Traveller's diarrhoea (TD) can quickly turn a dream holiday into a nightmare. Yet new research has emphasised the extent to which holidaymakers from the UK underestimate the risks and are poorly prepared for the situation.
Statistics suggest that between 20-40% of travellers suffer diarrhoea to some degree, and this figure rises to 50% for travellers who go to developing countries and exotic destinations. A recent survey showed that 46% of all those interviewed didn't recognise the risk of developing diarrhoea from those destinations that are traditionally seen as high risk, such as Egypt, Turkey and the Caribbean. A surprising 97% were unable to identify high-risk foods on holiday.
Where are the highest risk areas?
Egypt is the highest risk destination, but others not already mentioned include South East Asia, Africa, South America, India and China. The Dominican Republic is the highest risk Caribbean destination. However, all foreign travel confers some risk, and basic precautions are sensible, whatever the destination.
Is it safe to drink the water?
In high-risk areas, the local water supply can be a source of infection. Most tap water in Western Europe is safe. In all high-risk areas, and in any other areas where there is any doubt, it is best to stick to the following rules:
1. Don't drink tap water.
2. Don't use ice cubes, and always specifically order bar drinks without ice.
3. Don't use local water to brush your teeth.
4. Make sure bottled water is served from a sealed bottle. Carbonated water may be safer to drink in bars and restaurants, as it is less likely to have been topped up with tap water.
5. If not drinking bottled water, then boil all drinking water or use water purification tablets or drops.
What foods are best avoided?
Trying the local food is part of the pleasure of foreign holidays, but certain restrictions will reduce the likelihood of diarrhoea due to food-borne infection. Try to avoid:
1. Cold meats
2. Shellfish and raw seafood
3. Reheated food, or food that has been kept warm. Hot buffet-style meals can contain a lot of bacteria, unless the food has been kept at the correct temperature. Similarly, cold buffets are a risk if the food has been at room temperature for too long.
4. Food washed with water from the local supply.
5. Salads, uncooked vegetables and unpeeled fruit. Although these are regarded by many travellers as low risk foods, salads, raw vegetables and unpeeled fruit are very high risk as they can be covered in bacteria, or may have been washed in the local tap water.
6. Food likely to contain uncooked eggs or unpasteurised dairy products.
7. Ice-creams from unreliable sources.
How should I treat TD?
It is important to replace lost fluids with plenty of bottled water. Oral rehydration sachets are usually only necessary for children or the frail elderly. Initially, limit food intake to plain biscuits, crackers or dry toast. A wider diet can be gradually introduced over a few days, but fatty foods are best avoided in the first few days. An anti-diarrhoeal remedy can be taken from the outset. The most useful preparation to buy in the UK is Loperamide. This is available over the counter at pharmacies for adults and children over the age of 12.
A medical opinion should be sought if there is an associated fever above 38 degrees Centigrade, if there is blood or mucus in the stool, or if the diarrhoea is not settling after 48 hours.
