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Infectious diseases

Traveler's diarrhea is the most common infectious disease experienced by international travelers. It can be caused by bacteria (most common), viruses or parasites that have been ingested through contaminated food or drink. Traveler's diarrhea can be mild to extreme in severity.

Preventing traveler's diarrhea

Remember: boil it, cook it, peel it, or forget it! In other words, if you don't boil, cook, or peel your food, you could get sick.

Other prevention tips include:

  • Wash your hands with soap and water or use alcohol-based hand sanitizers before eating.
  • If you're having coffee, tea, or other drinks that require water for preparation, use bottled or disinfected water.
  • Don't use tap water for drinking or brushing your teeth, and be sure to avoid ice. Drink bottled water with an intact seal or purify water yourself.bottled water.jpg
  • Avoid unpasteurized dairy products.
  • Avoid food of questionable preparation or origin (like buffets).
  • Avoid food from street vendors.
  • Steer clear of food that has been rewarmed (like quiche).
  • To clean vegetables, start with boiled water, and add bleach (2-4 drops per liter of water). You may also use enough iodine tablets to make the water the color of dark tea. Soak veggies in the water for several hours, and then drain produce and rinse again with clean water.

Treating traveler's diarrhea

Traveler's diarrhea can range from mild to severe. Treatment varies based on severity.

Mild diarrhea

Mild traveler's diarrhea is characterized by 3-4 unformed stools in 24 hours with mild cramping.

intestines.jpgRecommended treatment:

  • Drink plenty of clear fluids or consider the use of Oral Rehydration Solution (ORS) or Ceralyte. (Appropriate for adults and children.)
  • Loperamine (Imodium AD) will decrease diarrhea for about 4 hours, allowing you to travel or sleep. Follow the directions on the box of loperamine. Not to be used for children under 12 or if you have bloody diarrhea.
  • Try to eat as soon as possible. It's best to start with easily digested foods, like bananas, rice, applesauce and toast. Avoid milk products for 72 hours after last diarrhea.

Moderate diarrhea

Symptoms of moderate traveler's diarrhea include increased frequency of unformed bowel movements with one or more of the following: Fever up to 101° F, abdominal pain, nausea or vomiting.

Recommended treatment:

  • Drink plenty of clear fluids or consider the use of Oral Rehydration Solution (ORS) or Ceralyte. (Appropriate for adults and children.)
  • Loperamine (Imodium AD) will decrease diarrhea for about 4 hours, allowing you to travel or sleep. Follow the directions on the box of loperamine. Not to be used for children under 12 or if you have bloody diarrhea.
  • Prior to your trip, an antibiotic will be prescribed for you depending on your history and destination. It is important to discuss all your medications with your provider before taking antibiotics, as some drugs reduce the efficacy of antibiotics, or cause unpleasant side effects:
    • Ciprofloxacin (Cipro), which should be taken in conjunction with Loperamine (Imodium AD). Not to be used in pregnant or breastfeeding women, or in children under 18.
    • Azithromycin (Zithromax), the preferred medication for children under 18. It may be dispensed as a powder to allow a parent or guardian to administer it as a liquid. Azithromycin should be taken with food to avoid stomach upset.
    • Rifaximin (Xifaxan), which is used for individuals who are not able to tolerate other antibiotics.

Severe diarrhea

Severe traveler's diarrhea is moderate diarrhea with or without abdominal cramping/pain, fever, blood in stool, dehydration. You can take antibiotics if you have severe diarrhea, but if symptoms worsen seek medical care. These symptoms could indicate a more severe infection, such as giardia or amoebiasis.

Diarrhea in children

Young children (under age 5) are particularly susceptible to becoming dehydrated from diarrhea. Do not use loperamine (Imodium AD) in children.

If a breastfeeding infant has diarrhea, continue breastfeeding. An infant or toddler should have at least one wet diaper every 4-6 hours. If there is a longer period between wet diapers, the child needs more fluids and should be seen by a health care provider. Parents and guardians should have a low threshold for seeking medical help if a child in their care experiences vomiting and diarrhea.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff, May 2014


What is dengue (deng-gay) fever?

Dengue fever and dengue hemorrhagic fever are viral illnesses transmitted by the bite/sting of a mosquito. The mosquito species that carries dengue virus is active, biting during daylight hours, with a peak of activity just after daybreak, and then again for several hours before dark. These insects are often present indoors, and are common in areas of human habitation, including urban and rural areas throughout the tropical areas of the world.

Symptoms

Symptoms of dengue fever include:

  • Relatively sudden onset of high fever
  • Severe frontal headache
  • Muscle and joint pains
  • Nausea and/or vomiting
  • Rash

On the third or fourth day of the fever, many people will develop a rash on the torso, which then spreads to the arms and legs.

Usually the illness is "self-limited" in travelers and relatively mild, meaning it runs its course over a week or two, though in rare circumstances it can cause severe symptoms.

Another name for this illness is "break-bone fever" due to the extreme bone pain that can accompany this disease.

Treatment

There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. To help with recovery:

  • Get plenty of bed rest
  • Drink lots of fluids
  • Take acetaminophen to reduce fever (not aspirin nor non-steroidal anti-inflammatory products such as aspirin or ibuprofen)

Risk to travelers

International travelers to areas where Dengue Fever occurs are at risk, more so if there is current epidemic activity underway at the time of the trip. Dengue is becoming an increasing health concern worldwide due to spread of significant disease in 2005-2007 in areas of the world without previous recent Dengue Fever.

Luckily, cases of severe Dengue Hemorrhagic Fever are rare, since this typically afflicts only those persons who reside in areas where dengue exists and are subject to repeated infections. Your travel health care adviser will let you know if dengue is a risk for you on your planned travel abroad.

Prevention of dengue fever

Since there is no vaccine against dengue at this time, the best prevention is to avoid getting bitten by mosquitoes in the first place. Follow these tips to prevent being bitten by mosquitoes:

  • Stay in screened or air-conditioned environments as much as possible
  • Use DEET-containing insect repellent on your skin

Your travel health adviser will discuss use of DEET in preventing dengue and other mosquito-borne diseases including malaria during your Travel Clinic visit.

If you have dengue fever

  • Avoid mosquito bites while you have a fever. Don't let mosquitoes bite you. They can infect other members of your family with dengue after biting you.
  • Use mosquito barriers until the fever subsides, to prevent day-biting mosquitoes from biting a sick person, becoming infected, and then biting someone else.
  • Rest in a screened room or under a bed net.
  • Use insect repellents and spray insecticide indoors if there are mosquitoes.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


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