Volume 93, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The effect of origin and destination country on traveler's diarrhea incidence rates in Southeast Asia is poorly understood, and research generally only addresses diarrhea in travelers from the developed world. This study evaluated the attack rate and effects of traveler's diarrhea by origin and destination and analyzed key risk factors. A self-administered questionnaire was provided to foreign travelers departing Southeast Asia from Suvarnabhumi Airport, Bangkok, Thailand. It evaluated traveler demographics, relevant knowledge and practices, experiences of diarrhea, and the details and consequences of each diarrheal episode. A total of 7,963 questionnaires were completed between April 2010 and July 2011. Respondents were 56% male (mean age 35) with a mean and median duration of stay of 28 days and 10 days, respectively. Most respondents were from Europe (36.8%) or East Asia (33.4%). The attack rate of traveler's diarrhea was 16.1%, with an incidence rate of 32.05 per 100 person months. Travelers' origin and destination countries significantly related to diarrhea risk. Oceanians had the highest risk (32.9%) and East Asians the lowest (2.6%). Vietnam and Indonesia were the highest risk destinations (19.3%). Other significant factors were youth, trip duration, number of countries visited, and frequently drinking beverages with ice.


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  1. Steffen R, Amitirigala I, Mutsch M, , 2008. Health risks among travelers–need for regular updates. J Travel Med 15: 145146.[Crossref] [Google Scholar]
  2. Steffen R, Hill DR, DuPont HL, , 2015. Traveler's diarrhea: a clinical review. JAMA 313: 7180.[Crossref] [Google Scholar]
  3. Chongsuvivatwong V, Chariyalertsak S, McNeil E, Aiyarak S, Hutamai S, Dupont HL, Jiang ZD, Kalambaheti T, Tonyong W, Thitiphuree S, Steffen R, , 2009. Epidemiology of travelers' diarrhea in Thailand. J Travel Med 16: 179185.[Crossref] [Google Scholar]
  4. Piyaphanee W, Kusolsuk T, Kittitrakul C, Suttithum W, Ponam T, Wilairatana P, , 2011. Incidence and impact of travelers' diarrhea among foreign backpackers in southeast Asia: a result from Khao San road, Bangkok. J Travel Med 18: 109114.[Crossref] [Google Scholar]
  5. Evans MR, Shickle D, Morgan MZ, , 2001. Travel illness in British package holiday tourists: prospective cohort study. J Infect 43: 140147.[Crossref] [Google Scholar]
  6. World Centre of Excellence for Destinations, 2011. Double-Digit Growth for Asia and the Pacific in 2010. Available at: http://www.ced.travel/destinations-news/145-double-digit-growth-for-asia-and-the-pacific-in-2010.html. Accessed February 21, 2011. [Google Scholar]
  7. DuPont HL, , 2005. Travelers' diarrhea: antimicrobial therapy and chemoprevention. Nat Clin Pract Gastroenterol Hepatol 2: 191198.[Crossref] [Google Scholar]
  8. Mitsui Y, Chanyasanha C, Boonshuyar C, Shimada M, Moji K, , 2004. Incidence of travelers' diarrhea among Japanese visiting Thailand. Trop Med Int Health 32: 2126.[Crossref] [Google Scholar]
  9. Piyaphanee W, Steffen R, Shlim DR, Gherardin T, Chatterjee S, , 2012. Travel medicine for Asian travelers–do we need new approaches? J Travel Med 19: 335337.[Crossref] [Google Scholar]
  10. Piyaphanee W, Kittitrakul C, Lawpoolsri S, Tangkanakul W, Sa-Ngiamsak N, Nasok P, Wongchai S, Ponam T, Wichianprasat P, Phumratanaprapin W, , 2014. Incidence and spectrum of health problems among travelers to Laos. J Travel Med 21: 163168.[Crossref] [Google Scholar]
  11. Al-Abri SS, Beeching NJ, Nye FJ, , 2005. Traveller's diarrhoea. Lancet Infect Dis 5: 349360.[Crossref] [Google Scholar]
  12. Steffen R, van der Linde F, Gyr K, Schar M, , 1983. Epidemiology of diarrhea in travelers. JAMA 249: 11761180.[Crossref] [Google Scholar]
  13. Angst F, Steffen R, , 1997. Update on the epidemiology of traveler's diarrhea in east Africa. J Travel Med 4: 118120.[Crossref] [Google Scholar]
  14. Kozicki M, Steffen R, Schar M, , 1985. ‘Boil it, cook it, peel it or forget it’: does this rule prevent travellers' diarrhoea? Int J Epidemiol 14: 169172.[Crossref] [Google Scholar]
  15. Merson MH, Morris GK, Sack DA, Wells JG, Feeley JC, Sack RB, Creech WB, Kapikian AZ, Gangarosa EJ, , 1976. Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress. N Engl J Med 294: 12991305.[Crossref] [Google Scholar]
  16. Hill DR, Beeching NJ, , 2010. Travelers' diarrhea. Curr Opin Infect Dis 23: 481487.[Crossref] [Google Scholar]
  17. Soonawala D, Vlot JA, Visser LG, , 2011. Inconvenience due to travelers' diarrhea: a prospective follow-up study. BMC Infect Dis 11: 322.[Crossref] [Google Scholar]
  18. Shah N, DuPont HL, Ramsey DJ, , 2009. Global etiology of travelers' diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg 80: 609614. [Google Scholar]

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  • Received : 24 Feb 2015
  • Accepted : 12 May 2015
  • Published online : 02 Sep 2015

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