By Dr Angela Rai of The London General Practice
Diarrhoea is a common problem affecting international travellers especially when visiting high risk destinations.
Classic travellers’ diarrhoea is defined as three or more loose stools in 24 hours and can be associated with symptoms such as cramps, nausea, fever, or vomiting. In most cases it causes a mild illness and symptoms clear within 3 to 4 days.
The risk of acquiring travellers’ diarrhoea depends on a number of factors the most important being the destination country and poor standards of hygiene. Low risk countries include Western Europe, USA, Canada, Australia, and New Zealand. High risk countries include Africa and most parts of Asia. The peak incidence of travellers’ diarrhoea is in the summer.
In areas with poor sewage facilities, hand washing facilities, or access to safe drinking water, there is a high risk of contamination of food and water. Trekkers, campers and passengers on cruise ships are at increased risk. Eating shellfish and other filter feeders (such as mussels and oysters) tend to concentrate viral, bacterial pathogens and toxins.
Measures recommended for preventing travellers’ diarrhoea
- General hygiene and hand washing before consuming food.
- Food should have been thoroughly cooked, and must remain steaming hot prior to serving.
- Food from buffets, markets and street vendors should be avoided if this has not been kept hot or refrigerated.
- Fruits and vegetables should be peeled and those with damaged skins should be avoided. Ice should be avoided, unless it has been made from safe water.
- Bottled water is the safer choice for drinking water and it is important to check the seal has not been tampered with.
- Carbonated bottled beverages are usually safe to drink provided they are sealed.
Management of symptoms
Fluid intake should be increased to prevent dehydration, this is particularly important for infants, young children, and elderly people. This should be safe drinking water, bottled, boiled or treated.
Oral rehydration solutions are effective and sachets that you can buy from pharmacies are sensible to pack when you travel. Safe drinking water should be used to reconstitute oral rehydration salt sachets.
Antidiarrhoeal medicines are usually not necessary, however you may wish to reduce the number of trips that you need to make to the toilet.
Most people with travellers’ diarrhoea do not need treatment with antibiotics. However, antibiotic treatment is sometimes advised if a specific infection has been identified after testing of your stool sample.
Prescription for antibiotics can be considered beforehand for those staying in places where medical assistance is poor or not available.
Medical assistance must be sought if stools are blood-stained, there is fever or if it is difficult to maintain adequate hydration and symptoms are worsening or persist for more than 3-4 days.
The London General Practice provides testing for many gastrointestinal pathogens including;
Bacteria and bacterial toxins – Salmonella • Shigella • Campylobacter • Clostridium difficile Toxin A/B • Enterotoxigenic E. coli • E. coli O157 • Shiga-like Toxin producing E. coli • Vibrio cholerae • Yersinia enterocolitica
Viruses – Adenovirus 40/41 • Rotavirus A • Norovirus GI/GII
Parasites – Giardia • Entamoeba histolytica • Cryptosporidum