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1
Herwaldt BL, de Arroyave KR, Roberts JM, Juranek DD, 2000. A multiyear prospective study of the risk factors for and incidence of diarrheal illness in a cohort of Peace Corps volunteers in Guatemala. Ann Intern Med 132 :982–988.
-
2
Hoge CW, Shlim DR, Echeverria P, Rajah R, Herrmann JE, Cross JH, 1996. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA 275 :533–538.
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3
Hillel O, Potasman I, 2005. Correlation between Adherence to Precautions Issued by the WHO and Diarrhea among Long-Term Travelers to India. J Travel Med 12 :243–247.
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4
Al-Abri SS, Beeching NJ, Nye FJ, 2005. Travellers’ diarrhoea. Lancet Infect Dis 5 :349–360.
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5
Cook GC, 2001. Influence of diarrhoeal disease on military and naval campaigns. J R Soc Med 94 :95–97.
-
6
Connor P, Farthing MJ, 1999. Travellers’ diarrhoea: a military problem? J R Army Med Corps 145 :95–101.
-
7
Hyams KC, Bourgeois AL, Merrell BR, Rozmajzl P, Escamilla J, Thornton SA, Wasserman GM, Burke A, Echeverria P, Green KY, et al., 1991. Diarrheal disease during Operation Desert Shield. N Engl J Med 325 :1423–1428.
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8
Sanchez JL, Gelnett J, Petruccelli BP, Defraites RF, Taylor DN, 1998. Diarrheal disease incidence and morbidity among United States military personnel during short-term missions overseas. Am J Trop Med Hyg 58 :299–304.
-
9
Wasserman GM, Martin BL, Hyams KC, Merrill BR, Oaks HG, McAdoo HA, 1997. A survey of outpatient visits in a United States Army forward unit during Operation Desert Shield. Mil Med 162 :374–379.
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10
Buma AH, van Ameijden E, Huyboom M, 1999. Morbidity surveillance among Dutch troops during a peace support operation in Cambodia. Mil Med 164 :107–111.
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11
Sanchez JL Jr, Craig SC, Kohlhase K, Polyak C, Ludwig SL, Rumm PD, 2001. Health assessment of U.S. military personnel deployed to Bosnia-Herzegovina for operation joint endeavor. Mil Med 166 :470–474.
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12
Gambel JM, Drabick JJ, Martinez-Lopez L, 1999. Medical surveillance of multinational peacekeepers deployed in support of the United Nations Mission in Haiti, June–October 1995. Int J Epidemiol 28 :312–318.
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13
McKee KT Jr, Kortepeter MG, Ljaamo SK, 1998. Disease and nonbattle injury among United States soldiers deployed in Bosnia-Herzegovina during 1997: summary primary care statistics for Operation Joint Guard. Mil Med 163 :733–742.
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Taylor SF, Lutz RH, Millward JA, 2001. Disease and nonbattle injury related to peacekeeping operations in South America: summary patient care statistics for CABANAS 2000. Mil Med 166 :1059–1061.
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17
Egger M, Smith GD, Altman DG, 2001. Systematic Reviews in Health Care. London, UK: BMJ Publishing Group.
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Ericsson CD, DuPont HL, Mathewson JJ, 2001. Optimal dosing of ofloxacin with loperamide in the treatment of non-dysenteric travelers’ diarrhea. J Travel Med 8 :207–209.
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Johnson GP, Weston TD, Ward JE, 1992. Treatment of acute diarrhea with norfloxacin during Desert Storm deployment. Aviat Space Environ Med 63 :717–720.
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28
Petruccelli BP, Murphy GS, Sanchez JL, Walz S, DeFraites R, Gelnett J, Haberberger RL, Echeverria P, Taylor DN, 1992. Treatment of travelers’ diarrhea with ciprofloxacin and loperamide. J Infect Dis 165 :557–560.
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29
Adachi JA, Ericsson CD, Jiang ZD, DuPont MW, Martinez-Sandoval F, Knirsch C, DuPont HL, 2003. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico. Clin Infect Dis 37 :1165–1171.
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DuPont HL, Ericsson CD, Mathewson JJ, DuPont MW, 1992. Five versus three days of ofloxacin therapy for travelers’ diarrhea: a placebo-controlled study. Antimicrob Agents Chemother 36 :87–91.
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INCIDENCE, ETIOLOGY, AND IMPACT OF DIARRHEA AMONG LONG-TERM TRAVELERS (US MILITARY AND SIMILAR POPULATIONS): A SYSTEMATIC REVIEW
MARK S. RIDDLE
MARK S. RIDDLE
Uniformed Services University of the Health Sciences, Bethesda, Maryland
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JOHN W. SANDERS
JOHN W. SANDERS
Uniformed Services University of the Health Sciences, Bethesda, Maryland
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SHANNON D. PUTNAM
SHANNON D. PUTNAM
Uniformed Services University of the Health Sciences, Bethesda, Maryland
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DAVID R. TRIBBLE
DAVID R. TRIBBLE
Uniformed Services University of the Health Sciences, Bethesda, Maryland
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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.
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-
1
Herwaldt BL, de Arroyave KR, Roberts JM, Juranek DD, 2000. A multiyear prospective study of the risk factors for and incidence of diarrheal illness in a cohort of Peace Corps volunteers in Guatemala. Ann Intern Med 132 :982–988.
-
2
Hoge CW, Shlim DR, Echeverria P, Rajah R, Herrmann JE, Cross JH, 1996. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA 275 :533–538.
-
3
Hillel O, Potasman I, 2005. Correlation between Adherence to Precautions Issued by the WHO and Diarrhea among Long-Term Travelers to India. J Travel Med 12 :243–247.
-
4
Al-Abri SS, Beeching NJ, Nye FJ, 2005. Travellers’ diarrhoea. Lancet Infect Dis 5 :349–360.
-
5
Cook GC, 2001. Influence of diarrhoeal disease on military and naval campaigns. J R Soc Med 94 :95–97.
-
6
Connor P, Farthing MJ, 1999. Travellers’ diarrhoea: a military problem? J R Army Med Corps 145 :95–101.
-
7
Hyams KC, Bourgeois AL, Merrell BR, Rozmajzl P, Escamilla J, Thornton SA, Wasserman GM, Burke A, Echeverria P, Green KY, et al., 1991. Diarrheal disease during Operation Desert Shield. N Engl J Med 325 :1423–1428.
-
8
Sanchez JL, Gelnett J, Petruccelli BP, Defraites RF, Taylor DN, 1998. Diarrheal disease incidence and morbidity among United States military personnel during short-term missions overseas. Am J Trop Med Hyg 58 :299–304.
-
9
Wasserman GM, Martin BL, Hyams KC, Merrill BR, Oaks HG, McAdoo HA, 1997. A survey of outpatient visits in a United States Army forward unit during Operation Desert Shield. Mil Med 162 :374–379.
-
10
Buma AH, van Ameijden E, Huyboom M, 1999. Morbidity surveillance among Dutch troops during a peace support operation in Cambodia. Mil Med 164 :107–111.
-
11
Sanchez JL Jr, Craig SC, Kohlhase K, Polyak C, Ludwig SL, Rumm PD, 2001. Health assessment of U.S. military personnel deployed to Bosnia-Herzegovina for operation joint endeavor. Mil Med 166 :470–474.
-
12
Gambel JM, Drabick JJ, Martinez-Lopez L, 1999. Medical surveillance of multinational peacekeepers deployed in support of the United Nations Mission in Haiti, June–October 1995. Int J Epidemiol 28 :312–318.
-
13
McKee KT Jr, Kortepeter MG, Ljaamo SK, 1998. Disease and nonbattle injury among United States soldiers deployed in Bosnia-Herzegovina during 1997: summary primary care statistics for Operation Joint Guard. Mil Med 163 :733–742.
-
14
Taylor SF, Lutz RH, Millward JA, 2001. Disease and nonbattle injury related to peacekeeping operations in South America: summary patient care statistics for CABANAS 2000. Mil Med 166 :1059–1061.
-
15
Black RE, 1990. Epidemiology of travelers’ diarrhea and relative importance of various pathogens. Rev Infect Dis 12 (suppl 1):S73–S79.
-
16
Bourgeois AL, Gardiner CH, Thornton SA, Batchelor RA, Burr DH, Escamilla J, Echeverria P, Blacklow NR, Herrmann JE, Hyams KC, 1993. Etiology of acute diarrhea among United States military personnel deployed to South America and west Africa. Am J Trop Med Hyg 48 :243–248.
-
17
Egger M, Smith GD, Altman DG, 2001. Systematic Reviews in Health Care. London, UK: BMJ Publishing Group.
-
18
Kaveh G, Shojania BWD, McDonald KM, Wachter RM, 2001. Evidence-Based Review Methodology. Making Health Care Safer: A Critical Analysis of Patient Safety Practices: San Francisco, CA: University of California at San Francisco (UCSF)–Stanford University.
-
19
Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW, 1998. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chron Dis Canada 19 :170–176.
-
20
DerSimonian R, Laird N, 1986. Meta-analysis in clinical trials. Control Clin Trials 7 :177–188.
-
21
DuPont HL, Ericsson CD, Mathewson JJ, Palazzini E, DuPont MW, Jiang ZD, Mosavi A, de la Cabada FJ, 1998. Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea. Digestion 59 :708–714.
-
22
Ericsson CD, DuPont HL, Mathewson JJ, 2001. Optimal dosing of ofloxacin with loperamide in the treatment of non-dysenteric travelers’ diarrhea. J Travel Med 8 :207–209.
-
23
Salam I, Katelaris P, Leigh-Smith S, Farthing MJ, 1994. Randomised trial of single-dose ciprofloxacin for travellers’ diarrhoea. Lancet 344 :1537–1539.
-
24
Thornton SA, Wignall SF, Kilpatrick ME, Bourgeois AL, Gardiner C, Batchelor RA, Burr DH, Oprandy JJ, Garst P, Hyams KC, 1992. Norfloxacin compared to trimethoprim/sulfamethoxazole for the treatment of travelers’ diarrhea among U.S. military personnel deployed to South America and West Africa. Mil Med 157 :55–58.
-
25
Johnson GP, Weston TD, Ward JE, 1992. Treatment of acute diarrhea with norfloxacin during Desert Storm deployment. Aviat Space Environ Med 63 :717–720.
-
26
Taylor DN, Sanchez JL, Candler W, Thornton S, McQueen C, Echeverria P, 1991. Treatment of travelers’ diarrhea: cipro-floxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Ann Intern Med 114 :731–734.
-
27
Kuschner RA, Trofa AF, Thomas RJ, Hoge CW, Pitarangsi C, Amato S, Olafson RP, Echeverria P, Sadoff JC, Taylor DN, 1995. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis 21 :536–541.
-
28
Petruccelli BP, Murphy GS, Sanchez JL, Walz S, DeFraites R, Gelnett J, Haberberger RL, Echeverria P, Taylor DN, 1992. Treatment of travelers’ diarrhea with ciprofloxacin and loperamide. J Infect Dis 165 :557–560.
-
29
Adachi JA, Ericsson CD, Jiang ZD, DuPont MW, Martinez-Sandoval F, Knirsch C, DuPont HL, 2003. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico. Clin Infect Dis 37 :1165–1171.
-
30
DuPont HL, Ericsson CD, Mathewson JJ, DuPont MW, 1992. Five versus three days of ofloxacin therapy for travelers’ diarrhea: a placebo-controlled study. Antimicrob Agents Chemother 36 :87–91.
-
31
Sanders JW, Isenbarger DW, Walz SE, Pang LW, Scott DA, Tamminga C, Oyofo BA, Hewitson WC, Sanchez JL, Pitarangsi C, Echeverria P, Tribble DR, 2002. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection. Am J Trop Med Hyg 67 :533–538.
-
32
Sanders JW, Putnam SD, Gould P, Kolisnyk J, Merced N, Barthel V, Rozmajzl PJ, Shaheen H, Fouad S, Frenck RW, 2005. Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001-Egypt. Diagn Microbiol Infect Dis 52 :85–90.
-
33
Haberberger RL, Scott DA, Thornton SA, Hyams KC, 1994. Diarrheal disease aboard a U.S. Navy ship after a brief port visit to a high risk area. Mil Med 159 :445–448.
-
34
Cohen D, Sela T, Slepon R, Yavzori M, Ambar R, Orr N, Robin G, Shpielberg O, Eldad A, Green M, 2001. Prospective cohort studies of shigellosis during military field training. Eur J Clin Microbiol Infect Dis 20 :123–126.
-
35
Paparello SF, Garst P, Bourgeois AL, Hyams KC, 1993. Diarrheal and respiratory disease aboard the hospital ship, USNS-Mercy T-AH 19, during Operation Desert Shield. Mil Med 158 :392–395.
-
36
Echeverria P, Jackson LR, Hoge CW, Arness MK, Dunnavant GR, Larsen RR, 1993. Diarrhea in U.S. troops deployed to Thailand. J Clin Microbiol 31 :3351–3352.
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