Quimby FW, Olstad M, Weiner E: Experimental toxic shock syndrome in baboons. Fed Proc 1984, 43:378. Todd JK, Ressman M, Caston SA, Todd 61 Infectious Diseases Newsletter 4(8) August 1985 BH, Wiesenthal AM: Corticosteroid therapy for patients with toxic shock syndrome. JAMA 252:3399-3402, 1984. A Consensus on Travelers' Diarrhea Sherwood L. Gorbach, MD School of Medicine, Tufts University, Boston, Massachusetts Diarrheal illness has plagued travelers for centuries, affecting all social classes. Numerous theories of causation have been advanced and the disease has achieved worldwide fame by its various euphemisms, some of which are lilting, others brackish. Within the glossary of de- scriptive epithets that have been ap- plied to the intestinal agonies of travelers are G.I. trots, Gippy tummy, Casablanca crud, Aden gut, Barsa belly, Turkey trot, Hong Kong dog, Delhi belly, Aztec two-step, Montezuma's revenge, and turista. In recent years a disease associated with Giardia infection acquired by travelers to the Soviet Union has been called "the Trotskys." At times, battles have been decided less by strength of force or ingenuity of plan than by the extent of enteric losses. Interruption of international business or long-planned vacations by intestinal illness has led to finan- cial loss as well as discomfort and disappointment. Of the estimated 300 million in- ternational travelers who will cross the world's frontiers this year, at least 16 million people from in- dustrialized countries will travel to developing countries. Approxi- mately one-third of those traveling to developing countries will get di- arrhea. The economic impact of travelers' diarrhea (TD) is substan- tial, because fear of sickness is one of the major deterrents to tourism. The National Institutes of Health convened a Consensus Conference on Travelers' Diarrhea, which was held in Washington, DC on Decem- ber 28-30, 1984. Summary papers were presented by the leading authorities in this field. A panel of impartial experts heard the evidence, and wrote a consensus statement that provides recommendations to American travelers and their physi- cians. The panel consisted of gastro- enterologists, infectious-disease physicians, biostatisticians, general physicians, and representatives of the travel industry. The summary statement, as well as the complete proceedings, will be published within the next several months. Herein fol- lows a brief summary of their find- ings. Travelers' diarrhea is defined as a syndrome of a twofold or greater increase in the frequency of un- formed bowel movements, com- monly associated with other symp- toms, such as abdominal cramps, nausea, bloating, and urgency. Travelers at risk are defined as per- sons from industrialized countries visiting for a period of up to 1 month in a region or country where there is an increased risk of TD. The major determinant of risk is the destination. High-risk destinations, with incidences of 20-50% of TD, include developing countries of Latin America, Africa, the Middle East, and Asia. Intermediate-risk destina- tions include most of the Southern European countries and a few Caribbean islands. Low-risk destina- tions include Canada, Northern Europe, Australia, New Zealand, the United States, and a number of the Caribbean islands. Travelers' diarrhea is acquired through ingestion of fecally con- taminated food and/or water. The condition is somewhat more com- mon in young adults than older people. It usually occurs within the first week of travel, but can begin at any time during the visit and even after returning home. Travelers who consume raw foods, tap water, ice, unpasteurized milk and dairy prod- ucts, and unpeeled fruit are at in- creased risk. Also, those eating food purchased from street vendors or in restaurants have more risk than those eating in private homes. Tile condition typically causes 4-5 loose watery stools per day, and generally lasts 3-4 days. In an ex- tensive survey of several hundred thousand Swiss travelers, no deaths could be attributed to TD. It is now clear that infectious agents are the primary causes of TD. Enterotoxigenic Escherichia coli (ETEC) are the major pathogens, accounting for 40-70% of cases in various countries. A long litany of other pathogens has been im- plicated, but always in lower num- bers. It does appear, however, that most cases are caused by bacterial agents rather than viral, protozoal, or metazoal organisms. This state- ment is based on the high degree of protection (approximately 90%) afforded by antibacterial drugs. Even with the application of the best cur- rent methods for detecting patho- gens, in various studies 20-50% of cases remain without specific etio- logic diagnosis. This discrepancy is probably related to the inefficiency of our detection methods. The major controversy in this field relates to preventive measures for TD. Four approaches can be fol- lowed: instruction regarding food and beverage consumption; immuni- © 1985 Elsevier SciencePublishing Co., Inc. 0278-2316/85/$0.00+ 2.20