What you need to know to avoid getting sick on vacation

WATCH ABOVE: With recent reports of Canadian travellers coming down with illnesses while on vacation, Dr. Samir Gupta provides tips on avoiding falling ill while travelling abroad in this week’s On Call.

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TORONTO — There have been increasing reports of outbreaks of travellers’ diarrhea at high-end resorts lately, so we thought it would be a good idea to go over the topic in detail, with some tips on how to avoid it.

So called travellers’ diarrhea usually starts as early as about four days after travel, and can occur up to 10 days after return from travel.

The causes really do vary according to the region one is visiting, but broadly, the most common cause is bacterial infection.

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It can be caused by several different types of bacteria, the most common of which would be E. Coli.

Viruses are also a cause, the most common being rotavirus. Less commonly, parasites are to blame.

All of these organisms are usually transmitted by food and/or water, so the key to prevention is to be very careful about what you consume.

Generally speaking, heat will kill the organisms. So only eat food that has been well cooked and is served hot; if you eat raw fruits, make sure that they are peeled (ideally in front of you or by you), as the organisms may be in the water used to rinse the fruit.

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Also, drink only boiled or bottled water, pasteurized dairy, and fully carbonated beverages.

It’s also important to have an understanding of previous outbreaks in the location that you are travelling to, and the track record of the actual hotel or resort that you are staying in.Some resorts use exclusively bottled water for all drinks and cooking, which reduces the risk dramatically.

Another general factor to be aware of is that the risk of travellers’ diarrhea is higher in warmer and wetter seasons. Certain activities such as buying food from street vendors are also considered “high risk.”

In terms of actual medical prophylaxis, there are a few options.

Several different antibiotics, along with an agent called bismuth salicylate have been shown to be effective at reducing the risk of travellers’ diarrhea, but given that travellers’ diarrhea is a self-limited disease (i.e. in most cases it resolves on its own), and given the possible side effects of antibiotics (including allergic reactions, sun sensitivity, yeast infections, C. difficile colitis, etc.), we generally don’t recommend antibiotic prophylaxis.

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Exceptions include patients who might have severe consequences from these diarrheal infections, such as those with diseases that compromise their immune system.

Probiotics are another alternative, and certain studies have also shown that probiotics can successfully reduce the rates of travellers’ diarrhea, though results have varied with the type of probiotic (e.g. Lactobacillus GG was effective but nonviable Lactobacillus acidophilus was not).

Finally, the Dukoral vaccine (which is actually a vaccine against the cholera toxin) also provides some protection against the most common bacterial cause of travellers’ diarrhea, which is Enterotoxigenic E. coli (ETEC).

What about treatment?

Given that travellers’ diarrhea is almost always self-limited, the main issue to be aware of is not as much the infection as it is the risk of dehydration. So the key is to keep hydrated.

If you have diarrhea, you need to drink enough to keep peeing several times a day, and if the urine is very dark, it means you need to drink more.

For milder cases, any liquid with some salt or sugar will do the job (e.g. chicken broth or juice), but for more severe cases, it’s a good idea to pack a few packets of oral rehydration solution (ORS); this replaces needed electrolytes in the appropriate concentrations (it’s available in most pharmacies).

There are also several different antibiotics that can reduce the duration of an episode of travellers’ diarrhea. These are antibiotics in the “quinolone” class (including ciprofloxacin), which can be taken for three days after the onset of symptoms.

We often give patients a prescription to take the antibiotic with them on their travels, and to use it only if symptoms are severe or if the diarrhea really starts interfering with the trip itself.

People can also take over-the-counter “antimotility agents” — drugs such as Immodium or Lomotil — which slow down the frequency of diarrhea but don’t actually treat the infection.

Generally speaking, these agents should only be used if antibiotics are also being used, as there is a risk of making the infection worse by slowing down the emptying of the infected bowels.

Traveller’s Diarrhea: TOP 5 Easy Mistakes To Avoid

1. Don’t drink beverages with ice – Freezing doesn’t kill most of the organisms that cause traveller’s diarrhea. So drinks should be served without ice (unless the ice is made of filtered, boiled or bottled water).
2. Alcoholic beverages are no exception – Alcohol will not sterilize water from melted ice cubes or in mixed drinks — so the same rules apply to alcoholic beverages.
3. Use a straw – Bottled beverages are generally safe, but organisms can be found on the outside of glass bottles so it’s a good idea to drink from a straw.
4. Don’t forget about condiments – Sometimes people take extreme caution with their main food choices, but forget about the risk of contaminated condiments. Condiments like salsa and guacamole can harbour lots of bacteria, and are a common cause of traveller’s diarrhea.
5. Airline food is not always safe – People often think they are safe once they board the plane for home, but if food provided on the plane ride home is sourced locally, use the same precautions as you would while still on vacation.