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

Context Traveler's diarrhea (TD) can incapacitate travelers. Characteristic s 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, J amaica. Subjects To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts, T o investigate etiology, 322 patients (hotel guests) with TD provided stool samples. Main Outcome Measures Attack and incidence rates of reported diarrhea and o f classically defined TD (greater than or equal to 3 unformed stool samples in 24 hours and greater than or equal to 1 accompanying symptom), incapaci ty, risk factors, and etiology. Results The attack rate for diarrhea was 23.6% overall, with 11.7% having c lassically defined TD, For a mean duration of stay of 4 to 7 days, the inci dence rate was 20.9% (all TD) and 10.0% (classic TD), Among airport respond ents, the incapacity lasted a mean of 11.6 hours. Less than 3% of all trave lers avoided potentially highrisk food and beverages. The most frequently d etected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Sal monella 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.