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 Apoptosis Compound Library 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. In industrialized countries, the incidence of fecal-orally transmitted infections, such as hepatitis A, typhoid fever, and shigellosis, has declined substantially.1–4 Currently, most cases in these countries arise from visits to non-industrialized countries.2 A few studies have addressed trends in hepatitis A or typhoid fever among international travelers, buy Protease Inhibitor Library finding that, over the past decades, their risk of acquiring
hepatitis A or typhoid fever has decreased.5–7 This decline is often attributed to pretravel vaccination and improvements in hygienic and sanitary conditions at travel destinations. However, their absolute or relative contributions are unknown, given the lack of studies on the influence of hygienic factors on the incidence of fecal-orally transmitted diseases. This study analyzes region-specific trends in attack rates of hepatitis A, typhoid fever, and shigellosis among Dutch travelers, combining Dutch travelers’ statistics with information from the national infectious diseases notification system. All three diseases are transmitted through fecally contaminated water or food. Hepatitis A virus (HAV) infection causes an acute viral liver disease and confers lifelong immunity.
It is a common childhood disease in developing countries, but the prevalence of hepatitis A antibodies is low in developed regions.1,8 In the Netherlands, an inactivated HAV vaccine is available O-methylated flavonoid for risk groups, such as travelers, and is almost 100% effective.9 Typhoid fever is a bacterial systemic infection caused by Salmonella enterica serotype Typhi.3,10 Immunity following infection is limited and can be overcome.9 Two parenteral capsular polysaccharide vaccines are available in the Netherlands, and studies report their efficacy at 35% to 70%.11 Shigellosis is a bacterial enteric disease, caused by one of the four serogroups of Shigella. Immunity following infection is type-specific and probably limited.4 No vaccine is available. To study if the attack rates of fecal-orally transmitted diseases in travelers are influenced by improvements in hygienic standards at travel destinations, we compared trends in vaccine-preventable hepatitis A and typhoid fever with trends in non-vaccine-preventable shigellosis.