Biegunka podróżnych – Epidemiologia

Biegunka podróżnych
Epidemiologia

Biegunka podróżnych (TD) stanowi najczęstsze schorzenie wśród podróżujących z krajów rozwiniętych do regionów rozwijających się, z zachorowalnością wahającą się od 30% do 70% w ciągu 14 dni pobytu, zależnie od regionu i sezonu. Najwyższe ryzyko obserwuje się w Afryce Subsaharyjskiej, Azji Południowej (ponad 20%) oraz Ameryce Łacińskiej i na Bliskim Wschodzie. Czynniki ryzyka obejmują miejsce docelowe, warunki sanitarne, konsumpcję żywności od ulicznych sprzedawców, a także wiek (najwyższa zachorowalność w grupie 15-30 lat) i stan immunologiczny. Etiologia jest głównie bakteryjna (80-90%), z dominującymi patogenami takimi jak Escherichia coli enterotoksyczna (ETEC), enteroagregacyjna (EAEC), Campylobacter jejuni, Shigella i Salmonella, a także wirusy (norowirus, rotawirus) i pasożyty (Giardia, Cryptosporidium). Sezonowe wahania zachorowań korelują z porą roku i klimatem, np. wzrost zachorowań w Azji Południowej przed monsunem.

Epidemiologia biegunki podróżnych

Biegunka podróżnych (ang. Traveler’s diarrhea, TD) jest najczęstszym schorzeniem dotykającym osoby podróżujące z krajów rozwiniętych do regionów rozwijających się. Wskaźniki zachorowalności na tę chorobę są alarmująco wysokie, wahając się od 30% do 70% podróżujących w ciągu 2-tygodniowego okresu, w zależności od miejsca docelowego i pory roku podróży.¹² Szacuje się, że rocznie około 10-15 milionów międzynarodowych podróżnych doświadcza biegunki podróżnych, co czyni ją kluczowym problemem zdrowia publicznego w kontekście turystyki międzynarodowej.³⁴

Rozkład geograficzny zachorowań

Częstość występowania biegunki podróżnych różni się znacząco w zależności od regionu geograficznego. Najwyższe wskaźniki zachorowań odnotowuje się w następujących obszarach:⁵⁶

Afryka Subsaharyjska – najwyższe wskaźniki zachorowalności spośród wszystkich regionów
Azja Południowa (Indie, Pakistan, Bangladesz, Nepal) – wskaźniki przekraczające 20% podróżujących
Ameryka Łacińska i Karaiby – wysokie wskaźniki zachorowalności
Bliski Wschód – wysokie ryzyko zachorowania

⁷⁸

Badania przeprowadzone wśród osób odwiedzających Tajlandię wykazały, że skumulowana częstość występowania biegunki podróżnych w ciągu pierwszych 14 dni pobytu wyniosła 23,5%, a w ciągu 28 dni wzrosła do 33,0%.⁹ Natomiast w badaniu przeprowadzonym wśród osób odwiedzających Cusco w Peru, zachorowalność wyniosła 2,2 epizodu na 90 osobodni.¹⁰

Należy zauważyć, że kraje o średnim ryzyku, takie jak Chiny, Rosja i niektóre wyspy karaibskie, mają wskaźniki zachorowalności na poziomie 8-20%, podczas gdy kraje o niskim ryzyku (Stany Zjednoczone, Kanada, Australia, Nowa Zelandia, Japonia i Europa Zachodnia) charakteryzują się wskaźnikami poniżej 8%.⁶¹¹

Sezonowa zmienność występowania biegunki podróżnych

Ryzyko zachorowania na biegunkę podróżnych wykazuje sezonowe wahania w wielu regionach świata. W regionach o klimacie umiarkowanym obserwuje się wyraźne różnice w częstości występowania tej choroby w zależności od pory roku.¹² Przykładowo:

W Azji Południowej znacznie wyższe wskaźniki zachorowań odnotowuje się w gorących miesiącach poprzedzających monsun¹²
Ogólnie, sezony deszczowe są związane z wyższym ryzykiem biegunki podróżnych wywołanej przez większość bakteryjnych patogenów jelitowych, natomiast przeciwne zależności obserwuje się w przypadku wirusów¹¹
Szczytowa zachorowalność dla podróżnych z USA przypada na czerwiec i październik¹³

Czynniki ryzyka epidemiologicznego

Ryzyko zachorowania na biegunkę podróżnych jest determinowane przez liczne czynniki, które można podzielić na środowiskowe i związane z gospodarzem:⁸¹⁴

Czynniki środowiskowe:

Miejsce docelowe podróży – główny czynnik determinujący ryzyko zachorowania¹⁵
Warunki higieniczne w restauracjach lokalnych i deficyty w infrastrukturze sanitarnej¹
Konsumpcja żywności od ulicznych sprzedawców – szczególnie wysokie ryzyko⁸
Podróże obejmujące wiele destynacji – wyższy wskaźnik zachorowań w porównaniu z wizytą w jednej lokalizacji¹⁴
Wycieczki all-inclusive – wyższa zachorowalność, prawdopodobnie z powodu nadmiernego spożycia napojów alkoholowych¹⁴

¹⁶

Czynniki związane z gospodarzem:

Wiek – najwyższa zachorowalność wśród osób młodych (15-30 lat)¹⁴¹⁷
Kraj pochodzenia – podróżni z krajów rozwiniętych mają wyższe ryzyko⁴
Predyspozycje genetyczne¹⁴
Wcześniej istniejące choroby, szczególnie zaburzenia żołądkowo-jelitowe¹⁴
Niedobór kwasów żołądkowych¹⁴
Stan immunologiczny – osoby z obniżoną odpornością są bardziej podatne¹⁵

Interesujący jest fakt, że czas pobytu również wpływa na ryzyko zachorowania – najwyższe ryzyko występuje w pierwszych dwóch tygodniach podróży.⁴ Badanie przeprowadzone na długoterminowych podróżnych wykazało, że skumulowana częstość występowania biegunki podróżnych wynosiła 36,3 przypadków na 100 osobomiesięcy, z najwyższą zachorowalnością w pierwszym miesiącu podróży.¹⁸

Nadzór nad biegunką podróżnych

Nadzór epidemiologiczny nad biegunką podróżnych jest kluczowy dla zrozumienia jej rozprzestrzeniania, identyfikacji nowych patogenów i opracowania skutecznych strategii zapobiegawczych.¹⁹ Systemy nadzoru dostarczają cennych danych na temat częstości występowania, etiologii i wzorców oporności na antybiotyki.

Globalne systemy nadzoru

Jednym z najważniejszych systemów nadzoru jest GeoSentinel Surveillance Network, który zbiera dane od podróżnych na całym świecie.²⁰ Ten system dostarcza informacji o geograficznym rozmieszczeniu patogenów powodujących biegunkę podróżnych oraz o zmianach w ich częstości występowania w czasie.

Innym ważnym aspektem nadzoru jest monitorowanie pojawiających się patogenów. Dane nadzorcze wskazują na potencjalną rolę nowych patogenów w etiologii biegunki podróżnych, takich jak:¹²

Aeromonas spp.
Plesiomonas spp.
Aliarcobacter
Enterotoksyczny Bacteroides fragilis
Larobacter

Zmiany w nadzorze w ostatnich dekadach

W ciągu ostatnich dekad nastąpiły istotne zmiany w metodach nadzoru nad biegunką podróżnych. Tradycyjne metody oparte na kulturach bakteryjnych są coraz częściej uzupełniane lub zastępowane nowoczesnymi technikami diagnostycznymi, takimi jak reakcja łańcuchowa polimerazy (PCR) i inne metody molekularne, które oferują szybką, czułą i specyficzną detekcję patogenów bakteryjnych, wirusowych i pasożytniczych.²¹

Szczególnie istotna jest coraz szersza implementacja nadzoru nad kolonizacją podróżnych przez bakterie produkujące beta-laktamazy o rozszerzonym spektrum (ESBL-PE). Badania wykazują, że podróżni mogą zostać skolonizowani przez ESBL-PE, a ryzyko to wzrasta przy ekspozycji na antybiotyki podczas pobytu za granicą.²²²³ Jest to istotny problem z perspektywy zdrowia publicznego, ponieważ podróżni mogą wprowadzać oporne bakterie do swoich społeczności po powrocie do domu.

Etiologia biegunki podróżnych w świetle danych nadzoru

Dane z systemów nadzoru epidemiologicznego pozwalają na określenie głównych patogenów odpowiedzialnych za biegunkę podróżnych. Bakterie są najczęstszą przyczyną, odpowiadając za 80-90% przypadków.²⁴¹² Najczęstsze patogeny to:

Escherichia coli enterotoksyczna (ETEC) – najczęstsza bakteryjna przyczyna²⁵
Escherichia coli enteroagregacyjna (EAEC)²⁶
Campylobacter jejuni²⁴
Gatunki Shigella²⁴
Gatunki Salmonella²⁴
Wirusy (np. norowirus, rotawirus) – stanowią mniejszy odsetek przypadków²⁴
Pasożyty (np. Giardia, Cryptosporidium)²⁴

Warto zauważyć, że rozkład patogenów różni się w zależności od regionu geograficznego. Na przykład, w badaniu przeprowadzonym w Tajlandii stwierdzono, że Plesiomonas, Vibrio, Campylobacter i norowirus są ważnymi patogenami powodującymi ostrą biegunkę wśród podróżnych i ekspotów przebywających w Bangkoku.²⁷ Natomiast w badaniu przeprowadzonym w Peru zidentyfikowano norowirus (14% próbek), ETEC (11%), Campylobacter (9%), Shigella (6%), EAEC (4%), Giardia (4%) i Cryptosporidium (3%).¹⁰

Nadzór wśród specjalnych grup populacyjnych

Ważnym aspektem nadzoru jest monitorowanie biegunki podróżnych wśród specjalnych grup populacyjnych, takich jak personel wojskowy. Personel wojskowy jest szczególnie narażony na biegunkę podróżnych podczas misji zagranicznych, co może mieć znaczący wpływ na operacje wojskowe, od obniżonej wydajności pracy do utraconych dni służby.²⁸

Badania przeprowadzone wśród personelu wojskowego wykazały podobne wskaźniki zachorowalności jak w przypadku cywilnych długoterminowych podróżnych. Czynniki ryzyka obejmują pierwszą podróż lub misję, podróż lub misję do krajów rozwijających się, młodszy wiek i brak ostrożności dietetycznej.²⁹

Inną specjalną grupą są sportowcy uczestniczący w międzynarodowych zawodach. Badanie przeprowadzone podczas wydarzenia przed-olimpijskiego Aquec Rio 2015 miało na celu ocenę epidemiologii i wpływu biegunki podróżnych na uczestników zawodów żeglarskich w Rio de Janeiro.³⁰ Tego typu nadzór jest kluczowy dla zapewnienia zdrowia i bezpieczeństwa uczestników dużych międzynarodowych wydarzeń sportowych.

Znaczenie nadzoru epidemiologicznego

Nadzór nad biegunką podróżnych ma kilka kluczowych zastosowań i korzyści:³¹³²

Implikacje dla porad zdrowotnych dla podróżujących

Dane z nadzoru epidemiologicznego są niezbędne do opracowania odpowiednich zaleceń dla podróżnych. Badania pokazują, że 94% podróżnych do Cusco w Peru szuka jakiegoś rodzaju wskazówek profilaktycznych przed podróżą.³² Jednakże, podróżni z Ameryki Północnej do Peru rzadziej niż podróżni z Europy Zachodniej szukają porad przed podróżą od specjalisty medycyny podróży (37% vs 45,8%) i od pracownika służby zdrowia (52,0% vs 67,1%).³²

Istnieje potrzeba lokalnych, regionalnych i krajowych wytycznych opartych na dowodach naukowych. Najbardziej aktualne wytyczne dotyczące zapobiegania i leczenia biegunki podróżnych zostały opracowane przez International Society of Travel Medicine (ISTM).³³ Różnice między różnymi wytycznymi dotyczą głównie zaleceń dotyczących stosowania profilaktycznych antybiotyków.³⁴

Monitorowanie oporności na antybiotyki

Nadzór epidemiologiczny odgrywa kluczową rolę w monitorowaniu wzorców oporności na antybiotyki wśród patogenów powodujących biegunkę podróżnych. Jest to szczególnie ważne w kontekście rosnącej oporności na chinolony/fluorochinolony w niektórych regionach.³⁵

Profilaktyczne stosowanie antybiotyków nie zapewnia ochrony przed patogenami niebakteryjnymi i może usunąć normalnie ochronną mikroflorę z jelit, zwiększając ryzyko nabycia opornych patogenów bakteryjnych.²²²³ Podróżni, którzy przyjmują antybiotyki, są narażeni na ryzyko kolonizacji przez organizmy oporne na leki, co może prowadzić do potencjalnej szkody dla podróżnych – szczególnie osób z obniżoną odpornością i osób podatnych na infekcje dróg moczowych – oraz do możliwości wprowadzenia opornych bakterii do społeczności.²³

Ocena skuteczności interwencji profilaktycznych

Dane z nadzoru epidemiologicznego pozwalają na ocenę skuteczności różnych interwencji profilaktycznych. Na przykład, badania wykazały, że tam, gdzie zapewniono skuteczne kursy dotyczące obchodzenia się z żywnością, ryzyko biegunki podróżnych zmniejszyło się.¹²

Jednakże, przestrzeganie zaleceń mających na celu zmniejszenie ekspozycji na patogeny poprzez unikanie niebezpiecznych produktów żywnościowych jest słabe wśród podróżnych ze wszystkich krajów.³⁶ Wdrażanie programów edukacyjnych dotyczących bezpieczeństwa żywności może być trudne do osiągnięcia.³⁷

Identyfikacja długoterminowych następstw biegunki podróżnych

Nadzór epidemiologiczny pozwala również na identyfikację długoterminowych następstw biegunki podróżnych, takich jak zespół jelita drażliwego po infekcji (PI-IBS). Badania wykazują, że do 17% pacjentów, którzy przebyli biegunkę podróżnych, może doświadczać przewlekłych zaburzeń jelitowych.³⁸

PI-IBS jest jednym z głównych problemów po chorobach żołądkowo-jelitowych u personelu wojskowego.³⁹ Rola mikrobiomy jelitowej w biegunce podróżnych zaczyna być badana, z obiecującymi wskazówkami dotyczącymi jej roli w oporności i podatności na biegunkę podróżnych.³⁹

Wyzwania i przyszłe kierunki w nadzorze nad biegunką podróżnych

Pomimo postępów w nadzorze epidemiologicznym nad biegunką podróżnych, istnieje kilka wyzwań i potencjalnych kierunków przyszłych badań:¹⁸¹⁹

Ograniczenia obecnych systemów nadzoru

Nadzór oparty na obiektach medycznych może nie odzwierciedlać prawdziwej częstości występowania biegunki podróżnych, ponieważ wielu podróżnych nie szuka pomocy medycznej
Ograniczona dostępność danych z niektórych regionów geograficznych
Trudności w standaryzacji definicji przypadków i metod diagnostycznych
Wyzwania związane z identyfikacją przyczynowego związku między patogenami obecnymi w kale a chorobą biegunkową³²

Potrzeba ściślejszego nadzoru epidemiologicznego

Istnieje potrzeba ściślejszego nadzoru epidemiologicznego ze względu na globalne zmiany epidemiologiczne w czynnikach etiologicznych i wzorcach oporności na antybiotyki.¹⁹ Oczekuje się zmian w następnej dekadzie z powodu pojawienia się oporności i stosowania szczepionek przeciwko biegunce podróżnych.

Szczegółowa charakterystyka czynników ryzyka i zmian w dystrybucji patogenów wśród podróżnych z różnych regionów wymaga dalszych badań.³¹ Nasze zrozumienie biegunki podróżnych i jej wpływu na podróżnych będzie ewoluować wraz z poprawą metod nadzoru.

Rola nowoczesnych technologii w nadzorze

Nowoczesne technologie, takie jak metody diagnostyki molekularnej, oferują nowe możliwości dla nadzoru nad biegunką podróżnych. Te metody pozwalają na szybką i dokładną identyfikację patogenów, w tym tych, które są trudne do wykrycia za pomocą tradycyjnych metod.²¹

Ponadto, badania mikrobiomowe otwierają nowe możliwości zrozumienia roli mikrobioty jelitowej w biegunce podróżnych. Analizy mikrobiomowe dostarczają ciekawych wskazówek dotyczących jej roli w biegunce podróżnych, z bakteriami Ruminiclostridium spp. związanymi z opornością i niehodowanymi taksonami Ruminococcaceae UCG-013 związanymi z podatnością na biegunkę podróżnych.³⁹

Implikacje dla profilaktyki i leczenia

Dane z nadzoru epidemiologicznego są kluczowe dla opracowania skutecznych strategii profilaktyki i leczenia biegunki podróżnych. Ze względu na znaczenie zespołu jelita drażliwego po biegunce podróżnych, potrzebny jest większy nacisk na profilaktykę poprzez leki lub szczepionki.¹⁹

Wyzwaniem pozostaje opracowanie skutecznych interwencji profilaktycznych, które byłyby zarówno bezpieczne, jak i akceptowalne dla podróżnych. Profilaktyczne stosowanie antybiotyków nie jest zalecane dla większości podróżnych ze względu na ryzyko rozwoju oporności na antybiotyki.²²

Pomimo tych wyzwań, nadzór epidemiologiczny nad biegunką podróżnych pozostaje kluczowym narzędziem do zrozumienia i kontrolowania tego powszechnego schorzenia wśród podróżnych międzynarodowych. Dane z nadzoru wspierają rozwój lepszych metod zapobiegania, diagnostyki i leczenia, ostatecznie poprawiając zdrowie i jakość życia milionów podróżnych każdego roku.

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Materiały źródłowe

#1 Travelersâ Diarrhea | Yellow Book | CDC
https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html
Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30% to 70% of travelers during a 2-week period, depending on the destination and season of travel. […] Poor hygiene practices in local restaurants and underlying hygiene and sanitation infrastructure deficiencies are likely the largest contributors to the risk for TD. […] Surveillance also points to Aeromonas spp., Plesiomonas spp., and newly recognized pathogens (Aliarcobacter, enterotoxigenic Bacteroides fragilis, Larobacter) as potential causes of TD. […] In South Asia, for example, much higher TD attack rates are reported during the hot months preceding the monsoon. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] However, even in high-income countries, food handling and preparation in restaurants has been linked to diarrhea caused by pathogens such as Shigella sonnei.
#2 Travelersâ Diarrhea | Yellow Book | CDC
https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea
Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30% to 70% of travelers during a 2-week period, depending on the destination and season of travel. […] Poor hygiene practices in local restaurants and underlying hygiene and sanitation infrastructure deficiencies are likely the largest contributors to the risk for TD. […] Surveillance also points to Aeromonas spp., Plesiomonas spp., and newly recognized pathogens (Aliarcobacter, enterotoxigenic Bacteroides fragilis, Larobacter) as potential causes of TD. […] In South Asia, for example, much higher TD attack rates are reported during the hot months preceding the monsoon. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] However, even in high-income countries, food handling and preparation in restaurants has been linked to diarrhea caused by pathogens such as Shigella sonnei.
#3 New Developments in Travelerâs Diarrhea â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/february-2011/new-developments-in-travelers-diarrhea/
Abstract: Travelerâs diarrhea (TD) is a crucial area for research, as it affects millions of tourists each year and creates a large economic burden. […] More than 100 million individuals travel from industrialized countries to developing regions of the tropical or semitropical world each year, placing themselves at risk for developing diarrhea. […] By far, the most common medical illness seen in international travelers is diarrhea. TD occurs in 15â50% of individuals traveling to high-risk regions of tropical or semitropical areas of Latin America, the Caribbean (Haiti and the Dominican Republic), southern Asia, and Africa. Approximately 100 million individuals from developed countries travel each year to one of these high-risk regions, resulting in up to 40 million cases of TD each year.
#4 Travelers’ diarrhea – Wikipedia
https://en.wikipedia.org/wiki/Travelers%27_diarrhea
An estimated 10 million people 20 to 50% of international travelers develop TD each year. It is more common in the developing world, where rates exceed 60%, but has been reported in some form in virtually every travel destination in the world. […] Estimates of the percentage of people affected range from 20 to 50 percent among travelers to the developing world. TD is particularly common among people traveling to Asia (except for Japan and Singapore), the Middle East, Africa, Latin America, and Central and South America. […] The risk is greatest in the first two weeks of travel and among young adults. People affected are more often from the developed world.
#5 Travelers Diarrhea – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459348/
Traveler’s diarrhea is a common ailment in individuals traveling to resource-limited destinations overseas. It is estimated to affect nearly 40 to 60 percent of travelers and is the most common travel-associated condition. […] Estimates place the incidence of travelers diarrhea at 30% to 60% of travelers to resource-limited destinations. Incidence and causal agent vary by destination, with the highest incidence reported in sub-Saharan Africa. Other locations with high incidence include Latin America, the Middle East, and South Asia. Risk factors are typically related to poor hygiene in resource-limited areas. These include poor hygienic practices in food handling and preparation; lack of refrigeration due to inadequate electrical supply; and poor food storage practices.
#6 Approach to Treatment and Prevention of Travelerâs Diarrhea
https://www.uspharmacist.com/article/approach-to-treatment-and-prevention-of-travelers-diarrhea
Travelers diarrhea (TD) is the most common ailment affecting persons from industrialized countries who visit developing areas. Depending upon the region being visited, approximately 30% to 70% of international travelers develop TD, with the highest rates occurring in Latin America, Southern Asia, and Africa. […] According to the CDC, the travelers destination is the most important determinant of risk, with the world divided into three risk grades: low, intermediate, and high. The highest-risk regions for acquiring TD are the Middle East, Latin America, Southern Asia, Mexico, and Africa. Rates of TD in these regions range from 20% to 90% per 2-week stay. Intermediate-risk areas include Eastern Europe, South Africa, and parts of the Caribbean Islands, with TD occurring in approximately 8% to 20% of visitors. The United States, Canada, Australia, New Zealand, Japan, and Western Europe are considered low-risk regions, with TD rates of less than 8%. Travelers who are immunosuppressed or who have a history of inflammatory bowel disease or diabetes are at higher risk for developing TD.
#7 Travelersâ diarrhea: update on the incidence, etiology and risk in military and similar populations â 1990-2005 versus 2005â2015, does a decade make a difference? | Tropical Diseases, Travel Medicine and Vaccines | Full Text
https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0077-1
Travelers diarrhea remains a prevalent illness impacting individuals visiting developing countries, however most studies have focused on this disease in the context of short term travel. This study aims to determine the regional estimates of travelers diarrhea incidence, pathogen-specific prevalence, and describe the morbidity associated with diarrheal disease among deployed military personnel and similar long term travelers. […] Military personnel were evaluated in 69% of studies and non-military long term travelers in 34%, with a median duration of travel of 4.9 months, and travel predominantly to the Middle East, Southeast Asia, and Latin America and the Caribbean. […] The incidence of TD from studies with longitudinal data was 36.3 cases per 100 person-months, with the highest rates in Southeast Asia, Latin America and the Caribbean, and the Middle East, with higher estimates from those studies using self-reporting of disease.
#8 Emerging Options for the Management of Travelersâ Diarrhea â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/supplements/emerging-options-for-the-management-of-travelers-diarrhea/
Other high-risk destinations include some areas in the Middle East and nearly all of Africa (with the exception of South Africa). […] Risk factors for TD are related to the environment and the host. […] Environmental risk factors include the macro-epidemiology, meaning a specific country or region, as well as the micro-epidemiology, such as hotels. […] According to a survey on the incidence of TD at hotels in Jamaica with at least 40 clients, one hotel had zero cases, a few had an incidence of less than 10%, and some exceeded 30%. […] The incidence of TD mirrors the hygienic conditions in the kitchen. […] TD can affect anyone, even guests at 5-star hotels. […] Other environmental risk factors include the characteristics of travel. […] Backpackers who obtain raw or improperly cooked food from street vendors are at highest risk.
#9 Incidence of Travelersâ Diarrhea among Adult Foreign Travelers in Thailand: A Prospective Study in: The American Journal of Tropical Medicine and Hygiene Volume 102 Issue 5 (2020)
https://www.ajtmh.org/view/journals/tpmd/102/5/article-p1009.xml
Travelers diarrhea (TD) is common among foreign travelers to Thailand. We performed a prospective cohort study to determine the TD incidence among foreign adult travelers to Thailand. The cumulative incidences of the participants developing TD were 14.0% (49/349), 23.5% (82/349), and 33.0% (115/349) at 7, 14, and 28 days, respectively. Thailand has been reclassified as an intermediate risk country for TD after being considered a high-risk country. A decade ago, a prospective cohort study among European travelers who visited a clinic and traveled between 1 and 8 weeks around developing countries found a lower TD rate incidence in Thailand than in other regions and reported an incidence of 17.4% for Southeast Asia. Given the lack of updated data or prospective studies to define the incidence of TD in Thailand, we designed this prospective study to estimate the precise incidence of TD and also find updated risk factors associated with the incidence of TD. The cumulative incidence of TD during the first 14 days in this study is higher than the incidences found a decade ago. However, the TD incidence in this study was lower than that found among travelers to Southeast Asia by clinics in the Netherlands and higher than the incidence demonstrated among adult foreign travelers to Thailand. The median duration before TD occurrence in this study was 9 days, and this was longer than that in the study conducted among backpackers in Thailand but shorter than that in a prospective study conducted in Switzerland. We identified factors significantly associated with an increase in TD incidence, namely, age, drinking tap water, and eating street food. Travelers arriving from other Southeast Asian countries or traveling outside Thailand during the follow-up period were also associated with a higher risk of TD. In conclusion, about one-third of adult foreign travelers experienced travelers diarrhea within 28 days after arrival in Thailand. We identified factors, including tap water, street food, hand washing, and travel with children or the elderly, associated with the incidence of TD.
#10 CaseâCase Analysis Using 7 Years of Travelers’ Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru in: The American Journal of Tropical Medicine and Hygiene Volume 96 Issue 5 (2017)
https://www.ajtmh.org/view/journals/tpmd/96/5/article-p1097.xml
During the 7-year passive surveillance period, 230 adults (66% female) aged 1876 (median = 24, interquartile range [IQR] = 7) years with diarrhea were enrolled in the study. […] The diarrhea incidence among cases was 2.2 episodes per 90 person-days (230/9,417.5) in Cusco. […] A pathogen was identified in 45% of 230 cases. […] NV was identified in 14% of samples (6 GI, 26 GII), ETEC in 11%, Campylobacter in 9%, Shigella in 6%, EAEC in 4%, Giardia in 4%, and Cryptosporidium in 3%. […] Coinfections with more than one pathogen were identified in 12 (5%) participants. […] NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. […] Destination-specific risk factors include consumption of the local beverage chicha, which was associated with Cryptosporidium infection.
#11 New Developments in Travelerâs Diarrhea â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/february-2011/new-developments-in-travelers-diarrhea/
The risk of acquiring TD in a region is influenced by a number of factors, including the level of food contamination, the season (ie, rainy seasons are associated with a higher risk than dry seasons for TD caused by most enteric bacterial pathogens, with the opposite true for viruses), the local weather conditions, and the type of travel (ie, camping and backpacking are associated with a higher risk of TD than business travel). […] It appears that the rate of TD in high-risk regions has not changed significantly in the past 50 years. […] TD rates for travel to intermediate-risk regions, such as China, Russia, and some of the Caribbean islands, range from 8% to 15%. […] Individuals traveling from 1 low-risk area to another low-risk area have a low likelihood of developing TD (~4%) during their visit.
#12 Travelersâ Diarrhea | CDC Yellow Book
https://relief.unboundmedicine.com/relief/view/cdc-yellow-book/204162/all/Travelers%E2%80%99_Diarrhea
Travelers diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30% to 70% of travelers, depending on the destination and season of travel. Poor hygiene practice in local restaurants is likely the largest contributor to the risk for TD. Bacterial pathogens are the predominant risk, thought to account for up to 80%90% of TD. TD occurs equally in male and female travelers and is more common in young adult travelers than in older travelers. In short-term travelers, bouts of TD do not appear to protect against future attacks, and 1 episode of TD may occur during a single trip. In more temperate regions, there may be seasonal variations in diarrhea risk. In south Asia, for example, much higher TD attack rates are reported during the hot months preceding the monsoon. In destinations in which effective food handling courses have been provided, the risk for TD has been demonstrated to decrease. However, even in developed countries, pathogens such as Shigella sonnei have caused TD linked to handling and preparation of food in restaurants. Controlled studies have shown that use of antibiotics reduces diarrhea attack rates by 90% or more. The prophylactic antibiotic of choice has changed over the past few decades as resistance patterns have evolved. Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk of infection with resistant bacterial pathogens. Travelers may become colonized with extended-spectrum -lactamase (ESBL)-producing bacteria, and this risk is increased by exposure to antibiotics while abroad.
#13 Traveler’s Diarrhea
https://mobile.fpnotebook.com/GI/Diarrhea/TrvlrsDrh.htm
Incidence: 20-50% per short visit to endemic area (affects 10 million patients annually) […] Peak Incidence for travelers from U.S. in October and June […] Most common among younger patients (children, teens and young adults) […] Developing countries in Africa, South Asia, Latin America, Middle East […] Highest risk countries: Kenya, Tunisia, Morocco, Egypt, Mexico, Honduras, Thailand, India.
#14 Emerging Options for the Management of Travelersâ Diarrhea â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/supplements/emerging-options-for-the-management-of-travelers-diarrhea/
Trips that involve multiple destinations have a higher incidence rate as compared with a visit to one location. […] The incidence of TD has been shown to be higher in all-inclusive trips, most likely because visitors may overindulge in unlimited alcoholic drinks. […] Consumption of alcohol can result in diarrhea, even without contamination from food and beverages. […] There are several host risk factors. […] In all studies, the incidence of TD is highest among young people, ages 15 to 30 years. […] Travelers originating in countries with an intermediate or high risk of TD have a far lower incidence rate compared with those from low-risk countries. […] Also, those who stay in a developing country apparently develop some immunity, which partially protects them for a few months during subsequent travel. […] There may be a genetic predisposition toward developing the disorder. […] Preexisting illnesses, such as gastrointestinal disorders and possibly immunodeficiency, may result in a high risk of TD. […] Lack of gastric acids has also been associated with a high risk.
#15 Travelerâs Diarrhea | AAFP
https://www.aafp.org/pubs/afp/issues/2005/0601/p2095.html
Destination is the most significant risk factor for developing travelers diarrhea. Regions with the highest risk are Africa, South Asia, Latin America, and the Middle East. Travelers who are immunocompromised and those with lowered gastric acidity are more susceptible to travelers diarrhea. […] Food and water contaminated with fecal matter are the main reservoirs for the pathogens that cause travelers diarrhea. Unsafe foods and beverages include salads, unpeeled fruits, raw or poorly cooked meats and seafood, unpasteurized dairy products, and tap water. Eating in restaurants increases the probability of contracting travelers diarrhea and food from street vendors is particularly risky. […] The prevalence of specific organisms varies with travel destination. Available data suggest that E. coli is the predominant cause of travelers diarrhea in Latin America, the Caribbean, and Africa, while invasive pathogens are relatively uncommon.
#16
https://link.springer.com/article/10.1007/BF00145049
Travellers from temperate climates to the tropics of the Third World face a high risk of acquiring traveller’s diarrhea. Epidemiology plays a major role in the exact description of this syndrome. This paper describes the epidemiology of traveller’s diarrhea in 3696 Austrian tourists and the influence of various epidemiologic parameters on incidence is evaluated. […] Destination and season of travel influences attack rates, in particular in the sub-tropics. High (up to app. 60% incidence) and low risk (below 35% incidence) regions can be described, exhibiting risk differences of nearly 100%. Individual parameters, like age and body weight, can influence the risk in an evident manner and, of course, the duration of stay plays a major role. It is pointed out that accommodation and travel characteristics are important factors for risk evaluation, as well as dietary hygiene.
#17 Traveler’s diarrhea: epidemiology and impact on visitors to Fortaleza, Brazil. â Department of Paediatrics
https://www.paediatrics.ox.ac.uk/publications/1532645
OBJECTIVE: To assess the epidemiology and impact of traveler’s diarrhea (TD) among visitors to the city of Fortaleza, Cear, Brazil, as part of a global study on TD carried out in four countries. […] The total diarrhea attack rate was 13.4%. Younger people ( 36 years) had significantly higher TD attack rates than did older persons. […] According to that analysis, characteristics that are slightly predictive of TD are gender, length of stay, and visiting as a tourist rather than for some other purpose. […] TD affected the travel plans and activities of many of the visitors to Fortaleza.
#18 Travelersâ diarrhea: update on the incidence, etiology and risk in military and similar populations â 1990-2005 versus 2005â2015, does a decade make a difference? | Tropical Diseases, Travel Medicine and Vaccines | Full Text
https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0077-1
We estimated a pooled incidence of TD among long-term travelers of 36.3 cases per 100 person-months. […] The rate of seeking care appeared to have increased since the 2006 review. […] This updated review reveals that travelers diarrhea remains a major medical concern among deployed US military and other long-term travelers, with a pooled incidence of over 30 cases per 100 person-months, and the highest incidence in the first month of travel. […] Despite this relative short duration of symptoms, there remains a significant burden of morbidity due to more severe cases, with a high rate of individuals being incapacitated as a result of their illness or requiring IV rehydration. […] While the incidence of diarrheal disease and its associated morbidity among long term travelers does not appear to have changed since the original systematic review, there has been some improvement in the rates of care seeking. […] Diarrheagenic E. coli (ETEC and EAEC, particularly), Campylobacter, and Shigella species remain significant diarrheal pathogens globally, with some variations in prevalence geographically.
#19 New Developments in Travelerâs Diarrhea â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/february-2011/new-developments-in-travelers-diarrhea/
The same rate is also seen in international travelers from high-risk regions who are visiting low-risk regions. […] Recent research has helped to define TD, identify new causes, show the incidence of important complications, and provide recommendations for prevention and therapy. […] Although global epidemiologic changes in etiologic agents as well as antibiotic resistance patterns have been better understood recently, changes should be expected during the next decade due to new prevention and treatment approaches. […] A greater emphasis on TD prevention via drugs or vaccines is needed due to the importance of post-TD functional bowel disease. […] Close epidemiologic surveillance will also be needed, as changes are expected during the next decade due to the emergence of resistance and use of TD vaccines.
#20 DOAJ Logotype
https://doaj.org/article/c167a07175ed4e26ac76667dc17b9661
The present study, wants to highlight and review the most prevalent disease amongst travelers. […] A recent review of GeoSentinel Surveillance Network database, with a very large sample size was the basis for epidemiologic appraisals.
#21
https://ejournal.warmadewa.ac.id/index.php/ijbstm/article/view/10256
Travelers diarrhea (TD) remains a prevalent condition affecting individuals traveling to regions with varying sanitation standards. […] Recent updates highlight the integration of polymerase chain reaction (PCR) and other molecular diagnostic methods that offer rapid, sensitive, and specific detection of bacterial, viral, and parasitic pathogens. […] Emerging research emphasizes the need for a tailored diagnostic approach considering geographic region, patient history, and symptom profile. […] This update underscores the importance of adopting a multifaceted diagnostic strategy to improve the accuracy of TD diagnosis, thereby enhancing patient care and contributing to the development of targeted treatment and preventive measures.
#22 Travelersâ Diarrhea | Yellow Book | CDC
https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html
Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens. […] Travelers can become colonized with extended-spectrum beta lactamase-producing enterobacteriaceae (ESBL-PE), a risk that is increased by exposure to antibiotics while abroad. […] Prophylactic antibiotics are not recommended for most travelers.
#23 Travelersâ Diarrhea | Yellow Book | CDC
https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea
Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens. […] Travelers can become colonized with extended-spectrum beta lactamase-producing enterobacteriaceae (ESBL-PE), a risk that is increased by exposure to antibiotics while abroad. […] Travelers who take antibiotics are at risk of becoming colonized by drug-resistant organisms (e.g., ESBL-PE), resulting in potential harm to travelersparticularly immunocompromised people and people prone to urinary tract infectionsand the possibility of introducing resistant bacteria into the community.
#24 Approach to Treatment and Prevention of Travelerâs Diarrhea
https://www.uspharmacist.com/article/approach-to-treatment-and-prevention-of-travelers-diarrhea
Bacterial pathogens are thought to account for 80% to 90% of TD. The most causative organism is enterotoxigenic Escherichia coli, followed by Campylobacter jejuni, Shigella species, and Salmonella species. Some bacteria release toxins that bind to the intestinal wall and cause diarrhea, while others damage the intestine merely by their presence. Enteric viruses (e.g., rotavirus and norovirus), which occur primarily in infants and children, can cause TD; parasitic pathogens such as Giardia and Cryptosporidium can cause it as well.
#25 Travelerâs Diarrhea
https://www.salixmedical.com/therapeutic-areas/travelers-diarrhea/
TD is the most common travel-associated condition. […] TD affects an estimated 40% to 60% of travelers. […] Bacterial sources represent the most frequent etiology in patients with acute illness; the most common bacterial cause is enterotoxigenic Escherichia coli. […] The most common cause of TD varies geographically, and the causative agent is often not identified as part of diagnosis and management. […] Most cases of TD occur 4 to 14 days after arrival and generally last approximately 1 to 5 days. […] Approximately 8% to 15% of patients have symptoms lasting longer than 1 week, and as many as 2% may have symptoms that last longer than 1 month. […] Potential long-term sequelae, such as chronic gastrointestinal symptoms (particularly irritable bowel syndrome) have been reported.
#26 Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler’s diarrhea | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236703
However, while common diarrhea-causing pathogens have been implicated in the majority of TD cases, a large proportion of cases have no known cause. […] The role of the gut microbiome, both in terms of harboring potential TD-causing pathogens and providing either protection or susceptibility to TD, has not been fully explored. […] Our findings showed that diarrheagenic E. coli pathogens were predominant at this site, with EAEC as the most common, followed by ETEC, EPEC, and STEC. […] These findings show the complexity of TD among deployed military personnel and highlight the challenges in prevention and treatment efforts for multi-microbial infections of bacterial, viral, and protozoan pathogens. […] The potential of these pathogens to cause continued sequelae beyond the duration of deployment may be difficult to detect, especially for National Guard and Army Reserve personnel who return to civilian lives and are not frequently followed by the Military Health System.
#27 Epidemiology and etiology of Travelerâs diarrhea in Bangkok, Thailand, a case-control study | Tropical Diseases, Travel Medicine and Vaccines | Full Text
https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-019-0085-9
Travelers diarrhea (TD) is a common health problem among visitors from developed to developing countries. […] The etiology of TD in adult travelers to Bangkok is largely unknown. […] We conducted a prospective case-control study of patients presenting with TD to Bumrungrad International Hospital in Bangkok, Thailand during 20012003 in order to describe both TD etiology and epidemiology among adult residents of developed countries visiting Thailand. […] Our findings suggest that Plesiomonas, Vibrio, Campylobacter, and norovirus are important pathogens causing acute diarrhea among travelers and expatriates to Bangkok. […] Our study also suggests that composition of diarrhea etiologic agents varies by the travelers nationality. […] Despite these limitations, our findings suggest that facility-based surveillance of TD in Thailand is feasible.
#28 Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler’s diarrhea | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236703
Travelers diarrhea (TD) is the most prevalent illness encountered by deployed military personnel and has a major impact on military operations, from reduced job performance to lost duty days. […] An increasing number of ailments include an altered or aberrant gut microbiome. […] Travelers diarrhea (TD) remains a major risk to deployed military forces worldwide, in addition to its impact on civilian travelers and mobile populations. […] The U.S. military has placed a high priority on the development of effective methods to prevent the most common enteropathogenic diseases. […] Bacterial pathogens, such as enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, and Shigella spp. are often the most frequent causes of TD in both adults and children, with variability among regions around the world.
#29 Travelersâ diarrhea: update on the incidence, etiology and risk in military and similar populations â 1990-2005 versus 2005â2015, does a decade make a difference? | Tropical Diseases, Travel Medicine and Vaccines | Full Text
https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0077-1
In comparison to results from the prior systematic review, there were no significant differences in incidence, pathogen prevalence, or morbidity; however there was a trend toward improved care-seeking by sick individuals. […] The risks for developing acute TD are similar between military and non-military long-term travelers, with first time travel or deployment, travel or deployment to developing nations, younger age, and lack of dietary discretion being common risk factors. […] Our 2006 systematic review highlighted the incidence, etiology, and impact of travelers diarrhea among US military personnel and similar travelers. […] In updating the prior systematic review, we demonstrate how diarrheal illness has changed among long term travelers in the past decade, so that in both the civilian and military populations providers can better manage this prevalent disease using the most current data.
#30 Epidemiology and impact of travellersâ diarrhoea on participants in the pre-Olympic test event Aquec Rio 2015 | British Journal of Sports Medicine
https://bjsm.bmj.com/content/51/21/1572.1
Sailing competitions during the 2016 Olympic Games in Rio de Janeiro took place in the sewage polluted Guanabara Bay. After strong media exposure a year before the Games, World Sailing deployed a medical team to study the impact of the environment on participants, particularly to assess the epidemiology and impact of travellers diarrhoea (TD) on athletes participating in the pre-Olympic test event in August 2015. […] A total of 688 persons participated in the Aquec Rio 2015 sailing event and received a questionnaire from the cross-sectional study; 396 questionnaires were included in the study (response rate 57.6%).
#31 Epidemiology and etiology of Travelerâs diarrhea in Bangkok, Thailand, a case-control study | Tropical Diseases, Travel Medicine and Vaccines | Full Text
https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-019-0085-9
Understanding TD etiology and epidemiology will improve pre-travel health advice, empiric treatment and estimates of vaccine-preventable disease in this population. […] Etiology of TD in Thailand is mainly caused by bacterial origin. […] More detailed characterization of the risk factors and pathogen distribution variations among travelers from different regions warrants further study.
#32 CaseâCase Analysis Using 7 Years of Travelers’ Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru in: The American Journal of Tropical Medicine and Hygiene Volume 96 Issue 5 (2017)
https://www.ajtmh.org/view/journals/tpmd/96/5/article-p1097.xml
Previous work shows that 94% of travelers to Cusco seek some sort of pretravel preventive guidance. […] However, North American travelers to Peru are less likely than western European travelers to seek pretravel preventive medical advice from a travel medicine practitioner (37% versus 45.8%, P0.01) and from a health-care professional (52.0% versus 67.1%, P 0.01). […] Thus, the benefits of reducing TD incidence extend beyond the travel period. […] A casecase approach allows a comparison of symptom severity between pathogens identified in the stool, although it lacks mechanisms to question if a particular pathogen present in the stool is causally related to diarrheal disease. […] To describe the etiology of medically attended TD, evaluate regional risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers from high-income countries, we conducted this casecase analysis of 7 years of prospective surveillance data from adults presenting to a physician in Cusco with TD.
#33 A Review of Guidelines/Guidance from Various Countries Around the World for the Prevention and Management of Travellersâ Diarrhoea: A Pharmacistâs Perspective
https://www.mdpi.com/2226-4787/7/3/107
International travel is growing and pharmacists are well placed to provide travel health services for the prevention and management of travellersâ diarrhoea (TD). […] Currently, whilst many guidelines/guidance exist worldwide for the prevention and management of TD, there is no review that focuses on similarities and differences between these and between guidelines on TD and travel related and non-travel related acute diarrhoea. […] The literature reviewed in this article indicates that where no specific guidelines/guidance existed, some pharmacists used the WHO guidelines (WHO), highlighting a need for local, regional and national evidence based guidelines in these countries. […] The most recent guideline for the prevention and management of TD is set by The International Society of Travel Medicine (ISTM).
#34 A Review of Guidelines/Guidance from Various Countries Around the World for the Prevention and Management of Travellersâ Diarrhoea: A Pharmacistâs Perspective
https://www.mdpi.com/2226-4787/7/3/107
The differences between various guidelines lie in recommendations on the use of prophylactic antibiotics. […] The Australian evidence-based guidelines prepared by the Royal Australian College of General Practitioners (RACGP) recommend using oral rehydration salts to prevent dehydration followed by an antimotility agent, such as loperamide, which is preferred over the diphenoxylate/atropine (Lomotil) combination due to its potential adverse effects profile. […] It is interesting to note that this advice differs from the usual advice to complete a course of antibiotics and advises to keep the rest of the antibiotics for further treatment should TD reoccur. […] The authors who developed the guidelines for the prevention and management of TD have also developed the American College of Gastroenterology (ACG) clinical guideline on diagnosis, treatment, and prevention of non-travel related and travel related acute diarrheal infections in adults.
#35 A Review of Guidelines/Guidance from Various Countries Around the World for the Prevention and Management of Travellersâ Diarrhoea: A Pharmacistâs Perspective
https://www.mdpi.com/2226-4787/7/3/107
Comparison between the guidelines from various countries on the prevention and management of TD showed many similarities regarding recommendations on the use of quinolones/fluoroquinolones in regions where resistance was /is reportedly high to this class of drugs. […] There is a dearth of literature specifically directed towards the role of pharmacists in the prevention and management of TD.
#36 Epidemiology of travelers’ diarrhea: details of a global survey
https://www.zora.uzh.ch/id/eprint/19265/
BACKGROUND: Recent epidemiologic data on travelers’ diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures. […] To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. […] Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. […] TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. […] Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries.
#37 Epidemiology of travelers’ diarrhea: details of a global survey. â Oxford Vaccine Group
https://www.ovg.ox.ac.uk/publications/1532651
Epidemiologic data on travelers’ diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures. To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. Overall, 73,630 short-term visitors completed a questionnaire. The total diarrhea attack rate varied between a high of 54.6% in Mombasa and a low of 13.6% in Fortaleza, but only between 31.5% and 5.4% of all travelers had classic TD. The 14-day incidence rates varied between 19.5% and 65.7%. Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. The impact, measured as incapacity or quality-of-life scores, was very considerable. TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries. […] Implementation of food safety education programs may be difficult to achieve.
#38 Gastrointestinal infections in returned travelers | Fedor | International Maritime Health
https://journals.viamedica.pl/international_maritime_health/article/view/66611
Gastrointestinal infections are one of the most frequent medical conditions diagnosed in patients who travel to tropical or subtropical destinations. The most common disorder occurring in up to 60% travelling people is travelers diarrhea (TD). […] Another issue, which is gaining more and more importance in recent years, is post-infectious irritable bowel syndrome, a chronic disturbance affecting up to 17% of patients, who have had travelers diarrhea. […] This review aims to promote prophylaxis of gastrointestinal disorders and to extend knowledge about their after-effects in returned travelers. […] Steffen R. Epidemiology of travellers’ diarrhea. J Travel Med. 2017; 24(suppl_1): S2S5. CrossRefPubMed […] DuPont H, Khan F. Travelers’ diarrhea: epidemiology, microbiology, prevention, and therapy. J Travel Med. 1994; 1(2): 8493. CrossRef
#39 Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler’s diarrhea | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236703
Post-infectious irritable bowel syndrome (PI-IBS) is one of the major concerns following GI disease in military personnel. […] The role of the gut microbiome in TD is beginning to be explored. […] Our analyses of the gut microbiome provide tantalizing clues into its role in TD, with a Ruminiclostridium spp. associating with resistance and an uncultured Ruminococcaceae UCG-013 taxa associating with susceptibility to TD in this study.