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Avoiding Travelers' Diarrhea

Frank Gillingham, MD

Global travel can be extremely enjoyable, but it also creates some health risks for the traveler, including most commonly Travelers' Diarrhea, or TD for short. (This is a condition with many other names, such as Montezuma's Revenge, for example). This column will focus on basic information about TD and the food and water precautions you should follow to avoid this scourge.

TD is extremely common, striking 30-70% of travelers to developing countries, and the best evidence is that nearly all cases are caused by infectious agents, such as viruses, bacteria, and protozoa. The two most common symptoms are diarrhea and abdominal cramping. Nausea and vomiting, bloating, malaise, fever and blood in the stool also occur. TD usually strikes quickly, typically during the first week of your trip, but can occur upon return home. Most cases last 3-4 days, untreated, and 90% resolve within a week. According to the CDC, the risk of acquiring TD is highest when you travel to developing countries in Latin America, Africa, the Middle East and Asia. Intermediate risk destinations include countries in Southern Europe and several Caribbean islands. Low-risk destinations include Canada, Northern Europe, Australia, New Zealand, the United States and many of the more developed Caribbean Islands.

TD is spread through fecally contaminated food, primarily, and water. Obviously the risk of contamination occurring is highest in places without adequate sanitation facilities. High risk foods include raw and undercooked meats, seafood, raw fruits and vegetables. Tap water, ice and unpasteurized milk and dairy products such as cheese may be associated with increased risk of TD. Where you eat also seems to matter. Highest risk: street vendors: Lowest risk: food prepared in private homes.

If you are pregnant or traveling with small children, you will need to be extra careful. Please discuss your situation with a physician prior to leaving home.

Here are some specific suggestions on avoiding TD: