Understanding Traveler’s Diarrhea

The Impact of Illness on Travel

Whether traveling for business or leisure, falling ill while away can significantly disrupt plans. Traveler’s diarrhea stands out as the most prevalent illness affecting travelers, often leading to disappointing experiences. This condition primarily impacts individuals journeying from high-income nations to developing regions. The likelihood of experiencing traveler’s diarrhea varies by destination, with South Asia and West or Central Africa presenting the highest risks. Although occurrences have decreased compared to two decades ago, this ailment remains a common issue, causing travelers to miss valuable vacation and work days. Fortunately, research has identified effective strategies to mitigate the risk of infection while traveling. Below, we will explore the primary methods for preventing traveler’s diarrhea.

What Is Traveler’s Diarrhea?

Clinically, traveler’s diarrhea is characterized by the passage of three or more loose stools within a 24-hour period upon reaching a destination, accompanied by at least one additional intestinal symptom such as abdominal pain or cramps. This illness typically spreads through the consumption of contaminated food and water. Symptoms are usually mild and can resolve without treatment in about four to five days.

Causes of Traveler’s Diarrhea

Various bacteria, viruses, and other pathogens can lead to traveler’s diarrhea. The types of germs present can differ based on geographical regions, and subsequent treatment may vary depending on the travel destination. It’s crucial to recognize that an initial episode of traveler’s diarrhea does not provide immunity, and multiple incidents can occur within the same trip.

Risk Factors

The risk of contracting traveler’s diarrhea extends beyond the destination. Age is a significant factor, with young adults being more susceptible due to their potentially higher food intake, increasing the chance of ingesting harmful bacteria. Infants and toddlers are also at a heightened risk and often experience more severe illness. Travelers with pre-existing medical conditions such as stroke, diabetes, inflammatory bowel disease, and AIDS fall into the high-risk category. Consulting a medical professional prior to travel can help identify these individuals and provide necessary preventive measures.

Top 3 Ways to Reduce the Risk of Traveler’s Diarrhea

1. Choose Safe Food and Water Sources

While sampling local cuisine is a highlight of travel, contaminated food and water are leading causes of traveler’s diarrhea. Although travelers can monitor their food and water intake, factors like poor restaurant hygiene are beyond their control. Basic precautions can help minimize risks.

Food Safety

Travelers should exercise caution with street vendors, as they are often associated with food contamination. It is advisable to avoid salads and raw vegetables, unpasteurized dairy products, and condiments served from open containers. Foods that are served hot, as well as freshly and thoroughly cooked meats and fish, are generally safe. Fruits, including tomatoes, can be consumed if washed with clean water and peeled. Hand washing with soap and water before meals is essential; when hands are not visibly dirty, alcohol-based hand sanitizers are also effective.

Water Hygiene

Avoiding tap and well water is crucial, as they may not be safe for consumption. This caution extends to drinks made from unsafe water sources, such as certain juices and ice cubes. Instead, travelers should opt for boiled, bottled, or carbonated beverages. If clean water is unavailable, unsafe water can be treated through heat sterilization, filtration, chemical disinfection, or ultraviolet light.

2. Preventive Treatment with Bismuth Subsalicylate

Bismuth subsalicylate (BSS) is a widely used gastrointestinal medication that can help prevent traveler’s diarrhea. Research indicates that regular intake of BSS for up to three weeks can provide up to 65% protection against this condition. Side effects are minimal when BSS is taken according to recommended doses for less than three weeks. However, individuals taking anticoagulants or salicylates, those allergic to BSS, and young children should avoid this medication.

3. Consider Antibiotics and Vaccine Treatment

Antibiotics and vaccines serve as additional options for preventing traveler’s diarrhea, though they come with higher costs and potential side effects, making them more suitable for high-risk travelers.

Antibiotics

Antibiotics are the most effective preventive measure against traveler’s diarrhea. Fluoroquinolones are commonly prescribed due to their effectiveness against many pathogens responsible for the illness. Despite their protective benefits, fluoroquinolones can cause significant side effects, including tendon damage, and may lead to antibiotic-resistant bacteria.

Vaccines

Dukoral, a vaccine aimed at preventing cholera, has shown limited efficacy against traveler’s diarrhea. Due to its modest protective effects, the Committee to Advise on Tropical Medicine and Travel (CAMAT) recommends Dukoral primarily for high-risk, short-term travelers. Other vaccines are currently undergoing development and may be available in the future.

Conclusion

In summary, traveler’s diarrhea is a common concern for individuals traveling from high-income to developing countries. Exercising caution regarding food and water hygiene is a fundamental step in reducing infection risk. Additionally, medications such as BSS, antibiotics, and vaccines can be effective preventive measures. Seeking medical advice before travel can further assist in identifying high-risk travelers and implementing appropriate precautions.

Author Information

Written by Raffaele Camasta, PhD.

References

Giddings, S. L., Stevens, A. M., & Leung, D. T. (2016). Traveler’s Medical Clinics of North America, 100(2), 317–330.
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.
Steffen, R. (2005). Epidemiology of Traveler’s Diarrhea. Clinical Infectious Diseases, 41(Supplement_8), S536–S540.
CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2018 [cited 2018 Dec 12]. Traveller’s Diarrhea. Available from: http://www.e-cps.ca