Travelers Diarrhea (TD)

  • TD is the most common illness affecting travelers.
  • Attacks range from 30-70% depending mostly on the area.
  • High risk areas: Asia, Middle East, Africa, Mexico and Central and South America.
  • Bacteria cause approximately 80% of TD cases, primarily E. Coli.
  • The primary source of infection is ingestion of fecally contaminated food or water.
  • Poor Hygiene in local restaurants is largest contributor.  Poorly educated regarding food sanitation.
  • You can prevent by washing hands, following drinking water precautions and making smart food choices.
  • Common symptoms are diarrhea, abdominal cramping, bloating, nausea/vomiting, fever, urgency, and malaise.
  • Most cases are benign and resolve in 1-2 days without treatment. TD is rarely life-threatening. The natural history of TD is that 90% of cases resolve within 1 week, and 98% resolve within 1 month.
  • You may have repeat bouts with other contaminants.

Preventive Measures for FOOD SAFETY:

  • Avoid street-vendor food and unhygienic eating establishments.
  • Avoid eating raw or undercooked eggs, meat and seafood.
  • Avoid eating raw fruits (oranges, bananas, avocados) unless YOU peel them.
  • Avoid uncooked vegetables (including salad) especially in questionable locations.
  • Unpasteurized milk and dairy products (chesses) are associated with increased risk.
  • If handled properly, well-cooked and packaged foods usually are safe.
  • Wash your hands before eating…every time!

Preventive Measures for WATER SAFETY:

  • Drink only bottled water or commercially sealed beverages.
  • Ensure cap has intact seal.
  • Avoid Ice cubes
  • Do not avoid drinking fluids, as you risk dehydration….Drink safe!
  • If in doubt, boil for at least 5 minutes or use a water filter or purification tablets
  • Brush teeth with bottled water

Treatment Measures for Travelers’ Diarrhea:

  • TD usually is a self-limited disorder and often resolves without specific treatment.
  • Oral rehydration is recommended to replace lost fluids and electrolytes.
  • Clear liquids are best (water, apple/cranberry/grape juices, ginger ale or other clear carbonated drinks from safe containers, clear sports drinks, clear broth).
  • Travelers who develop three or more loose stools in an 8-hour period---especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools---may benefit from antibiotics.
  • Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day for 3-5 days.
  • Over-the-counter Pepto-Bismol or Immodium, as directed, should help to solidify stools.
  • Make sure you have the appropriate information and medications to treat TD before you leave!!

**If diarrhea becomes severe — or if diarrhea is bloody, or fever occurs with shaking chills, or abdominal pain becomes marked, or diarrhea persists for more than 72 hours — Seek medical treatment!


Mosquito Borne Diseases:

  • MALARIA is one of the most frequent problems faced by travelers to the tropics and sub-tropics. It is transmitted through the bite of infected mosquitoes and occasionally through blood transmission. The mosquito-borne infection is most common in Central and South America, Africa, India, Southeast Asia, the Middle East, and the South Pacific Islands. Four different forms of malaria have a variety of impacts from fever and chills, to vomiting and diarrhea. Untreated, serious infection can lead to death. Infection usually occurs between dusk and dawn. Symptoms will occur 7-9 days after bite. Travelers can protect themselves from insect borne disease by wearing long sleeved shirts and slacks and using insect repellent. Preventive medication is recommended when traveling to areas where malaria is present. The type of medication used depends upon the region of travel and a prescription is necessary. Anti-malarial drugs are taken in pill form, either daily or weekly 1-2 weeks prior to departure, and continue for 1-4 weeks after leaving the area. Cost can vary and depend upon region of travel, length of stay, and drug resistant strains of malaria. It is imperative to complete ALL ordered medications.

**No antimalarial is 100% effective and must be combined with use of personal protective measures, such as using insect repellent with 30-50% DEET, wearing long sleeved shirt/pants and sleeping with nets or in mosquito free settings. Mosquitos are most active at dusk and dawn.

  • DENGUE FEVER is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia. This disease is spread through the bites of infected mosquitoes and cannot be spread person to person. Dengue virus is present in all tropical and many subtropical areas worldwide. The mosquitoes that carry dengue bite most often in the morning and evening and during hot, wet times of the year. However, they can bite and spread infection all year long and at any time of day. Common symptoms include fever, headache, pain behind the eyes, joint pain, rash, nausea/vomiting, easy bruising or bleeding from nose/gums. Severe dengue can be fatal, but with good treatment, less than 1% of patients die from dengue. People who have had dengue before may get severe dengue if they are infected again. Travelers can reduce their risk of dengue infection by using personal protective measures to prevent mosquito bites (see malaria above). For up to date information on specific areas, see the Dengue Map on the CDC website. There is no vaccination.

What to do if you Become Sick of Injured

  • Have Diarrhea AND a fever above 102F
  • Have bloody Diarrhea
  • Are visiting a marlaria-risk country and develop flu-like illness or fever
  • Are bitten or scratched by an animal
  • Have been in a car accident
  • Have been seriously injured
  • Are Sexually assaulted