{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:29:02Z","timestamp":1785403742918,"version":"3.56.0"},"reference-count":18,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>International travel is thought to be a major risk factor for developing gastrointestinal illness in England. Transmission is thought to be more likely in countries which have lower food hygiene standards, poorer sanitation, and lack of access to clean water. However, many studies are conducted within travel clinic settings which may bias findings. Here, we present a case\u2013control study undertaken in returning English travellers in the community conducted with cases of gastrointestinal illness notified to UKHSA.<\/jats:p>\n                  <jats:p>All Cryptosporidiosis, Giardiasis, non-typhoidal Salmonellosis, and Shigellosis cases notified to the UK Health Security Agency (UKHSA) between 01 July 2023 and 15 October 2023 were asked to complete an anonymous electronic questionnaire if travelling during their incubation period. Asymptomatic travellers were recruited as controls via a market research panel and asked to complete the same questionnaire. A destination water, hygiene, and sanitation score were derived from the WHO \u2018Attributable fraction of diarrhoea to inadequate WASH\u2019 dataset. Demographics, travel details, and exposures while travelling were compared by Pearson\u2019s chi-squared test, and pathogen and destination specific multivariable analyses were performed using a forward stepwise approach.<\/jats:p>\n                  <jats:p>A total of 653 cases and 483 controls were included. The odds of being a case were significantly higher when travelling to countries outside of the EU (OR:4.6, 95%CI:3.5\u20136.0; p\u00a0=\u00a0&lt;0.001) and to countries with high-risk WASH score (OR 6.6, 95%CI:4.9\u20139.1; p\u00a0=\u00a0&lt;0.001), particularly Egypt, Mexico, Tunisia, and Turkey. For those travelling to a low-risk destination, eating undercooked meat or fish and swallowing water from environmental water sources were significantly associated with higher odds of illness by multivariable analysis (p\u00a0&lt;\u00a00.05). At high-risk destinations, eating foods consumed on excursions, swallowing water from environmental sources, and eating foods from hotel buffets were significantly associated with higher odds of being a case.<\/jats:p>\n                  <jats:p>Travel to popular tourist destinations is a potentially under-recognized risk factor for acquiring gastrointestinal infections. Exposures at low-risk destinations were broadly similar to risk factors in the UK. Exposures in high-risk destinations highlighted potential risks associated with catered hotels and tourist excursions which should be explored further.<\/jats:p>","DOI":"10.1017\/s0950268826101058","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:13:02Z","timestamp":1769062382000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors associated with acquiring gastrointestinal infections in UK international travellers: a case\u2013control study"],"prefix":"10.1017","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3750-7158","authenticated-orcid":false,"given":"Nicola K","family":"Love","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"},{"id":[{"id":"https:\/\/ror.org\/04xs57h96","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Liverpool"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1328-5094","authenticated-orcid":false,"given":"Yanshi","family":"Yanshi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisha","family":"Katwa","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Mohamed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipti","family":"Patel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"National Travel Health Network and Centre (NaTHNaC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Kirkbride","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sooria","family":"Balasegaram","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00vbvha87","id-type":"ROR","asserted-by":"publisher"}],"name":"UK Health Security Agency North East (UKHSA)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"S0950268826101058_r9","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815002290"},{"key":"S0950268826101058_r12","first-page":"1","article-title":"Travel-related diagnoses among U.S. nonmigrant travelers or migrants presenting to U.S. GeoSentinel sites - GeoSentinel network, 2012-2021","volume":"72","author":"Brown","year":"2023","journal-title":"Morbidity and mortality weekly report Surveillance summaries (Washington, DC: 2002)"},{"key":"S0950268826101058_r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pt.2018.07.004"},{"key":"S0950268826101058_r14","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.20-0053"},{"key":"S0950268826101058_r10","unstructured":"[10] World Health Organization TGHO (2022) Attributable fraction of diarrhoea to inadequate water, sanitation and hygiene. Available from: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/attributable-fraction-of-diarrhoea-to-inadequate-water-sanitation-and-hygiene."},{"key":"S0950268826101058_r15","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.05185-22"},{"key":"S0950268826101058_r11","unstructured":"[11] Office for National Statistics (2022) Travelpac: travel to and from the UK2022. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/leisureandtourism\/datasets\/travelpac."},{"key":"S0950268826101058_r1","unstructured":"[1] Office for National Statistics (2023) Travel trends: 2023 Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/leisureandtourism\/articles\/traveltrends\/2023."},{"key":"S0950268826101058_r8","unstructured":"[8] UK Health Security Agency (2010) Notifiable diseases and causative organisms: how to report. Available from: https:\/\/www.gov.uk\/guidance\/notifiable-diseases-and-causative-organisms-how-to-report."},{"key":"S0950268826101058_r16","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx170"},{"key":"S0950268826101058_r4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1708-8305.2008.00203.x"},{"key":"S0950268826101058_r5","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268824000827"},{"key":"S0950268826101058_r3","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taae008"},{"key":"S0950268826101058_r6","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taw072"},{"key":"S0950268826101058_r7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1937"},{"key":"S0950268826101058_r17","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taw072"},{"key":"S0950268826101058_r13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis052"},{"key":"S0950268826101058_r18","doi-asserted-by":"publisher","DOI":"10.1002\/9781444346961"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268826101058","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:54:54Z","timestamp":1784271294000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268826101058\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":18,"alternative-id":["S0950268826101058"],"URL":"https:\/\/doi.org\/10.1017\/s0950268826101058","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e36"}}