traveler's diarrhea

Whether you travel for business or leisure, getting sick while traveling is a surprise everyone wants to avoid. Traveler’s diarrhea is the most common illness related to traveling and the culprit of many ruined trips. This ailment typically affects people traveling from high-income countries to developing countries.

The odds of suffering from traveler’s diarrhea may depend on the destination, with South Asia and West or Central Africa being the regions causing the highest risk. Although this illness occurs less frequently than it did two decades ago, it is still very common and causes people to lose vacation and business days while being incapacitated.

The good news is that research has shed some light on what individuals can do to reduce the risk of infection while traveling. Below, we will discuss the top three ways to prevent traveler’s diarrhea.

Before we discuss prevention, let’s talk about what exactly traveler’s diarrhea is and how it affects people.

What is traveler’s diarrhea?

Clinically, traveler’s diarrhea is defined as the passage of three or more loose stools over a 24-hour period upon arrival at a destination accompanied by at least one other intestinal symptom such as abdominal pain or cramps. This illness spreads through the ingestion of contaminated food and water. Symptoms of traveler’s diarrhea are generally mild and resolve without treatment in approximately four to five days.

What causes traveler’s diarrhea?

Several types of bacteria, viruses, and other germs can cause this gastrointestinal disorder. Different germs are present in various regions of the world and treatment choices may depend on travel destinations. It is also important to note that traveler’s diarrhea does not provide protection after a first infection, and multiple episodes might happen in a single trip.

Risk factors

The risk of infection does not only depend on the travel destination. The traveler’s age also plays a role. Young adults are at higher risk for traveler’s diarrhea because they may eat more food and therefore ingest a larger amount of harmful bacteria. Infants and toddlers are also at higher risk of infection and often suffer from a more severe form of the illness.

Travelers with a medical history of stroke, diabetes, inflammatory bowel disease, and AIDS are considered high-risk travelers. These, as well as other pre-existing conditions, make people more likely to suffer from complications of diarrhea. A medical consultation while planning a trip can identify high-risk travelers and provide counseling and preventive treatment when necessary.

Top 3 ways to reduce the risk of traveler’s diarrhea

1. Choose safe food and water sources

Trying out the local cuisine while abroad is often a must, but contaminated food and water are leading causes of traveler’s diarrhea. Unfortunately, while we can easily monitor what water we drink and what food we eat, we have no control over other factors such as poor restaurant hygiene. Nonetheless, travelers should be aware of some basic precautions.

Food safety

Travelers should be wary of street vendors as they are more likely to serve contaminated food. Salads and other raw vegetables, unpasteurized dairy products, and condiments in open bottles should also be avoided.

Food items served piping hot are generally safe. Meats and fish are safe to eat when recently and thoroughly cooked. Fruits (including tomatoes) are safe if washed in clean water and peeled. It is important to remember to wash hands with soap and water before eating. Unless hands are visibly dirty, alcohol-based hand sanitizers are also a good option.

Water hygiene

Tap and well water may not be safe and should be avoided. The same goes for products made from unsafe water sources such as alcoholic drinks, juice, and ice cubes made using tap water. Unsealed bottled drinks should also be avoided.

Safe water sources include boiled, bottled, or carbonated beverages. When clean water is not available, it is possible to treat unsafe water by means of heat sterilization, filtration, chemical disinfection, and ultraviolet light.

traveler's diarrhea

2. Preventive treatment with bismuth subsalicylate

Bismuth subsalicylate (BSS) is a common gastrointestinal drug that can prevent traveler’s diarrhea. A study showed that when taken regularly for up to three weeks, BSS offers up to 65% protection against traveler’s diarrhea. Side effects are also minimal when the drug is taken for less than three weeks at the recommended doses. Individuals taking anticoagulants or salicylates and those allergic to BSS, as well as young children, should avoid this medication.

traveler's diarrhea

3. Consider antibiotics and vaccine treatment

Antibiotics and vaccines are both valid options to prevent traveler’s diarrhea. However, these approaches involve higher costs and undesirable side effects. For these reasons, these medications are ideal only for high-risk travelers.

Antibiotics

Antibiotics are the treatment which offers the best level of protection against traveler’s diarrhea. Fluoroquinolones are effective against many of the microbes causing the illness and are often the antibiotic of choice. Despite offering good protection, fluoroquinolones come with important side effects such as tendon damage. Other concerns with the use of antibiotics are the emergence of resistant bacteria and the risks of infection that come by altering the normal intestinal flora.

Vaccines

Dukoral is a vaccine used to prevent cholera. A study evaluated the efficacy of Dukoral against traveler’s diarrhea and revealed only a small protective effect. Given the limited protection offered, the Committee to Advise on Tropical Medicine and Travel (CAMAT) advises Dukoral for mainly high-risk, short-term travelers. Other vaccines for this disease are under development and may become available in the future.

In summary, traveler’s diarrhea is very common among people traveling from high-income countries to developing countries. Caution about food and water hygiene while abroad is a good start to reduce the risk of infection. Medications such as BSS, antibiotics and vaccines are also valid options. Pre-travel medical consultation can provide advice and identify high-risk travelers.

traveler's diarrhea


Written by Raffaele Camasta, PhD.

References:

  1. Giddings, S. L., Stevens, A. M., & Leung, D. T. (2016). Traveler’s Medical Clinics of North America, 100(2), 317–330.
  2. Steffen, R., Hill, D. R., & DuPont, H. L. (2015). Traveler’s diarrhea a clinical review. JAMA – Journal of the American Medical Association, 313(1), 71–80.
  3. Steffen, R. (2005). Epidemiology of Traveler’s Diarrhea. Clinical Infectious Diseases, 41(Supplement_8), S536–S540.
  4. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2018 [cited 2018 Dec12]. Traveller’s Diarrhea. Available from:http://www.e-cps.ca

Disclaimer: The data provided in this article are for informational purposes only. It is not intended to and should not be relied upon or construed as medical opinion or medical advice regarding any specific issue or circumstance.

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