A LARGE OUTBREAK OF HISTOPLASMOSIS AMONG AMERICAN TRAVELERS ASSOCIATED WITH A HOTEL IN ACAPULCO, MEXICO, SPRING 2001

JULIETTE MORGAN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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MARIA V. CANO Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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DANIEL R. FEIKIN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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MAUREEN PHELAN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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OSCAR VELAZQUEZ MONROY Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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PABLO KURI MORALES Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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JOSEPH CARPENTER Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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ANDRE WELTMAN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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PETER G. SPITZER Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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HANS H. LIU Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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SARA A. MIRZA Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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DAVID E. BRONSTEIN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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DANIEL J. MORGAN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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LAURA A. KIRKMAN Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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MARY E. BRANDT Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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NAUREEN IQBAL Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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MARK D. LINDSLEY Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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DAVID W. WARNOCK Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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RANA A. HAJJEH Mycotic Diseases Branch, Respiratory Diseases Branch, and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology, Ministry of Health, Mexico City, Mexico; Pennsylvania Department of Health, Harrisburg, Pennsylvania; Bryn Mawr Medical Specialists, Bryn Mawr, PA

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During spring 2001, college students from Pennsylvania reported an acute febrile respiratory illness after returning from spring break vacation in Acapulco, Mexico. Acute pulmonary histoplasmosis was presumptively diagnosed and the cluster of illness was reported to the Centers of Disease Control and Prevention. A large investigation then ensued, which included finding student-travelers for interviews and requesting sera for histoplasmosis testing. We defined a clinical case by fever and at least one of the following: cough, shortness of breath, chest pain, or headache, in an Acapulco traveler during March–May 2001. A laboratory-confirmed case had positive serology. An initial study determined that the likely site of histoplasmosis exposure was Hotel H; we therefore performed a large cohort study among travelers who stayed at Hotel H. Of 757 contacted, 262 (36%) met the clinical case definition. Of 273 serum specimens tested, 148 (54%) were positive. Frequent use of Hotel H’s stairwells, where construction was ongoing, was associated with increased risk of illness (relative risk = 10.5, 95% confidence interval = 3.7–30.5; P < 0.001). This is the first histoplasmosis outbreak associated with a hotel undergoing construction. Hotels in endemic areas should consider construction precaution measures to prevent histoplasmosis among their guests.

Author Notes

Reprint requests: Juliette Morgan, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop C-09, Atlanta, GA, 30333, Telephone: 404-639-4723, Fax: 404-639-3059, E-mail: JMorgan1@cdc.gov.
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