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Item No.:
02
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Site:
Medical-Electronic Medical Log
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Violation:
The electronic medical data management system has the old VSP definition of a reportable case of gastrointestinal (GI) illness programmed in. This system does not allow a person with less than 3 loose stools to be a case unless accompanied by fever or vomiting, and forces anyone with 3 or more loose stools to be a GI illness case if they have 3 or more loose stools, even if there are underlying medical conditions which could be causing those episodes.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The AGE Surveillance Log in the electronic medical database is not identical to the VSP AGE log provided in section 13.2 of the 2011 VSP Operations Manual. The identical AGE log could not be exported from this system either.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person?s name; (5) person?s age; (6) person?s sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24-hour period; (b) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Crew GI Illness Case Management
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Violation:
An assistant waiter reported 2 initial diarrheal episodes on 9 June at 10:45 am. They were issued anti-diarrheal medication at 11:34 am on 9 June and at 7:30 pm that evening experienced the last GI illness symptom. There was no notation of the symptom(s) experience or the number of episodes. The crew member was listed as non-reportable in the AGE surveillance log.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
08
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Site:
Potable Water-Mid-Ship and Fwd Bunker stations
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Violation:
In the mid-ship bunker station, the middle in-use potable water hose was not labeled 'potable water only' near the fill line end. Also, the label on the first in-use potable water hose from the entrance was faded and hard to read near the fill line and two potable water hoses in the hose locker were not labeled 'potable water only' on either end of the hose. In the forward bunker station, the label on the third in-use potable water hose from the entrance was faded and hard to read near the fill line.
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Recommendation:
Label potable water hoses with the words ?POTABLE WATER ONLY? in letters at least 13 millimeters (0.5 inch) high at each connecting end.
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Item No.:
08
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Site:
Potable Water-Striping
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Violation:
There was no blue or blue/green/blue striping on the production water line after chlorination until the potable water tanks.
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Recommendation:
Stripe the potable water piping blue/green/blue downstream from the chlorination injection point.
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Item No.:
09
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Site:
Recreational Water Facilities-
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Violation:
On March 31, 2012 the free residual chlorine readings on the chart recorders for slide A between 12:45 p.m. and 6:00 p.m. were at least 1 ppm, but less than 2 ppm. On June 16, 2012 the free residual chlorine readings on the chart recorders for slide D between 11:30 a.m. and 6:00 p.m. were at least 1 ppm but less than 2 ppm. On June 22, 2012 the free residual chlorine readings on the chart recorders for slides b and c between 11:30 a.m. and 6:00 p.m. was at least 1 ppm, but less than 2 ppm.
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Recommendation:
Maintain a free residual halogen in recirculated RWFs in the following ranges: (1) swimming pools, between 1.0 and 5.0 mg/L (ppm); (2) children's pools, between1.0 and 5.0 mg/L (ppm); (3) wading pools, between 1.0 and 5.0 mg/L (ppm); (4) interactive RWFs (activity pools), between 2.0 and 5.0 mg/L (ppm); (5) baby-only water facilities, between 3.0 and 10.0 mg/L (ppm) free chlorine or between 4.0 and 10.0 mg/L (ppm) bromine; and (6) whirlpool spas and spa pools, between 3.0 and 10.0 mg/L (ppm) free chlorine or between 4.0 and 10.0 mg/L (ppm) bromine.
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Item No.:
10
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Site:
Recreational Water Facilities-Shock Halogenation
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Violation:
The recorded free halogen residual for the whirlpool spas at the beginning of shock halogenation was 6.0 ppm. The whirlpool spas were shock halogenated for over one hour each time and the free halogen residual recorded at the end of shock halogenation was at least 10.0 ppm.
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Recommendation:
Increase the free residual halogen to at least 10.0 mg/L (ppm) and circulate for at least 1 hour every 24 hours. Test the free residual halogen both at the start and completion of shock halogenation. Superhalogenate the water in the entire RWF system to 10 ppm to include the whirlpool spa/spa pool tub, compensation tank, filter housing, and all associated piping before starting the 1-hour timing. Ensure a written or electronic record of the date and time of water dumping and shock halogenation (concentration in ppm at the start and completion and time) is available for review during inspections.
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Item No.:
10
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Site:
Recreational Water Facilities-Filter Housing Disinfection
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|
Violation:
The sand filter housings were cleaned, rinsed, and disinfected before new media was used, but the concentration and contact time used for the disinfection was not recorded.
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Recommendation:
Clean, rinse, and disinfect the filter housing before the new filter media is placed in it. Ensure disinfection is accomplished with an appropriate halogen-based disinfectant. At a minimum, use a 50-ppm solution for 1 minute, or equivalent CT value. Maintain records on all inspection and cleaning procedures.
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Item No.:
10
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Site:
Recreational Water Facilities-Sample Points
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Violation:
The sample points for the RWFs in the water park were not directly from the RWFs or before the compensation tank.
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Recommendation:
Install chart recorders or electronic data loggers with security features that record pH and halogen measurements for each individual RWF. Ensure the sample line for the analyzer probe (monitoring) is either directly from the RWF or on the return line from each RWF and before the compensation tank. Install appropriate sample taps for analyzer calibration. In the event of equipment failure, measure free residual halogen and pH by a manual test kit at the RWF or return line at least hourly for whirlpool spas, spa pools, children?s pools, and wading pools and every 4 hours for all other RWFs. Record manual readings on a chart or log, retain for at least 12 months, and ensure that they are available for review during inspections. Complete repairs on malfunctioning halogen analyzer-chart recorders within 30 days of equipment failure. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment
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Violation:
The dual gravity drains for the two swimming pools were greater than 3 feet apart and did not have approved antientrapment drain covers or an alarm installed. Also, the whirlpool spas had one blockable gravity drain and two suction fittings less than 3 feet apart that did not have approved antientrapment drain covers and no SVRS' or APS' were installed. Documentation was available during the inspection showing staff have ordered the new covers and SVRS' needed.
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Recommendation:
For RWFs with suction fittings and a single blockable drain or multiple drains (less than 3 feet apart), provide an ASME A112.19.8 compliant antientrapment/antientanglement drain cover and a safety vacuum release system or automatic pump shut-off system.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Signs
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|
Violation:
The safety sign at the Water Park did not state the exact language 'take children on frequent bathroom breaks' or 'take children on freqent toilet breaks'.
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Recommendation:
Provide safety signs for all RWFs, except for baby-only water facilities. Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #. For children?s RWF signs, include the exact wording ?TAKE CHILDREN ON FREQUENT BATHROOM BREAKS? or ?TAKE CHILDREN ON FREQUENT TOILET BREAKS.?
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Item No.:
11
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Site:
Medical-Crew GI Illness Case Management
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|
Violation:
A stateroom steward (food worker) experienced their final GI illness symptoms at 9 am on July 1, but during the follow-up medical visit at 8:15 am on July 2 was granted clearance to return to work. This employee worked on July 2 from 8:32 am to 1:40 pm and 5:30 pm to 10:10 pm. In another case an assistant waiter with GI illness symptoms has notations in the electronic record that he is still experiencing symptoms on a follow-up medical visit at 6 pm on 18 June, while the record also indicates his last GI illness symptom was at 5:45 pm on 17 June (first symptom was 5:15 pm on 17 June). The follow-up medical visit on 19 June noted him as symptom free and he was released to return to work. He did work on 19 June from 7 pm to 11 pm.
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|
Recommendation:
When food employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 48 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document date and time of last symptom and clearance to return to work.
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Item No.:
11
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Site:
Medical-Crew GI Illness Case Management
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|
Violation:
The electronic record listed a pastry chef with diarrhea starting at 10 am on 12 June who reported to the medical facility at 9 am on 14 June. The employee was not listed as a food worker and was released after being symptom free on the follow-up visit to medical at 8:21 am on 15 June. After checking the personnel record it was determined this employee was in fact an ordinary seaman who disembarked the vessel shortly after this period.
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Recommendation:
When nonfood employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 24 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document the date and time of last symptom and clearance to return to work.
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Item No.:
11
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Site:
Medical-Crew GI Illness Case Management
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|
Violation:
An assistant waitress initially reported one diarrheal episode at 5:10 pm on 11 June, then was issued anti-diarrheal medication at 5:42 pm. At 2 am on 12 June she experienced addtional symptoms, but was granted approval to return to work at 9:20 am on 13 June. She worked on 13 June from 5:11 pm to 10:09 pm. The record did not detail what additional symptoms occurred on 12 June or the number of episodes, so it was unclear why this was not reported as a case and why there was approval to work following only 24 hours of being symptom-free.
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|
Recommendation:
Exclude food employees suspected of, diagnosed with, or exposed to any communicable disease caused by Salmonella typhi, Shigella spp., E. coli O157:H7, hepatitis A virus, norovirus, or other communicable diseases that can be transmitted by food, from working in any food or food related areas or operations, including working with exposed food, warewashing, equipment, utensils, table linens, single-service articles and single-use articles. Do not allow the excluded individual to return to the above duties until they are symptom free for a minimum of 48 hours.
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Item No.:
16
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|
Site:
Provisions-Hotel General Stores
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|
Violation:
A gray plastic bin with six flats of raw shell eggs was stored outside of refrigeration inside the hotel storage. The internal temperature of the eggs ranged in temperature from 58F to 62F.
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Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less. The minimal allowable temperature for raw shell eggs is 45 F.
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Item No.:
16
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Site:
Provisions-Dairy Walk-In Rm 22
|
|
Violation:
A gray plastic bin with four flats of raw shell eggs was stored in walk-in Rm 22. The internal temperature of the raw shell eggs was 56 F. The eggs were warm to the touch.
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Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less.
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Item No.:
19
|
|
Site:
Provisions-Dairy Walk-In Rm 22
|
|
Violation:
Four flats of cracked raw shell eggs were stored in a gray plastic container. Below the cracks eggs was a large block of cheese and numerous vacuum sealed bags of salad dressing. Spilled egg white, yolk, and shells coated the exterior of the cheese and salad dressing bags.
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|
Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (2) In a clean, dry location; (3) Where it is not exposed to splash, dust, or other contamination; and (4) At least 15 centimeters (6 inches) above the deck.
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Item No.:
19
|
|
Site:
Galley-Deck 11 - Pasta Bar
|
|
Violation:
A fly trap was located above the preparation counter with a cold top attached.
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|
Recommendation:
Do not locate insect control devices, such as insect light traps, over food storage, food preparation areas, food service stations, or clean equipment. Prevent dead insects and insect fragments from falling on exposed food.
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Item No.:
20
|
|
Site:
Galley-Deck 0 - Center (Hot)
|
|
Violation:
Chipping and pitting made the gray plastic end cover of the slicer difficult to clean.
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|
Recommendation:
Replace the plastic end cover.
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Item No.:
20
|
|
Site:
Galley-Deck 10 - Lido Center
|
|
Violation:
Corrosion and pitting covered the right metal splash guard adjacent to the bulk milk dispenser tube.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
20
|
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Site:
Galley-Deck 10 - Deli Preparation
|
|
Violation:
Corrosion, cracks and field weld repairs made the cast grills difficult to clean. In addition, the material used for the field weld repairs could not be determined.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
20
|
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Site:
Galley-Deck 3 - Hot Lines (both sides of bulkhead)
|
|
Violation:
Corrosion, cracks and field weld repairs made the cast grills difficult to clean. In addition, the material used for the field weld repairs could not be determined.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
20
|
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Site:
Galley-Deck 3 - Service Bar
|
|
Violation:
The plastic ice container of the previously cleaned ice blender was cracked. In addition, the metal blade located near the dispensing chute was corroded.
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|
Recommendation:
Replace the blender ice container.
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Item No.:
20
|
|
Site:
Galley-Blast Chiller Temperature Probe
|
|
Violation:
Corrosion covered the metal food contact stems of the blast chiller temperature probes in the Lido Galley, Main Galley and Crew Galley.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
20
|
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Site:
Other-Steakhouse Grill
|
|
Violation:
There was damage to at least 3 of the iron grill plates where the metal was split or cracked. Two had been repaired with welding, but it was unclear what the metal was for those welded sections and it's recommended the plates be replaced when damaged.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
22
|
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Site:
Galley-Deck 0 - Warewash
|
|
Violation:
The conveyor speed of the in-use flight-type warewash machine measured 6 to 7 feet per minute. The data plate required a maximum speed of 5 feet per minute.
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|
Recommendation:
Adjust the speed of the conveyor to meet the requirements of the dataplate (machine manufacturer's instructions).
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Item No.:
22
|
|
Site:
Galley-Deck 10 - Warewash
|
|
Violation:
The liquid crystal display on the in-use flight-type warewash machine was difficult to read and appeared to be failing.
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|
Recommendation:
Repair or replace the liquid crystal display.
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Item No.:
24
|
|
Site:
Bar-Lido Sunset Bar
|
|
Violation:
The bucket of sanitizing solution on the front bar counter had 0 ppm chlorine residual inside. There were several wiping cloths inside the solution and the bar was open. The water was immediately changed.
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|
Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
24
|
|
Site:
Bar-Lido Sunset Bar
|
|
Violation:
One of the two sanitizing solutions in buckets on the back bar counter had more than 200 ppm of chlorine inside. the solution was changed immediately. The bar was open.
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|
Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
26
|
|
Site:
Pantry-Deck 1 Port Pantry
|
|
Violation:
The pantry ice machine water bath had an accumulation of a loose black granular product in the water.
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|
Recommendation:
Ensure food only contacts surfaces of equipment and utensils that are cleaned and sanitized. Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
|
|
Site:
Buffet-Staff Mess
|
|
Violation:
Deposits of old grease encrusted the in-use Panini press (clamshell grill).
|
|
Recommendation:
Ensure food-contact surfaces of cooking equipment and pans are kept free of encrusted grease deposits and other soil accumulations.
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Item No.:
26
|
|
Site:
Galley-Deck 10 - Storage Locker
|
|
Violation:
Food residue and grease covered the previously cleaned clamshell grill, stored in the storage locker across from the potwash.
|
|
Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
27
|
|
Site:
Galley-Deck 10 - Burrito Preparation
|
|
Violation:
Food residue soiled the inside of the food service lift number 10350032-u-ze.
|
|
Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
|
|
Site:
Galley-Deck 3 - Pastry
|
|
Violation:
A pink sticky food residue soiled the technical space of the drip pan housings of the two ice cream machines.
|
|
Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
33
|
|
Site:
Other-Steakhouse Grill
|
|
Violation:
There was a section of deckhead damaged along the connection of the deckhead exhaust hood maintenance panel and the surround deckhead panels. Damage included gaps, dents, and bent metal along edges and profiles that made the panels uneven and misaligned so cleaning was difficult.
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|
Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, bars, and food and equipment storage areas are constructed and maintained for easy cleaning. Do not use carpet in these areas.
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Item No.:
33
|
|
Site:
Bar-Steakhouse Bar
|
|
Violation:
There was dust and hair on many of the decorative bulbs and the lights fitted throughout the deckhead over the front bar. The high number of bulbs thoughout this deckhead made cleaning difficult as well.
|
|
Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
41
|
|
Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
|
|
Violation:
The written OPRP did not include the notification letters for outbreaks to guests boarding or those continuing on voyages where the previous cruise or segment was an outbreak. The food and beverage instructions for bars specified use of 1,000 ppm chlorine on all bar surfaces and on ice scoops and bar counters. A vital oxide fogging chemical was specified when fogging, but the concentration and contact time were not listed. There were no specific procedures for protection of crew and passengers from both dermal and inhalation exposures to disinfectant chemicals. The entire plan was under revision and the updated version has not been transmitted yet to the ship.
|
|
Recommendation:
Ensure each vessel has a written OPRP that details standard procedures and policies to specifically address AGE onboard. Include the following in the written OPRP: (1) Duties and responsibilities of each department and their staff for all the passenger and crew public areas; (2) Steps in outbreak management and control and the trigger for required action at each step. Ensure the triggers address a graduated approach to outbreak management in response to increasing case counts; (3) Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times. Ensure the disinfectant products or systems are effective against human norovirus or an acceptable surrogate (e.g., caliciviruses); (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak; (6) Procedures to protect the passengers and crew from exposure to disinfectants, if not already included in the vessel?s safety management system. Ensure this protection includes: (a) Material safety data sheets (MSDSs); (b) Personal protective equipment for crew; (c) Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew.
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Item No.:
42
|
|
Site:
Children Area-Camp Carnival
|
|
Violation:
The posted sign at the entrance to the child center included a statement at the bottom quoting the CDC Vessel Sanitation Program definition of an acute gastroenteritis case, but the definition did not match the current definition in the 2011 VSP Operations Manual with respect to diarrheal disease.
|
|
Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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