Travellers

Travel Health Information Sheets

Travellers' Diarrhoea

 

Key messages:

Travellers’ diarrhoea is the most common health problem to affect travellers


It is caused by bugs picked up by eating or drinking contaminated food or water


The risk is highest for those travelling to low income countries


Symptoms usually only last a few days but for some, may last longer


Older travellers, young children and those with certain health problems are at greater risk of getting travellers’ diarrhoea and of having more severe illness


This information sheet provides tips on reducing the risk and how you can prepare to look after yourself if you do get ill.

 
 

What is travellers’ diarrhoea and what are the symptoms?

Travellers’ diarrhoea (TD) is .the most common health problem to affect travellers. It is caused by a wide variety of bugs (bacteria, viruses and parasites).

 

It is usually picked up from contaminated food or drinking water. Recreational water can also be a source of infection.  Swimming pool-related outbreaks of illness are not common but have been reported when the treatment and disinfection of the water has been inadequate.

 

Travellers’ diarrhoea is defined as three or more loose stools in a 24 hour period, often accompanied by at least one of the following symptoms: raised temperature (fever), feeling sick, vomiting, stomach cramps, or bloody stools (dysentery). Symptoms often resolve naturally within four days but can lead to disruption of travel plans. Approximately 20 per cent of travellers affected are confined to bed for 1 or 2 days, 40 per cent have to change their itinerary. In approximately two per cent of travellers, symptoms persist for longer than one month and a small number of those affected develop irritable bowel syndrome following a bout of travellers’ diarrhoea.

 

Where is it found?

Travellers’ diarrhoea can occur anywhere in the world. It is more common in areas where sanitation is poor.

 

According to a Health Protection Agency report in 2010, more than 20 per cent of travellers to Africa, Asia, the Middle East, South and Central America will experience travellers’ diarrhoea (these are high risk destinations). Between 8 and 20 per cent of travellers to Eastern Europe, Russia and some Caribbean islands (intermediate risk destinations) are affected. Less than 7 per cent of travellers to Australia, Canada, Northern and Western Europe, Japan, New Zealand and the USA (low risk destinations) will experience this illness.  

 

Figure 1 Map showing risk zones for travellers’ diarrhoea

 

 

Source: Health Protection Agency. Foreign travel-associated illness – a focus on travellers’ diarrhoea. 2010 report.

 

What is my risk?

Where you go and what you eat and drink can alter your risk. Travelling to higher risk destinations, especially to areas of poor sanitation, and eating out rather than cooking and preparing your own food can add to your chance of getting travellers’ diarrhoea.

 

Certain travellers are more prone to developing diarrhoea and / or are more prone to developing more severe symptoms or complications from the illness. The affects of diarrhoea are generally greater in the very young, the elderly and the frail. Those with special health needs for example immune suppression, inflammatory bowel disease, kidney or heart disease, pregnant women and those taking antacid medication should also take particular care to avoid contaminated food and water and be prepared to manage the symptoms of diarrhoea.

 

How do I reduce my risk?                                

Travellers’ diarrhoea is difficult to prevent for those who cannot prepare their own food and drinks. However, it is sensible to try and avoid possible sources of infection:  

  • Hands should be washed after visiting the toilet, and always before preparing or eating food. Alcohol gel can be helpful when hand-washing facilities are not available. 
  • Choose food that has been freshly prepared and served piping hot where possible. All food, but especially meat, fish and poultry must be thoroughly cooked - most bugs are killed by temperatures above 60°C.
  • Select fruit that you can peel yourself such as bananas and oranges.
  • Ensure dairy produce such as yoghurts, milk and cheese has been pasteurised.
  • In some parts of the world, tap water is unsafe to drink, avoid ice also if it could have been made with tap water.
  • Drinks made with boiled water and served steaming hot are generally safe such as tea and coffee.
  • Drinks served in unopened, factory produced cans or bottles (with intact seals) such as carbonated drinks, commercially prepared fruit drinks, water and pasteurized drinks generally can be considered safe.
  • Avoid swallowing water while swimming where possible.
 

Further tips on reducing the risk from contaminated food and water can be found in NaTHNaCs Information sheet on food and water hygiene.

 

Following the advice above is sensible but these measures do not offer full protection. Being prepared to manage the symptoms of diarrhoea will make things easier if you do get ill (see ‘what should I do if I get travellers diarrhoea’ below).

 

Is there a vaccine?

There is no vaccine to cover all the bugs that cause travellers’ diarrhoea. There are vaccines to prevent some illnesses that may cause diarrhoea such as cholera and typhoid.

 

In the UK, the current vaccine against cholera is not recommended for preventing travellers’ diarrhoea. It should only be offered to people with a high risk of cholera, such as aid workers travelling in areas affected by a cholera outbreak.

 

Typhoid does not cause the illness known as travellers’ diarrhoea. Vaccination is only recommended for those going in to risk areas for this disease.

 

What should I do if I get travellers’ diarrhoea?

Many cases of travellers’ diarrhoea are mild and will resolve naturally, without any treatment, within about four days. For those with more severe or prolonged symptoms, treatment options are available.

Diet and Fluids

It is important to drink enough fluids to prevent dehydration. Adults without underlying medical problems, with mild to moderate symptoms, can usually stay hydrated by continuing to drink and eat as normal.

 

Babies and young children with diarrhoea are at high risk of dehydration, which can be dangerous. Older people and anyone with an existing illness are also more at risk of complications. For these travellers, oral rehydration powders such as Dioralyte® or Electrolade® can be mixed with clean drinking water. This helps replace lost minerals and salts. These powders are relatively cheap and light weight to carry and they are also helpful for adults with more severe symptoms. Breastfed babies should continue feeding if possible. Children should also continue to eat their usual food if they have diarrhoea.

 

Any baby or child with diarrhoea who cannot keep fluids down or repeatedly vomits needs emergency medical treatment.

 

Treating the symptoms

Diarrhoeal symptoms can be reduced with loperamide, a drug you can buy in UK pharmacies. This medicine slows down muscle movements in the gut which leads to more water being absorbed from stools. The stools become firmer and are passed less frequently. This is useful for long journeys or work meetings, when diarrhoea would be especially inconvenient. It should never be taken regularly or used if you have fever or bloody diarrhoea. It is not suitable for babies and young children or people with bowel problems, such as ulcerative colitis. Check the instructions on the pack carefully.

 

Antibiotics

Taking antibiotics to prevent diarrhoea is not recommended if you are fit and well. They can be considered if you have a serious medical problem that could be made worse by diarrhoea. If you think this applies, ask your doctor or hospital specialist for advice.

 

A short course of antibiotics can be prescribed by your GP or a travel clinic to treat moderate to severe travellers’ diarrhoea. Antibiotics only treat diarrhoea caused by bacteria and some parasites; they are not effective against diarrhoea caused by viruses.

 

Medical Care

You should seek medical care if your symptoms do not improve within three days.

 

Immediate medical care should be obtained if you develop:

  • fever (38C or more)
  • blood and/or mucus in the stool 
  • confusion
  • severe stomach pain
  • rash or jaundice (yellow colour of the eyes or skin)
 

Medical care should also be sought early for older travellers, children and frail people if they are not managing to drink fluids or are showing signs of dehydration.

 

For more information:

NaTHNaC: Food and water hygiene

Public Health England: Travellers’ diarrhoea

NHS Choices: Diarrhoea

 

Advice current at: 18 February 2014