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 Sangster International Airport and 10 hotels in Montego Bay area, Jamaica. Subjects 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 (greater than or equal to 3 unformed stool samples in 24 hours and greater than or equal to 1 accompanying symptom), incapacity, risk factors, and etiology. Results The attack rate for diarrhea was 23.6% overall, with 11.7% having classically defined TD, For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9% (all TD) and 10.0% (classic TD), Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3% of all travelers avoided potentially highrisk 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.