Foreign Travel Immunization

Sunday, February 7th, 2010 at 2:20 pm

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Protecting Against Travellers Diarrhoea

What is Travellerâ€™s Diarrhoea?

Travellerâ€™s diarrhoea (TD) is a condition characterised by a marked increase in the frequency of unformed bowel movements and is commonly accompanied by abdominal cramps, urgency, nausea, bloating, vomiting and fever.
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Episodes of TD usually begin abruptly, and occur during travel or soon after returning home. The onset of TD is usually within the first week of travel, but can occur at any time during the visit and even after returning home.
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TD typically results in four to five (sometimes more) loose or watery stools per day. The average duration of diarrhoea is three or four days but about 10% of the cases persist longer than a week, approximately 15% of cases experience vomiting, and up to 10% have diarrhoea accompanied by fever or bloody stools, or both.

Who gets TD?

TD affects 11 million people worldwide annually and attacks up to 50% of holiday makers23. Current treatments only provide relief from the symptoms when they occur and cannot prevent contracting the illness.Â TD occurs in up to a half of European travellers who spend two or more weeks in developing parts of the world.

TD is slightly more common in young adults (18-30) than in older people but attack rates are similar in men and women. It is possible for travellers to experience more than one episode of TD during a single trip.

What causes TD?

The most important determinant factor is the destination of the traveller. High-risk destinations include most of Latin America, Africa, the Middle East, and Asia, where attack rates of up to 50% have been reported.

The organisms most commonly associated with traveller's diarrhoea are; E.Coli, Salmonella, Campylobacter, Shigella, Rotavirus and Giardia.

TD is usually acquired by ingestion of faecally contaminated food or water. Both cooked and uncooked foods may be implicated if they have been improperly handled. The location in which food is prepared appears to be an important variable. Listed in order of increasing risk they are private homes, hotels, restaurants, and street vendors.

Particularly risky foods include raw or undercooked meat, poultry, seafood, raw fruits and vegetables. Tap water, ice, and unpasteurised milk and dairy products are also associated with increased risk of TD.
Worldwide, unsafe drinking water is a major problem. Most of the general information sites for travellers recommend avoiding tap water abroad, but country specific information can be found from the local tourism office.

How can you prevent TD?

Intestinal flora play an important role in protecting against infection and managing immunity. They also provide specific enzymes needed to digest particular substances in the diet. Many digestive health problems including TD can escalate as our delicate intestinal flora is disturbed by the environmental and dietary changes associated with foreign travel.

Travellers can minimise these digestive health risks by preparing with a well balanced and healthy intestinal flora and by maintaining this protective shield throughout their travels.

A prebiotic powder has recently been proven to have protective benefits against TD.Â Its prebiotic properties mean that it is not destroyed, digested or absorbed in the stomach or small intestine.Â It therefore reaches the colon intact to selectively target and feed the bodyâ€™s immunity boosting bifidobacteria while reducing harmful bacteria.

Some useful precautions include:

Boost your immune system with a prebiotic health supplement before you travel and whilst your away
Unless you are sure of the purity of the water supply, don't drink it. This also applies to water used for ice-cubes and for cleaning teeth. Use water purifying treatments where available
Water from sealed lid bottles is usually safe, as are hot tea and coffee, fizzy drinks, beer and wine
Take care with local cheeses and ice cream. Boil unpasteurised milk before use.
Cook meat thoroughly and eat while still hot. Avoid leftovers
Fish and shellfish may be hazardous even if well cooked. Take local advice, but avoid seafood if in doubt
Eat only cooked vegetables and avoid salads
Peel all fruit, including tomatoes. Avoid food exposed to flies.
Wash all dishes and cutlery in clean, hot water
Wash your hands thoroughly before eating or handling food, and always after using the toilet

No vaccines are available and none are expected to be available in the near future that are effective against TD.

Attention to hygiene during food and beverage consumption can greatly decrease the likelihood of developing TD. Many travellers, however, encounter difficulty in observing these restrictions.

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