4 million inhabitants (65%) to 1,943,000 per 163 million inhabi

4 million inhabitants (6.5%) to 1,943,000 per 16.3 million inhabitants (11.9%). This increase largely

reflects travel to the Arab region (305,000 travelers in 1995 vs 968,000 in 2006), including its popular destinations of Turkey (99,000 vs 593,000) and Egypt (26,000 vs 203,000). The number of Dutch travelers to Latin America also showed an annual increase (from 164,000 in 1995 to 378,000 in 2006) particularly for the Caribbean (from 93,000 to 225,000). Travel to Sub-Saharan Africa and Asia fluctuated; the median annual number of travelers was 87,000 and 387,000, respectively. Table 2 shows the region-specific trends in attack rates for hepatitis A, typhoid fever, and shigellosis among Dutch travelers to developing countries. Overall, the attack rate per 100,000 VX809 such travelers declined for hepatitis A from 22.3 to 5.5, for typhoid fever from 5.6 to 1.0, and for shigellosis from 26.8 to 8.4. Among travelers to Latin America, attack rates significantly declined for hepatitis and shigellosis; for typhoid fever, attack rates were low and remained stable. In this region, the Caribbean had the lowest median attack rates; the median typhoid DAPT fever rate was even 0.0. As compared to the other regions, attack rates among travelers in Latin America and the Caribbean were generally

low. For Sub-Saharan Africa, attack rates for all three diseases were high and fluctuated without showing a decrease. Median rates among travelers to Western/Middle

Africa were all higher than among travelers to Eastern/Southern Africa, where the median typhoid fever rate was even 0.0. For the Arab region, attack rates for all three diseases declined significantly. In particular, for the popular tourist destinations of Turkey and Egypt, attack rates dropped substantially. The median typhoid fever rate for Turkey was very low. For Asia, attack rates for Ribonucleotide reductase hepatitis A fluctuated without showing a decrease; for typhoid fever and shigellosis attack rates declined significantly. Median rates for the Indian subcontinent remained high, especially for typhoid fever. As compared to all other world regions, median rates for Thailand/Malaysia were the lowest. Figure 1 shows the trends in HDI, SI, and WSI, respectively. Indices increased for all regions studied. The HDI for all regions increased from 0.622 in 1995 to 0.679 in 2005 (+5.7%) (not shown in Figure 1). Egypt had the biggest increase: 9.5%. Sub-Saharan Africa had the smallest increase: 2.3%. During the study period, HDI levels for Latin America, Turkey, and Thailand/Malaysia were the highest; HDI levels for Sub-Saharan Africa and South Asia were the lowest. The SI for all regions increased from 0.452 in 1995 to 0.539 in 2006 (+8.6%) (not shown in Figure 1). Egypt had the biggest increase: 11.0%. Turkey had the smallest increase: 2.0%.

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