• 1

    Bruni M, Steffen R, 1997. Impact of traveler-related health impairments. J Travel Med 4 :61–64.

  • 2

    MacDonald KL, Cohen ML, 1986. Epidemiology of travelers’ diarrhea: Current perspectives. Rev Infect Dis 8 (Suppl 2):S117–S121.

  • 3

    Steffen R, 1986. Epidemiologic studies of travelers’ diarrhea, severe gastrointestinal infections, and cholera. Rev Infect Dis 8 (Suppl 2):S122–S130.

    • Search Google Scholar
    • Export Citation
  • 4

    Cabada MM, Maldonado F, Quispe W, Serrano E, Mozo K, Gonzales E, Seas C, Verdonck K, Echevarria JI, Gotuzzo E, 2005. Pretravel health advice among international travelers visiting Cuzco, Peru. J Travel Med 12 :61–65.

    • Search Google Scholar
    • Export Citation
  • 5

    Mattila L, Siitonen A, Kyronseppa H, Simula II, Peltola H, 1995. Risk behavior for travelers’ diarrhea among Finnish travelers. J Travel Med 2 :77–84.

    • Search Google Scholar
    • Export Citation
  • 6

    Steffen R, Collard F, Tornieporth N, Campbell-Forrester S, Ash-ley D, 1999. Epidemiology, etiology, and impact of travelers’ diarrhea in Jamaica. JAMA 281 :811–817.

    • Search Google Scholar
    • Export Citation
  • 7

    Gorbach SL, Carpenter CCJ, Grayson R, Gryboski J, Guerrant RL, Hendrix TR, Hornick RB, Marr JS, Morris J, Polk BF, Waters SR, Williams GW, Wolfe MS, 1986. Consensus Development Conference Statement. Rev Infect Dis 8 (Suppl 2):S227–S233.

    • Search Google Scholar
    • Export Citation
  • 8

    Blaser MJ, 1986. Environmental interventions for the prevention of travelers’ diarrhea. Rev Infect Dis 8 (Suppl 2):S142–S150.

  • 9

    Black RE, 1986. Pathogens that cause travelers’ diarrhea in Latin America and Africa. Rev Infect Dis 8 (Suppl 2):S131–S135.

  • 10

    PromPeru, 2000. Perfil del Turista Extranjero. Available at: www.peru.org.pe/catalogo/Attach/175.pdf. Accessed December 29, 2004.

  • 11

    Cavalcanti A, Costa Clemens SA, Von Sonnenburg F, Collard F, De Clercq N, Steffen R, Clemens R, 2002. Travelers’ diarrhea: Epidemiology and impact on visitors to Fortaleza, Brazil. Pan Am J Public Health 11 :245–252.

    • Search Google Scholar
    • Export Citation
  • 12

    Reinthaler FF, Feierl G, Stunzner D, Marth E, 1998. Diarrhea in returning Austrian tourists: Epidemiology, etiology and cost-analyses. J Travel Med 5 :65–72.

    • Search Google Scholar
    • Export Citation
  • 13

    Steffen R, van der Linde F, Gyr K, Schär M, 1983. Epidemiology of diarrhea in travelers. JAMA 249 :1176–1180.

  • 14

    Hoge CW, Shlim DR, Echevarria P, Rajah R, Herrmann JE, Cross JH, 1996. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA 275 :533–538.

    • Search Google Scholar
    • Export Citation
  • 15

    Shlim DR, 2005. Update in travelers’ diarrhea. Infect Dis Clin North Am 19 :137–149.

  • 16

    Al-Abri SS, Beeching NJ, Nye FJ, 2005. Travellers’ diarrhoea. Lancet Infect Dis 5 :349–360.

  • 17

    Horvath LL, Murray CK, DuPont HL, 2003. Travel health information at commercial travel websites. J Travel Med 10 :272–278.

  • 18

    Provost S, Gaulin C, Piquet-Gauthier B, Emmanuelli J, Venne S, Dion R, Grenier JL, Dessau JC, Dubuc M, 2002. Travel agents and the prevention of health problems among travelers in Quebec. J Travel Med 9 :3–9.

    • Search Google Scholar
    • Export Citation
  • 19

    Leggat P, 2002. Health advice provided to hostelers from Australia: Influence of a travelers’s information evening. J Travel Med 9 :24–28.

    • Search Google Scholar
    • Export Citation
  • 20

    Krause E, Grundmann H, Hatz C, 1999. Pre-travel advice neglects rabies risk for travelers to tropical countries. J Travel Med 6 :163–167.

    • Search Google Scholar
    • Export Citation
  • 21

    Goldsmid JM, Bettiol SS, Sharples N, 2003. A preliminary study on travel health issues of medical students undertaking electives. J Travel Med 10 :160–163.

    • Search Google Scholar
    • Export Citation
  • 22

    Peetermans WE, Van Winjgaerden E, 2001. Implementation of pretravel advice: Good for malaria, bad for diarrhoea. Acta Clin Belg 56 :284–288.

    • Search Google Scholar
    • Export Citation
  • 23

    McIntosh IB, Reed JM, Power KG, 1997. Travellers’ diarrhoea and effect of pre-travel health advice in general practice. Br J Gen Pract 47 :68–69.

    • Search Google Scholar
    • Export Citation
  • 24

    Cobelens FG, Leentvaar-Kuijpers A, Kleijnen J, Coutinho RA, 1998. Incidence and risk factor of diarrhoea in Dutch travellers: Consequences for priorities in pre-travel health advice. Trop Med Int Health 3 :896–903.

    • Search Google Scholar
    • Export Citation
  • 25

    Jiang ZD, Okhuysen PC, Guo D, He R, King TM, DuPont HL, Milewicz DM, 2003. Genetic susceptibility to enteroaggregative Escherichia coli diarrhea: Polymorphism in the interleu-kin-8 promotor region. J Infect Dis 188 :506–511.

    • Search Google Scholar
    • Export Citation
  • 26

    Casburn-Jones AC, Farthing MJG, 2004. Travelers’ diarrhea. J Gastroenterol Hepatol 19 :610–618.

  • 27

    DuPont HL, Jiang ZD, Okhuysen P, Ericsson CD, DuPont MW, Steffen R, de la Cabada FA, Martinez-Sandoval F, 2005. A randomized placebo controlled trial of rifaximin prevention of travelers’ diarrhea in Mexico where diarrheagenic E. coli are major causes of illness. Ann Intern Med 142 :805–812.

    • Search Google Scholar
    • Export Citation
  • 28

    Okhuysen PC, Jiang ZD, Carlin L, Forbes C, DuPont HL, 2004. Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico. Am J Gastroenterol 99 :1774–1778.

    • Search Google Scholar
    • Export Citation
  • 29

    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.

    • Search Google Scholar
    • Export Citation
  • 30

    van Loon FP, Bennish ML, Speelman P, Butler C, 1989. Double blind trial of loperamide for treating acute watery diarrhoea in expatriates in Bangladesh. Gut 30 :492–495.

    • Search Google Scholar
    • Export Citation
  • 31

    Murphy GS, Bodhidatta L, Echevarria P, Tansuphaswadikul S, Hoge CW, Imlarp S, Tamura K, 1993. Ciprofloxacine and loperamide in the treatment of bacillary dysentery. Ann Intern Med 118 :582–586.

    • Search Google Scholar
    • Export Citation
  • 32

    Cartwright RY, Chahed M, 1997. Food borne diseases in travellers. World Health Stat Q 50 :102–110.

  • 33

    Ashley DV, Walters C, Dockery-Brown C, McNab A, Ashley DE, 2004. Interventions to prevent and control food-borne diseases associated with a reduction in travelers’ diarrhea in tourists to Jamaica. J Travel Med 11 :364–369.

    • Search Google Scholar
    • Export Citation

 

 

 

 

RISK FACTORS ASSOCIATED WITH DIARRHEA AMONG INTERNATIONAL VISITORS TO CUZCO, PERU

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  • 1 Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Nacional San Antonio Abad del Cuzco, Cuzco, Peru; Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium; University of Texas–Houston School of Public Health; St. Luke’s Episcopal Hospital; and Baylor College of Medicine, Houston, Texas

The objective of this study was to determine the risk factors for travelers’ diarrhea (TD) reported by visitors to Cuzco, Peru. In this cross-sectional study, self-administered questionnaires looking at perceived occurrence of health problems and pre-travel health advice were obtained from departing travelers at Cuzco’s International Airport between August and November 2002. A total of 5,988 travelers participated in the study. The mean age was 35 years, and 51% were women. The prevalence of TD was 24%. Factors associated with TD in the multivariable analysis were use of antibiotic prophylaxis (OR: 3.20), vaccination against cholera (OR: 1.44), history of advice for safe food and water consumption (OR: 1.46), being younger than 35 years of age (OR: 1.37), being a resident of the United States (OR: 1.28), not staying in hotels in Cuzco (OR: 1.13), and number of unsafe food or beverages consumed (OR: 1.04). Remaining in Cuzco < 1 week was a protective factor (OR: 0.58). TD is common among travelers to Cuzco. This study suggests that conventional recommendations are not invariably effective at decreasing TD.

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