Travel and Diarrhea

More than malaria and dengue fever, nothing affects travelers more than diarrhea. It does not matter where you are from or where you are going, if you are out of the country where you usually live, beware of the food and water! Of course you must be more alert in a developing country, especially ones where clean drinking water is hard to find, but developed countries have many foodborne diseases too. Read on as you will likely be surprised at what you should and should not do when you get diarrhea.

Preventing Traveler's Diarrhea at Home and on the Road

• If you eat out a lot, read about what to order at a restaurant to stay healthy. These tips are useful at home and abroad.
• Travelers should always keep in mind the do's and do not's of water and food safety.

Three Kinds of Diarrhea

• Acute watery diarrhea is the most typical kind of diarrhea you will experience. The name of the game here is rehydration with oral rehydration salts (ORS) and plenty of it. You will usually get better without any further treatment other than good hydration, a toilet and lots of patience.
• Long-lasting diarrhea goes on more than 14 days. Besides dehydration and malnutrition, infection outside of the intestines could occur, so see a doctor.
• Acute bloody diarrhea, also called dysentery, can be caused by Shigella, E. coli 0157:H7 and other bugs. Go see a doctor whose goal will be to prevent infection throughout the body, intestinal damage, malnutrition and dehydration.

The most common organism that causes of diarrhea is enterotoxigenic E. coli, also just known as ETEC.

Go to the Doctor if Diarrhea:

• Is Bloody
• Lasts more than 6 days (Some references say more than 10-14 days)
• Is extremely painful
• Causes severe dehydration
• Symptoms return periodically
• Is accompanied by fever and/or vomiting that is difficult to control
• Occurs in children younger than 1 year old

Causes of Diarrhea and Diagnosis

Diarrhea is a common symptom of many diseases. The causes of diarrhea are too numerous to list, but include: viruses, bacteria, parasites, and other infectious diseases and certain underlying diseases. Salmonella, typhoid fever, E. coli, norovirus, cholera, giardia, amoebas, C.difficile, and diseases like malaria and measles can also cause diarrhea. If your doctor suspects a parasite, viral or a bacterial cause for diarrhea, he or she might request you to take a stool sample to a laboratory to be examined. Children are often affected by rotavirus.

DO

Take Oral Rehydration Salts, known as ORS, dissolved in clean drinking water. Drink as much liquid as you feel like since diarrhea dehydrates the body. A sports drink with electrolytes, fruit juices or broth is acceptable, but ORS is better. ORS is available from pharmacies without a prescription in small or large packets. Mix the salts with water according to the directions on the packaging. Pedialyte is a good solution to give children if its available. You don't need to take ORS for cases of mild diarrhea.

Do NOT

• Take anti-diarrhea medications. Most people are surprised to learn that unless you must travel and cannot get to a toilet, or a doctor prescribes them, you should not take anti-diarrheal medications. Just remember to keep well hydrated by drinking oral rehydration salts with clean drinking water.

• Take antibiotics. Antibiotics do not treat most forms of diarrhea. Taking antibiotics not prescribed by a doctor only expose the body to unnecessary drugs and increase the risk of fueling the development of drug-resistant bugs. Doctors will rarely prescribe antibiotics to treat or prevent diarrhea.

What to Pack

• ORS, Oral Rehydration Salts.
• Anti-diarrhea medication only for those times when you must travel and will not have 24-hour access to a toilet.
• Take sugar and salt along to make your own ORS in case you cannot find ORS in a pharmacy.
• Take the ORS recipe for pharmacists along in case you can have a pharmacist make ORS for you. This ORS version is better than the homemade one.
• Discuss your travel plans with your doctor for other recommendations.

A Word about Vaccines

The rotavirus vaccine, RotaTeq is now routinely given to infants in the US to avoid diarrhea caused by that virus.

There is a vaccine called Dukoral against cholera and e.coli enterotoxigenic e.coli (ETEC). Unfortunately, the vaccine is not usually recommended for three reasons:

• Immunity does not last long
• Only 60% of people vaccinated with Dukoral are immune to ETEC and a booster shot is needed after three months, and 85% vaccinated with Dukoral are immune to cholera, but only for 6 months, while just 57% are immune to cholera for two years
• Vaccination against just two pathogens transmitted through contaminated food and water does not mean a person can let down their guard when traveling. There are many more foodborne pathogens out there than just E. coli and cholera.

_Sources:

British Columbia Ministry of Health. BC Health Files. Dukoral Vaccine for Traveler's Diarrhea and Cholera. Retrieved August 2, 2007.

Heymann, David (2004.) Control of communicable diseases manual. Washington D.C.: American Public Health Association.