Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland

Background. Surveillance using admissions to hospital, while being useful, is a poor indicator of the real incidence of disease encountered by travelers. An alternative is self-reported illness among those who attended at a pretravel clinic prior to their travels. Method. Estimates of incidence and risk factors were determined for attendees at a travel clinic in Scotland using a questionnaire. Analysis for risk factors was carried out for those travelers visiting countries in Africa, Asia, or South and Central America, who had traveled for 1 week or more and had returned between 1997 and 2001 (N = 4,856). Multivariate logistic regression was used to test the hypotheses that time abroad and age-group would be significant for both respiratory and diarrheal symptoms regardless of which of the three geographical areas are visited. Results. From 2006 returned questionnaires (response rate = 41.3%), diarrhea and respiratory symptoms were reported by 44.2 and 16.8% of respondents, respectively; the incidence was significantly greater among travelers to Asia for both diarrheal (55.5%) and respiratory (23.7%) symptoms than among travelers to Africa (36.6 and 12.2%, respectively) or South and Central America (39.5 and 16.2%, respectively). For diarrhea, age was a highly significant risk factor for travelers to Asia, South and Central America, and Africa. Being a self-organized tourist/backpacker, traveling to Asia was associated with increased risk, while for Africa and South and Central America visiting family or friends was associated with a lower risk. For travelers to Asia, traveling to the Indian subcontinent was significantly associated with increased risk. Conclusions. The majority of travelers had an adverse event while traveling abroad, with diarrhea and respiratory conditions being especially common despite attending a travel clinic for advice prior to departure. However, the limitations of this surveillance-based strategy have highlighted the requirement for more research to understand more fully the issues of risk and incidence among travelers to high-risk destinations from Scotland.