Gastrointestinal infection among international travelers globally.
BACKGROUND
Data on relative rates of acquisition of gastrointestinal infections by travelers are incomplete. The objective of this study was to analyze infections associated with oral ingestion of pathogens in international travelers in relation to place of exposure.


METHODS
We performed a multicenter, retrospective observational analysis of 6,086 travelers ill enough with any gastrointestinal infection to seek medical care at a GeoSentinel clinic after completion of travel during 2000 to 2005. We determined regional and country-specific reporting rate ratios (RRRs) in comparison to risk in northern and western Europe.


RESULTS
Travel to sub-Saharan Africa (RRR = 282), South America (RRR = 203), and South Asia (RRR = 890) was associated with the greatest rate of gastrointestinal infections. RRRs were moderate (25-142) for travel to Oceania, the Middle East, North Africa, Central America, the Caribbean, and Southeast Asia. RRRs were least (<28) following travel to southern, central, and eastern Europe; North America; Northeast Asia; and Australasia. Income level of the country visited was inversely proportional to the RRR for gastrointestinal infection. For bacterial and parasitic infections examined separately, the regions group in the same way. RRRs could be estimated for 28 individual countries and together with regional data were used to derive a global RRR map for travel-related gastrointestinal infection.


CONCLUSIONS
This analysis of morbidity associated with oral ingestion of pathogens abroad determines which parts of the world currently are high-risk destinations.
Greenwood
Zoe
Z
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia.
Black
James
J
Weld
Leisa
L
O'Brien
Daniel
D
Leder
Karin
K
Von Sonnenburg
Frank
F
Pandey
Prativa
P
Schwartz
Eli
E
Connor
Bradley A
BA
Brown
Graham
G
Freedman
David O
DO
Torresi
Joseph
J
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology*; D015984:Causality; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010272:Parasitic Diseases / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014195:Travel / Q000706:statistics & numerical data*; D014330:Tropical Medicine