Preventing Turista and Other Travelers' Ailments

by Food and Drug Administration (FDA)

I was in my hotel room in Guatemala when it hit. That sudden urge to go to the bathroom, right now. If it had been the first time that morning I would not have thought twice about it. But it was the fourth time in less than an hour. I knew I had it, that dreaded affliction of American tourists overseas — travelers' diarrhea.

Travelers' diarrhea is the affliction most likely to strike the 8 million Americans who travel abroad each year, but it is not the only disease or medical condition they should be wary of.

There are also a number of other diseases or medical conditions that are rare or nonexistent in the United States but common abroad, especially in developing countries. These include the ancient scourges of malaria, typhoid, cholera, and yellow fever. Other exotic ailments like schistosomiasis can also strike the unsuspecting.

But should Americans or any other of the estimated 250 million-a-year worldwide travelers change their itineraries to include only safe areas or limit their trips to within their own country's borders because of a fear of such diseases?

"Oh, no," responds Hans Lobel, M.D., of the Centers for Disease Control in Atlanta. "What's the purpose of living if you can't enjoy it?" he asks.

Fortunately, travelers can take many precautionary measures to reduce the risk of getting most diseases Americans are likely to be exposed to in other countries. Vaccines and drugs are also available to prevent or treat those diseases. Some are prescription medications, but others are sold over the counter.

Simple precautions include, experts say, knowing what health conditions might be encountered, making sure immunizations are up to date, taking along a supply of medicines, and being careful about what you eat, drink or do abroad. Travelers, especially older ones or those with diseases such as diabetes, are also advised to discuss their travel plans and any special medical needs with their physicians before leaving.

"People should travel with care," says Pamela Prindle, administrative director of immunizations at Foxhall Internists, a Washington, D.C., medical practice specializing in travelers' health. "Travel as wisely and as healthy as you can," Prindle advises Foxhall's patients.

The specific diseases or medical conditions any traveler might be exposed to depend on where that individual is going, how long he or she will be staying, and how that person will be living once there, says Theodore Nash, M.D., a senior scientist at the National Institutes of Health's Laboratory of Parasitic Diseases.

Traveling in Europe is safer, for example, than in tropical Africa or Asia. But staying in a London or Paris hotel for a few days differs from spending weeks in rural Yugoslavia or Greece. Similarly, there is a big difference between going to an African city such as Nairobi and undertaking a wildlife safari in the bush. And traveling for business or sightseeing is not the same as living in a rural area for weeks, months or years.

In general, the diseases that concern most travelers are found largely in tropical Central and South America, Africa and Asia, says R. Bradley Sack, M.D., director of the international travel clinic at the Johns Hopkins University School of Medicine in Baltimore. The bacteria, viruses and parasites that cause such diseases thrive in hot climates and in countries or areas where sanitation and medical care usually fall below U.S. standards.

Even so, the chances of getting a serious tropical disease are remote for most tourist and business travelers, especially if precautions are taken. For example, each year, only a thousand or so Americans traveling abroad get malaria, says Lobel, chief of CDC's malaria surveillance program. In East Africa, where most American tourists to that continent go, the risk is 1 in about 200. In India and southern Asia, it is 1 in 50,000.

Travelers' Diarrhea

Some 20 to 50 percent of Americans visiting the tropics get what is called "Montezuma's revenge," the "skitters" or, in Spanish-speaking countries, "turista," says Martin Wolfe, M.D., director of the Travelers' Medical Service in Washington, D.C.

Its symptoms include loose and watery stools, nausea, bloating, abdominal cramps, and sometimes fever and malaise. Fortunately, it is a self-limiting disease. Even if untreated, its symptoms usually go away in three or four days. If diarrhea lasts more than four days or is accompanied by severe cramps, bloody stools, or foul-smelling gas, the individual should see a physician.

Most travelers' diarrhea is caused by a special strain of the common intestinal bacteria Escherichia coli. This strain of E. coli, as it is usually known, accounts for at least 40 percent of all travelers' diarrhea. Other bacteria, such as the ones responsible for salmonellosis and shigellosis, can also cause diarrhea, as can such parasitic conditions as giardiasis and amebiasis.

Whatever the cause, the best way to treat travelers' diarrhea, the experts say, is to prevent it. Most diarrhea-causing organisms are water-borne, passed on in untreated water or by food handlers who have not washed their hands adequately.

Savvy tourists will avoid using untreated or suspect water in areas where travelers' diarrhea is common. This includes not drinking tap water or using it to brush your teeth (even in good hotels), not using ice in sodas or alcoholic drinks, and not mixing alcohol with water. It's also smart to skip milk and other dairy products unless you are sure they have been pasteurized.

For brushing your teeth or drinking in your hotel room, boil the water you intend to use for at least five minutes or add water purification tablets. Avoid bottled water unless it is carbonated — the carbonation process inhibits bacterial growth. Drink carbonated beverages, beer, wine, and coffee or tea. And wipe off bottle or can tops before drinking from them.

Also, be cautious about food, especially in developing countries. Don't eat raw vegetables, fruits, meats, or seafood. Avoid cold buffets left in the sun for several hours, garden or potato salads, and food from street vendors. Eat only hot cooked meals, fruits you have peeled yourself, and packaged foods.

If, despite all your best efforts, travelers' diarrhea strikes, medical experts and experienced travelers alike recommend drinking plenty of fluids to replace water and adding oral rehydration packets to fluids to replace lost minerals. Additionally, several prescription and over-the-counter drugs will relieve diarrhea's symptoms or kill bacteria that cause the disease.

The first line of defense now for early treatment of travelers' diarrhea is the antibiotic trimethoprim/sulfamethoxazole (Bactrim). Long used for other illnesses, it is the only antibiotic approved by the Food and Drug Administration for travelers' diarrhea. Bactrim is 90 percent effective against the organisms that cause the disease, says John Hopkins' Sack. It usually shortens the illness and makes it less severe. Travelers can ask their physicians for a prescription to take along so it will be available at the first signs of travelers' diarrhea.

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