Travellers’ diarrhoea is a very common illness affecting between 20%-50% of all international travellers. High-risk destinations are developing countries. Mostly a nuisance but can cause travel delays and hospital presentations overseas or on return. Individuals at risk for more severe disease include infants, immunosuppressed persons, those with bowel issues such as inflammatory-bowel disease, irritable bowel, diverticulitis, reflux, diabetics, and those with any chronic illness.
Food, water and hand hygiene remain the best ways to prevent, however there are other ways to prevent and manage.
We are all familiar with the symptoms of travellers diarrhea / gastro. Severity varies but most travellers experience four to five loose or watery bowel movements each day. Other commonly associated symptoms are nausea, vomiting, abdominal cramping, bloating, fever, urgency, and malaise. Blood in the stool and fever are more sinister signs. Most cases last a few days, 90% of cases resolve within 1 week, and 98% resolve within 1 month. Hydration is the most important thing to manage.
Food, water and hand hygiene remain the best ways to prevent, however there are other ways to prevent and manage. This can include cholera vaccine before travel or Travelan capsules during travel as well as self-treatment medication kits to carry and used to treat effectively.
Common travellers’ diarrhoea is caused by a variety of organisms, mostly bacteria, including E.coli (which is the most frequent cause), salmonella, shigella and campylobacter. In Australia, gastro is usually caused by viruses.
Giardia – leads to a more intermittent chronic diarrhoea with burping, a bloated feeling, cramping stomach pain, and passing excess wind.
Dysentery is bloody diarrhoea with a fever and is caused by either a bacteria or amoeba. It can cause severe illness requiring medical assistance.
Avoid eating under-cooked foods especially meat, chicken, eggs and seafood. Salads and fruit peeled or chopped by someone else may be risky. Well-cooked, particularly vegetarian food is generally safer. Avoid tap water, ice, and unpasteurized milk. Sealed bottled drinks are generally safe, as are hot tea or coffee, beer, wine, and water that has been boiled, filtered or treated. Hand washing or the use of alcohol hand gel after visiting public toilets and before eating reduces the risk of transfer of organisms from hand to mouth.
There is a safe and effective vaccine, taken as a drink in two doses a week apart, which provides between 3 and 6 months protection against E Coli, responsible in some parts of the world for up to two thirds of the diarrhoea experienced by travellers. This can be boosted for further travel within 2 years of the initial doses, with another single dose of vaccine.
Travelan capsules are shown to be effective at reducing the risk of travellers diarrhoea and are taken before meals while travelling.
Mild travellers’ diarrhoea usually resolves without treatment; however, rest and oral rehydration is the most important part of early management, especially in children. Oral rehydration salts are specially formulated to help rehydrate the body and avoid the need to eat. Early reintroduction of bland foods is recommended.
Diarrhoea stoppers such as loperamide can be used in adults only for convenience. They are not a cure however and should not be used regularly. More severe illness may benefit from specific antibiotics, especially if there is evidence of dysentery (bloody diarrhoea). Giardia requires a different type of medication.
Nausea, vomiting and cramps often accompany travellers’ diarrhoea and specific drugs may help including buscopan, stemetil, maxolon, ondansetron.
These and other medications (with instructions) are available in our self-treatment gastro kits. Severe or on-going illness always requires medical attention.