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Traveler's Diarrhea

What is traveler's diarrhea?

Traveler's diarrhea (TD) 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. It is the most common illness affecting travelers. About 80 to 90 percent of TD cases are caused by bacterial pathogens--Escherichia coli, Campylobacter jejuni, Shigella sp., and Salmonella sp. Ten percent of TD cases in long-term travelers are caused by the protozoal pathogen--Giardia intestinalis. Intestinal viruses, including norovirus, rotavirus, and astrovirus, account for 5 to 8 percent of cases.  

What are the causes of traveler's diarrhea?

Traveler's diarrhea describes a specific condition that may occur when traveling to countries that have poor public sanitation and hygiene. Poor hygiene practice in local restaurants has been identified as the main contributor to the risk for TD. High-risk areas are often located in developing countries, such as Africa, Asia, Mexico, Central and South American, and the Middle East.

Traveler's diarrhea is caused by drinking water or eating foods contaminated with fecal material, unsafe storage of food, improper food handling and preparation, and inadequate sterilization of surfaces and utensils used in food preparation.

What are the symptoms of traveler's diarrhea?

A normal course of traveler's diarrhea lasts about two to five days. In rare cases, protozoal diarrhea can persist for weeks to months without treatment. Symptoms may include:

  • Nausea

  • Vomiting

  • Bloating

  • Urgency

  • Fatigue

  • Loose, watery stools

  • Fever

Can traveler's diarrhea be prevented?

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 (alcohol-based gel can also be used to wash 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

  • Do not eat food or drink beverages from unknown sources, and only drink beverages that have been bottled and sealed

  • Do not put ice in drinks

  • Any raw food could be contaminated, including:

    • Fruits, vegetables, salad greens

    • Unpasteurized milk and milk products

    • Raw meat

    • Shellfish

    • Any fish caught in tropical reefs rather than the open ocean

Although antibiotics, antimicrobial drugs, antidiarrheals, as well as other over-the-counter medications are sometimes used as preventives, the CDC does not recommend their use without the specific advice and supervision of a doctor. 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, often resolves without specific treatment in only a few days. Dehydration (loss of fluids) can be a serious side effect, especially for children and babies. Drinking plenty of noncontaminated fluids is important.

For diarrhea that is worse than normal or lasts more than three days, it is best to consult a doctor, especially for pregnant women and children. Antibiotics may be needed for these cases, and some doctors will prescribe a short course of antibiotics to be filled before leaving on an overseas trip. Seek medical help when diarrhea is:

  • Severe

  • Bloody

  • Not getting better within a few days

  • Accompanied by fever and chills

  • Causing dehydration