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Incidence Rate and Risk Factors Associated with Travelers’ Diarrhea in International Travelers Departing from Utah, USA

Valerie FernandezDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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Sharia M. AhmedDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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Michael C. GravesDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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Melissa A. PenderDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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Holly ShoemakerDivision of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah;

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Holly BirichSalt Lake County Health Department, Salt Lake City, Utah;

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Jakrapun PupaiboolDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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L. Scott BensonDivision of Public Health, University of Utah School of Medicine, Salt Lake City, Utah

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Daniel T. LeungDivision of Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah;

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ABSTRACT.

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.

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Author Notes

Address correspondence to Daniel T. Leung, Division of Infectious Diseases, University of Utah School of Medicine, 26 N. Medical Dr., Wintrobe 513, Salt Lake City, UT 84132. E-mail: daniel.leung@utah.edu

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: u1208745@utah.edu, sharia.m.ahmed@utah.edu, michael.c.graves@dmu.edu, melissa.pender@hsc.utah.edu, jakrapun.pupaibool@hsc.utah.edu, and daniel.leung@utah.edu. Holly Shoemaker, Population Health Sciences, University of Utah Health, Salt Lake City, UT, E-mail: holly.shoemaker@hsc.utah.edu. Holly Birich, Travel Clinic, Salt Lake County Health Department, Salt Lake City, UT, E-mail: hbirich@slco.org. L. Scott Benson, University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, E-mail: scott.benson@hsc.utah.edu.

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