TitleTravelers’ diarrhea and other gastrointestinal symptoms during and after travel among Boston-area international travelers
AuthorsStoney RJ, Han PV, Barnett ED, Wilson ME, Jentes ES, Benoit CM, Macleod WB, Hamer DH, Chen LH, for the Boston Area Travel Medicine Network
PublicationThe American Journal of Tropical Medicine and Hygiene. 2017 Mar;.


This prospective cohort study describes travelers’ diarrhea (TD) and non-TD gastrointestinal (GI) symptoms among international travelers from the Boston area, the association of TD with traveler characteristics and dietary practices, use of prescribed antidiarrheal medications, and the impact of TD and non-TD GI symptoms on planned activities during and after travel. We included adults who received a pretravel consultation at three Boston-area travel clinics and who completed a three-part survey: pretravel, during travel, and posttravel (2–4 weeks after return). TD was defined as self-reported diarrhea with or without nausea/vomiting, abdominal pain, or fever. Demographic and travel characteristics were evaluated by F2 test for categorical and Wilcoxon rank-sum test for continuous variables. Analysis of dietary practices used logistic generalized estimating equation models or logistic regression models. Of 628 travelers, 208 (33%) experienced TD and 45 (7%) experienced non-TD GI symptoms. Of 208 with TD, 128 (64%), 71 (36%), and 123 (62%) were prescribed ciprofloxacin, azithromycin, and/or loperamide before travel, respectively. Thirty-nine (36%) of 108 took ciprofloxacin, 20 (38%) of 55 took azithromycin, and 28 (28%) of 99 took loperamide during travel. Of 172 with TD during travel, 24% stopped planned activities, and 2% were hospitalized. Of 31 with non-TD GI symptoms during travel, six (13%) stopped planned activities. International travelers continue to experience diarrhea and other GI symptoms, resulting in disruption of planned activities and health-care visits for some. Although these illnesses resulted in interruption of travel plans, a relatively small proportion took prescribed antibiotics
Related ProjectsKnowledge, Attitudes, and Practices of Travelers in the Boston Area Travel Medicine Network (BATMN)