Food and waterborne infections associated with package holidays.

The surveillance and prevention of food and waterborne infections in package holiday tourists relies more on common sense and experience rather than evidence based scientific facts. In spite of the major economic value to both sending and receiving countries it is a problem that is largely ignored by health departments at both local and national levels. Package holiday tourism is a growing industry with over 20 million holidays sold every year in the UK. Destinations are in every continent including countries with poorly developed, as well as those with an advanced, public health infrastructure. The incidence of gastrointestinal infection is not reflected in official surveillance programmes as they largely fail to capture information on travel associated infections. Outbreaks of food and waterborne infections in these resorts are largely not investigated. Major British tour operators have responded by developing a crude but effective continuous surveillance system for subjective travellers' diarrhoea. The importance of food and water hygiene is, however, not ignored and proactive preventative programmes are being developed and implemented in some resort as well as by the tourist industry and international agencies. There is a need for further cooperation and partnership between workers in different countries, different disciplines and between the public and private sectors.