Seasonal Variation in Etiology of Travelers' Diarrhea

Abstract

The etiology of travelers' diarrhea was studied in 579 adult Finnish tourists participating in two packaged tours to Morocco in the winter (n = 233) and fall (n = 346) of 1989. A research team accompanied the travelers, and a laboratory for enteric pathogens was established in Agadir. At least one pathogen was found in 62% of the 60 diarrhea cases in winter and in 58% of the 111 diarrhea cases in fall. Multiple pathogens were found less often in winter (8%) than in fall (21%, P less than .05). Campylobacter strains were the leading cause of travelers' diarrhea in winter, found alone or with other pathogens in 28% of the cases (but in only 7% in fall), whereas enterotoxigenic Escherichia coli (ETEC) was the most common pathogen in fall, present in 32% of the cases (8% in winter). Both differences are highly significant (P less than .001). Salmonella enterica was almost as common as ETEC in fall (25% of diarrhea cases) but rare in winter (10%, P less than .05). Thus, the etiology of travelers' diarrhea varied according to the season in the same tourist destination. This finding has relevance to both antimicrobial treatment and prophylaxis.

Incidence of Travelers' Diarrhea Among Japanese Visiting Thailand

“…Risk of TD was found to vary by season (Mattila et al, 1992). Since the present study was conducted in the cooler season (January to February) in Thailand, the incidence and cumulative probability of FTD are expected to be higher in the warmer season.…”

“…But in reality, it was similar to that from Japan. this may be due to a seasonal variation (Mattila et al, 1992) and to the inclusion of developed countries such as the U.S. A. and Australia in "other pre-region". Since the January to February Period is winter in India and Nepal and the incidence of diarrhea is low (Hoge et al, 1996), the effect of pre-regions might not reflect strongly on the cumulative probability of FTD in the present study.…”

Behaviors and Perceptions of Japanese Tourists Affecting Diarrheal Illness and Health Care Need Assessment: A Questionnaire Study

“…Several previous clinical-based studies have been focused on identifying etiologic/pathogens, i.e., bacteria, parasites, protozoa and viruses that cause diarrhea (4)(5)(6). Risk factors and seasonal variations in the etiology of diarrhea at various destinations have also been investigated (3,(5)(6)(7)(8)(9).…”

Prevention and self-treatment of travelers' diarrhea

“…and P. shigelloides have also been associated with travel to Asia (148,170). Seasonal variation in the incidence of ETEC infection has been documented in semitropical countries such as Morocco (112) and Mexico (47); ETEC is isolated more commonly in the wet summer and fall months and uncommonly during the dry winters, when Campylobacter acquires greater importance.…”