Preventing and Treating the Number One Travel Illness - Traveler's Diarrhea

If you are planning international travel for a vacation, a business trip or a holiday you may be at risk for contracting the most common illness affecting travelers, "Traveler's Diarrhea" (TD). Approximately 50,000 travelers per day fall prey to TD. Destination, quality of accommodations , and length of stay are the 3 major variables that contribute to the likelihood of contracting TD.

Traveler's diarrhea is a clinical syndrome resulting from the ingestion of microbial contaminated food and water. Symptoms of TD are: loose, watery or semi-formed stools, urgent in nature, which may or may not be accompanied by abdominal cramping. Associated vomiting may occur in up to 15% of cases. Duration of the illness usually lasts 3-4 days. A similar but much less common syndrome is toxic gastroenteritis, caused by ingestion of pre-formed toxins. Vomiting is the predominate symptom of this syndrome and usually resolves within 12-18 hours.

The Centers for Disease Control and Prevention (CDC) estimates 30-50% of travelers with high- risk destinations will develop traveler's diarrhea during a 1- to 2-week stay. Countries are ranked by the CDC according to risk into 3 categories:

Low-risk countries:
o Australia
o United States
o New Zealand
o Japan
o Northern Europe
o Canada
o Western Europe

Intermediate-risk countries:
o Caribbean Islands
o Eastern Europe
o South Africa

High-risk countries:
o Africa
o Asia
o Central and South America
o Middle East

Traveler's diarrhea is defined more by the circumstances of acquisition that by a specific microbial agent. It may occur during or shortly after traveling and most commonly affects persons traveling from an area of more highly developed hygiene and sanitation infrastructure to a less developed one.
Cases of traveler's diarrhea are most commonly caused by bacteria (80%-85%). Parasites account for approximately 10% and viruses 5%.

Preventative measures are:
o Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
o Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. (My husband's excuse to drink beer.) Avoid tap water, fountain drinks, and ice cubes.
o Do not eat food purchased from street vendors.
o Do not eat undercooked or raw food
o Avoid dairy products, unless you can ascertain they have been pasteurized.
o Peel fresh fruits and vegetables eaten raw.

Antibiotics are the principle element in treating TD. Therefore it is advised that you see your physician 4-6 weeks prior to your departure date to obtain the appropriate medical advice and needed prescriptions to take with you in the event you develop the symptoms of TD. Adjunctive treatments include taking an anti-motility agent such as loperamide to reduce the frequency of diarrhea and allow the traveler to resume activities while waiting for the antibiotic to take effect. Replenishment of fluids and electrolytes through oral rehydration is also very important to prevent dehydration.

Bismuth subsalicylate (Pepto-Bismol) should only be taken if approved by your physician as it contains aspirin-like ingredients that can be dangerous for those on aspirin or anticoagulant therapy as well as those with renal insufficiency.

Children and pregnant or nursing mothers should consult their respective medical experts for guidance in the prevention and treatment of TD.

Hopefully this information will allow you to spend your vacation engaged in recreational activities as opposed to spending it in the bathroom.