Traveler's Diarrhea

Traveler's diarrhea is loose, watery, and frequent stools that occur after visiting areas with contaminated water supplies, poor sewage systems, or inadequate food handling. High-risk destinations include third-world or developing countries, including Latin America, Africa, the Middle East, and Asia. Traveler's diarrhea describes a specific condition that happens when visitors from countries that have good public sanitation and hygiene travel to countries that have poor public sanitation and hygiene, and their immune systems have not been exposed to these organisms. People living in these areas often don't get sick because their bodies have developed some degree of immunity.

Causes: Traveler's diarrhea is a term used to describe the diarrhea caused by infection with bacteria, protozoa, or viruses ingested by consuming food or water that has been contaminated. Two life-threatening types of traveler's diarrhea are caused by cholera and giardiasis.

Effects: Traveler's diarrhea is rarely life-threatening for adults. It is more serious in children as it can frequently lead to dehydration. A normal course of traveler's diarrhea lasts about 3 to 7 days, and may be accompanied by:

• nausea
• bloating
• urgency
• fatigue
• loose, watery stools

Recommendations: Prevention of traveler's diarrhea: You can decrease your risk of developing traveler's diarrhea by avoiding water and food that may be contaminated. The goal of the traveler's diarrhea diet is to reduce the impact of this illness and avoid severe dehydration.

• Water:
  • Do not use tap water for drinking or brushing teeth.
  • Do not use ice made from tap water.
  • Use only boiled water (at least 5 minutes) for mixing baby formula.
  • For infants, breast-feeding is the best and safest food source. However, the stress of traveling may decrease milk production.
• Other beverages:
  • Drink only pasteurized milk.
  • Drink bottled drinks if the seal on the bottle hasn't been broken.
  • Carbonated drinks are generally safe.
  • Hot drinks are generally safe.
• Food:
  • Do not eat raw fruits and vegetables unless you peel them.
  • Do not eat raw leafy vegetables (e.g. lettuce, spinach, cabbage); they are hard to clean.
  • Do not eat raw or rare meats.
  • Avoid shellfish.
  • Do not buy food from street vendors.
  • Eat hot, well-cooked foods. Heat kills the bacteria. Hot foods left to sit may become re-contaminated.
• do not eat food or drink beverages from unknown sources
• any raw food could be contaminated, including:
  • fruits, vegetables, salad greens
  • unpasteurized milk and milk products
  • any fish caught in tropical reefs rather than the open ocean
• Sanitation:
  • Wash hands often.
  • Watch children carefully. They put lots of things in their mouths or touch contaminated items and then put their hands in their mouths.
  • If possible, keep infants from crawling on dirty floors.
  • Check to see that utensils and dishes are clean.

The best preventives for traveler's diarrhea are:

• only use water that has been boiled or chemically disinfected for:
  • drinking, or preparing beverages such as tea or coffee
  • brushing teeth
  • washing face and hands
  • washing fruits and vegetables
  • washing eating utensils and food preparation equipment
  • washing the surfaces of tins, cans, and bottles that contain food or beverages

Treatment: If you or your child get diarrhea, continue eating and drinking. For adults and young children, continue to drink fluids such as fruit juices and soft drinks (non-caffeinated). Salted crackers, soups, and porridges are also recommended.

Dehydration presents the most critical problem, especially for children. Signs of severe dehydration include:

• Decreased urine (fewer wet diapers in infants)
• Dry mouth
• Sunken eyes
• Few tears when crying

Oral rehydration fluids are advised for children with traveler's diarrhea to prevent severe dehydration. These fluids contain salts (mainly sodium, potassium, and chloride) with small amounts of glucose (a form of sugar). They replace lost fluids and minerals. Most stores in the U.S. sell rehydration fluids in the infant section. In third world countries, many health agencies stock packets of salts to mix with water.

If rehydration fluids are not available, you can make an emergency solution as follows:

• 1/2 teaspoon of salt
• 2 tablespoons sugar or rice powder
• 1/4 teaspoon potassium chloride (salt substitute)
• 1/2 teaspoon trisodium citrate (can be replaced by baking soda)
• 1 liter of clean water

Give the child small amounts to drink often. Small amounts decrease the likelihood of vomiting. One guideline is to give one cup of fluid for every loose stool passed.

If you or your child have signs of severe dehydration, or if fever or bloody stools develop, seek immediate medical attention.

There is no vaccine against traveler's diarrhea. However, for adults, your doctor may recommend medicines to help reduce your chances of getting sick. For example, taking two tablets of Pepto-Bismol four times a day before and during international travel can help prevent many cases of diarrhea. Pepto-Bismol should not be taken for more than 3 weeks.

For Children: no anti-diarrhea medicines are advised. The body is trying to rid the body of the toxins, and keeping the diarrhea inside can make it worse.

Prophylactic antibiotics are those used to prevent diarrhea while traveling. At this time, prophylactic antibiotics are not generally recommended unless the person is at increased risk for complications of TD. People at such risk include those with chronic bowel diseases, kidney disease, diabetes, or HIV.

Although antibiotics, antimicrobial drugs, antidiarrheals, as well as other over-the-counter medications are sometimes used as preventives, the Centers for Disease Control and Prevention does not recommend their use without the specific advice and supervision of a physician. Taking any medication without medical supervision can be dangerous. In addition to side effects or allergic reactions, long-term use of medications can mask symptoms that may need medical attention.

Treatment for traveler's diarrhea: Traveler's diarrhea, although uncomfortable and unpleasant, usually lasts only a few days. Dehydration (loss of fluids) can be a serious side effect, especially for children and babies. Drinking plenty of non-contaminated fluids is important.

For diarrhea that is worse than normal or lasts more than three days, it is best for the traveler to consult a physician rather than try self-medication - especially for pregnant women and children. Seek medical help when diarrhea is:

• severe.
• bloody.
• does not get better within a few days.
• accompanied by fever and chills.
• causes dehydration.

Copyright 2009. UAB/International Adoption Clinic. All rights reserved. No part of this work may be reproduced in any form without the prior written permission of the UAB/International Adoption Clinic.