Economic Aspects of Travelers’ Diarrhea

Abstract

Travelers’ diarrhea (TD) is a common disease among travelers to developing countries. Although usually self‐limiting, it can disrupt vacations and business trips and cause substantial economic and medical costs. There is abundant information on the epidemiology of TD but only little information on its economic impact. This review provides an overview of the relevant studies and available data to address the various economic aspects of TD and makes an attempt to estimate the costs attributable to TD. The number of international travelers is steadily increasing. The United Nations World Tourism Organization (UNWTO) estimates the number of international tourist arrivals to exceed 800 million in 2005.1 This is an increase of nearly 50% from 1995. UNWTO’s Tourism 2020 Vision forecasts that international arrivals are expected to reach nearly 1.6 billion by the year 2020.1 Of these travelers, an estimated 80 million people travel from industrialized countries to developing countries, some 35.2 million coming from North America (31.7 million from the United States), 25 million from Europe, 11.4 million from Japan, and 3.3 million from Australia/New Zealand (Figure 1).2,3 Figure 1 Travelers from industrialized areas to developing areas 1999 (WTO). WTO = World Tourism Organization. Among travel‐related diseases, TD is the most frequent illness for travelers originating in industrialized countries visiting developing countries.4 Classical TD is defined as three or more unformed stools per 24 hours starting during or shortly after a period of foreign travel, with at least one accompanying symptom, such as fecal urgency, abdominal cramps, nausea, vomiting, fever.5 The attack rate of TD occurrence in high‐risk regions averages 30% to 50%.5–10 Thus, approximately 24 to 40 million people worldwide are affected by TD, including 7.5 to 12.5 million from Europe and 9.5 to 15.9 million from the United States. Although usually a self‐limiting disease, … Corresponding Author: Thomas D. Szucs, MD, MBA, MPH, LLM, Institute for Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH‐8001 Zurich, Switzerland. E‐mail: thomas.szucs{at}ifspm.uzh.chGuest Editor: Herbert L. DuPont, MD