Traveller’s diarrhea is the most common health concern affecting travellers to tropical countries. Each year between 20% to 50% of international travelers (around 10 million people), develop diarrhea. Those at high-risk include young adults, as well as people with suppressed immune systems, inflammatory-bowel disease, diabetes, or people taking H-2 blockers or antacids.
Attack rates are similar for men and women.
What is traveller’s diarrhea?
Traveller's diarrhea is frequent, loose, or watery bowel movements resulting from eating or drinking contaminated foods or liquids. Symptoms may include nausea, vomiting, stomach cramps, bloating and feeling unwell. Symptoms can begin suddenly and last 3 to 5 days.
The most common cause of traveller’s diarrhea is food or water contaminated with bacteria called enterotoxigenic E. coli (ETEC). These bacteria are found in the bowel movements (stool) of infected people. People who use the bathroom without properly washing their hands after can pass the bacteria on to others through food preparation or hand-to-mouth contact. Food can also be contaminated when stool is used as fertilizer, or when contaminated water is used to spray vegetables in market stalls.
For more information on hand washing, see HealthLinkBC File #85 Hand Washing for Parents and Children.
How do I prevent traveller's diarrhea?
A vaccine is available to help protect against traveller’s diarrhea caused by enterotoxigenic E. Coli (ETEC). It also protects against cholera. For more information on this vaccine, see HealthLinkBC File #41k Traveller’s Diarrhea and Cholera Vaccine.
The current vaccine only protects against 1 type of bacteria that causes traveller’s diarrhea, so following good personal hygiene (cleaning) practices and being careful about what you eat and drink are the best ways to prevent traveller’s diarrhea.
The following tips can help you stay healthy while travelling.
- Eat foods that are well cooked.
- Use bottled or boiled water for brushing teeth.
- Drink bottled water, bottled beverages, or drinks made with boiled water.
- Wash and peel your own fruits and vegetables.
- Make sure dairy products, such as milk, cheese or yogurt, are pasteurized and refrigerated. If in doubt, avoid them.
- Drink tap water or add ice to your beverages.
- Eat leftovers or food at buffets that has been sitting unrefrigerated for a long time or not stored properly.
- Eat at a buffet that does not use food covers.
- Eat undercooked or raw meat, fish or shellfish.
- Eat food sold by street vendors.
- Eat raw vegetables, salads, or fruits that cannot be peeled such as grapes or strawberries.
- Eat fruits and vegetables if the skin is broken or bruised.
- Eat watermelon as it may have been injected with local water to increase weight.
- Eat creamy desserts, custards, mousses, mayonnaise, or hollandaise sauce that may not have been properly refrigerated.
How do I treat water for drinking?
There are several ways to treat water so it is safe to drink.
Bring water to a full boil for at least 1 minute. Cool to room temperature in a covered container. At elevations over 2,000 meters (6,500 feet), boil water for at least 2 minutes to disinfect it. Water boils at a lower temperature at this elevation.
Tincture of iodine (2.5%)
Add 5 drops per litre of clear water, or 10 drops per litre of cloudy water. Let stand for at least 30 minutes. Pregnant women, children, people with thyroid problems, or known iodine sensitivity should not use iodine drops to purify water.
Tetraglycine hydroperiodide tablets and halzone tablets
The tablets are available in Canadian pharmacies and sporting goods stores. Follow the instructions on the package.
Household bleach (contains 4-6% Chlorine)
Add 1 drop per litre of clear water, or 4 drops per litre of cloudy water. Strain cloudy water through a clean cloth first. Mix well and let stand for 30 minutes.
Water filters and iodine treatment
Portable water filters with a fine filter and iodine treatment can be purchased from sporting goods or travel stores. Read the label to make sure it will filter bacteria, viruses, and parasites.
For more information about disinfecting drinking water at home and when you travel, see HealthLinkBC File #49b Disinfecting Drinking Water or visit Health Canada – Drinking Water In The Great Canadian Outdoors at www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/outdoor-plein_air-eng.php.
How do I treat traveller's diarrhea?
The most important treatment for diarrhea is to replace the fluids your body loses. These fluids should be replaced by drinking clear fluids, such as bottled water, for 24 to 48 hours.
If diarrhea is severe or does not improve after 24 hours, start drinking beverages that will replace the electrolytes or body salts being lost. Use a pre-packaged oral rehydration salt (ORS) drink such as Gastrolyte®. If you do not have an ORS mix, you can make your own using the recipe below.
|Glass #1||8 oz fruit juice|
½ tsp corn syrup, sugar or honey
Pinch of table salt
|Glass #2||8 oz boiled or bottled carbonated water|
¼ tsp baking soda
|Drink some from glass #1 and some from glass #2. Repeat until you are no longer thirsty.|
Do not give this homemade drink to children under 12 years of age. Pre-packaged oral rehydration solutions are available in most countries and can be used to prevent or treat dehydration in children under 12.
If you are not hungry, drink fluids. When you feel better, slowly start eating small amounts of bland, easily digested food such as bananas, crackers, carrots, or rice. Avoid food and drinks that might irritate your stomach, such as alcohol, coffee, strong tea, spicy food, greasy food, and dairy products.
Contact a health care provider if you have these symptoms:
- high fever;
- blood or pus in stools;
- signs of dehydration such as dry mouth, rapid pulse, reduced urine output or dark coloured urine; or
- if the diarrhea does not stop within 48 to 72 hours.
A number of medications may be recommended for treatment of traveller's diarrhea. For more information, speak with your health care provider.