On December 5, 1989, the Mexican Field Epidemiology Training Program (FETP), Directorate of Epidemiology, Secretariat of Health, was notified of an outbreak of dermatitis among employees of the 17 tourist hotels in Cozumel in October and November. Cozumel, an island located 10 miles off the coast of the Yucatan peninsula of southern Mexico, is 7 miles wide by 35 miles long. The island has 43,000 permanent residents and a daily average of 3000-5000 tourists.
The FETP initiated an investigation by interviewing a probability sample of 417 hotel employees from eight of the 17 hotels (total employees: 1436). Because scabies was initially suspected, a case was defined as a person who had onset since July 1 of a rash that itched continually and lasted >1 week. Of the 417 employees, 19 (4.6%) met the case definition. However, 91 (21.8%) reported nonspecific dermatitis of <1 week's duration since July 1.