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No Lettuce, No Ice Cubes

Worldwide travel is increasing, but the last large-scale look at traveler's diarrhea was almost 20 years ago. The first part of a new global study of the disease focused on travelers to Jamaica, where tourism has tripled since 1980.

Of more than 30,000 travelers surveyed before leaving the Montego Bay airport in 1996 and 1997, 23.6 percent reported traveler's diarrhea, with moderate-to-severe symptoms in 85 percent. Diarrhea was more common in 16- to 35-year-olds than those over 55 (26.6 percent vs. 12.1 percent), in honeymooners than business travelers (30.2 percent vs. 16.1 percent), and in those from the U.K. (42 percent) or the U.S. (22.6 percent) than those from Japan (11.7 percent) or Latin America (6.2 percent).

Fewer than 3 percent of those surveyed followed standard dietary precautions. Ninety-five percent had ice cubes; 90 percent had salads; 80 percent had dairy products and tap water; 55 percent had ice cream, hamburgers, or incompletely cooked fish or poultry; and 24 percent ate from street vendors. Only 2 percent took prophylactic medication, usually bismuth subsalicylate. Pathogens were isolated in 31.7 percent of 322 stool specimens from acutely ill hotel guests: most often enterotoxigenic Escherichia coli (ETEC), followed by rotavirus and salmonella.

Comment: This study suggests that traveler's diarrhea is about as common as it was 20 years ago and that most travelers are quite cavalier about precautions. Whether an ETEC vaccine, currently under development, will be cost effective is unknown.

— A Zuger

Published in Journal Watch General Medicine March 23, 1999

Citation(s):

Steffen R et al. Epidemiology, etiology and impact of traveler's diarrhea in Jamaica. JAMA 1999 Mar 3 281 811-817.

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