Travellers' Diarrhea

Travellers' diarrhea, sometimes called by more colourful names such as "turista" and "Montezuma's revenge", is an illness that most commonly affects people from industrialized nations who travel to areas with poor standards of hygiene and poor food handling practices. It is spread by ingesting contaminated food or water and exceptionally through direct person-to-person contact. The risk of developing the illness depends on several factors including the destination, the length of the trip and the type of accommodations, the season and the travellers themselves. Most episodes are not severe and resolve on their own within 1 to 5 days.

Symptoms

Travellers' diarrhea is characterized by frequent, loose and watery bowel movements (3 or more unformed stools in a 24-hour period) with at least one of the following symptoms:

• Abdominal cramping or pain
• Nausea
• Vomiting
• Fever
• Pus, mucus or blood in stool

Prevention

The best defence against travellers' diarrhea is to use common sense and to practice good hygiene measures. Here is a list of suggestions that may help you keep travellers' diarrhea at bay:

• Only eat fruits and vegetables that have been freshly peeled or freshly cooked. Avoid salads and lettuce.
• Only eat meat, fish or seafood that has been well cooked and that is served hot.
• Avoid hot and cold buffets, unless you are ready to only choose foods that are well cooked and still hot.
• Avoid eating foods or drinking beverages purchased from street vendors.
• Avoid sauces (i.e.: salsa, ketchup).
• Only drink beverages that are bottled and sealed (water, soft drinks, juice, beer, wine).
• Do not add ice to beverages.
• Drink pasteurised milk that has been properly refrigerated.
• Brush teeth with purified or bottled water.
• Do not trust the food safety precautions in place at your resort or hotel, even if it is a luxury establishment.
• Avoid swimming in bodies of water that are polluted or contaminated.
• Wash hands thoroughly with soap and water before eating, drinking, preparing food and after having used the washroom. If soap and water are not available, use an alcohol-based hand disinfectant.
• Before you leave, talk to a doctor or pharmacist as preventive treatments, if indicated, are available (i.e.: vaccine, medication). These healthcare professionals may also recommend that you bring certain products with you in case you need them during your trip.

Treatment

If you develop travellers' diarrhea in spite of all these precautions, the following measures may help:

• Drink plenty of fluids to prevent dehydration such as electrolyte solutions that contain salt, sugar and water (i.e.: Gastrolyte® or Pedialyte®)
• Avoid alcohol, coffee/tea and sweet beverages (i.e.: soft drinks and sweet fruit juices)
• If there is no fever or blood in the stool, take an antidiarrheal according to the directions for use recommended by the pharmacist

If you were prescribed antibiotics prior to your departure, you can take them rather than consulting a doctor in another country. You may, however, need to see a doctor if:

• You present signs of dehydration (i.e.: darker coloured urine, decreased frequency of urination, increased thirst, dry mouth and tongue, dark circles under the eyes and confusion). Monitor young children closely as they tend to become dehydrated more quickly.
• You have a high fever.
• You have severe abdominal pain.
• You have bloody stool or severe vomiting.
• Your symptoms do not improve within 24 to 48 hours of starting antibiotics.
• You are sick for more than 10 to 14 days.

For more information or for support:

Public Health Agency of Canada

www.publichealth.gc.ca