Gastroenteritis Outbreaks in 2 Tourist Resorts, Dominican Republic

Nine patients originated from Somalia, Ethiopia, or Yemen. Few cases have previously been reported from this area (3), although Ethiopian migrants have been shown to have an egg positivity of 0.4% on routine screening (4). Patients 5 and 6 had not returned to Africa for >20 years, suggesting that they acquired their infection in Europe. Therefore, a risk factor may exist that is specifi c to this ethnic group within the United Kingdom. Six cases were diagnosed at 1 hospital. All 6 patients reported current or past use of locally bought khat, a leaf chewed for its stimulant properties. It is imported fresh to the United Kingdom from Africa and is an ideal environment for the survival of Fasciola cercariae. It is used most commonly by migrants from the Horn of Africa and Yemen and has been reported in association with acute fascioliasis in the United Kingdom (5). Use of imported khat may explain the apparently higher incidence of fascioliasis in this ethnic group residing in the United Kingdom. Despite the described parallel rise in human and veterinary fascioliasis, none of these cases provide clear evidence that recent human cases resulted from zoonotic transmission within the United Kingdom. Most cases occurred in migrants from the Horn of Africa and Yemen, some of whom may have acquired Fasciola spp. in their country of origin; other cases appear likely to have been acquired in the United Kingdom, possibly due to use of imported khat. Physicians need a heightened awareness of fascioliasis when investigating impaired liver function or abnormal abdominal imaging in migrants or travelers from high-risk areas.