Friday, July 20, 2012
A quick guide to traveler's diarrhea
Traveler's Diarrhea Overview
Diarrhea occurs in a significant number of people who travel to foreign countries. Travelers to developing countries of the world become ill from eating or drinking food or water contaminated by infected human bowel waste.
Traveler's diarrhea can be defined as three or more unformed stools in a 24-hour period.
Traveler's Diarrhea Causes
A person can become infected by eating or drinking food or water that has come in contact with feces. Food and water become contaminated when they are handled by people with fecal content on their hands - not in direct contact with feces. Restaurants are common sites for exposure to this type of food poisoning. Food from street vendors is even more risky. Eating in a private home is the safest food source.
High-risk food and drink
Certain items are considered high risk for transmission and include the following:
Raw or undercooked meats
Raw leafy vegetables
Unpasteurized dairy products
Tap water (A common mistake travelers make is to avoid tap water but to place ice cubes in a beverage. Contaminated ice is still able to transmit disease. Do not use ice cubes.)
Safe products to eat and drink
Bottled carbonated beverages
Hot coffee or tea
Water boiled or treated appropriately with chlorine
Specific bacterial causes of traveler's diarrhea
Up to 85% of traveler's diarrhea is caused by bacteria. The remaining cases are caused by viruses and protozoa. The most common organism causing traveler's diarrhea is Escherichia coli accounting for up to 72% of cases in some regions.
Is Traveler's Diarrhea Contagious?
Yes, no matter what the pathogenic cause (bacterial, viral or parasitic, see above) traveler's diarrhea is contagious. The vast majority of individuals obtain the pathogens by orally ingesting them. Common routs that lead to oral ingestion are by eating food or drinking water contaminated with the pathogens. Pathogens also survive sometimes for days on surfaces such as handrails, doorknobs, computer keys, children's toys, and many other similar items. The pathogens are then transferred to the mouth by a person simply touching their face on or near an oral mucosal area (lips, tongue, gums, teeth, for example).
Traveler's Diarrhea Treatment
Drink 2-3 quarts of fluid per day. In the first 24 hours the best fluids to drink are bottled fruit juices and beverages, caffeine-free soft drinks, hot tea, and broth; try to match the amount of fluid lost in the stools with the amount of fluid taken in orally.
During the next 24 hours, eat bland foods such as rice, soup, bread, crackers, eggs, and cereals. Advance to regular foods after two or three days.
With more severe cases, over-the-counter medications may help reduce symptoms and shorten the time they last.
Antimotility agents, such as loperamide (Imodium), give the stools more consistency and provide some relief from symptoms, however, many health care practitioners use these agents for emergencies only (airplane travel) because the decreased motility may prolong the disease.
Bismuth subsalicylate ( (Pepto-Bismol) is also moderately effective. Use according to package directions or upon direction of a doctor
How can I avoid traveler's diarrhea?
When you will be traveling to an area where the water may not be clean, see your doctor 4 to 6 weeks before your trip. Your doctor may want to give you some medicines, such as antibiotics or shots, to protect you from illness while you are away. During your trip, be careful about the following things:
Do not drink tap water and do not use it to brush your teeth.
Do not drink bottled water if the seal on the bottle has been broken.
Do not use ice unless you're sure it's made from purified water.
Do not drink milk or eat dairy products that have not been pasteurized (heated to a temperature that kills all germs).
Do not eat raw fruits or vegetables unless they can be peeled and you are the one who peels them.
Do not eat cut-up fruit salad.
Do not eat lettuce or other leafy raw vegetables (such as spinach).
Do not eat raw or rare (slightly cooked) meat or fish.
Do not eat food from people who sell it on the street.
Boiling water will kill the germs that cause diarrhea, making the water safe to drink. Boil water vigorously for 1 minute and allow it to cool to room temperature (do not add ice). When traveling in high altitudes (6,562 feet or higher), boil water for 3 minutes.
What is safe to eat or drink?
When you are in a place where you could get traveler's diarrhea, it is probably safe to eat or drink the following:
Soft drinks that are carbonated (such as cola).
Hot drinks, such as tea or coffee.
Carbonated or noncarbonated bottled water, as long as you are the one who breaks the seal on the bottle.
Raw fruits or vegetables that can be peeled, as long as you are the one who peels them.
Food that is served hot.
Meat that is well cooked.