Travel Plans? Are you at risk of Traveler’s Diarrhea?

With the summer of 2023 incoming, you may be planning to travel. Depending on your itinerary, you may be at greater risk of contracting traveler’s diarrhea. Over 80 million people worldwide contract traveler’s diarrhea each year. This infection is rarely life threatening but can make your next trip very unpleasant. Fortunately, there are steps you can take to decrease your chance of contracting traveler’s diarrhea, and there are treatment options if you need them.

What causes Traveler’s Diarrhea?

Traveler’s diarrhea (TD) is an uncomfortable infection that is caused by a variety of intestinal germs but is most commonly caused by Escherichia coli (E. coli). About 30% of traveler’s diarrhea cases are thought to be caused by E. coli. The symptoms of TD can be broad depending on the cause and are further described below.

How does this relate to travel? Is it the same as food poisoning?

TD is the most predicable travel-related illness and is estimated to affect nearly 30% to 70% of travelers according to the Centers for Disease Control and Prevention (CDC). The rates of TD and common cause vary by region; however, TD appears to be more common in warmer climates. You may get TD from swallowing unsafe food or water, close contact with someone who has TD (such as young children), traveling within areas that lack access to clean water for bathing/washing, exposure to feces through sexual contact with someone who is sick or recently sick, transferring germs picked up from contaminated surfaces, and contact with animals. Food poisoning is an overarching term that is related to traveler’s diarrhea, with the origin being related to ingestion while traveling.

What are the symptoms of Traveler’s Diarrhea?

TD results in bothersome symptoms that may range in severity from mild cramps to urgent loose stools with severe abdominal pain, fever, vomiting, and/or bloody diarrhea.

  • Mild: diarrhea that is tolerable, is not distressing, and does not interfere with planned activities.
  • Moderate: diarrhea that is distressing or interferes with planned activities.
  • Severe: diarrhea that completely prevents planned activities, is not improving with treatment, if you are running a fever over 101 degrees F and diarrhea that contains blood is considered severe.

Dehydration may occur due to your body rapidly losing fluids, vitamins, and minerals. Extreme cases may lead to sepsis, a life-threatening medical emergency as a result of your body’s response to an infection.

What are the risk factors of Traveler’s Diarrhea?

There are multiple risk factors to developing TD.

  • Age
    • TD is more common in young adult travelers than adults aged 65 and older. This may be due to children having both less developed immune systems and decreased awareness of germs and hygiene.
    • Young children, infants, and pregnant women are also at higher risk of developing dehydration. These signs may be more difficult for guardians and caregivers recognize due to the need for frequent monitoring and lack of verbal communication.
  • Other risk factors include:
    • Traveling to warmer climates
    • Unsafe food handling
    • Lack of clean water

According to multiple studies, having TD does not appear to protect against future episodes of TD. In addition, TD does not appear to infect people differently between males and females, suggesting equal risk for all travelers.

How can I prevent Traveler’s Diarrhea?

Effective prevention strategies

  • Proper hand washing and hygiene
  • Avoid consumption of raw or undercooked food
  • Avoid unsafe sources of water/ice/food such as undercooked meals, raw foods, unwashed fruits/vegetables, unpasteurized foods, and food that may be from unclean water sources, such as shellfish.

Possibly ineffective prevention strategies

  • According to the CDC, use of preventative antibiotics is generally not recommended as it may contribute to antibiotic resistance. This is where bacteria become able to fight off antibiotics and make infections harder to treat
  • Furthermore, antibiotics are ineffective for nonbacterial sources of TD
  • Studies are conflicting about whether probiotics can help prevent TD.
Treatment options:

Although TD is typically a self-resolving condition, depending on your risk factors and severity listed above, you may need treatment. If your TD is not improving after three to five days or is getting worse, you should seek treatment.

  • Oral rehydration therapy is first line to ensure the fluids and electrolytes lost from diarrhea are replaced. Oral rehydration fluids such as Pedialyte provide improved rehydration with electrolytes that aren’t found in water and are mostly available at pharmacies.

If you contract a severe case of TD with symptoms such as frequent vomiting, bloody diarrhea, and abdominal cramps that worsen or do not go away, you need to seek medical treatment.

  • Antimotility agents may be used to provide symptomatic relief due to frequent bowel movements. However, diarrhea is often a method of your body getting rid of toxins caused by bacteria; therefore, antimotility agents are not recommended in patients with blood diarrhea or those with a fever. These are severe symptoms where antibiotics may be necessary, unlike mild or moderate symptoms where antimotility agents may be helpful. An example of an antimotility agent is loperamide, found over-the-counter at most pharmacies.
  • Antibiotics are effective in TD caused by bacteria. Antibiotic agents and length of therapy vary by TD severity and cause. Different travel locations may have different resistance rates for common germs, which may mean different antibiotics selected for you.

In summary: The best way to treat TD is through prevention and preparation! Before you leave, schedule a travel consultation with your local pharmacy or healthcare provider. They can help you figure out what travel vaccines you may need, discuss how to stay safe on your trip, and provide the tools you need to help prevent and treat TD.

Prepared by Alex Kuo, PharmD Candidate 2023

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