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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.
Received September 15, 2005. Accepted for publication December 29, 2005.
* Address correspondence to Mark S. Riddle, NAMRU 3, PSC 452, Box 105, FPO AE 09835. E-mail: markriddlemd{at}hotmail.com
Authors’ addresses: Mark S. Riddle, NAMRU-3, PSC 452, Box 105, FPO AE 09835, E-mail: markriddlemd{at}hotmail.com. John W. Sanders, Infectious Disease Service, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, E-mail: jwsanders{at}bethesda.med.navy.mil. Shannon D. Putnam, U.S. Embassy Jakarta, NAMRU 2, Box 8132, FPO AP 96520, E-mail: sha8299{at}hotmail.com. David R. Tribble, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, E-mail: tribbled{at}nmrc.med.navy.mil.
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