Traveller's diarrhoea

Abstract

Travellers' diarrhoea is the commonest health affliction for visitors to developing countries and to resorts with an inadequate water supply and sewage disposal systems. Attack rates may exceed 50% and although rarely a severe health hazard may be the cause of an economic deprivation to a community if it discourages tourism. Enterotoxigenic Escherichia coli (ETEC) is the predominant causative organism. It is spread from man to man through water and food. The fundamental preventative strategy must be an improvement in drinking water supplies, safe sewage collection and disposal, and the achievement of high levels of hygiene at all stages of the food chain. Travellers visiting under-developed areas can take simple dietary and beverage precautions. Prophylactic antimicrobial agents will reduce the risk to an individual but may be detrimental to the community by encouraging the emergence of resistant bacterial strains. Vaccines are being developed against ETEC. The corner stone of treatment is fluid replacement. Symptomatic relief can be provided by antimotility drugs and the disease shortened by antibiotics. There is a need for a greater understanding of the faecal-oral pathways, for ongoing epidemiological studies and for cost benefit analysis studies of prophylactic and treatment schedules.

A study of fructo oligosaccharides in the prevention of travellers’ diarrhoea

“…The subjects were recruited through consumer magazines, probably read by mainly health conscious individuals of whom the majority were over 50 years of age and who might already be taking all the necessary precautions to avoid travellers’ diarrhoea. However, the prevalence of diarrhoea in this group was 42% and as such, reflects very closely other reported incidence rates in widely differing populations 1 –7 . Compliance with the regime was also good.…”

“…It is particularly frequent in visitors to Central America, the Far East, India and parts of Africa. Current estimates are that 60 million travellers from the West visit high risk areas annually, and of these 30–50% have episodes of diarrhoea 1 –7 …”

Food and waterborne infections associated with package holidays

“…Gastrointestinal infections are regarded as the commonest travel associated illnesses. The term travellers' diarrhoea is used to cover the majority of these infections and has been the subject of many reviews (Farthing 1992;Cartwright 1993;Castelli and Carosi 1995;Cartwright and Chahed 1997) but little sustained epidemiological and microbiological study. Studies such as that by Steffen et al (1999) have primarily concentrated on the presentation of the illnesses, their duration and severity, the causative agents and the effect of various medications.…”

“…Travellers’ diarrhoea can be caused by a wide range of gastrointestinal pathogens and have been the subject of reviews including those by Farthing (1992), Cartwright (1993), Castelli and Carosi (1995), and Cartwright and Chahed (1997). A study by Steffen et al (1999) in Jamaica revealed that the most frequently detected pathogens were enterotoxigenic Escherichia coli , Rotavirus and Salmonella species.…”

Risk factors associated with travel to rabies endemic countries

“…Although the risks of food and water-borne pathogens have been recognized, often there is little direct action being taken to avoid their distribution. Enterotoxigenic Escherichia coli is the commonest health burden for visitors to developing countries, especially countries with inadequate water supplies and sewage disposal systems (Cartwright 1993). Of the emerging diseases, the most significant are zoonotic viral pathogens (Taylor et al 2001), which includes RABV.…”