Outbreak of Shigella flexneri 2a Infections on a Cruise Ship
During August 29-September 1, 1994, an outbreak of
gastrointestinal illness occurred on the cruise ship Viking
Serenade (Royal Caribbean Cruises, Ltd.) during its roundtrip
voyage from San Pedro, California, to Ensenada, Mexico. A total of
586 (37%) of 1589 passengers and 24 (4%) of 594 crew who completed
a survey questionnaire reported having diarrhea or vomiting during
the cruise. One death occurred in a 78-year-old man who was
hospitalized in Mexico with diarrhea. Shigella flexneri 2a has been
isolated from fecal specimens from at least 12 ill passengers.
Antimicrobial susceptibility testing of representative isolates
indicated resistance to tetracycline and susceptibility to
ampicillin and trimethoprim-sulfamethoxazole. The subsequent two
cruises of the ship were canceled. Investigation of the mode of
transmission is under way.
Additional information is available from the Vessel Sanitation
Program, Special Programs Group, National Center for Environmental
Health, telephone (305) 539-6730.
Reported by: Communicable Disease Control, Los Angeles County Dept
of Health Svcs; Div of Communicable Disease Control, California
Dept of Health Svcs. Foodborne and Diarrheal Diseases Br, Div of
Bacterial and Mycotic Diseases, National Center for Infectious
Diseases; Vessel Sanitation Program, Special Programs Group,
National Center for Environmental Health; Div of Field
Epidemiology, Epidemiology Program Office, CDC.
This recommendation allows slightly higher doses of prilocaine
when body weight is measured in pounds rather than kilograms (8
mg/kg=3.6 mg/lb).
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