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                k. December 1990, Jeddah: 23 cases of AGE were treated.
       The suspected food was catered vanilla pudding/custard filled
       cake, from which Staphylococcus aureus enterotoxin and bacillus
       cereus were cultured.

                 1. January 1991, Cairo West: eight cases of AGE seen
       over a 24 hour period. There were other complaints of personnel
       reportedly ill but not seeking medical treatment. The suspected
       food was ham/tuna casserole which was served cold the next day.
       Patrons had reheated individual portions in a microwave oven.

                 m. January 1991, Jeddah: 648 cases, Implicated meal was
       smoked veal sandwich in catered boxed lunch prepared in off base
       local national facility and served all day 20 January.
       Clostridium perfringens was the suspected pathogen. All stool
       specimens were negative. However, the local host nation
       laboratory did not include testing for anaerobes.

                n. February 1991, Jeddah: 59 cases of AGE were treated,
      14 of which were admitted. The suspect meal was catered
      undercooked baked turkey. Salmonella enteritidis type d was
      cultured from stools. The local national caterer cited
      complacency of one of their middle managers as cause or problem.
      The manager was subseauently transrerred.

                 o. March 1991, A1 Dhafra: 10 cases with a mixture of GI
       symptoms approximately six - eight hours after eating dinner. A
 I    case-control study showed an association with eating yakisoba at
      chow hall #2. Food samples were not available. Leftovers had
      been discarded. Food handling practices were evaluated and found
      acceptable as was personal hygiene. These symptoms and
      incubation were consistent with staphylococcal or Bacillus cereus
      food poisoning.

      p. March 1991, Doha: 14 cases of AGE, five
      hospitalized. Five had stools positive for Salmonella
      enteritidis Type D. Although no common meal was implicated, a
      USAF dining facility was suspected. No food remained for
      testing. Rectal swaps of foodhandlers were obtained.

      V. PROBLEMS ENCOUNTERED:

           1. There was no dedicated vehicle for use by Environmental
     Health and Bioenvironmental Engineering in the conduct of
     preventive medicine tasks. Access to a vehicle was a limiting
     factor in efforts to inspect food facilities and food.
           2. The Wing Commander did not have tradition control over
      feeding facilities run by local nationals. USAF sanitary
      standards could not be enforced in some cases.

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