Abstract
BackgroundAcute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care. Multiple types of enteric pathogens can cause travel-acquired AGE and, while bacterial pathogens have a predominant role, the importance of viruses, such as norovirus, is increasingly recognized. There is a lack of information on travel-acquired norovirus incidence among symptomatic and asymptomatic individuals irrespective of healthcare-seeking behavior. Our aim is to estimate the incidence of travel-acquired AGE due to norovirus and to characterize the burden of disease among international travelers from the United States and Europe.MethodsWe describe a prospective cohort study implemented in five US and European sites to estimate the role of AGE due to norovirus among adult international travelers. We enrolled individuals aged 18 years and older who are traveling to regions of moderate-high risk of AGE, or via cruise ship with an international port stop, with a trip duration of 3–15 days. The study will generate a wide range of health and travel-related data for pre-, during, and up to 6-months post-travel. We will identify laboratory-confirmed travel-acquired norovirus infections among both symptomatic and asymptomatic individuals from self-collected whole stool samples tested via quantitative RT-PCR. Coinfections will be identified in a subset of travelers with AGE using a multiplex molecular-based assay.DiscussionThis study is unique in design and breadth of data collected. The prospective collection of health and behavioral data, as well as biologic samples from travelers irrespective of symptoms, will provide useful data to better understand the importance of norovirus AGE among international travelers. This study will provide data to estimate the incidence of norovirus infections and AGE and the risk of post-infectious sequelae in the 6-month post-travel period serving as a baseline for future norovirus AGE vaccination studies. This study will contribute valuable information to better understand the role of norovirus in travel-acquired AGE risk and the impact of these infections on a broad set of outcomes.
Highlights
Acute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care
Our aim is to identify the burden of AGE, those cases caused by norovirus, among travelers leaving from North America and Europe to areas at moderate to high risk of traveler’s diarrhea by utilizing a prospective design that enables attribution of infection to the travel period
We present a unique study design for a broad assessment of the burden of AGE due to norovirus acquired during international travel
Summary
Acute gastroenteritis (AGE) is the leading cause of illness among returning travelers seeking medical care. Travelers’ diarrhea (TD) (loose/watery stools as dominate symptom while traveling or upon return which may include other symptoms, e.g. abdominal cramps, nausea, vomiting) has been estimated to occur in up to 50% of international travelers during the initial 2 weeks of travel, depending upon study methods, population, and destination(s) [5,6,7,8,9]. AGE — usually described as diarrhea — is still the leading diagnosis of ill returning travelers seeking medical care [12,13,14,15,16], as well as illness while abroad among cohorts of travelers from high-resource settings [17, 18]
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