Kids running outside with pool floaties on vacation

The Facts on Diarrhea when Travelling

Written by: CDHF

Updated: September 7th, 2023

Ready to plan your next escape to a beach somewhere near the equator? If you’re anything like me, you’ve already started planning, and are probably thinking about the essential steps… booking your travel and accommodation, packing the right clothes, ensuring you have enough spending money, planning excursions, etc. However, you should add chatting with your healthcare professional for pre-travel health advice to your to-do list!

The majority of Canadians are not as travel-savvy as they should be when it comes to the potential causes, symptoms and risks of a gastrointestinal infection. According to the US Centers for Disease Control and Prevention, approximately 30-70% of travellers may experience diarrhea during travel on vacation. If you’ve had diarrhea during travel before – you know this is NOT how you want to be spending your time on vacay!

What are the risk factors?

The most detrimental risk factor for the development of diarrhea during travel is the destination. Developing countries all over the world represent the highest risk of diarrheal disease. Those being the Caribbean, Latin America, Africa, the Middle East, and Asia.

Diarrhea during travel is typically contracted by ingesting bacteria-contaminated food or water, with food being the primary cause. Approximately 80% of reported cases of diarrhea during travel are caused by bacteria, specifically Escherichia coli (E. coli).

There are six unique classes of E. coli that can cause inflammation of the stomach and bowels and are termed enterovirulent E. coli (EEC). Brace yourself, you may not be able to pronounce these classes, but it doesn’t mean you won’t get them! They include:

Enterotoxigenic E. coli (ETEC) is one of the leading causes of diarrhea in travellers.
- ETEC produces two toxins, a heat-stable toxin (ST) and a heat-labile toxin (LT). Although different strains of ETEC can secrete either one or both of these toxins, the illness caused by each toxin is similar.
Enteroinvasive E. coli (EIEC) invades (passes into) the intestinal wall to produce severe diarrhea.
Enterohemorrhagic E. coli (EHEC) can cause bloody diarrhea and hemolytic uremic syndrome (anemia and kidney failure).
Enteropathogenic E. coli (EPEC) can cause diarrhea outbreaks in newborn nurseries.
Diffusely adherent E. coli (DAEC) is a heterogeneous group and has been particularly associated with persistent diarrhea in developing countries, mainly affecting children older than one year.
Enteroaggregative E. coli (EAEC) can cause acute and chronic (long-lasting) diarrhea in children.

One of the most common bacterium that causes diarrhea in travellers is ETEC.

Symptoms and Complications

Diarrhea in travelers is characterized by a sudden onset of not-so-pleasant symptoms including:

watery and/or bloody diarrhea
fever
nausea
vomiting
abdominal pain
chills
headache
muscle aches
bloating

These symptoms can occur 1-3 days after ingesting contaminated food or water. The effects of diarrhea during travel can be very serious, especially for children and older adults. Rehydration measures must be taken in case of diarrhea.

Which travelers are at risk for diarrhea during travel?

Men and women are at equal risk for developing diarrhea during travel, but some individuals are more commonly afflicted.

Certain groups of people are also more likely to develop diarrhea during travel.

At-risk groups include:

immunosuppressed persons (such as HIV, cancer, chemotherapy, steroid use)
those with chronic illnesses such as diabetes, chronic renal failure, and congestive heart failure
persons with underlying abdominal disorders (inflammatory bowel diseases, irritable bowel syndrome, gastrectomy, achlorhydria, vagotomy, patients continuously taking proton pump inhibitors or H2 receptor antagonists)
history of repeated severe traveler’s diarrhea

How to reduce the risk of diarrhea during travel, you ask?

You should pay close attention to diet as it is of foremost importance in the prevention of diarrhea during travel. We’ve compiled a list of things to keep in mind while on vacation:

Foods should be well-cooked and served warm.
Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided.
Dairy products, tap water and ice (including frozen drinks not made from filtered water) are also high-risk foods.
Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled, and canned products generally are safe.
The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors.
Frequent hand washing with soap and clean water will decrease the likelihood of the bacteria spreading, especially to others that you may be travelling with.

Knowing how to manage food and water intake, and personal hygiene, is so important while on vacation. Before you head on vacation, sit down with your healthcare professional to discuss preventative measures. These may include:

A vaccine like DUKORAL^® – Oral Inactivated Cholera and LT-producing ETEC diarrhea vaccine

DUKORAL^® is a drinkable vaccine that helps prevent and protect against diarrhea caused by cholera and a particular strain of bacteria producing a heat-sensitive toxin called heat-labile toxin producing enterotoxigenic Escherichia coli (LT-producing ETEC).

DUKORAL^® is used to help protect people who are travelling to an area where there is a risk of diarrhea caused by cholera and/or LT-producing ETEC. This vaccine may be given to adults and children 2 years of age and older.

The Canadian Digestive Health Foundation (CDHF) recommends considering DUKORAL^® as an option to prevent LT-producing ETEC diarrhea during travel.

There are multiple causes responsible for acute diarrhea in travellers. DUKORAL^® can only confer protection against diarrhea caused by cholera and LT-producing ETEC. Therefore, DUKORAL^®does not replace standard hygienic measures and food and water precautions.

Like any vaccines, DUKORAL^® may not protect 100% of people who receive it and may cause side effects. Talk to your doctor to see if DUKORAL^® is right for you.