Epidemiology, Etiology, and Impact of Traveler's Diarrhea in Jamaica

Steffen, Robert; Collard, François; Tornieporth, Nadia; Campbell-Forrester, Sheila; Ashley, Deanna; Thompson, Sharon; Mathewson, John J.; Maes, Edith; Stephenson, Barbara; DuPont, Herbert L.; Sonnenburg, Frank von

doi:10.1001/jama.281.9.811

Cited by 158 publications

(119 citation statements)

References 17 publications

(18 reference statements)

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“…Increasing age is negatively correlated with diarrhea (Steffen, 1986;Cobelens et al, 1998). Steffen et al (1999) found that teenagers and young adults were at a higher risk for TD, probably due to their great appetite and consequent ingestion of a higher dose of pathogens. Since the age of the subjects in the present study clustered undter the age of 30 years, this age group is probably to be at a higher risk of acquiring TD than other older age groups.…”

Section: Discussionmentioning

confidence: 99%

“…As in previous studies (Steffen et al, 1999;von Sonnenburg et al, 2000), classic TD was defined as the passage of three or more unformed stools per 24 hours with as least one accompanying symptom such as nausea or vomiting, abdominal pain, fever, or blood in stools. Moderate TD was defined as either the passage of one to two unformed stools with at least one additional symptom, or more unformed stools without additional symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…Ten to 80 percent of travelers suffer from diarrhea (Black, 1990;Cobelens et al, 1998;Steffen, 1986;von Sonnenburg et al, 2000). Although TD is a self-limiting illness that usually resolves spontaneously within a few days, travelers often have to change their itinerary because of it (Hill, 2000;Steffen et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Travelers' Diarrhea Among Japanese Visiting Thailand

et al. 2004

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Abstract:A cross-sectional survey of 327 Japanese short-term travelers (!3 weeks) arriving in Bangkok, Thailand was conducted to assess the incidence of travelers' diarrhea (TD) as well as their symptoms and treatment-seeking behaviors. The incidence of the first episode of TD (FTD) was ascertained retrospectively by questionnaire. Reported by 69 travelers, FTD clustered within the first 8 days of arrival in Thailand, and the incidence rate varied from 2% to 8% with the highest incidence on the third day.Cumulative probability of FTD was 19% for those arriving in Thai directly from Japan, 42 % for those arriving via Southeast Asia, and 25% for those arriving via other regions at Day 7 by the Kaplan-Meier survival analysis. Log rank test revealed a higher FTD risk for travelers arriving via other Southeast Asian countries than for those arriving directly from Japan (P < 0.005). Of all the 69 FTD episodes, 33% had classic TD defined as "3 unformed stools per 24 hours with at least one accompanying symptom, 49% had moderate TD defined as !2 unformed stools with at least one additional symptom or more unformed stools without additional symptoms, and 17% had mild TD defined as with !2 unformed stools without additional symptoms. Cumulative probability of FTD at Day 7 was 12% for classic TD, 25% for classic plus moderate TD and 30% for all the TD. More than 38% of travelers with diarrhea took medicine brought from Japan. Among travelers with classic TD, 35% bought medicine in Thailand, whereas 47-50% of travelers with moderate and mild TD took only rest without any treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Incidence of Travelers' Diarrhea Among Japanese Visiting Thailand

et al. 2004

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“…These limitations mean that we are unable to provide estimates of the risk associated with travelling to tropical regions that take these factors into account. Thirdly, tourism in tropical regions may be followed by chronic diarrhoea, weight loss and fever even in immunocompetent people (STEFFEN et al, 1999). About 2% of travellers with diarrhoea suffer symptoms for more than 1 month after their return and this chronic course is often associated with significant weight loss (ERICSSON & DUPONT, 1993).…”

Section: Discussionmentioning

confidence: 99%

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Furrer

Chan

Weber

et al. 2001

Transactions of the Royal Society of Tropical Medicine and Hygi

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HIV-infected patients from moderate regions who travel in tropical countries may experience clinical disease progression due to exposure to bacteria (including mycobacteria), fungi and parasites. In the Swiss HIV Cohort Study we examined the hypothesis that travelling increases the risk of tuberculosis, wasting syndrome, cryptosporidiosis, isosporiasis, cryptococcosis, coccidiomycosis, histoplasmosis and Salmonella septicaemia. A total of 4549 participants were included (in 1988-98) ofwhom 596 (13' 1%) travelled at least once. During 16 800 person-years of follow-up 23 1 patients developed at least 1 of the diseases of interest. Wasting syndrome was the only diagnosis significantly associated with travelling (hazard ratio 2.16, 95% confidence interval 1.09 to 4.30). The risk ofwasting syndrome ('slim disease') should be taken into account when counselling HIV-infected patients intending to travel in tropical regions.

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“…Pour les mêmes raisons de coût, les études d'évaluation de stratégies préventives sont également difficiles à réaliser. Au-delà de leur intérêt scientifique, elles auraient pourtant une justification financière: la banale diarrhée du voyageur coûte à la collectivité environ 100 euros par voyageur [9] soit, si l'on reprend le chiffre de 700 millions de voyageurs annoncé plus haut, 70 milliards d'euros.…”

Section: Pour Faire Quoi?unclassified

Médecine des voyages

Bouchaud

2003

Med Sci (Paris)

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Médecine des voyages:What's that? C'est en effet la réac-tion fréquente de son interlocuteur lorsque qu'un médecin des voyages décline son activité. La même remarque a dû être entendue lors de la création de la médecine du travail. Ces deux disciplines ont d'ailleurs des similitudes: elles sont d'existence récente (la médecine des voyages n'existe formellement que depuis une vingtaine d'années) et s'intéressent plus particulièrement, mais non exclusivement, au champ de la prévention. Pourquoi une médecine des voyages? Une façon indirecte de répondre est de donner quelques chiffres qui soulignent l'importance que revêt le voyage dans nos sociétés. Il suffit également de se pencher un peu sur notre histoire pour réaliser que le voyage fait partie de l'homme, qui aurait très bien pu s'appeler Homo vagans Pourquoi une médecine des voyages?Sur le plan médical, l'existence d'une médecine des voyages se justifie largement. Là encore quelques chiffres peuvent situer le problème (Tableau I): la proportion des voyageurs se plaignant d'un problème de santé, quel qu'il soit, est de l'ordre de 60 % avec des écarts qui varient de 15 à 78 % selon les études, et la fameuse diarrhée du voyageur, la turista, touche près de un voyageur sur deux [3][4][5][6]. En revanche, certaines maladies typiquement tropicales, particulière-ment redoutées par les voyageurs, sont relativement rares voire très rares: 2 à 3 % pour le paludisme, 3/100000 pour la fièvre thyphoïde et 3/1000000 pour le choléra. Des problèmes de santé beaucoup moins « exotiques » sont plus fréquents et souvent graves: 1/3 des rapatriements sanitaires sont justifiés par des accidents traumatiques, 1/3 par des accidents cardio-vasculaires et près de 1/10 par des décompensations psychiatriques [3,7]. Cet aspect quantitatif global de l'évaluation des risques ne rend pas compte de la diversité des situations. Ainsi, pour MEDECINE/SCIENCES 2003 ; 19 : 489-90

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Epidemiology, Etiology, and Impact of Traveler's Diarrhea in Jamaica

Abstract: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal.

Cited by 158 publications

References 17 publications

Incidence of Travelers' Diarrhea Among Japanese Visiting Thailand

Incidence of Travelers' Diarrhea Among Japanese Visiting Thailand

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Médecine des voyages

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