Traveler diarrhea is the most common disease that affects people travelin g from areas of the world with good sanitation and adequate hygiene practices to areas where these are deficient. It can occur during the trip or in the 10 days after it ends; It affects 40%-60% of travelers; It usually resolves on its own (is self-limiting) in a few days and without consequences. However, if there is dehydration other health problems can arise, and be serious; It is an infectious gastrointestinal disease: In acute cases it is more often due to bacteria, among which the enterotoxinogenic Escherichia coli stands out. Viruses and parasites can also cause traveler diarrhea. Water and other drinks and food are the main sources of infection, but poor individual hygiene practices also play an important role. Not all destinations have the same risk Traveler diarrhea can happen anywhere . However, the risk is greater in areas with poor sanitation and hygiene practices. Among the destinations with the highest risk of traveler diarrhea are countries in South and Southeast Asia, Africa, Central and South America. Countries in Eastern Europe, the Middle East, the Caribbean, Central Asia and East Asia have a medium risk . The microorganisms that cause traveler diarrhea are not unique to these countries. The risk is related to the shift to worse sanitation and poor hygiene practices, particularly those related to food handling, storage, and preparation. People who habitually live in a high-risk country are less likely to get traveler diarrhea. In the same destination, the risk is not always the same for travelers, being greater in hot and humid seasons, which favor the proliferation of microorganisms. Travel time is also important During the first week of a trip the risk is higher , then it decreases over time. Most cases occur between 4 and 14 days after arriving at the destination. However, it can happen before or after as it also depends on the microorganisms involved and the amount ingested. How to prevent traveler diarrhea Carefully choosing the drinks and food to consume , as well as the places for meals, is the main preventive measure: Drink only bottled beverages (water and other) and make sure the bottles are still closed when you buy it or they are deliver to you. Prefer drinking from the bottle with a straw; Do not use ice in drinks, including alcoholic beverages. Freezing and alcohol in drinks do not kill the microorganisms that cause traveler diarrhea; Use bottled water to brush your teeth; Peel the fruits just before eating them. Do not eat the peel of the fruits, nor eat fruits that are not peelable; Do not eat raw foods, such as vegetable or fruit salads; Avoid ice cream and desserts prepared with raw foods or unpasteurized milk; Eat only well-cooked food that has been cooked recently and is still hot; Avoid reheated food; Avoid restaurants and other eating spaces with poor hygienic conditions. If you do not have bottled water : Boiling water for 3 minutes and then letting it cool to room temperature is the best way to eliminate microorganisms that may be present; Use disinfectant products for water, respecting the specific instructions that accompany them. And, of course, wash your hands! The microorganisms that cause traveler diarrhea can be carried on the hands and give rise to infection when we touch face, eyes or mouth even without noticing; Therefore, frequent hand washing is even more important in the context of travel to risk countries : before eating or drinking, after touching surfaces or objects that may be contaminated, after using the toilet, after coughing or sneezing, when they are dirty and in any additional situations that you consider necessary; Always having a hand sanitizer product with you is also a good measure. Symptoms and treatment of traveler diarrhea In most cases, traveler diarrhea is not serious and is self-limiting, that is, it resolves on its own. The most common symptoms are malaise , lack of appetite and abdominal cramps , followed suddenly by watery diarrhea . Nausea , vomiting and fever may also occur. The most important thing in traveler diarrhea is to drink fluids to avoid dehydration . The need for medication depends on medical evaluation , which will make it possible to determine the diarrhea cause and indicate any additional treatment that may be necessary. Seek medical care if : Diarrhea and other symptoms do not improve or get worse; You have diarrhea with blood in the stool, high fever, or signs of dehydration. Author : Saraiva da Cunha Sources Adler AV, Ciccotti HR, Trivitt SJH, Watson RCJ, Riddle MS. What's new in travellers' diarrhoea: updates on epidemiology, diagnostics, treatment and long-term consequences . J Travel Med 2022;29:taab099. LaRocque R, Harris JB. Travelers’ diarrhea: microbiology, epidemiology and prevention . LaRocque R, Harris JB. Travelers’ diarrhea: clinical manifestations, diagnosis and treatment . Meet the infectious diseases clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
