Title: Adhesion of travelers to the measures to prevent from food/water borne diseases and its relation to travelers’ diarrhea
Abstract: Background: Diarrhea is the most common travel related infectious disease. Food and water precautions are supposed to be the most important means to prevent the disease. However, adherence to these measures is not always achieved. Studies on this subject are scarce and most of them do not address the possible association between non-adherence and getting sick. Methods & Materials: To assess the adherence to food and water precautions and its correlation with diarrhea incidence, we invited travelers consulted by one of the doctors from the travel medicine center from the UFRJ (Centro de Informação em Saúde para Viajantes - Cives) between April, 2014 and November, 2015 to participate in the study. Those who accepted were contacted by phone between 28 and 90 days after return and interviewed with the use of a semi-structured questionnaire, evaluating adherence to food and water borne preventive measures instructed during counselling. Diarrhea incidence was also evaluated. Results: From the 128 travelers contacted, 85 were included in the study. Complete adherence to all food and water precautions was reported by 17% of the travelers. Tooth brushing with mineral water had the lowest rate of complete adherence (38%) while refraining from eating street food had the highest (72%). Older age was associated with higher compliance with those measures (p 0.007). Diarrhea occurred in 24% of travelers. All cases were self-limited and had a mean duration of 1.8 days. There was no association between adherence to food and water precautions and diarrhea, except for the use of water purifiers. Those who used chlorinated water had higher incidence of this disease (p 0.03). Conclusion: Most studies report that travelers' diarrhea (TD) can be multifactorial and related to risks that are not under traveler's control. Our study found no association between food and water precaution adherence and occurence of diarrhea. All TD episodes were self-limited and with short duration. Therefore, it is important that during travel counseling, the traveler is informed about the high incidence of TD in some destinations and about the difficulties in its prevention. Foremost, ensure traveler is properly instructed to deal with any TD episode that may occur during the trip.