Update on the Epidemiology of Traveler's Diarrhea in East Africa

Background: Traveler's diarrhea (TD), the most frequent health problem in visitors to subtropical and tropical regions, needs to be reassessed in view of the development of vaccines against its most frequent causative agent, enterotoxigenic Escherichia coli. Methods: Passengers returning from Mombasa to Europe were interviewed by self-applied questionnaires during the flights. Main outcome measures were subjective TD, defined as having had more diarrhea in East Africa than at home, objective TD as traditionally defined, and the cumulative incidence calculated by the method of Kaplan-Meier survival analysis. Results: Subjective TD was reported by 1117 (49.3%) of the 2268 tourists. The cumulative incidence of subjective TD reached 36.7% after a 1-week stay and 47.6% after 2 weeks. Conclusion: Subjective TD attack and incidence rates continue to be high even at frequently visited destinations.