Self-Reported Stomach Upset in Travellers on Cruise-Based and Land-Based Package Holidays

Abstract

BackgroundInternational travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays.MethodsA major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers.ResultsFrom summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p<0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p<0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%).ConclusionsIn this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.

‘Holiday sickness’—reported exploratory outcome of over 500 United Kingdom holidaymakers with travellers’ diarrhoea

“…The literature search found no studies of 'travellers diarrhoea' or 'holiday sickness' in a UK based population reporting the incidence of post-infective IBS to date. Reports from the UK have commented on the crude incidence of travellers from the UK reporting symptoms of diarrhoea (25.7%) [9] (44.2%) [10], with another depicting a higher incidence of suffering from illness on land based holidays over cruises due to an evolving more hygienic standard being employed on cruises (7.2% v 4.8% RR = 1.5, p=0.0005) [4].…”

“…There are many reports in the literature regarding the risk of developing 'holiday sickness' or what is more commonly known as 'traveller's diarrhoea' but only a few have specifically examined the prevalence in a UK based population that travels abroad with none reporting the incidence of post infective IBS, [3,4]. A pre-study literature review demonstrated that many studies have examined and reported unusual bacterial breakouts in countries visited, as well as the risk of on-going symptoms, [3,5].…”

Respiratory infections and gastrointestinal illness on a cruise ship: A three-year prospective study

“…In Europe, the SHIPSAN TRAINET Project has developed a similar set of influenza outbreak prevention and response guidelines for cruise ships [13,42]. With the adoption of preventive operations as recommended, the incidence of and their outcome of respiratory and gastrointestinal diseases can improve [43].…”

Gastrointestinal infections in returned travelers

“…has been the most identified pathogen in travelers to Southeast asia (32%), which is important to remember when adjusting the treatment, as there is a high resistance of these strains to commonly used ciprofloxacin [4]. viruses, especially the norovirus species, are often connected with outbreaks of the illness in small travel communities such as passengers of a cruise ship [3,17]. rotavirus infection is a common diarrhea cause in travelers to Mexico [2].…”