NEW YORK, Jul 10 (Reuters Health) - "Don't drink the water," is the old
advice for tourists. But new study findings suggest that very few travelers to
tropical and subtropical parts of the world where the risk of developing
diarrhea is high actually follow food and beverage recommendations that would
reduce this risk.
"Almost two of three tourists developed traveler's diarrhea during 2-week
stays at high-risk destinations," according to Dr. Robert Steffen from the
University of Zurich in Switzerland, and colleagues. The international team of
researchers analyzed questionnaires completed by more than 65,000 tourists
returning from India, Kenya, Jamaica and Brazil. In addition, almost 1,000
submitted stool samples for analysis, the authors report in the July 8th issue
of The Lancet.
Overall, 61% of those returning from India and 66% returning from Kenya
reported at least mild traveler's diarrhea. Thirty-eight percent of those
returning from Jamaica and 20% of those who traveled to Brazil also reported
symptoms.
British tourists were significantly more likely to report diarrhea than
those from northwestern Europe or North America, the researchers report,
regardless of whether they stayed at the same hotels and ate only at their
hotels.
"Few travelers avoided all potentially contaminated food and beverage
items," state Steffen and colleagues, adding that "most people abstained at
least from most of them" in India and Kenya, considered high-risk destinations
for traveler's diarrhea. The authors note that the rule of "boil it, cook it,
peel it--or forget it" was fully followed by few tourists. High-risk foods
include tap water, ice cubes, dairy products, rare meat, seafood and salads.
Regardless of whether they developed mild or severe illness, the incubation
period for diarrheal disease was the same, and even those with mild cases were
prevented from pursuing planned activities.
Although the bacteria Escherichia coli was the most frequently found
pathogen in tourists' stools, accounting for up to one third of cases, other
bacteria and viruses were also identified, the report indicates.
"Travelers often develop diarrhea during stays in tropical and subtropical
destinations," Steffen and colleagues note. "We suggest that food-safety
programs and future enteric vaccines will reduce the magnitude of this disease."
