Avoiding Turista, Coping with Travelers’ Diarrhea

Studies presented at the annual International Society of Travel Medicine Conference offer new preventive measures for avoiding the most common travel illness.

When you run a travel medicine clinic in Kathmandu, Nepal, as David R. Shlim, M.D. has done for several years, it’s tough to avoid developing a keen interest traveler’s diarrhea. Why, he asked himself, do 40-50% of the 60 million travelers who travel each year between a developing country and an industrialized one suffer from the disease? Why, too, do children account for most of the 2.2 millions deaths from diarrhea each year?

In a seminar at the 8th annual Conference of the International Society of Travel Medicine, Dr. Shlim presented some interesting findings: In a 1995 study published in The Pediatric Medicine Journal, a number of children under 15 were observed to see how well they followed the dietary maxim: “Boil It, Peel It, Cook It, or Forget It.” Parents can probably guess the result: only about half of the teens followed by researchers could keep up with the suggested dietary rules.

In many other studies, researchers found that over 95% of travelers could not avoid making dietary errors. Other findings led Dr. Shlim to believe that the risks of eating in a restaurant were much greater than dining at home, but he also noted the effect of the season, proximity of flies, and immunity of the individual on the incidence of illness in travelers to developing nations. After further study, he concluded that traveler’s diarrhea may have some genetic basis and for many travelers, is largely unavoidable.

Preventive Strategies & Remedies

TD remains the most common ailment experienced by travelers who have ever been affected by a travel-related illness, according to a 2008 Harris Poll. Fortunately, only about 5% of travelers surveyed reported experiencing any illness on vacation, but of those, 63% reported incidents of diarrhea and 34% reporting stomach cramping and nausea. Dr. Shlim has a few practical tips to minimize the risks of getting it. He recommends that everyone follow the “Boil It, Peel It, Cook It, or Forget It” rule, even in his or her hometown. Additionally, he notes that selecting from a buffet (a much more likely breeding ground for illness) is riskier than ordering freshly prepared hot food. But he admits that several other important factors, including climate, the environment and even a genetic propensity to succumb to the most common bacteria are beyond the control of the diner.

Therefore, Dr. Shlim suggests that all travelers be prepared with medication (ciprofloxacin is a typical antibiotic treatment) prescribed by a physician or with medication prescribed by a pediatrician for children. In his experience, two doses, taken just 12 hours apart, should be administered at the onset of TD to stop the disease immediately. Hydration is especially important for young children while the illness runs it course.

Another medical viewpoint has emerged, one that focuses on strengthening the body’s own immunity to food-borne illnesses. Patricia Raymond, M.D. at Eastern Virginia Medical School, suggests the use of natural probiotics for preventing TD and other intestinal ailments, a home remedy common in Europe and other parts of the world. Dr. Raymond also cautions against anti-diarrheal medications: “Eliminating the diarrhea is important, yes, but stopping it up and keeping the toxins in your intestine for a length of time is not a good idea.”

Dr. Raymond explains, “Try a probiotic supplement for several days before a trip and during the trip. There has been scientific study showing a reduction in travelers’ diarrhea with a Saccharomyces probiotic species, and I’ve actually used the brand Florastor personally for this purpose with success.”

The main problem affecting the development of a vaccine is the fact that there are so many causes of diarrhea and they are all diverse. As the travel patterns of international travelers continues to change, so too do the cases of traveler’s diarrhea, making it increasingly necessary to have a single vaccine. For more information on traveler’s diarrhea please go to Center For Disease Control.