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Key facts

  • Travellers’ Diarrhoea (TD) is the most common travel-related illness with up to 70% of travellers affected, depending on the destination and season of travel1
  • TD is a clinical syndrome that can result from a variety of intestinal pathogens, including bacteria and viruses1
  • The risk of infection is greatest for travellers to places with poor sanitation, especially parts of Asia, the Middle East, Africa, Mexico, and Central and South America1
  • Symptomatic TD is defined as three or more unformed stools in a 24 hour period, often accompanied by at least one of the following: fever, nausea, vomiting, cramps, or bloody stools (dysentery)2
  • TD can usually be treated but travellers can reduce the risk of infection through taking precautionary food, water and personal hygiene measures3,4

Risk areas for Travellers’ Diarrhoea5

Adapted from: Steffen R. Epidemiology of Traveler’s Diarrhea. Clin Infect Dis 2005:41(S8);S536–40.

What is Travellers’ Diarrhoea?

Travellers’ Diarrhoea is a clinical syndrome caused by the ingestion of food or water that has been contaminated with certain bacteria, viruses or protozoa.1 Enterotoxigenic Escherichia coli (ETEC), Rotavirus, Salmonella and Cholera are all causes of diarrhoea, dependant on geographical location and travel conditions.6,7 However, in a significant number of cases (approximately 40%) the pathogen that caused the illness is unknown.2

Affecting a large proportion of travellers, TD can result in substantial discomfort and disruption for travellers, with approximately 20% confined to bed for 1–2 days, while 40% have to change their itinerary as a result of infection.8


Where does Travellers’ Diarrhoea occur?

The world is generally divided into three grades of risk for Travellers’ Diarrhoea – low, intermediate, and high.1

  • Low-risk countries include the United States, Canada, Australia, New Zealand, and countries in Northern and Western Europe
  • Intermediate-risk countries include those in Eastern Europe, South Africa, and some of the Caribbean islands
  • High-risk areas include most of Asia, the Middle East, Africa, Mexico, and Central and South America.

Which travellers are at risk of contracting Travellers’ Diarrhoea?

All travellers are potentially at risk of infection. There are several risk factors for acquiring Travellers’ Diarrhoea including diet, gender, age, host genetics, destination, season of travel and choice of eating establishment. Of these, the destination country and choice of eating establishment are considered to be the most important factors.2


What are the symptoms of Travellers’ Diarrhoea?

Symptomatic Travellers’ Diarrhoea is defined as three or more unformed stools in a 24 hour period, often accompanied by at least one of the following: fever, nausea, vomiting, cramps, or abdominal cramps with blood or mucous in the stool (dysentery). However, both vomiting and dysentery are uncommon.2

The symptoms of TD usually occur during the first week of arrival and are often self-limiting, lasting three to four days. In approximately two percent of cases, symptoms persist for longer than a month.2


How is Travellers’ Diarrhoea treated?

Travellers’ Diarrhoea usually resolves spontaneously. However, for those who suffer on-going symptoms, the aim of treatment is to avoid dehydration, reduce the severity and duration of symptoms and reduce the interruption to travel plans.2

Primarily, travellers should maintain adequate fluid intake to avoid dehydration. Where symptoms are more severe, or for those prone to complications from dehydration, oral rehydration solutions can help to rebalance electrolytes.2

Anti-motility agents (such as loperamide), bismuth subsalicylate and antibiotics can be used to provide relief from the symptoms of TD.2

For those adults travellers unfortunate enough to be affected by TD whilst away, the Travellers’ Diarrhoea Self-Treatment Kit (containing: ciprofloxacin; loperamide; oral rehydration salt tablets; disposable thermometer; instruction leaflet) allows sufferers to manage their symptoms*.

All travellers should seek medical care if:2

  • symptoms do not improve within three days, such as:
    • persistent vomiting
    • bloody stools or severe diarrhoea
    • a fever of 102oF (39oC) or more
    • dry mouth, no sweating even if very hot, or crying without tears
    • signs of being unusually sleepy, drowsy or unresponsive
    • decreased volume of urine; (including fewer wet nappies in infants)
  • they are elderly, children or other vulnerable travellers

* Do not prescribe ciprofloxacin for the following groups (seek specialist advice): Children and adolescents; Women who are pregnant or breastfeeding; People travelling to countries where quinolone resistance is prevalent (for example Thailand and the Far East); People for whom quinolones are not suitable or contraindicated.9

How can you prevent Travellers’ Diarrhoea?

Taking simple precautions with food, drinks and personal hygiene can help to prevent Travellers’ Diarrhoea.3,4



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