Travelers' diarrhea: update on the incidence, etiology and risk in military and similar populations - 1990-2005 versus 2005-2015, does a decade make a difference?

Scott Olson, Alexis Hall, Mark S Riddle, Chad K Porter, Scott Olson, Alexis Hall, Mark S Riddle, Chad K Porter

Abstract

Background: 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.

Methods: We updated a prior systematic review to include publications between January 1990 and June 2015. Point estimates and confidence intervals of travelers' diarrhea and pathogen prevalence were combined in a random effects model and assessed for heterogeneity. Eighty-two studies were included in the analysis, including 29 new studies since the prior systematic review.

Results: 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. Sixty-two percent of tested cases were due to bacterial pathogens, with enterotoxigenic E. coli (ETEC), enteroaggregative E. coli (EAEC), and Campylobacter predominating, and significant regional variability. 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. Morbidity remained significant, with 21% being incapacitated or placed sick in quarters (SIQ) by their illness, 15% requiring intravenous fluids, and 3% requiring hospitalization.

Conclusions: 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.

Keywords: Campylobacter; Enteroaggregative E. coli (EAEC); Enterotoxigenic E. coli (ETEC); Long term traveler; Travelers’ diarrhea.

Conflict of interest statement

This study was reviewed and approved by the Naval Medical Research Center IRB.As the data for this systematic review lack subject identifiers or other personal identifying information (PII), consent from individual subjects is not required.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection for inclusion in the updated systematic review. We identified 454 candidate studies for inclusion since the last systematic review by query of electronic bibliographic databases. After review of titles and abstracts, 193 studies were identified for full review, with 164 studies excluded. Thirty studies were identified for inclusion in the final systematic review, with a total of 82 studies when those from the prior review were included
Fig. 2
Fig. 2
Pathogen prevalence of diarrheal illness among long term travelers, 1990–2015. Of those cases for which diagnostic testing was performed, 62% were positive for bacterial pathogens, with viruses (7%) and parasites (4%) being detected at lower rates. ETEC was the most commonly isolated bacterial etiology (44%), followed by EAEC (21%) and Campylobacter spp. (19%). Multiple pathogens were detected in 11% of tested cases and no identified pathogens in 36%
Fig. 3
Fig. 3
Region specific pathogen prevalence of diarrheal illness among long term travelers, 1990–2015. We identified variability of pathogen prevalence across studies from different regions. In Latin America/Caribbean, Africa, and the Middle East, the most common identified pathogen was ETEC, while in SE Asia Campylobacter spp. predominated
Fig. 4
Fig. 4
Incidence of diarrheal illness among long-term travelers, 1990–2016. We found an estimated overall pooled incidence of TD among long-term travelers of 36.3 cases per 100 person-months. Studies included in the prior systematic review (AJTMH, 64(5), 2006) are listed at the top of the forest plot, with studies since that time included at the bottom of the figure (2018 Update). Weights calculated by random effects model

References

    1. Scallan E, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis. 2011;17(1):7–15. doi: 10.3201/eid1701.P11101.
    1. Riddle MS, et al. Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg. 2006;74(5):891–900. doi: 10.4269/ajtmh.2006.74.891.
    1. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers’ diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009;80(4):609–614. doi: 10.4269/ajtmh.2009.80.609.
    1. Kollaritsch H, Paulke-Korinek M, Wiedermann U. Traveler’s diarrhea. Infect Dis Clin N Am. 2012;26(3):691–706. doi: 10.1016/j.idc.2012.06.002.
    1. Al-Abri SS, Beeching NJ, Nye FJ. Traveller’s diarrhoea. Lancet Infect Dis. 2005;5(6):349–360. doi: 10.1016/S1473-3099(05)70139-0.
    1. Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80. doi: 10.1001/jama.2014.17006.
    1. Connor P, Farthing MJ. Travellers’ diarrhoea: a military problem? J R Army Med Corps. 1999;145(2):95–101. doi: 10.1136/jramc-145-02-11.
    1. Sanders JW, et al. Impact of illness and non-combat injury during operations Iraqi freedom and enduring freedom (Afghanistan) Am J Trop Med Hyg. 2005;73(4):713–719. doi: 10.4269/ajtmh.2005.73.713.
    1. Riddle MS, et al. Past trends and current status of self-reported incidence and impact of disease and nonbattle injury in military operations in Southwest Asia and the Middle East. Am J Public Health. 2008;98(12):2199–2206. doi: 10.2105/AJPH.2007.131680.
    1. Riddle MS, Savarino SJ, Sanders JW. Gastrointestinal infections in deployed forces in the Middle East theater: an historical 60 year perspective. Am J Trop Med Hyg. 2015;93(5):912–917. doi: 10.4269/ajtmh.15-0200.
    1. Kendall ME, et al. Travel-associated enteric infections diagnosed after return to the United States, foodborne diseases active surveillance network (FoodNet), 2004-2009. Clin Infect Dis. 2012;54(Suppl 5):S480–S487. doi: 10.1093/cid/cis052.
    1. Greenwood Z, et al. Gastrointestinal infection among international travelers globally. J Travel Med. 2008;15(4):221–228. doi: 10.1111/j.1708-8305.2008.00203.x.
    1. Centers for Disease, C. and Prevention Outbreak of acute gastroenteritis associated with Norwalk-like viruses among British military personnel--Afghanistan, May 2002. MMWR Morb Mortal Wkly Rep. 2002;51(22):477–479.
    1. Thornton SA, et al. Gastroenteritis in US marines during operation Iraqi freedom. Clin Infect Dis. 2005;40(4):519–525. doi: 10.1086/427501.
    1. Bailey MS, et al. Gastroenteritis outbreak in British troops, Iraq. Emerg Infect Dis. 2005;11(10):1625–1628. doi: 10.3201/eid1110.050298.
    1. Egger MS, Davey-Smith G, Altman DG. Systematic Reviews in Health Care. London: BMJ Publishing Group; 2001.
    1. Kaveh GS, Duncan BW, McDonald KM, Wachter RM. Evidence-Based Review Methodology. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. San Francisco, CA: University of California at San Francisco (UCSF)-Stanford University; 2001.
    1. Sanchez JL, et al. Diarrheal disease incidence and morbidity among United States military personnel during short-term missions overseas. Am J Trop Med Hyg. 1998;58(3):299–304. doi: 10.4269/ajtmh.1998.58.299.
    1. Black RE. Epidemiology of travelers’ diarrhea and relative importance of various pathogens. Rev Infect Dis. 1990;12(Suppl 1):S73–S79. doi: 10.1093/clinids/12.Supplement_1.S73.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2.
    1. Adachi JA, et al. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico. Clin Infect Dis. 2003;37(9):1165–1171. doi: 10.1086/378746.
    1. Adkins H, et al. Travelers’ diarrhea among U.S. navy and marine corps personnel during a Western Pacific deployment. Mil Med. 1990;155(3):111–116. doi: 10.1093/milmed/155.3.111.
    1. Armstrong AW, et al. A randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of rifaximin for the prevention of travelers’ diarrhea in US military personnel deployed to Incirlik Air Base, Incirlik, Turkey. J Travel Med. 2010;17(6):392–394. doi: 10.1111/j.1708-8305.2010.00462.x.
    1. Arthur JD, et al. A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis. Am J Trop Med Hyg. 1990;43(6):608–613. doi: 10.4269/ajtmh.1990.43.608.
    1. Beecham HJ, 3rd, Lebron CI, Echeverria P. Short report: impact of traveler’s diarrhea on United States troops deployed to Thailand. Am J Trop Med Hyg. 1997;57(6):699–701. doi: 10.4269/ajtmh.1997.57.699.
    1. Bourgeois AL, et al. Etiology of acute diarrhea among United States military personnel deployed to South America and West Africa. Am J Trop Med Hyg. 1993;48(2):243–248. doi: 10.4269/ajtmh.1993.48.243.
    1. Brown JA, et al. Outcomes of diarrhea management in operations Iraqi freedom and enduring freedom. Travel Med Infect Dis. 2009;7(6):337–343. doi: 10.1016/j.tmaid.2009.09.001.
    1. Buma AH, van Ameijden E, Huyboom M. Morbidity surveillance among Dutch troops during a peace support operation in Cambodia. Mil Med. 1999;164(2):107–111. doi: 10.1093/milmed/164.2.107.
    1. Chen LH, et al. Illness in long-term travelers visiting GeoSentinel clinics. Emerg Infect Dis. 2009;15(11):1773–1782. doi: 10.3201/eid1511.090945.
    1. Cohen D, et al. Pilot study of an extended range of potential etiologic agents of diarrhea in the Israel defense forces. Isr J Med Sci. 1992;28(1):49–51.
    1. Cohen D, et al. Prospective cohort studies of shigellosis during military field training. Eur J Clin Microbiol Infect Dis. 2001;20(2):123–126.
    1. Cohen D, et al. Phenotypic characteristics of enterotoxigenic Escherichia coli associated with acute diarrhea among Israeli young adults. Foodborne Pathog Dis. 2010;7(10):1159–1164. doi: 10.1089/fpd.2009.0510.
    1. DuPont HL, et al. Five versus three days of ofloxacin therapy for traveler’s diarrhea: a placebo-controlled study. Antimicrob Agents Chemother. 1992;36(1):87–91. doi: 10.1128/AAC.36.1.87.
    1. DuPont HL, et al. Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea. Digestion. 1998;59(6):708–714. doi: 10.1159/000007580.
    1. DuPont HL, et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers’ diarrhea. Ann Intern Med. 2005;142(10):805–812. doi: 10.7326/0003-4819-142-10-200505170-00005.
    1. Echeverria P, et al. Diarrhea in U.S. troops deployed to Thailand. J Clin Microbiol. 1993;31(12):3351–3352.
    1. Ericsson CD, DuPont HL, Mathewson JJ. Optimal dosing of ofloxacin with loperamide in the treatment of non-dysenteric travelers’ diarrhea. J Travel Med. 2001;8(4):207–209. doi: 10.2310/7060.2001.24244.
    1. Frickmann H, et al. Surveillance of food- and smear-transmitted pathogens in European soldiers with diarrhea on deployment in the tropics: experience from the European Union training Mission (EUTM) Mali. Biomed Res Int. 2015;2015:573904.
    1. Haberberger RL, Jr, et al. Etiology of acute diarrhea among United States embassy personnel and dependents in Cairo, Egypt. Am J Trop Med Hyg. 1994;51(6):870–874. doi: 10.4269/ajtmh.1994.51.870.
    1. Haberberger RL, Jr, et al. Travelers’ diarrhea among United States military personnel during joint American-Egyptian armed forces exercises in Cairo, Egypt. Mil Med. 1991;156(1):27–30. doi: 10.1093/milmed/156.1.27.
    1. Haberberger RL, et al. Diarrheal disease aboard a U.S. navy ship after a brief port visit to a high risk area. Mil Med. 1994;159(6):445–448. doi: 10.1093/milmed/159.6.445.
    1. Heck JE, Cohen MB. Traveler’s diarrhea. Am Fam Physician. 1993;48(5):793–800.
    1. Herwaldt BL, et al. A multiyear prospective study of the risk factors for and incidence of diarrheal illness in a cohort of peace corps volunteers in Guatemala. Ann Intern Med. 2000;132(12):982–988. doi: 10.7326/0003-4819-132-12-200006200-00009.
    1. Hillel O, Potasman I. Correlation between adherence to precautions issued by the WHO and diarrhea among long-term travelers to India. J Travel Med. 2005;12(5):243–247. doi: 10.2310/7060.2005.12501.
    1. Hoge CW, et al. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA. 1996;275(7):533–538. doi: 10.1001/jama.1996.03530310039030.
    1. Hyams KC, et al. The navy forward laboratory during Operations Desert shield/desert storm. Mil Med. 1993;158(11):729–732. doi: 10.1093/milmed/158.11.729.
    1. Hyams KC, et al. Diarrheal disease during operation desert shield. N Engl J Med. 1991;325(20):1423–1428. doi: 10.1056/NEJM199111143252006.
    1. Hyams KC, et al. The impact of infectious diseases on the health of U.S. troops deployed to the Persian Gulf during operations desert shield and desert storm. Clin Infect Dis. 1995;20(6):1497–1504. doi: 10.1093/clinids/20.6.1497.
    1. Jiang X, et al. Diagnosis of human caliciviruses by use of enzyme immunoassays. J Infect Dis. 2000;181(Suppl 2):S349–S359. doi: 10.1086/315577.
    1. Johnson GP, Weston TD, Ward JE. Treatment of acute diarrhea with norfloxacin during desert storm deployment. Aviat Space Environ Med. 1992;63(8):717–720.
    1. Kasper MR, et al. Diarrhea outbreak during U.S. military training in El Salvador. PLoS One. 2012;7(7):e40404. doi: 10.1371/journal.pone.0040404.
    1. Kuschner RA, et al. Use of azithromycin for the treatment of campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis. 1995;21(3):536–541. doi: 10.1093/clinids/21.3.536.
    1. Lesho EP. Supply consumption and disease surveillance during an overseas training exercise in Southeast Asia. Mil Med. 1994;159(1):53–55. doi: 10.1093/milmed/159.1.53.
    1. Letizia A, et al. Effects of pre-deployment loperamide provision on use and travelers’ diarrhea outcomes among U.S. military personnel deployed to Turkey. Travel Med Infect Dis. 2014;12(4):360–363. doi: 10.1016/j.tmaid.2013.12.007.
    1. Marimoutou C, et al. Self-reporting compared to prospective surveillance to evaluate the incidence of diarrhea among French Army personnel deployed to N’djamena, Chad. J Travel Med. 2011;18(3):217–220. doi: 10.1111/j.1708-8305.2011.00510.x.
    1. Miser WF, Doukas WC, Lillegard WA. Injuries and illnesses incurred by an army ranger unit during operation just cause. Mil Med. 1995;160(8):373–380. doi: 10.1093/milmed/160.8.373.
    1. Monteville MR, et al. Incidence, etiology, and impact of diarrhea among deployed US military personnel in support of operation Iraqi freedom and operation enduring freedom. Am J Trop Med Hyg. 2006;75(4):762–767. doi: 10.4269/ajtmh.2006.75.762.
    1. Murphy GS, Jr, et al. Ciprofloxacin- and azithromycin-resistant Campylobacter causing traveler’s diarrhea in U.S. troops deployed to Thailand in 1994. Clin Infect Dis. 1996;22(5):868–869. doi: 10.1093/clinids/22.5.868.
    1. Oyofo BA, et al. A survey of enteropathogens among United States military personnel during operation bright star ’94, in Cairo, Egypt. Mil Med. 1995;160(7):331–334. doi: 10.1093/milmed/160.7.331.
    1. Oyofo BA, et al. Enteropathogens associated with diarrhea among military personnel during operation bright star 96, in Alexandria, Egypt. Mil Med. 1997;162(6):396–400. doi: 10.1093/milmed/162.6.396.
    1. Oyofo BA, et al. Norwalk-like virus and bacterial pathogens associated with cases of gastroenteritis onboard a US navy ship. Am J Trop Med Hyg. 1999;61(6):904–908. doi: 10.4269/ajtmh.1999.61.904.
    1. Paparello SF, et al. Diarrheal and respiratory disease aboard the hospital ship, USNS-mercy T-AH 19, during operation desert shield. Mil Med. 1993;158(6):392–395. doi: 10.1093/milmed/158.6.392.
    1. Pazzaglia G, Escamilla J, Batchelor R. The etiology of diarrhea among American adults living in Peru. Mil Med. 1991;156(9):484–487. doi: 10.1093/milmed/156.9.484.
    1. Petruccelli BP, et al. Treatment of traveler’s diarrhea with ciprofloxacin and loperamide. J Infect Dis. 1992;165(3):557–560. doi: 10.1093/infdis/165.3.557.
    1. Piyaphanee W, et al. Incidence and impact of travelers’ diarrhea among foreign backpackers in Southeast Asia: a result from Khao san road, Bangkok. J Travel Med. 2011;18(2):109–114. doi: 10.1111/j.1708-8305.2010.00484.x.
    1. de Santi VP, et al. Incidence, etiology, and determinants associated with acute diarrhea among French forces deployed to Chad. J Travel Med. 2011;18(2):115–120. doi: 10.1111/j.1708-8305.2010.00490.x.
    1. Porter CK, et al. Risk of functional gastrointestinal disorders in U.S. military following self-reported diarrhea and vomiting during deployment. Dig Dis Sci. 2011;56(11):3262–3269. doi: 10.1007/s10620-011-1762-3.
    1. Porter CK, et al. The incidence and gastrointestinal infectious risk of functional gastrointestinal disorders in a healthy US adult population. Am J Gastroenterol. 2011;106(1):130–138. doi: 10.1038/ajg.2010.371.
    1. Porter CK, et al. The epidemiology of travelers’ diarrhea in Incirlik, Turkey: a region with a predominance of heat-stabile toxin producing enterotoxigenic Escherichia coli. Diagn Microbiol Infect Dis. 2010;66(3):241–247. doi: 10.1016/j.diagmicrobio.2009.10.002.
    1. Putnam SD, et al. Self-reported description of diarrhea among military populations in operations Iraqi freedom and enduring freedom. J Travel Med. 2006;13(2):92–99. doi: 10.1111/j.1708-8305.2006.00020.x.
    1. Reaves EJ, et al. Outbreak of gastrointestinal illness during operation new horizons in Pisco, Peru, July 2012. MSMR. 2012;19(11):17–19.
    1. Riddle MS, et al. A prospective study of acute diarrhea in a cohort of United States military personnel on deployment to the multinational force and observers, Sinai, Egypt. Am J Trop Med Hyg. 2011;84(1):59–64. doi: 10.4269/ajtmh.2011.10-0093.
    1. Rudland S, et al. The enemy within: diarrheal rates among British and Australian troops in Iraq. Mil Med. 1996;161(12):728–731. doi: 10.1093/milmed/161.12.728.
    1. Salam I, et al. Randomised trial of single-dose ciprofloxacin for travellers’ diarrhoea. Lancet. 1994;344(8936):1537–1539. doi: 10.1016/S0140-6736(94)90350-6.
    1. Sanders JW, et al. Azithromycin and loperamide are comparable to levofloxacin and loperamide for the treatment of traveler’s diarrhea in United States military personnel in Turkey. Clin Infect Dis. 2007;45(3):294–301. doi: 10.1086/519264.
    1. Sanders JW, et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of campylobacter infection. Am J Trop Med Hyg. 2002;67(5):533–538. doi: 10.4269/ajtmh.2002.67.533.
    1. Sanders JW, et al. Diarrheal illness among deployed U.S. military personnel during operation bright star 2001--Egypt. Diagn Microbiol Infect Dis. 2005;52(2):85–90. doi: 10.1016/j.diagmicrobio.2005.02.005.
    1. Scott DA, et al. Norfloxacin for the prophylaxis of travelers’ diarrhea in U.S. military personnel. Am J Trop Med Hyg. 1990;42(2):160–164. doi: 10.4269/ajtmh.1990.42.160.
    1. Sebeny PJ, et al. Hotel clinic-based diarrheal and respiratory disease surveillance in U.S. service members participating in Operation Bright Star in Egypt, 2009. Am J Trop Med Hyg. 2012;87(2):312–318. doi: 10.4269/ajtmh.2012.11-0318.
    1. Sharp TW, et al. Illness in journalists and relief workers involved in international humanitarian assistance efforts in Somalia, 1992-93. J Travel Med. 1995;2(2):70–76. doi: 10.1111/j.1708-8305.1995.tb00630.x.
    1. Sharp TW, et al. Diarrheal disease among military personnel during operation restore Hope, Somalia, 1992-1993. Am J Trop Med Hyg. 1995;52(2):188–193. doi: 10.4269/ajtmh.1995.52.188.
    1. Shlim DR, et al. Persistent high risk of diarrhea among foreigners in Nepal during the first 2 years of residence. Clin Infect Dis. 1999;29(3):613–616. doi: 10.1086/598642.
    1. Stermer E, et al. Is traveler’s diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. Clin Infect Dis. 2006;43(7):898–901. doi: 10.1086/507540.
    1. Taylor DN, et al. Treatment of travelers’ diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Ann Intern Med. 1991;114(9):731–734. doi: 10.7326/0003-4819-114-9-731.
    1. Taylor DN, et al. Helicobacter pylori infection in desert storm troops. Clin Infect Dis. 1997;25(5):979–982. doi: 10.1086/516074.
    1. Thornton SA, et al. Norfloxacin compared to trimethoprim/sulfamethoxazole for the treatment of travelers’ diarrhea among U.S. military personnel deployed to South America and West Africa. Mil Med. 1992;157(2):55–58. doi: 10.1093/milmed/157.2.55.
    1. Tribble DR, et al. Diagnostic approach to acute diarrheal illness in a military population on training exercises in Thailand, a region of campylobacter hyperendemicity. J Clin Microbiol. 2008;46(4):1418–1425. doi: 10.1128/JCM.02168-07.
    1. Tribble DR, et al. Traveler’s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin Infect Dis. 2007;44(3):338–346. doi: 10.1086/510589.
    1. Trivedi KH, et al. The impact of post-infectious functional gastrointestinal disorders and symptoms on the health-related quality of life of US military personnel returning from deployment to the Middle East. Dig Dis Sci. 2011;56(12):3602–3609. doi: 10.1007/s10620-011-1766-z.
    1. Tuteja AK, et al. Development of functional diarrhea, constipation, irritable bowel syndrome, and dyspepsia during and after traveling outside the USA. Dig Dis Sci. 2008;53(1):271–276. doi: 10.1007/s10620-007-9853-x.
    1. Walz SE, et al. Pre-exposure anti-campylobacter jejuni immunoglobulin a levels associated with reduced risk of campylobacter diarrhea in adults traveling to Thailand. Am J Trop Med Hyg. 2001;65(5):652–656. doi: 10.4269/ajtmh.2001.65.652.
    1. Willshaw GA, et al. Isolation of enterotoxigenic Escherichia coli from British troops in Saudi Arabia. Epidemiol Infect. 1995;115(3):455–463. doi: 10.1017/S0950268800058611.
    1. Velasco JM, Valderamat MT, Nogrado K, et al. Diarrheal and respiratory illness surveillance during US-RP Balikatan 2014. MSMR. 2015;22(6):20–23.
    1. Ajami NJ, et al. Seroepidemiology of norovirus-associated travelers’ diarrhea. J Travel Med. 2014;21(1):6–11. doi: 10.1111/jtm.12092.
    1. Chern A, McCoy A, Brannock T, et al. Incidence and risk factors for disease and non-battle injury aboard the hospital ship USNS COMFORT during a Humanitarian Assistance and Disaster Response Mission, Continuing Promise 2011. Trop Dis Travel Med Vaccin. 2016;2(7):1–9.
    1. Sanders JW, Putnam SD, Antosek LE, Rockabrand DM, Hebst J, Tribble DR, Riddle MS, Sharp TW, Monteville MR. A Cross-Sectional Case-Finding Study of Travelers’ Diarrhea Among U.S. Military Personnel Deployed to Iraq. in 54th Annual Meeting of the American Society of Tropical Medicine and Hygiene: Washington, D.C; 2005. .
    1. Hameed JM, et al. Incidence, etiology and risk factors for Travelers’ diarrhea during a hospital ship-based military humanitarian Mission: continuing promise 2011. PLoS One. 2016;11(5):e0154830. doi: 10.1371/journal.pone.0154830.
    1. Hill DR, Beeching NJ. Travelers’ diarrhea. Curr Opin Infect Dis. 2010;23(5):481–487. doi: 10.1097/QCO.0b013e32833dfca5.
    1. Youmans BP, et al. Characterization of the human gut microbiome during travelers’ diarrhea. Gut Microbes. 2015;6(2):110–119. doi: 10.1080/19490976.2015.1019693.
    1. Beckmann C, et al. Gastrointestinal pathogens detected by multiplex nucleic acid amplification testing in stools of pediatric patients and patients returning from the tropics. Infection. 2014;42(6):961–970. doi: 10.1007/s15010-014-0656-7.
    1. Kotloff KL, et al. Global burden of diarrheal diseases among children in developing countries: Incidence, etiology, and insights from new molecular diagnostic techniques. Vaccine. 2017;35(49 Pt A):6783–6789. doi: 10.1016/j.vaccine.2017.07.036.
    1. De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers’ diarrhoea. Cochrane Database Syst Rev. 2000;3:CD002242.
    1. Riddle MS, et al. Trial evaluating ambulatory therapy of Travelers’ diarrhea (TrEAT TD) study: a randomized controlled trial comparing 3 single-dose antibiotic regimens with Loperamide. Clin Infect Dis. 2017;65(12):2008–2017. doi: 10.1093/cid/cix693.
    1. Steffen R. Epidemiology of traveler’s diarrhea. Clin Infect Dis. 2005;41(Suppl 8):S536–S540. doi: 10.1086/432948.
    1. Lalani T, et al. Epidemiology and self-treatment of travelers’ diarrhea in a large, prospective cohort of department of defense beneficiaries. J Travel Med. 2015;22(3):152–160. doi: 10.1111/jtm.12179.
    1. Soonawala D, Vlot JA, Visser LG. Inconvenience due to travelers’ diarrhea: a prospective follow-up study. BMC Infect Dis. 2011;11:322. doi: 10.1186/1471-2334-11-322.
    1. Klem F, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology. 2017;152(5):1042–1054. doi: 10.1053/j.gastro.2016.12.039.
    1. Schrader AJ, Tribble DR, Riddle MS. Strategies to improve Management of Acute Watery Diarrhea during a military deployment: a cost effectiveness analysis. Am J Trop Med Hyg. 2017;97(6):1857–1866. doi: 10.4269/ajtmh.17-0196.
    1. Vargas M, et al. Prevalence of diarrheagenic Escherichia coli strains detected by PCR in patients with travelers’ diarrhea. Clin Microbiol Infect. 1998;4(12):682–688. doi: 10.1111/j.1469-0691.1998.tb00652.x.
    1. Jiang ZD, et al. Prevalence of enteric pathogens among international travelers with diarrhea acquired in Kenya (Mombasa), India (Goa), or Jamaica (Montego Bay) J Infect Dis. 2002;185(4):497–502. doi: 10.1086/338834.
    1. Mattila L, et al. Seasonal variation in etiology of travelers’ diarrhea. Finnish-Moroccan Study Group. J Infect Dis. 1992;165(2):385–388. doi: 10.1093/infdis/165.2.385.
    1. Steffen R, et al. Epidemiology of travelers’ diarrhea: details of a global survey. J Travel Med. 2004;11(4):231–237. doi: 10.2310/7060.2004.19007.
    1. Chapin AR, et al. Prevalence of norovirus among visitors from the United States to Mexico and Guatemala who experience traveler’s diarrhea. J Clin Microbiol. 2005;43(3):1112–1117. doi: 10.1128/JCM.43.3.1112-1117.2005.

Source: PubMed

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