Abstract
BackgroundLimited data exist documenting the degree to which travelers are inconvenienced by travelers' diarrhea (TD). We performed a prospective follow-up study at the travel clinic of Leiden University Medical Center in The Netherlands to determine the degree of inconvenience and to determine how experiencing TD affects travelers' perception.MethodsHealthy adults who intended to travel to the (sub)tropics for less than two months were invited to take part. Participants filled out a web-based questionnaire before departure and after returning home. TD was defined as three or more unformed stools during a 24-hour period.Results390 of 776 Eligible travelers completed both questionnaires. Participants' median age was 31 years and mean travel duration 23 days. Of 160 travelers who contracted TD (incidence proportion 41%, median duration of TD episode 2.5 days) the majority (107/160, 67%) could conduct their activity program as planned despite having diarrhea. However, 21% (33/160) were forced to alter their program and an additional 13% (20/160) were confined to their accommodation for one or more daylight days; 53 travelers (33%) used loperamide and 14 (9%) an antibiotic. Eight travelers (5%) consulted a physician for the diarrheal illness. When asked about the degree of inconvenience brought on by the diarrheal illness, 39% categorized it as minor or none at all, 34% as moderate and 27% as large or severe. In those who regarded the episode of TD a major inconvenience, severity of symptoms was greater and use of treatment and necessity to alter the activity program were more common. Travelers who contracted travelers' diarrhea considered it less of a problem in retrospect than they had thought it would be before departure.ConclusionConventional definitions of TD encompass many mild cases of TD (in our study at least a third of all cases) for which treatment is unlikely to provide a significant health benefit. By measuring the degree of inconvenience brought on by TD, researchers and policy makers may be able to better distinguish 'significant TD' from mild TD, thus allowing for a more precise estimation of the size of the target population for vaccination or stand-by antibiotic prescription and of the benefit of such measures.
Highlights
Limited data exist documenting the degree to which travelers are inconvenienced by travelers’ diarrhea (TD)
Antibiotics shorten the duration of diarrhea by 0.7-1.5 days and reduce the number of unformed stools per 24 hour time interval by 1.6 on the first day of treatment, 2.1 on the second day, and 1.4 on the third day [7]
We found that approximately one-third of travelers who contracted TD were forced to change their activity program or stay indoors, which is in line with other reports [2,3,13,14,15]
Summary
Limited data exist documenting the degree to which travelers are inconvenienced by travelers’ diarrhea (TD). We performed a prospective follow-up study at the travel clinic of Leiden University Medical Center in The Netherlands to determine the degree of inconvenience and to determine how experiencing TD affects travelers’ perception. A number of studies describe the impact of TD on quality of life and incapacitation [2,3,13,14,15] Of those with TD, 20-45% is unable to pursue planned activities for 1 day and the quality of life is affected, mostly with regard to the ability to participate in leisure activities, sexual activity, and the feeling of general well-being [13]. The present prospective follow-up study was designed to determine the degree of subjective and objective inconvenience that Dutch travelers experience when they contract diarrhea during travel to the (sub)tropics. In addition we determined how an episode of TD affects travelers’ perception of TD and we explored risk factors
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