Traveller’s diarrhea is the commonest health challenge encountered by travellers during travels. It is popularity has earned it several names in different parts of the world which include “Montezuma’s Revenge,” the “Aztec Two Step,” “Turista” in Mexico, the “Delhi Belly” in India, and the “Hong Kong Dog” in the Far East.
Travellers’ diarrhoea (TD) has been defined as passing 3 or more loose/watery bowel motions in 24 hours. It is hardly life threatening but can make your trip very uncomfortable.
Most cases occur in the first week of travel. On average, symptoms last for 3-5 days and most cases resolve without any specific treatment.
However, symptoms can be severe enough to force a change in travel plans and to result in confinement to bed or, rarely, hospitalization, especially when accompanied by fever, bloody/mucoid stool, tummy cramps, nausea or vomiting.
The impact of TD on your trip be it leisure, business, pilgrimage, schooling and other purposes can be reduced by your awareness about ways to prevent it. Similarly, the severity of this disease can be minimized by prompt and well-informed self-treatment.
What determines your risk for Traveller’s Diarrhea?
Poor food and water hygiene: This plays a significant role since ingestion of contaminated food or drink is the means of acquiring TD. Your risk varies according to the attention you pay to your diet.
Your destination: Different countries carry different risks for TD. High-risk regions include the developing countries of Latin America, Africa, Asia, and parts of the Middle East, which have attack rates for TD ranging between 20 and 75 percent. Areas of intermediate risk include China, southern Europe, Israel, South Africa, Russia, and several Caribbean islands (especially Haiti and the Dominican Republic); attack rates of 8 percent to 20 percent have been recorded among travellers to these regions. Low-risk (<5%) destinations include Canada, the United States, Australia, New Zealand, Japan, northern European countries, and a few Caribbean islands.
Timing of your travel: Numerous studies have demonstrated that attack rates of TD are highest during the summer months and in rainy seasons and less at other times.
Location also modifies the level of risk, meals eaten in a private home carry lower risk than those eaten in a restaurant and the type of travel Travellers who participate in “adventure” travel or who go on hiking or camping trips are at increased risk, likely because of hygiene practices and choice of food. However, dining in expensive restaurants or luxury hotels does not reduce the risk of TD to zero; several outbreaks in such establishments have been reported. Purchasing food from street vendors is especially risky.
How to prevent traveller’s diarrhea
Avoid high risk foods, these include uncooked vegetables and unpeeled fresh fruit, raw or undercooked meat or seafood (particularly shellfish), and salads. Eat foods that are well cooked and served hot. Do not buy food from street vendors.
Drink only safe drinks, bottled water, carbonated beverages, beer or wine. Boiled or treated water. Ice, tap water, and unpasteurized milk carry increased risks of infection
Regular handwashing, carefully wash your hands with soap and water, especially after touching surfaces and using the restroom. This significantly reduces the risk of contaminating food substances with your unwashed hands. You can make use of an alcohol-based hand sanitizer if this is not readily available.
Vaccinations can also help prevent travellers’ diarrhea, Prophylactic vaccines like Ducoral are being marketed for protection against cholera and TD. It has been shown to be about 25-50 percent effective in the prevention against cholera and TD. However, it does not protect against several other pathogenic causes of TD. Hence, it is not routinely recommended for TD except for travellers travelling to where there are cholera outbreaks.
Antibiotics: Do not routinely use antibiotics to prevent TD. Individuals for whom antibiotic prophylaxis might be considered include those who are at increased risk of developing severe or complicated disease, the immunocompromised, those with inflammatory bowel disease, insulin-dependent diabetics, and those taking diuretics (who are therefore more susceptible to dehydration). It should be prescribed on the advice of your physician.
Non-antibiotic Options, Bismuth subsalicylate (BSS; Pepto-Bismol) is a well-recognised option in the prevention of TD. Consult with your physician before using it.
Self-treatment of traveller’s diarhhea while on a trip
TD is usually self- limiting though prompt self-treatment is still beneficial. Fluid and Electrolytes replacement is the first goal of therapy which can be of special concern for children, elderly, pregnant women, and people on diuretics. Commercial packets of oral rehydration salts containing both glucose (or complex sugars) and sodium chloride (ORS) are readily available in pharmacies and can be purchased prior to travel.
It is important to reconstitute them with purified water in the quantities indicated by the packet’s manufacturer and to adjust administered volumes according to weight. It is advised you carry ORS in your travel medical kit.
In the absence of ORS, you can readily replace fluid and electrolyte losses with a combination of salted crackers, carbonated non-caffeinated beverages, canned fruit juices, purified water, and clear salty soups. Antimotility agent (usually loperamide) and antibiotic (usually either azithromycin or ciprofloxacin) are useful in the treatment of TD. Both of which can be obtained prior to departure and carried unrefrigerated. Avoid dairy products and caffeine as they may worsen the symptoms, thereby intensifying fluid losses.
Adeniyi Bukola, Consultant Family Physician and Travel Medicine Physician
Q –Life Family Clinic
