Locals get travelers' diarrhea too: risk factors for diarrheal illness and pathogenic E. coli infection across an urban-rural gradient in Ecuador

Abstract:

Objectives: Diarrhea is a common and well-studied cause of illness afflicting international travelers. However, traveler’s diarrhea can also result from travel between high and low disease transmission regions within a country, which is the focus of this study. Methods: We recruited participants for a case-control study of diarrhea at four sites along an urbanrural gradient in Northern Ecuador: Quito, Esmeraldas, Borbón and rural communities outside of Borbón. At each of these sites, approximately 100 subjects with diarrhea (cases) were recruited from Ministry of Health clinics and were age-matched with subjects visiting the same clinics for other complaints (controls). Results: Travelers to urban destinations had higher risk of diarrhea and diarrheagenic E. coli (DEC) infections. Travel to Quito was associated with diarrhea (aOR = 2.01, 95% CI = 1.10-3.68) and travel to Guayaquil (another urban center in Ecuador) was associated with Diffuse Adherent E. coli infection (OR = 2.09, 95% CI = 1.01-4.33). Compared to those not traveling, urban origins were also associated with greater risk of diarrhea in Esmeraldas (aOR = 2.28, 95% CI = 1.20-4.41), and with higher risk of diarrheagenic E. coli infections in Quito (aOR = 2.61, 95% CI = 1.16-5.86), with >50% of travel from Quito and Esmeraldas specified as to another urban destination. Conclusions: This study suggests that individuals traveling from lower transmission regions (rural areas) to higher transmission regions (urban centers) within a single country are at a greater risk of acquiring a diarrhea-related illness. Investments to improve water, sanitation and hygiene conditions in urban areas could …

Año de publicación:

2018

Keywords:

Fuente:

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