Health Program

 Travelers' Diarrhea


Description Travelers' diarrhea (TD) is a clinical syndrome resulting from microbial contamination of ingested food and water; it occurs during or shortly after travel, most commonly affecting persons traveling from an area of more highly developed hygiene and sanitation infrastructure to a less developed one. In this syndrome, vomiting may predominate, and symptoms usually resolve within 12-18 hours.

Risk Factors

The most important determinant of risk is travel destination, and there are regional differences in both the risk and etiology of diarrhea. The world map is generally divided into three grades of risk: high, intermediate, and low. Low-risk countries include the USA, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe. Intermediate-risk countries include those in Eastern Europe, South Africa, and some of the Caribbean islands. High-risk areas include most of Asia, the Middle East, Africa, and Central and South America. Some destinations that were previously considered high risk have now been classified as low or intermediate risk, including parts of Southern Europe and some of the Caribbean islands. On average, 30%-50% of travelers to high-risk areas will develop TD during a 1- to 2-week stay. Based on the annual figure of 50 million travelers to developing countries, this estimate translates to approximately 50,000 cases of TD each day. In more temperate regions, there may be seasonal variations in diarrhea risk. In South Asia, for example, during the hot months preceding the monsoon, much higher TD attack rates are commonly reported.

Risk Groups

Travelers' diarrhea occurs equally in males and females and is more common in young adults than in older people. In short-term travelers, bouts of TD do not appear to protect against future attacks, and more than one episode of TD may occur during a single trip.


For travelers to high-risk areas, several approaches may be recommended, which can minimize but never completely eliminate the risk of TD. These include Care in selecting food and beverages for consumption may minimize the risk for acquiring TD. Travelers should be advised to eat foods that are freshly cooked and served piping hot and avoid water and beverages diluted with water (reconstituted fruit juices, ice, milk, and bottled water) and foods washed in water, such as salads. Other risky foods include raw or undercooked meat and seafood and raw fruits and vegetables. Safe beverages include those that are bottled and sealed or carbonated. Boiled beverages and those appropriately treated with iodine or chlorine might also be safely consumed. Studies of TD risk at high-risk destinations show that consumption of food or beverages from street vendors poses a particularly high risk, and some studies suggest certain food items such as reheated prepared foods or buffet items are also high risk.


Infectious diarrhea diseases for the United States are the following according to the National Digestive Diseases Information Clearinghouse (NDDIC).

  • There were 16 million new cases in 1996.

  • A count of 2,481 deaths in 2002.

  • Hospitalization cases ranged from 375,000 to 777,000 in 2002. Doctor visits among 8 to 12 million in 1985.

  • Prescribed patients ranged from 5 to 8 million in 1985.



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