Travelers’ diarrhea facts
Travelers' diarrhea is commonly accompanied by abdominal cramps, nausea, and bloating.
- Travelers' diarrhea is a gastrointestinal illness that occurs in travelers.
- Travelers' diarrhea usually is caused by eating food contaminated with bacteria or, less commonly, with parasites or viruses.
- The treatment of travelers' diarrhea is usually plenty of oral liquids as well as over-the-counter medications that control diarrhea and cramps.
- Antibiotic prophylaxis (prevention) for travelers' diarrhea is available but is not recommended generally.
- The prognosis of travelers' diarrhea is good. It is rarely fatal, and most cases resolve within a week.
What is travelers’ diarrhea?
Travelers' diarrhea is defined by most experts as three or more unformed stools in a 24 hour time period, passed by a person who is traveling. Travelers' diarrhea is commonly accompanied by abdominal cramps, nausea, and bloating. Travelers' diarrhea is a general term and does not specify any cause. Travelers' from temperate regions of the world frequently experience diarrhea four days to two weeks after arriving in certain other areas of the world. Other terms used to describe this illness include "Montezuma's Revenge," the "Aztec Two Step," and "Turista" in Mexico, the "Delhi Belly" in India, and the "Hong Kong Dog" in the Far East.
How common is travelers’ diarrhea?
Twenty percent to 50 percent of international travelers may develop diarrhea depending on the region of the world they visit. Diarrhea is the most common illness of travelers, affecting 10 million people each year, according to the Centers for Disease Control (CDC). In general, travelers at risk for diarrhea commonly come from industrialized nations and travel to high-risk areas that are primarily within developing or less industrialized nations of the world, including Latin America, Africa, the Middle East, and Asia. Areas of lesser risk include China and some Caribbean nations. Travel to areas of the United States, Canada, Northern Europe, and Australia pose the lowest risk to travelers.
Men and women are at equal risk for developing travelers' diarrhea. Younger individuals are more commonly afflicted, perhaps because of more adventurous eating habits. People with disorders that compromise their immune system (such as HIV, cancer, chemotherapy, steroid use), people with diabetes, and people with underlying abdominal disorders (irritable bowel syndrome, colitis) are more susceptible to travelers' diarrhea. People taking acid blockers for their stomachs (for example, famotidine [Pepcid], cimetidine [Tagamet], omeprazole [Prilosec], esomeprazole [Nexium]) also have a higher susceptibility to travelers' diarrhea because they have less stomach acid to protect them from the bacteria that cause the condition.
9 Tips to Prevent Travelers’ Diarrhea
Medical Author:
Melissa Conrad Stöppler, MD
Medical Editor:
Charles P. Davis, MD, PhD
Travelers’ diarrhea strikes up to half of all international travelers. It is
far and away the most common travel-related illness, affecting about 10 million
people per year worldwide. Infectious agents, particularly bacteria from water
contaminated with feces, cause travelers’
diarrhea. The most commonly identified bacteria associated with travelers’
diarrhea are what are called ETEC, or enterotoxigenic
Escherichia coli.
The destination is the most important risk factor for the development of
travelers’ diarrhea. Developing countries all over the world represent the
highest risk, and the highest-risk destinations are the developing countries of
Latin America, Africa, the Middle East, and Asia. Certain groups of people are
also more likely to develop travelers’ diarrhea. At-risk groups include:
- immunosuppressed persons,
- those with diabetes, and
- persons with inflammatory
bowel diseases.
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What is the prognosis for travelers’ diarrhea?
The prognosis for travelers' diarrhea is usually good.
- Most cases resolve within 2 days without treatment.
- The CDC estimates 90% of cases resolve within one week, and 98% resolve within one month.
- Travelers' diarrhea is rarely fatal.
How can travelers’ diarrhea be prevented?
Since food is the major source of infection, close attention to diet is of foremost importance in the prevention of travelers' diarrhea.
- Foods should be well-cooked and served warm.
- Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided.
- Dairy products, tap water, and ice (including frozen drinks not made from filtered water) are also high-risk foods.
- Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled, and canned products generally are safe.
- The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors.
- Also, frequent hand washing with soap and clean water will decrease the likelihood of the bacteria's spread, especially to other people that the person may be traveling with.
Antibiotics can be effective in preventing travelers' diarrhea but are not recommended for most people due to possible side effects (see "How is Travelers' Diarrhea Treated?").
Bismuth subsalicylate (Pepto-Bismol) also can be effective in preventing diarrhea in travelers although Pepto-Bismol may cause black stools and, rarely, ringing in the ears. People allergic to aspirin should avoid Pepto-Bismol. Studies have not shown bismuth subsalicylate to be safe for use longer than three weeks.
Probiotics such as Lactobacillus have shown inconclusive results in the prevention of travelers' diarrhea.
