Steffen R , Hill DR , DuPont HL , 2015. Traveler’s diarrhea: a clinical review. JAMA 313: 71–80.
Connor BA , 2019. “Chapter 2: Traveler’s Diarrhea.” CDC Yellow Book 2020: Health Information for International Travel. New York, NY: Oxford University Press.
Hill DR , 2006. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 7: 259–266.
Hill DR , 2000. Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries. Am J Trop Med Hyg 62: 585–589.
Giddings SL , Stevens AM , Leung DT , 2016. Traveler’s diarrhea. Med Clin North Am 100: 317–330.
Murray HW , 2020. The pretravel consultation: recent updates. Am J Med 133: 916–923 e2.
Heather CS , 2015. Travellers’ diarrhoea. BMJ Clin Evid 2015: 0901.
Wang M , Szucs TD , Steffen R , 2008. Economic aspects of travelers’ diarrhea. J Travel Med 15: 110–118.
Stoney RJ , Han PV , Macleod WB , Jentes ES , Barnett ED , Hamer DH , Benoit CM , Chen LH , Wilson ME , 2017. Travelers’ diarrhea and other gastrointestinal symptoms among Boston-area international travelers. Am J Trop Med Hyg 96: 1388–1393.
Freedman DO , Weld LH , Kozarsky PE , Fisk T , Robins R , Von Sonnenburg F , Keystone JS , Pandey P , Cetron MS , 2006. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 354: 119–130.
Chen LH , Han PV , Wilson ME , Stoney RJ , Jentes ES , Benoit C , Ooi WW , Barnett ED , Hamer DH , 2016. Self-reported illness among Boston-area international travelers: a prospective study. Travel Med Infect Dis 14: 604–613.
McFarland LV , 2007. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis 5: 97–105.
Pitzurra R , Steffen R , Tschopp A , Mutsch M , 2010. Diarrhoea in a large prospective cohort of European travellers to resource-limited destinations. BMC Infect Dis 10: 231.
Lertsethtakarn P et al.2016. Detection of diarrhea etiology among U.S. military personnel during exercise Balikatan 2014, Philippines, using TaqMan Array cards. Mil Med 181: e1669–e1674.
Jiang ZD , Dupont HL , 2017. Etiology of travellers’ diarrhea. J Travel Med 24: S13–S16.
Riddle MS et al.2017. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med 24: S57–S74.
Steffen R , 2017. Epidemiology of travellers’ diarrhea. J Travel Med 24: S2–S5.
Leung AKC , Leung AAM , Wong AHC , Hon KL , 2019. Travelers’ diarrhea: a clinical review. Recent Pat Inflamm Allergy Drug Discov 13: 38–48.
Greenwood Z et al.2008. Gastrointestinal infection among international travelers globally. J Travel Med 15: 221–228.
Hagmann SHF et al.2014. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract 31: 678–687.
Hachiya M , Kikuchi H , Mizoue T , 2010. Descriptive epidemiology of travel-associated diarrhea based on surveillance data at Narita International Airport. J Travel Med 17: 105–110.
Olson S , Hall A , Riddle MS , Porter CK , 2019. Travelers’ diarrhea: update on the incidence, etiology and risk in military and similar populations—1990–2005 versus 2005–2015, does a decade make a difference? Trop Dis Travel Med Vaccines 5: 1.
Smith SM et al.2019. Locals get travellers’ diarrhoea too: risk factors for diarrhoeal illness and pathogenic Escherichia coli infection across an urban-rural gradient in Ecuador. Trop Med Int Health 24: 205–219.
Freeman MC et al.2014. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health 19: 906–916.
Sharma C , Poovorawan K , Piyaphanee W , Soonthornworasiri N , Angsuwatcharakon P , Phumratanaprapin W , Leowattana W , Wilairatana P , 2020. Incidence of travelers’ diarrhea among adult foreign travelers in Thailand: a prospective study. Am J Trop Med Hyg 102: 1009–1015.
Steffen R , van der Linde F , Gyr K , Schar M , 1983. Epidemiology of diarrhea in travelers. JAMA 249: 1176–1180.
DuPont HL , Ericsson CD , Farthing MJ , Gorbach S , Pickering LK , Rombo L , Steffen R , Weinke T , 2009. Expert review of the evidence base for self-therapy of travelers’ diarrhea. J Travel Med 16: 161–171.
Vilkman K , Pakkanen SH , Laaveri T , Siikamaki H , Kantele A , 2016. Travelers’ health problems and behavior: prospective study with post-travel follow-up. BMC Infect Dis 16: 328.
McIntosh IB , Reed JM , Power KG , 1997. Travellers’ diarrhoea and the effect of pre-travel health advice in general practice. Br J Gen Pract 47: 71–75.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||179||179||16|
Despite knowledge on the causes and prevention strategies for travelers’ diarrhea (TD), it continues to be one of the most common illnesses experienced by U.S. international travelers. However, studies of risk factors associated with TD among U.S. travelers are limited. In this study, we aimed to determine the incidence rate of TD, the proportion of travelers who experience TD, and to identify risk factors associated with TD. In this cross-sectional study, we collected and analyzed data from anonymous posttravel questionnaires submitted by international travelers recruited during their pretravel visit at two travel clinics in Salt Lake City, Utah, from October 2016 to March 2020. Of 571 travelers who completed posttravel surveys, 484 (85%) answered the TD question, of which 111 (23%) reported TD, for an incidence rate of 1.1 episodes per 100 travel-days (95% confidence interval [CI]: 0.9–1.4). In a multivariable model, visiting Southeast Asian (odds ratio [OR]: 2.60; 95% CI: 1.45–4.72) and African (OR: 2.06; 95% CI: 1.09–3.93]) WHO regions, having 10 or more individuals in the group (OR: 3.91; 95% CI: 1.50–11.32]), longer trip duration (OR: 1.01; 95% CI: 1.00–1.02), visiting both urban and rural destinations (OR: 1.94; 95% CI: 1.01–3.90), and taking medications/supplements to prevent TD (OR: 2.74; 95% CI: 1.69–4.47) were statistically significantly associated with increased odds of reporting TD. TD continues to be common in international travelers from the United States. Our findings provide insights regarding travelers’ behaviors regarding TD in international travelers from high-income countries and shows the need for additional research into prevention strategies for travelers’ diarrhea.
These authors contributed equally to this work.
Funding: This work was supported by National Institutes of Health under R01AI135114 and Ruth L. Kirschstein National Research Service Award NIH T32AI055434.
Authors’ addresses: Valerie Fernandez, Sharia Ahmed, Michael C. Graves, Melissa Pender, Jakrapun Pupaibool, and Daniel T. Leung, Division of Infectious Diseases, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Holly Shoemaker, Population Health Sciences, University of Utah Health, Salt Lake City, UT, E-mail: email@example.com. Holly Birich, Travel Clinic, Salt Lake County Health Department, Salt Lake City, UT, E-mail: firstname.lastname@example.org. L. Scott Benson, University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, E-mail: email@example.com.