Epidemiology, etiology, and impact of traveler's diarrhea in Jamaica

CONTEXT: Traveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD. OBJECTIVE: To determine epidemiology, etiology, and impact of TD in Jamaica. DESIGN: Two-armed, cross-sectional survey conducted between March 1996 and May 1997. SETTING: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. MAIN OUTCOME MEASURES: Attack and incidence rates of reported diarrhea and of classically defined TD (> or = 3 unformed stool samples in 24 hours and > or = 1 accompanying symptom), incapacity, risk factors, and etiology. RESULTS: The attack rate for diarrhea was 23.6 percent overall, with 11.7 percent having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9 percent (all TD) and 10.0 percent (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3 percent of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species. CONCLUSIONS: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal (Au)

The aetiology of diarrhoea in five hotels in Jamaica

Diarrhoea is a self-limited disease which commonly affects tourists traveling from low risk to high risk destinations. It is estimated to affect 20-50 percent of the residents of industrialized countries who visit a developing country each year. Jamaica and other countries of the Caribbean, Latin America, Sub-Saharan African and South East Asia are considered to be intermediate to high risk tourist destinations. Data generated between 1979 and 1981 estimated that approximately 20 percent of European visitors to the Caribbean are afflicted with travellers' diarrhoea (TD) during their stay. Since the time, tourist arrivals to Jamaica have increased from 0.4 to 1.2 millions. To meet the challenges faced by this rapid growth, significant changes have been made to the tourism product, which may have impacted on the health visitors. Immediately following Jamaica's citation by the US Travel Advisory after an outbreak of typhoid in the parish of Westmoreland in 1991, the country was faced by a threat of a cholera epidemic in neighbouring Latin America. With a view to implementing a strategy for cholera prevention and control of cholera and other foodborne diseases, the Ministry of Health initiated a study of epidemiology and aetiology of TD in Jamaica. The first phase of the study was designed to assess the magnitude of TD amongst travellers to Jamaica, by region and by hotel. Those data have been reported elsewhere. Bacterial enteropathogens cause 80 percent of TD.(AU)