Travellers’ diarrhoea is the most common health problem to affect travellers abroad, affecting between 20-60% of travellers. In otherwise healthy adults, diarrhoea is rarely serious or life-threatening, but it can certainly make for an unpleasant trip. It can be difficult to avoid contaminated food and water, but it is sensible to try and reduce your risk as far as possible because contaminated food and water can spread a number of more serious diseases such as typhoid, hepatitis A and cholera. Certain individuals are also at increased risk from contaminated food and water, including older travellers, the immuno-compromised, young children and those taking medication to reduce stomach acid.
Good personal hygiene
Always wash your hands after using the toilet, changing nappies, any contact with animals or sick people and before preparing or eating food. Alcohol gel can be helpful when hand-washing facilities are not available.
Avoiding contaminated water
In some parts of the world, tap water is not available or is unsafe to drink. Avoid ice in your drinks as this could have been made from tap water and use safe water (such as boiled or bottled) to brush your teeth. Beware of fake bottled water, check the seal and avoid any product that you suspect may have been tampered with.
Drinks made with boiled water and served steaming hot are generally safe such as tea and coffee. Drinks served in unopened, factory produced cans or bottles such as carbonated drinks, commercially prepared fruit drinks, water and pasteurised drinks generally can be considered safe. Bottled water may not be suitable for babies if they contact high salt or mineral contents, and so bottle feeds should be made up with boiled, cooled water.
If you need to treat water, boiling it for a least one minute will kill all of the common water borne bugs. Chemical treatments can be used to disinfect water and chlorine preparations are usually effective, but not always against certain parasites. Using a water filter that has a filter size of ≤0.2 µm to 1.0 µm before using a chemical disinfectant is helpful as water filters can remove suspended matter, bacteria and parasites if they are functioning correctly. Even high quality water filters do not always remove viruses from the water so combining their use with a chemical treatment is sensible.
Portable, battery-operated devices utilising UV light can also be used to disinfect water. Water must be free of particulate material before treating. This method may not be practical if large quantities of water need to be disinfected.
Avoiding Contaminated Food
Adopt the ‘Boil it, cook it, peel it, or forget it’ mentality when it comes to food. Choose food that has been freshly prepared and served piping hot where possible. Select fruit that you can peel yourself such as bananas and oranges. Ensure dairy produce such as yoghurts, milk and cheese has been pasteurised.
Where possible avoid the following potentially unsafe foods:
People with diarrhoea should drink lots of fluids to stay hydrated. This is especially important for young children or adults with chronic illnesses. In serious cases of travellers’ diarrhoea, oral rehydration solution can be used for fluid replacement. This is widely available in pharmacies in developing countries.
If the diarrhoea is severe or sustained, treatment with an antibiotic may be required. If travelling to high risk areas, such as the Indian subcontinent, it may be worth consulting with your GP about taking an antibiotic with you in case of a serious diarrhoea infection.
Loperamide-based anti-diarrhoeal medications can be bought over-the-counter to treat the symptoms of diarrhoea. These drugs decrease the frequency and urgency of needing to use the bathroom, which is important when mobility is required such as onward travel which cannot be delayed. Most anti-diarrhoeal medicines are not suitable for children.
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