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Robert Steffen, MD; Françoise Collard, MSc; Nadia Tornieporth, MD, DTM&H; Sheila Campbell-Forrester, MD; David Ashley, PhD; Sharon Thompson, MSc; John J. Mathewson, MS, PhD; Edith Maes, MHA; Barbara Stephenson, MSc, PhD; Herbert L. DuPont, MD; Frank von Sonnenburg, MD, MPH

JAMA. 1999;281:811-817.

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, 30,369 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 (3 unformed stool samples in 24 hours and 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 high-risk 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.

Author Affiliations: Division of Epidemiology and Prevention of Communicable Diseases, University of Zurich Institute of Social and Preventive Medicine, Zurich, Switzerland (Dr Steffen); SmithKline Beecham Biologicals, Rixensart, Belgium (Mrs Collard and Dr Tornieporth); Division of International Medicine and Public Health, University of Munich, Munich, Germany (Drs Tornieporth and von Sonnenburg); Western Area Health Administration, Ministry of Health of Jamaica (Drs Campbell-Forrester and Ashley), Department of Microbiology, Cornwall Regional Hospital (Ms Thompson), Montego Bay, Jamaica; Center for Infectious Diseases, University of Texas, Houston (Dr Mathewson); The Lewin Group, Mechelen, Belgium (Mrs Maes); Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Science Centre, Hamilton, Ontario (Dr Stephenson); and St Luke's Episcopal Hospital, Houston (Dr DuPont).

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