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Travellers Diarrhoea

Travellers’ diarrhoea is a very common illness affecting between 20%-50% of all international travellers. High-risk destinations are developing countries. Individuals at risk for more severe disease include infants, immunosuppressed persons, those with bowel issues such as inflammatory-bowel disease, irritable bowel or diverticulitis, diabetics, and those with any chronic illness.

What is it caused by?
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. 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. Most cases last a few days, 90% of cases resolve within 1 week, and 98% resolve within 1 month.

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.

How to avoid travellers’ diarrhoea?
Avoid eating undercooked foods especially meat, chicken, eggs and seafood. Salads and fruit peeled or chopped by someone else may be risky. Well-cooked food is generally safe. 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.

Is there a vaccine to prevent it?
There is now a safe and effective vaccine, taken as a drink in two doses a week apart, which provides up to 2 years of protection against cholera. Thankfully cholera remains exceedingly rare in travellers but the vaccine also provides protection against E Coli, responsible in some parts of the world for up to a third of the diarrhoea experienced by travellers. For this reason the vaccine it is often used for E Coli protection rather than protection against Cholera. E coli protection is short lived, lasting up to 3 months, but can be boosted for further travel within 2 years of the initial doses, with another single dose of vaccine.

How do you treat it?
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. Early reintroduction of bland foods is recommended.

Diarrhoea stoppers such as loperamide can be used in adults 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. Giardia requires a different type of medication.

Nausea, vomiting and cramps often accompany travellers’ diarrhoea and specific drugs may help.
These and other medications (with instructions) are available in our self-treatment gastro kits. Severe or on-going illness always requires medical attention.

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