title: Traveler's diarrhea: epidemiology and impact on visitors to Fortaleza, Brazil.
abstract: OBJECTIVE
  To assess the epidemiology and impact of traveler's diarrhea (TD) among visitors to the city of Fortaleza, Ceará, Brazil, as part of a global study on TD carried out in four countries.
  
  
  METHODS
  Within a cross-sectional survey, questionnaires were completed by departing travelers at the Fortaleza airport between March 1997 and February 1998. The questions inquired about demographics, duration of stay, reason for their visit, pretravel health advice they had received, risky food and beverage consumption while in Fortaleza, and quality of life during the visit to Fortaleza in relation to having or not having contracted TD.
  
  
  RESULTS
  A total of 12,499 questionnaires were analyzed. The most common reason that the visitors gave for their travel to Fortaleza was a holiday (60.3%). The total diarrhea attack rate was 13.4%. Younger people (< 36 years) had significantly higher TD attack rates than did older persons. Using a logistic regression model, we investigated the visitors' risk factors, including age, gender, length of stay, and trip's purpose. According to that analysis, characteristics that are slightly predictive of TD are gender, length of stay, and visiting as a tourist rather than for some other purpose. Characteristics that protect against contracting TD include being older and traveling for business rather than for some other reason. Of those who were incapacitated by TD, the mean duration of the impairment was 42 hours.
  
  
  CONCLUSIONS
  TD affected the travel plans and activities of many of the visitors to Fortaleza. Further, although aware of the health risks, the majority of those travelers did not avoid all potentially contaminated food or beverage items. Given this pattern of behavior, future efforts to combat TD may have to depend on such other alternative strategies as new vaccines.
authors.affiliation: Instituto de Pós-graduação Médica Carlos Chagas, Rio de Janeiro, RJ, Brazil. rcs@baydenet.com.br
authors.forename: Anamaria
authors.initials: A
authors.lastname: Cavalcanti
authors.forename: Sue Ann Costa
authors.initials: SA
authors.lastname: Clemens
authors.forename: Frank
authors.initials: F
authors.lastname: Von Sonnenburg
authors.forename: Françoise
authors.initials: F
authors.lastname: Collard
authors.forename: Norbert
authors.initials: N
authors.lastname: De Clercq
authors.forename: Robert
authors.initials: R
authors.lastname: Steffen
authors.forename: Ralf
authors.initials: R
authors.lastname: Clemens
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014195:Travel