Epidemiology of traveler's diarrhea

Annually, over 75 million international passengers travel to tropical areas, more than 20 million of whom come from industrialized countries. They experience a high rate of traveler's diarrhea (TD), varying from 20 to 56%, which may result in serious limitations to their activities. The cause of TD is considered to be infectious in the overwhelming majority of cases and, apart from differences in relative importance, the list of responsible microbial agents is fairly constant regardless of geographic origin. The ingestion of contaminated food or water is considered to be the principal mode of transmission of the enteric pathogens of TD. Several factors have been proposed as playing a role in the etiogenesis of diarrhea in travelers, including personal (age, socioeconomic status, body weight, preexisting gastrointestinal illnesses), behavioral (mode of travel, standard of accommodation, eating in public places, dietary errors) and travel-related (destination, duration of stay, country of origin, season) factors, which are reviewed in detail.