Fecal‐Orally Transmitted Diseases Among Travelers Are Decreasing Due to Better Hygienic Standards at Travel Destination

OBJECTIVE: To evaluate whether changes in attack rates of fecal-orally transmitted diseases among travelers are related to changes in pretravel vaccination practices or better hygienic standards at travel destination. METHODS: National surveillance data on all laboratory-confirmed cases of travel-related hepatitis A, shigellosis, and typhoid fever diagnosed in the Netherlands from 1995 to 2006 were matched with the number of Dutch travelers to developing countries to calculate region-specific annual attack rates. Trends in attack rates of non-vaccine-preventable shigellosis were compared with those of vaccine-preventable hepatitis A and typhoid fever. Trends were also compared with three markers for hygienic standards of the local population at travel destinations, drawn from the United Nations Development Programme database: the human development index, the sanitation index, and the water source index. RESULTS: Attack rates among Dutch travelers to developing regions declined for hepatitis A, shigellosis, and typhoid fever. Region-specific trends in attack rates of shigellosis resembled trends of hepatitis A and typhoid fever. Declining attack rates of the three fecal-orally transmitted diseases correlated with improvements in socioeconomic, sanitary, and water supply conditions of the local population at travel destination. CONCLUSIONS: These findings suggest that improved hygienic standards at travel destination strongly contributed to the overall decline in attack rates of fecal-orally transmitted diseases among visiting travelers.