Emerging Infectious Diseases (Oct 2024)

Etiology and Epidemiology of Travelers’ Diarrhea among US Military and Adult Travelers, 2018–2023

  • Melissa S. Anderson,
  • Evelyn W. Mahugu,
  • Hayley R. Ashbaugh,
  • Aaron G. Wellbrock,
  • Maia Nozadze,
  • Sanjaya K. Shrestha,
  • Giselle M. Soto,
  • Rania A. Nada,
  • Prativa Pandey,
  • Mathew D. Esona,
  • Daniel J. Crouch,
  • Michelle Hartman-Lane,
  • Hunter J. Smith

DOI
https://doi.org/10.3201/eid3014.240308
Journal volume & issue
Vol. 30, no. 14
pp. 19 – 25

Abstract

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Travelers’ diarrhea has a high incidence rate among deployed US military personnel and can hinder operational readiness. The Global Travelers’ Diarrhea study is a US Department of Defense­–funded multisite surveillance effort to investigate the etiology and epidemiology of travelers’ diarrhea. During 2018–2023, we enrolled 512 participants at partner institutions in 6 countries: Djibouti, Georgia, Egypt, Honduras, Nepal, and Peru. Harmonized laboratory methods conducted at each partner institution identified >1 pathogens, including Escherichia coli (67%–82%), norovirus (4%–29%), and Campylobacter jejuni (2%–20%), in 403 (79%) cases. Among cases, 79.7% were single infections, 19.6% were double infections, and 0.7% were triple infections. The most common enterotoxigenic E. coli colonization factors identified were CS3 (25%) and CS21 (25%), followed by CS2 (18%) and CS6 (15%). These data can inform best treatment practices for travelers’ diarrhea and support US military health readiness.

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