title: Gastrointestinal infection among international travelers globally.
abstract: 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.
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Greenwood
authors.forename: James
authors.initials: J
authors.lastname: Black
authors.forename: Leisa
authors.initials: L
authors.lastname: Weld
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Brien
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
authors.forename: Frank
authors.initials: F
authors.lastname: Von Sonnenburg
authors.forename: Prativa
authors.initials: P
authors.lastname: Pandey
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Connor
authors.forename: Graham
authors.initials: G
authors.lastname: Brown
authors.forename: David O
authors.initials: DO
authors.lastname: Freedman
authors.forename: Joseph
authors.initials: J
authors.lastname: Torresi
mesh_terms: 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