Food poisoning cases related to Holiday Village Sarigerme
Response provided for information in relation to the Holiday Village Sarigerme and
reports of illness to NHS Health Protection Scotland.
Background – Health Protection Scotland surveillance of potential overseas
outbreaks of infectious intestinal disease.
As part of the routine investigation of cases of laboratory confirmed infection of some
gastrointestinal pathogens (e.g. Salmonella, Cryptosporidium, E. coli O157) the
cases may be interviewed by a member of the local Environmental Health Team or
Health Protection Team to obtain information on exposures prior to the onset of their
illness and to help establish if the case is linked to any other cases. The information
routinely collected on these questionnaires includes some details of any recent travel
history.
When local Health Protection Teams become aware of any potential outbreaks of
infectious intestinal disease (IID) where infection is believed to have been acquired
overseas, they may pass the relevant details to Health Protection Scotland (HPS).
HPS defines a potential overseas outbreak as two or more confirmed cases of
infection, or at least one confirmed case where others are alleged to have been ill.
When HPS is informed of a potential overseas outbreak, we circulate an anonymized
summary to the Health Protection Teams in Scotland and ask that if they are aware
of any cases locally that may be linked to the potential outbreak they inform HPS.
The summary is also sent either directly to the National Health Protection Authority in
the relevant country when HPS has contact details or via the Foreign and
Commonwealth Office for them to forward to their contacts in the relevant country if
they wish. The alerts enable the Health Protection Authorities in the relevant country
to undertake any local investigations they deem appropriate. Due to the potentially
serious complications associated with infection with E. coli O157 and other
verotoxigenic serogroups of E. coli (VTEC), HPS operates a similar system to that for
potential overseas outbreaks of infectious intestinal disease for single cases of VTEC
infection who report travel outside Scotland in the 14 days prior to the onset of
symptoms.
The purpose of our surveillance system is to identify a potential outbreak, alert our
health protection colleagues in Scotland, and inform the authorities in the originating
country. It does not purport to collect comprehensive information nor are the
authorities in the host country under any obligation to us to take action, or inform us
of any action they may take. This is a voluntary system and Health Protection Teams
in Scotland are under no obligation to report potential overseas outbreaks or linked
cases to HPS. The information HPS holds on outbreaks affecting Scottish residents
who may have acquired their infection outwith Scotland is therefore, for these and
other reasons, inevitably incomplete.
It is not part of the routine reporting of potential overseas outbreaks for HPS to report
details of potential outbreaks to individual tour operators, as the information known to
HPS often does not contain information on the tour operator and secondly a number
of hotels/resorts are used by more than one tour operator.
Question 1: Please confirm details of the food poisoning cases that you hold in
relation to this resort for 2009 and 2010.
HPS does not hold information on cases of food poisoning related to any resort, HPS
does however hold data on laboratory confirmed cases of a range of gastrointestinal
pathogens including Salmonella, Campylobacter, E. coli and Cryptosporidium who
are reported to HPS to be part of a potential overseas outbreak of IID as described
above. These organisms are gastro-intestinal pathogens that have a number of
routes of transmission including foodborne, waterborne, environmental and person to
person.
In 2009 HPS was aware of five confirmed cases of Salmonella infection and eight
confirmed cases of Cryptosporidium who had stayed at the resort.
In 2010 HPS was aware of one confirmed case of Salmonella, one confirmed case of
Cryptosporidium, one case with an organism possessing verotoxin genes (possibly
E. coli) and one case of haemolytic uraemic syndrome (HUS)
These cases reported staying at the Holiday Village Resort in Sarigerme Turkey. The
reports provide information on the hotel/resort that cases stayed at, they do not say
that the cases acquired their infection at a particular resort/hotel.
Question 2: Please confirm in what circumstances i.e. number of cases
reported, do you normally make a report to the tour operator and/or Foreign
and Commonwealth Office.
When local Health Protection Teams become aware of any potential outbreaks of
infectious intestinal disease (IID) where infection is believed to have been acquired
overseas, they may pass the relevant details to Health Protection Scotland (HPS).
HPS defines a potential overseas outbreak as two or more confirmed cases of
infection, or at least one confirmed case where others are alleged to have been ill.
When HPS is informed of a potential overseas outbreak, we circulate an anonymized
summary to the Health Protection Teams in Scotland and ask that if they are aware
of any cases locally that may be linked to the potential outbreak they inform HPS.
The summary is also sent either directly to the National Health Protection Authority in
the relevant country when HPS has contact details or via the Foreign and
Commonwealth Office for them to forward to their contacts in the relevant country if
they wish.
It is not part of the routine reporting of potential overseas outbreaks for HPS to report
details of potential outbreaks to individual tour operators, as the information known to
HPS often does not contain information on the tour operator and secondly a number
of hotels/resorts are used by more than one tour operator.
Question 3: Please can you confirm how many reports to tour operator’s
representatives you made in relation to this resort in 2009 and 2010. Please
confirm the dates of the reports.
It is not part of the routine reporting of potential overseas outbreaks for HPS to report
details of potential outbreaks to tour operator’s representatives.
Although it is not part of our routine practice, on 11 November 2010 at the request of
a local Consultant in Public Health Medicine, HPS sent an email to contacts at ABTA
advising them of cases of infectious intestinal disease that had recently been
reported to HPS who had returned from the Holiday Village in Sarigerme, Turkey.
The details provided to ABTA were:
Salmonella (provisionally Enteritidis) – 1 confirmed case
Holiday dates 7-14 October, onset 14 Oct 2010. Case reports others at hotel
to be unwell.
Cryptosporidium – 1 confirmed case
Holiday dates 13-23 Sept 2010, onset 27 Sept 2010
1 case HUS and 1 case with organism possessing verotoxin genes –
possibly E.coli
Holiday dates 18-25 Oct 2010, for both cases, cases in different nonconnected families.
Onset dates 23 Oct and 26 Oct 2010
Case of HUS reports 3 others in family with D&V.
Question 4: Please confirm whether you required them to take any action in
regard to the increased incidents of food poisoning.
The purpose of our surveillance system is to identify a potential outbreak, alert our
health protection colleagues in Scotland, and inform the authorities in the originating
country. It does not purport to collect comprehensive information nor are the
authorities in the host country under any obligation to us to take action, or inform us
of any action they may take. HPS does not have any authority to require another
country to take action in relation to these reports.
Question 5: Please confirm whether you received a response from the tour
operator or their representatives.
The email sent by HPS to ABTA on 11 November 2010, was acknowledged on 11
November 2010.
The contacts at ABTA forwarded the HPS email to the Public Health Advisor for the
Federation of Tour Operators which is part of the ABTA organisation on 11
November 2010.
Question 6: Please can you confirm how many reports to the Foreign and
Commonwealth Office were made in relation to this resort in 2009 and 2010.
Please confirm the date of the reports. Please can you advise us of the details
of your contact at the Foreign and Commonwealth Office?
In 2009, HPS sent seven reports of potential overseas outbreaks and two updates to
the Foreign and Commonwealth Office via our contacts at the Department of Health.
These reports comprised the five confirmed cases of Salmonella infection and eight
confirmed cases of Cryptosporidium who had stayed at the resort. The reports were
sent on 28 July 2009, 30 July 2009, 11 August 2009, 12 August 2009, 3 September
2009, 11 September 2009, 15 September 2009, 6 October 2009, and 30 October
2009.
In 2010, HPS sent three reports of potential overseas outbreaks to the Foreign and
Commonwealth office. These reports comprised one confirmed case of Salmonella,
one case with an organism possessing verotoxin genes and one case of haemolytic
uraemic syndrome (HUS). These reports were sent on 3 November 2010, 4
November 2010 and 5 November 2010.
In November 2010, the contact we sent the information to at the Foreign and
Commonwealth Office was the Desk Officer for Turkey.
Question 7: Please can you confirm whether you had any contact with the
relevant health authorities in Turkey.
HPS had no contact with the health authorities in Turkey. As is the HPS protocol
these reports were sent to the Foreign and Commonwealth Office.