Travelers’ diarrhea? High risk countries are...

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Travelers’ diarrhea attack rates range from 30% to 70% of travelers.

It was thought that TD could be prevented by following simple recommendations such as “boil it, cook it, peel it, or forget it,” but studies have found that people who follow these rules may still become ill. Poor hygiene practice in local restaurants is likely the largest contributor to the risk for TD, according to CDC.

What is commonly known as “food poisoning” involves the ingestion of preformed toxins in food. In this syndrome, vomiting and diarrhea may both be present, but symptoms usually resolve spontaneously within 12 hours.

The world is generally divided into 3 grades of risk: low, intermediate, and high.

Low-risk countries

-United States, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe.

Intermediate-risk countries

Eastern Europe, South Africa, and some of the Caribbean islands.

High-risk areas

- Asia, the Middle East, Africa, Mexico, and Central and South America.


What you need to know


A cohort of expatriates residing in Kathmandu, Nepal, experienced an average of 3.2 episodes of TD per person in their first year. In more temperate regions, there may be seasonal variations in diarrhea risk. In south Asia, for example, much higher TD attack rates are reported during the hot months preceding the monsoon.

In environments where large numbers of people do not have access to plumbing or latrines, the amount of stool contamination in the environment will be higher and more accessible to flies. Inadequate electrical capacity may lead to frequent blackouts or poorly functioning refrigeration, which can result in unsafe food storage and an increased risk for disease. Lack of safe water may lead to contaminated foods and drinks prepared with such water; inadequate water supply may lead to shortcuts in cleaning hands, surfaces, utensils, and foods such as fruits and vegetables. In addition, handwashing may not be a social norm and could be an extra expense, thus there may be no handwashing stations in food preparation areas. In destinations in which effective food handling courses have been provided, the risk for TD has been demonstrated to decrease. However, even in developed countries, pathogens such as Shigella sonnei have caused TD linked to handling and preparation of food in restaurants.

For travelers to high-risk areas, several approaches may be recommended that can reduce, but never completely eliminate, the risk for TD. These include instruction regarding food and beverage selection, use of agents other than antimicrobial drugs for prophylaxis, and use of prophylactic antibiotics. Carrying small containers of alcohol-based hand sanitizers (containing ≥60% alcohol) may make it easier for travelers to clean their hands before eating. No vaccines are available for most pathogens that cause TD. Care in selecting food and beverages for consumption helps to minimize the risk for acquiring TD.

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Last modified on Wednesday, 19 April 2017 20:54


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