Travellers’ diarrhea is the most common malady to affect Italian travellers abroad. In fact, it’s predicted that half of all travellers will experience an episode of travellers’ diarrhea during their trip. The stomach or intestinal infection is most commonly caused by consuming food or drink that has been contaminated by a parasitic pathogen. Travellers’ diarrhea is classified by three or more unformed stools in the course of 24 hours.
Symptoms of travellers’ diarrhea typically appear in adults at the start of a trip, on average after the third or fourth day. The onset of symptoms is usually later for children and people under the age of 20. Travellers’ diarrhea is often accompanied by at least one other symptom, including nausea, vomiting, abdominal cramps, or blood in the stool. Once contracted, travellers’ diarrhea typically lasts between three and four days, though five to 20% of Italian travellers seek professional help.
To add humour to what is an unfortunate travel situation, travellers’ diarrhea has earned several colloquialisms, including Delhi Belly and Bombay Belly in India, Pharaoh’s Revenge in Egypt, Kathmandu Quickstep in Nepal, and Beaver Fever in Canada.
Like cholera, some cases of travellers’ diarrhea can be prevented through an oral vaccination called Dukoral. Dukoral is reported to be effective against one quarter of travellers’ diarrhea cases. The oral vaccination is completed in two doses, with the first dose taken up to six weeks pre-departure and the second taken at least one week before travelling.
Dukoral protects against travellers’ diarrhea for up to three months. A booster dose of the vaccination is recommended every three months for travellers extending their stay in an at-risk destination.
The World Health Organization (WHO) does not recommend that Dukoral be routinely administered to travellers. Instead, it says a conditional recommendation should apply. Other vaccines are currently in clinical development but have not yet been approved for use in Italy.
To find out whether Dukoral may be right for you, visit our local Passport Health Travel Clinic.
Travellers’ diarrhea is never a welcome guest on your travels. While most symptoms will subside after a few days, there may be times when you need to stop the frequent urge to use the bathroom. In that case there are anti-motility medications that can be taken. Other treatments include:
- An fluoroquinolone antibiotic called ciprofloxacin
- The present protocol recommends bismuth subsalicylate as a prevention method and treatment for adults with travellers’ diarrhea
- Medications such as loperamide, diphenoxylate, and paregoric are not recommended by the PHA for self-treatment of the infection
People affected by travellers’ diarrhea should also drink plenty of fluids and may wish to consider oral rehydration salts or tablets during moderate to extreme cases. A Passport Health Travel Medicine Specialist can provide advice on when a travellers’ diarrhea medication may be appropriate for you.
The PHA suggests several preventative measures to prevent the onset of travellers’ diarrhea:
- Hot foods should be served at a minimum temperature of 65ºC in order to ensure most bacterial pathogens have been killed
- Avoid eating undercooked or raw meats and seafood, unpasteurized eggs, and dairy products
- Fruits and vegetables should be well washed in clean water and peeled
- Exercise extreme caution if you choose to buy food or drink from street food vendors
- Always treat your water by boiling it or using either water purification tablets or a UV filter – both are available for purchase at most Passport Health travel medicine clinics
- Ensure purchased bottled water has an intact seal
- Don’t put ice in your drink unless you know the water source was purified or bottled
While it can happen anywhere, travellers’ diarrhea most commonly occurs during travel to low and middle income countries. Risk of contraction is increased by a number of factors, including the length of stay, age, and presence of other medical conditions. Italian travellers under the age of 30 report the most cases of travellers’ diarrhea, with chance of infection increasing in likeliness during trips that last from two to three weeks. Long-term travellers may experience chronic diarrhea during their stays.
Travellers to sub-Saharan Africa, Central and South America, and South Asia report the highest incidence of travellers’ diarrhea. Countries such as Malaysia, Singapore, Mexico, as well as islands in the Caribbean are most at-risk. The Middle East and parts of eastern Europe are also considered hot spots for infection.
Your chance of contracting travellers’ diarrhea differs depending on your style of travel. Backpackers or tourists taking part in adventure tours are more likely to experience a case of travellers’ diarrhea than those staying in a beach resort or hotel.
To find out more about the Travellers' Diarrhea vaccination and other prevention methods, make an appointment with your Passport Health Travel Clinic today.