Epidemiology of travelers' diarrhea: details of a global survey.
BACKGROUND
Recent epidemiologic data on travelers' diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures.


METHODS
To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. The study period was March 1996 to July 1998.


RESULTS
Overall, 73,630 short-term visitors completed a questionnaire. The total diarrhea attack rate varied between a high of 54.6% in Mombasa and a low of 13.6% in Fortaleza, but only between 31.5% and 5.4% of all travelers had classic TD. The 14-day incidence rates varied between 19.5% and 65.7%. Few travelers meticulously avoided potentially dangerous food items, although in India and Kenya most travelers avoided those considered most dangerous. Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. The impact, measured as incapacity or quality-of-life scores, was very considerable.


CONCLUSIONS
TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries. Implementation of food safety education programs may be difficult to achieve.
Steffen
Robert
R
Division of Epidemiology and Prevention of Communicable Diseases, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
Tornieporth
Nadia
N
Clemens
Sue-Ann Costa
SA
Chatterjee
Santanu
S
Cavalcanti
Ana-Maria
AM
Collard
Françoise
F
De Clercq
Norbert
N
DuPont
Herbert L
HL
von Sonnenburg
Frank
F
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007563:Jamaica / Q000453:epidemiology; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014195:Travel