Incidence, Etiology, and Impact of Diarrhea Among Long-Term Travelers (Us Military and Similar Populations): A Systematic Review

Abstract

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.

Diarrheagenic Escherichia coli in sub-Saharan Africa: Status, Uncertainties and Necessities

“…[12,[84][85][86]. ETEC vaccines could therefore be revenue-generating and their development is consequently an area of priority research [11,87]. ETEC is also a major etiologic agent of infantile diarrhea in African countries, which could benefit considerably from vaccine development [66,88].…”

“…(This is probably an overestimate of the true traveller's diarrhea attack rate since Peace Corpers, in their early 20s, have typically had little previous travel experience and are more likely to engage in risky or adventurous behavior) [10]. In many cases, etiologic agents of travellers' and infantile diarrhea are similar but in some cases they are not and the extent to which the etiology of these two syndromes overlap is not precisely known [3,11,12].…”

Global Infectious Disease Surveillance at DoD Overseas Laboratories, 1999–2007

“…[37][38][39][40][41] GEIS partners at NAMRU-3 and WRAIR have additionally conducted revealing studies on the burden of diarrheal diseases among US and coalition troops in the Eurasian theater, recommending more aggressive empiric treatment. [11][12][13][14][42][43][44][45][46][47][48][49][50][51] Last, the DoD-GEIS network has supported the training of thousands of host-country scientists, epidemiologists, physicians, and laboratorians while simultaneously investing in physical laboratory capacity to extend the return on the local training. 52,53 Looking forward, DoD-GEIS expects the five DoD overseas laboratories discussed herein to continue in their current roles, conducting infectious disease surveillance of value to their various stakeholders and serving as health ambassadors around the globe.…”

Facilitated Molecular Typing of Shigella Isolates Using ERIC-PCR

“…Shigella is currently a serious burden on the health of children in impoverished regions and a significant cause of severe diarrhea in travelers 1,2 and military personnel. 3,4 The organism has a very low infectious dose, a welldocumented ability to cause sustained outbreaks from a wide variety of sources, and high rates of infection among close contacts.…”