Diarrhea Diseases from Travel

When To Call

Call 911 Now

• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Tropical disease suspected and fever present
• Tropical disease has been diagnosed and getting worse
• Tropical disease has been diagnosed and fever returns after gone for several days
• Tropical disease has been diagnosed and shaking chills return
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Tropical disease suspected, but no fever
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Questions about cholera
• Questions about typhoid fever
• Question about traveler's diarrhea (TD)
• Questions about preventing diarrhea during travel

Care Advice

Cholera Questions

What You Should Know About Cholera:

• It is a severe diarrhea disease caused by a bacteria.
• World Impact: There are over 4 million new cases per year. It causes over 100,000 deaths per year.

Symptoms:

• Mild to severe diarrhea. About 5% develop severe watery diarrhea.
• Without treatment, it can progress to severe dehydration and shock within 12 hours.
• Other symptoms are vomiting, leg cramps and fever.

Cause:

• Cholera is caused by the Vibrio cholera bacteria found in stool.
• You get sick by swallowing food or drink made dirty with germs from stools.

Time Period to Get Sick:

• The time from contact to symptoms is 1-5 days.

Contagious Period:

• The disease can be spread to others for 1-2 weeks if not treated with antibiotics.

Tests and Treatment:

• Stool tests are needed to diagnose it.
• It is treated with special electrolyte fluids by mouth or IV fluids. These fluids are life-saving.
• Antibiotics may also be helpful.

What to Expect:

• Good outcome if diarrhea losses are replaced promptly with fluid.

How to Prevent:

• Vaccine: new cholera vaccines taken by mouth are very protective.
• Good hand washing.
• Avoid unsafe food and drink.
• Drink only bottled or boiled water.
• Eat only well-cooked food.

Countries with Cholera:

• It is seen in Africa and other tropical countries.
• Rarely is seen in US in Florida and other Gulf states. Cause in US: shellfish that isn't cooked fully.
• For more info and current high-risk countries, see the CDC website.

Call Your Doctor If:

• You have other questions or concerns

Typhoid Fever Questions

What You Should Know About Typhoid Fever:

• It is a severe diarrhea disease caused by a bacteria.
• World Impact: There are 20 million new cases each year. It causes over 200,000 deaths each year.

Symptoms:

• Starts with fever, stomach pain and diarrhea.
• The fever lasts for weeks.
• The diarrhea worsens and can become bloody.
• Feeling tired, weakness and loss of appetite are common.
• A rash of small rose-colored spots may occur on the chest and stomach.

Cause:

• Typhoid is caused by the Salmonella typhi bacteria found in stool.
• You get sick by swallowing food or drink made dirty with germs from stools.

Time Period to Get Sick:

• The time from contact to symptoms is 6 to 30 days.

Contagious Period:

• Can be prolonged if not treated with antibiotics.
• Even those who are treated can become carriers.

Tests and Treatment:

• Stool tests and blood tests are needed to diagnose it.
• It is treated with special electrolyte fluids by mouth or IV fluids.
• Antibiotics are given to kill the bacteria.

What to Expect:

• With treatment, symptoms improve in 2 to 4 weeks.
• Without treatment, the symptoms may last for months.
• The disease may come back after treatment.

How to Prevent:

• Vaccine: there is a typhoid vaccine.
• Use good hand washing.
• Avoid unsafe food and drink.
• Drink only bottled or boiled water.
• Eat only well-cooked food.

Countries with Typhoid:

• It is common in Africa, Asia and Latin America.
• It does occur in the US in low numbers. Mainly in travelers coming back to the US.
• For more info and current high risk countries, see the CDC website.

Call Your Doctor If:

• You have other questions or concerns

Traveler's Diarrhea (TD) Questions

What You Should Know About Traveler's Diarrhea (TD):

• It is a disease seen in travelers to developing countries in the tropics.
• World Impact: in high-risk countries, TD affects up to 40% of travelers. There are about 20 million new cases each year. Mainly, it disrupts vacations. About 30% of people can't pursue planned activities. Deaths are very rare.

Symptoms:

• Sudden onset of loose stools, twice or more the normal number.
• Nausea is often present, but only 20% have vomiting.
• May also include stomach cramps and an urgent need to pass a stool.
• Fever occurs in 10%.
• Blood in the stools occurs in 5% of cases. This means the infection has become more severe.

Cause:

• Caused by germs from stools present in the water, food or drinks.
• Over 80% is caused by E. coli bacteria. These bacteria are not harmful ones. But, they are new to the traveler's body and gut.
• Sometimes, more serious bacteria such as Shigella are the cause.
• Parasites cause 5-10%. Diarrhea from parasites has a more gradual onset.

Time Period to Get Sick:

• The time from contact to symptoms is 1-3 days for bacteria.
• Diarrhea from parasites takes 2-4 weeks to start.

Contagious Period:

• TD can be passed to others until the stools are formed.

Tests and Treatment:

• Most often, the diagnosis is based upon symptoms and recent travel history. Lab tests are not needed.
• If the stools become bloody, stool tests may be done. If it lasts more than 2 weeks, parasite tests may be done.
• It is treated with special electrolyte fluids by mouth. Less than 1% of people need IV fluids.
• Probiotics (such as yogurt) may also be helpful.
• Antibiotics are sometimes given to kill the bacteria. They are mainly used if fever, bloody stools, severe diarrhea or stomach cramps occur.

What to Expect:

• TD is a self-limited illness.
• Most people that aren't treated have diarrhea that lasts 3 to 5 days.
• About 5% develop blood in the stools.
• It is more severe and lasts longer in young children.

How to Prevent:

• Wash Hands: use good hand washing.
• Diet: avoid unsafe food and drink. Drink only bottled or boiled water. Eat only well-cooked food.
• Medicines: in some cases, Pepto-Bismol 4 times a day is advised. Antibiotics to prevent TD are not advised for healthy people. Check with your doctor before you travel out of the country.
• Vaccine: there is no vaccine for TD.

Countries at Risk:

• High-risk countries are in Latin America, Africa and Southern Asia. About 40% of travelers there get diarrhea.
• Moderate-risk countries are in Southern Europe, Middle East, China and Russia. About 15% of travelers will get it.
• Low-risk countries are the US, Western Europe, Canada and Japan.
• For more info and for current high risk countries, see the CDC website.

Call Your Doctor If:

• You have other questions or concerns

Diarrhea Disease: How to Prevent

Safety Tips in All Countries:

• Hand washing is the key to prevent the spread of infections.
• Always wash the hands before eating, feeding or handling young children or cooking.
• Always wash the hands after any contact with vomit or stools.
• Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
• Cook all poultry fully. Never serve chicken that is still pink inside. Reason: Poultry that isn't cooked all the way is a common cause of diarrhea.

Extra Safety Tips in Developing Countries:

• Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
• Eat foods that have been fully cooked and that are still hot.
• Dry foods such as bread are usually safe.
• Avoid salads and raw veggies. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
• Avoid all meat and fish that isn't cooked all the way.
• Avoid buying foods and drinks from street vendors. Reason: this is a common cause of traveler's diarrhea.
• Formula for babies: breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
• Feeding babies: wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
• Brush your teeth with bottled or boiled water.

Call Your Doctor If:

• You have other questions or concerns

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