Epidemiology of travelers' diarrhea: details of a global survey.

BACKGROUND: Recent epidemiologic data on travelers' diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures. METHODS: To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. The study period was March 1996 to July 1998. RESULTS: Overall, 73,630 short-term visitors completed a questionnaire. The total diarrhea attack rate varied between a high of 54.6% in Mombasa and a low of 13.6% in Fortaleza, but only between 31.5% and 5.4% of all travelers had classic TD. The 14-day incidence rates varied between 19.5% and 65.7%. Few travelers meticulously avoided potentially dangerous food items, although in India and Kenya most travelers avoided those considered most dangerous. Risk factors were stays exceeding 1 week, age between 15 and 30 years, and residence in the UK. The impact, measured as incapacity or quality-of-life scores, was very considerable. CONCLUSIONS: TD continues to affect vacationers and business travelers as frequently as it did some 20 years ago. Compliance with recommendations to reduce exposure to pathogens by avoiding dangerous food items is poor among travelers from all countries. Implementation of food safety education programs may be difficult to achieve.

Traveler's diarrhea: epidemiology and impact on visitors to Fortaleza, Brazil.

OBJECTIVE: To assess the epidemiology and impact of traveler's diarrhea (TD) among visitors to the city of Fortaleza, Ceará, Brazil, as part of a global study on TD carried out in four countries. METHODS: Within a cross-sectional survey, questionnaires were completed by departing travelers at the Fortaleza airport between March 1997 and February 1998. The questions inquired about demographics, duration of stay, reason for their visit, pretravel health advice they had received, risky food and beverage consumption while in Fortaleza, and quality of life during the visit to Fortaleza in relation to having or not having contracted TD. RESULTS: A total of 12,499 questionnaires were analyzed. The most common reason that the visitors gave for their travel to Fortaleza was a holiday (60.3%). The total diarrhea attack rate was 13.4%. Younger people (< 36 years) had significantly higher TD attack rates than did older persons. Using a logistic regression model, we investigated the visitors' risk factors, including age, gender, length of stay, and trip's purpose. According to that analysis, characteristics that are slightly predictive of TD are gender, length of stay, and visiting as a tourist rather than for some other purpose. Characteristics that protect against contracting TD include being older and traveling for business rather than for some other reason. Of those who were incapacitated by TD, the mean duration of the impairment was 42 hours. CONCLUSIONS: TD affected the travel plans and activities of many of the visitors to Fortaleza. Further, although aware of the health risks, the majority of those travelers did not avoid all potentially contaminated food or beverage items. Given this pattern of behavior, future efforts to combat TD may have to depend on such other alternative strategies as new vaccines.

Soroprevalência para hepatite A e hepatite B em quatro centros no Brasil / Hepatitis A and hepatiti B seroprevalence in four centers in Brazil

Avaliou-se a prevalência de anticorpos para as hepatites A e B em 3.653 indivíduos, em quatro regiöes brasileiras. As prevalências de anti-VHA e de anti-HBc foram 64,7 por cento e 7,9 por cento, respectivamente. Prevalências mais elevadas de anti-VHA (92,8 por cento)e de anti-HBc (21,4 por cento) foram observadas na regiäo Norte. Em outras regiöes, prevalências de anti-VHA acima de 90 por cento foram alcancadas apenas em idades mais avançadas, indicando uma endemicidade intermediária e prevalência significativamente mais elevada foi observada no grupo de baixo nível sócio-econômico, entre 1 e 30 anos. Para o anti-HBc observou-se um aumento na prevalência entre adolescentes e uma prevalência significativamente mais elevada no grupo de baixo nível sócio-econômico, entre 1 e 20 anos. Prevalência de 3,1 por cento foi encontrada em crianças de 1 ano, sugerindo a transmissäo vertical. Os principais resultados deste estudo, indicam que pré-adolescente/adolescentes de algumas cidades brasileiras estäo em risco para as hepatites A e B, mas por diferentes motivos