INSIDE

Health Matters

By Virginia Lester,
RN, MSN, ARNP

Traveler’s diarrhea:
What You Should Know
Traveler’s diarrhea (TD) can occur when you travel to another country (usually a developing country). Acute diarrhea is the most common illness among travelers. Up to 55 percent of persons who travel from developed countries to developing countries are affected.

The classic definition of TD is three or more unformed stools in 24 hours with at least one of the following symptoms: fever, nausea, vomiting, abdominal cramps, or bloody stools. Most cases occur within the first two weeks of travel and last about four days without treatment.

A milder case with sudden watery diarrhea and stomach cramps can also occur. Most episodes of TD occur between four and 14 days after arrival, but can occur within a much shorter time frame if the concentration of bacteria ingested is sufficiently high. The illness is generally self-limited with symptoms lasting for approximately one to five days. However, eight to 15 percent of patients experience symptoms for more than one week and as many as two percent for more than one month.

Diarrheal disease in travelers may be caused by a variety of bacterial, viral, and parasitic organisms, which are most often transmitted by food and water. More than 90 percent of illnesses are caused by bacteria; the most common organism is enterotoxigenic Escherichia coli. The other 10 percent can be caused by viruses and parasites. The epidemiology of TD does vary from location to location and with the season of the year. Spices in food and changes in climate do not cause TD, although variations in diet, temperature, or even time zones can alter the way a traveler feels and the stresses of travel may exacerbate diarrheal symptoms. 

Food and water contaminated with fecal matter are the main reservoirs for pathogens that cause TD. Unsafe foods and beverages include salads, unpeeled fruits, raw or poorly cooked meats and seafood, non-pasteurized dairy products and tap water. Eating in restaurants increases the probability of contracting TD and food from street vendors is particularly risky. Cold sauces, salsas and foods that are cooked and then reheated are also risky. This cautionary advice also applies to expensive resorts and hotels. Travelers should be aware that food items on aircraft will often be obtained at the city of departure.

If water is of uncertain quality, travelers should avoid drinking it and should not use ice made from it; boiling will render water safe. Carbonated beverages, beer, wine, and drinks made from boiled water are safe. However, despite measures to avoid unsafe food and water, the risk of diarrheal disease does not necessarily diminish.

Dehydration is the main complication of TD, especially in children, pregnant women, older adults, and other people who get dehydrated easily. The primary and most important treatment of traveler’s (or any other) diarrhea is fluid replacement since the most significant risk is volume depletion. Patients with mild diarrhea may combine alternating sips of fluids with both salt and sugar to replete and maintain hydration. Broth, fruit juice, or similar fluids may be used. Pedialyte is frequently useful in children. Severe diarrhea should be treated with oral rehydration solution; it replaces needed electrolytes in the appropriate concentrations.

Medication treatment may be indicated for both prophylactic and active treatment of TD. For information regarding medications contact your health care provider prior to travel. Generally, if you don’t treat TD it will usually subside in four to five days; however, treatment can shorten the illness to one to two days.

You will find more information about TD at the Traveler’s Health section of the Centers for Disease Control and Prevention Web side (www.edc.gov/travel/diarrhea. htm). Healthy traveling.