. For instance, the sickling passengers should be separated from the others to minimize the spread of the infection and affected food handlers should stop their duties immediately as this causes great direct risk of infection to those feeding on such food. The investigation should be exhaustive to ensure that all cases are managed without leaving anything to chance.5The contact tracing exercise is followed by treatment of cases and installation of preventive measures. Health professionals such as medical officers, toxicologists, medical laboratory technicians, and pathologists among others should participate aggressively in the treatment of the cases.5 Exclusive case management is a key factor in eliminating an epidemic. Successful case management should be followed by introduction of preventive measures. Depending on the disease, prophylaxis treatment, exclusion and immunization are recommended. Prophylaxis treatment for the exposed reduces the risk of contracting the illness. For instance, the husband to the index case, the 26-year old lady at the cruise ship should be given such treatment. Exclusion involves the isolation of the identified cases to minimize the risk of transmission as they are being managed.5Another implementation measure is removing the source of contaminant and source of outbreak. This can only occur when the source of contamination is well known. In the case scenario, most of the passengers and crew who ate from the ship’s buffet complained of the diarrheal symptoms. Analytically, it is worth concluding that the food at the buffet was contaminated. One way of addressing this issue is investigating the cause. The cause may be the food itself or the food handling process. Affected food handlers should quit duties as soon as they begin to present with the symptoms.5 The leftovers of the questionable food should then be disposed to minimize the risk of further contamination. Removal of the source of the infection reduces the surge in new cases thus reducing the attack rate; this trend has a positive influence on the incidence rate of the disease.5Modification of procedures and improving sanitation can minimize the rate of disease outbreak.6 This includes food handling process and preparation, as the chain of food handling is long and complex. Adopting healthy standard guidelines for food handling is sensitive issue in promoting public health.6 Public health regulations require food handlers to have medical certificates as a confirmation that they are medically fit to handle food. Proper disinfection of food handling equipment will reduce any sanitation issues.6The investigation team will explore the existing procedures, evaluating their fitness in terms of health and sanitation. Condemning unhealthy procedures while giving out appropriate evidence-based recommendation will ensure that the rate of spread of the infection decreases due to improved food safety. If the outbreak persists, the victimized food premise can be closed. Implementing all these control measures will stop the propagation of the outbreak.4Analysis of the information and continued surveillance is important in evaluating the interventions while seeking for uncovered cases, as this is key in exclusive stoppage in the propagation of the outbreak.4 The process involves determining who is at risk and in need for intervention. The progress in addressing the outbreak should be communicated to relevant stakeholders like the management, public health, and disease surveillance bodies among other entities so that they can bring up their inputs when necessary.6Analytically, the case scenario presents the passengers, the crew and food handlers as persons at risk. The proposed preventive measures such as prophylaxis therapy should be directed to such groups of people because prophylactic therapy reduces the risk of infection. The outbreak control plan reports shoul