title: Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review.
abstract: To determine regional estimates of pathogen-specific prevalence and incidence, as well as, describe morbidity associated with diarrhea among deployed US military and similar populations, a systematic review was conducted for publications between January 1990 to June 2005. Point estimates and confidence intervals of pathogen prevalence and travelers' diarrhea incidence were combined in a random effects model and assessed for heterogeneity. In total, 262 studies were identified for potential inclusion, of which 52 fulfilled inclusion criteria. Overall, 38% were from the Middle East, 29% from Southeast Asia, 27% from Latin America/Caribbean, and 6% from sub-Saharan Africa. Median duration of travel was 1.5 months (interquartile range, 1-3 months). Enterotoxigenic Escherichia coli (ETEC), Campylobacter, and Shigella were identified as causing 38-45% of diarrhea, with regional and population differences. Incidence based on self-report was higher than studies using passive surveillance or clinic-based methods (29 versus 7 versus 6 episodes per 100 person-months, respectively) without regional differences.
authors: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. markriddlemd@hotmail.com
authors: Mark S
authors: MS
authors: Riddle
authors: John W
authors: JW
authors: Sanders
authors: Shannon D
authors: SD
authors: Putnam
authors: David R
authors: DR
authors: Tribble