title: Self-reported stomach upset in travellers on cruise-based and land-based package holidays.
abstract: BACKGROUND
  International travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays.
  
  
  METHODS
  A major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers.
  
  
  RESULTS
  From summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p<0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p<0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%).
  
  
  CONCLUSIONS
  In this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, United Kingdom ; EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Launders
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, United Kingdom ; EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg ; Department of Hygiene and epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece ; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Nichols
authors.affiliation: Federation of Tour Operators, London, United Kingdom.
authors.forename: Rodney
authors.initials: R
authors.lastname: Cartwright
authors.affiliation: Travel and Migrant Health Section, Public Health England, London, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lawrence
authors.affiliation: Travel and Migrant Health Section, Public Health England, London, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Jones
authors.affiliation: EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg ; Department of Hygiene and epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Hadjichristodoulou
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006693:Holidays; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012621:Seasons; D057566:Self Report; D013272:Stomach Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014195:Travel; D057236:Travel Medicine; D055815:Young Adult