Traveler’s diarrhea is a type of diarrhea that develops during, or after domestic or international travel. It is defined as loose or watery stools, for at least more than 3 times a day. It is the most predictable travel-related illness and has a prevalence rate of 30 to 70% among travelers, depending upon destination and season of travel.
Causes
It is caused by ingestion of food items or having drinks, containing certain microbes or their toxins. Bacteria are the most common ones including E.coli, Campylobacter, Shigella. Viral infections can occur because of norovirus, rotavirus. The most common protozoal infection can be because of Giardia followed by Entamoeba and Cryptosporidium.
The incubation period between the exposure to certain pathogen vs clinical symptoms can give an idea about the etiology:
- Bacterial toxins may cause symptoms within a few hours
- Bacteria and viral pathogens may initiate symptoms after 24 to 72 hours
- Protozoal pathogens have generally high incubation period and may present symptoms after 1-2 weeks of ingestion
Risk Factors
Locations where sanitation and hygiene measures are compromised (generally developing countries) are at high risk of causing diarrhea among travelers. South and Southeast Asia, West and North Africa are considered as high-risk locations whereas North America, Australia, New Zealand are low-risk nations, the reason being improved hygiene.
Male and females are equally affected with young travelers getting it more frequently compared to adult ones. Multiple risk factors can lead to an increase in the frequency of episodes,
- Inadequate electricity can lead to frequent power cuts and poorly functioning refrigeration, thus unsafe food storage and increased risk of disease
- Lack of clean water leads to contaminated food and drinks prepared with such water
- Inadequate supply of water leads to poor hygiene conditions in terms of cleaning hands, utensils, food such as fruits and vegetables
- Frequent hand washing may not be a social norm, adding microbes to the food prepared
Studies have shown that effective food handling courses if given at a certain destination have helped to prevent the episodes of diarrhea among travelers.
Treatment
Dehydration is one of the major complications of diarrhea and replenishment of fluids is of utmost importance. In the case of traveler’s diarrhea, generally, dehydration is not that severe unless accompanied by vomiting that aggravates the situation.
ORS (oral rehydration solution) sachets are easily available over the counter in pharmacies, have a perfect balance of water, salts, and sugar, and can be used for fluid replacement. Please assure that clean water is needed to mix the sachets.
Pharmacotherapy is considered in the case when frequent episodes last for more than 3 days or there is blood in stools or its black colored stools or diarrhea is accompanied by fever and chills suggesting an underlying infection.
Prevention
To reduce the chances of getting traveler’s diarrhea, the following precautions can be undertaken,
- Avoid drinking tap water
- Avoid using tap water to prepare foods or drinks, or even to brush your teeth
- Avoid drinking unpasteurized milk
- Avoid eating from street vendors
- Avoid eating seafood that is not well cooked or not served hot
- Sanitize your hand regularly if soap is not available to wash hands
Travelers’ diarrhea is a condition that can be avoided in the majority of the cases by keeping a check on the food habits as well as socializing in places that maintain good hygiene where food and drinks are being handled.
Reference list
- A. Connor, B. (2016). Travelers’ Diarrhea - Chapter 2 - 2020 Yellow Book | Travelers’ Health | CDC. [online] Cdc.gov.
- Heather, C.S. (2015). Travellers’ diarrhoea. BMJ Clinical Evidence, [online] 2015.
- Knott, D.L. (2017). Traveller’s Diarrhoea | Loose Stools When Travelling. [online] patient.info.
- National Institute of Diabetes and Digestive and Kidney Diseases (2019). Treatment for Diarrhea | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases.
