The U.S. Code of Federal Regulations (42 §71.21) requires that the master of a ship destined to a U.S. port of entry report certain illnesses, as well as any death onboard to the nearest CDC Quarantine Station (1). On December 30, 2015, the U.S. Coast Guard notified CDC of the death of a crew member of a foreign cargo vessel off the coast of Puerto Rico. Four days earlier, on December 26, the patient, a man aged 50 years from India, developed abdominal pain, headache, and fever (103.0°F [39.4°C]), followed by loose stools and pruritus. On December 28, a vesicular rash appeared on his face, neck, and shoulders.
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