Food Protection Trends - May/June 2022 - 198

and 1,956 (40%) being children between 1 and 4 years old.
Salmonella was isolated from 197 (44%) of 450 children
under 1 year old. Among positive cases, Salmonella Derby
was isolated from 71% of samples (66). A similar situation
occurred in Suriname, where children younger than 5 years old
and adults over 60 years old were more frequently hospitalized
for diarrheal infection (54).
In many Caribbean countries, there is a culture of selling
food at roadside stalls, whether sheltered or unsheltered.
These businesses are not likely to have access to running
potable water, resulting in the unsanitary preparation and
sale of food (12). Minimal resources for temperature control
and sanitation are likely contributing factors for microbial
contamination by pathogens such as Salmonella. For example,
in Dominica, it was observed that the highest incidence
(160/972, 13.1%) of acute gastroenteritis occurred in an
area with diverse ethnic groups, where small roadside shops
sell food. Of the 160 individuals with acute gastroenteritis,
29.8% were associated with the consumption of contaminated
street food (6). With deficiencies in water supply and sanitary
practices, the problem may be exacerbated by handling readyto-eat
foods with bare hands. It has been demonstrated that
depending on the concentration of the inoculum, Salmonella
can survive on fingers for up to 3 h and be transferred to food;
however, substantial reductions are observed after fingers
were thoroughly washed (58). As indicated in the study
in Dominica described here, there was a relatively higher
incidence of gastrointestinal illnesses in areas with many food
outlets along the roads (6). Hence, both consumers and food
handlers need to be trained on the prevention mechanisms of
food contamination.
The burden of salmonellosis on the tourism industry
The tourism industry is vulnerable to the effects of infectious
diseases, including salmonellosis. Salmonella was among the
pathogens commonly associated with travel-related illnesses,
accounting for 32% of the 64,039 enteric infections reported
to the U.S. Foodborne Diseases Active Surveillance Network.
Of these, most travel-related enteric infections were after
visits to Latin America and the Caribbean (47). Because the
illness is temporary and not usually severe, not all cases are
reported, and little nonanecdotal evidence is available. For
example, between December 1994 and March 1996, travelers
to Negril, Jamaica, had severe diarrhea because of foodborne
disease. Salmonella was among the etiologic agents identified
in stool specimens (56). A surveillance program in Jamaica
led to a reduction in travel-related diarrhea (8). However, a
similar outbreak occurred in the same area, when travelers
returning to the United States reported diarrhea, abdominal
cramps, and other symptoms to the Kansas Department of
Health and Environment. The illnesses were determined to
be salmonellosis, with contaminated eggs as the most likely
source of the infection (46). Additionally, between 2010 and
2011, residents of Ontario, Canada, reported travel-related
198 Food Protection Trends May/June
salmonellosis caused by S. Enteritidis. Among those, there
was a significantly high frequency of reports from tourists that
visited Mexico and the Caribbean, where Antigua, Jamaica,
and Barbados were the countries with the highest odds of
acquiring infection (65). These reports indicate that greater
efforts need to be made to train foodservice employees in the
hospitality industry in food hygiene practices and possibly
source raw materials from safer suppliers.
Strategies to manage salmonellosis in CARICOM
countries
CARICOM, as a body and as individual countries, must
continue to find strategies to mitigate the risk of foodborne
salmonellosis. There is evidence that CARICOM is making
changes to improve public health. One great example is the
creation of the Caribbean Public Health Agency, established
in July 2011, which combines the functions of five agencies:
the Caribbean Environmental Health Institute, the Caribbean
Epidemiology Centre, the Caribbean Food and Nutrition
Institute, the Caribbean Health Research Council, and the
Caribbean Regional Drug Testing Laboratory. Among the
functions of this agency are surveillance and management
of communicable and noncommunicable diseases (14).
According to the Caribbean Public Health Agency, countries
are also required to provide potable domestic water supplies
to residents for drinking, cleaning, and sanitation. In the
Caribbean, services are available for domestic use and
sanitation, but there are problems with the ability to maintain
these services and the operation of this infrastructure (15).
Additionally, there may be an adequate provision in urban
and peri-urban areas, but in some rural communities, supply
is limited, as documented for Jamaica and Belize, potentially
contributing to underdevelopment in rural areas (22, 40).
Additionally, application of World Health Organization
" golden rules, " such as storing cooked foods under sanitary
conditions and keeping kitchen counters meticulously clean,
are short-term solutions to improve food safety (55).
The high frequency of underreported illness cases indicates
the need for improved and expanded epidemiological
surveillance. An adequate surveillance system should have
the capacity for data collection, analysis, and dissemination
of public health programs (64). As indicated by the lack of
data described in this article, more information is required
to determine appropriate public health interventions in
CARICOM. Information gathering should be an ongoing
process used to guide and support preventive measures.
However, CARICOM's response to diseases and illness still
appears to be mostly reactive rather than based on longterm
strategies (52). There is a need for greater awareness of
pathogens, symptoms of disease, and ways to prevent illness.
Food safety and sanitation information may be circulated
through radio, television, and social media platforms, but
not every country has the same level of dissemination. For
example, in Trinidad and Tobago, consumers were aware
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