Infections transmitted by the fecal-oral route: developing a global score.

RATIONALE FOR REVIEW: Enteric pathogens circulate widely in low-income countries, exposing residents and travelers to untreated tap water and contaminated foods. A score could enhance awareness for the risk of fecal-oral transmission. A simple score was developed based on the frequency of defecating in the open (country prevalence >1%), occurrence of domestic cholera in the period between 2021 and 2017 (≥1 case in a country in 5 years) and reported typhoid fever cases between 2015 and 2019 (rate >2/105/year).

KEY FINDINGS: Scores were available for 199 of 214 countries; 19% scored 3 (high risk), 47% scored 1 or 2 (moderate risk), and 34% scored 0 (minimal risk). As expected, the percentage of countries scoring 3 was highest in Africa (53%) and lowest in Oceania (0%) and Europe (0%). In contrast, only 2 (4%) countries in Africa scored 0 (Canary Islands and Madeira).

CONCLUSIONS: Travelers, expatriates, and residents should be made aware that tap water and cold beverages are unsuitable for drinking in score 3 countries. The score should help to reduce water- and food-borne illnesses.