Diarrhea Diseases From Travel

• Tropical diseases that cause diarrhea
• Includes cholera, typhoid and traveler's diarrhea
• Spread by food or drink made dirty with infected human waste
• Your child has no symptoms of tropical disease. If your child has symptoms, use other guides.
• Tropical diseases occur in people who travel to or live in high-risk countries. These mainly are developing countries near the Equator. You may have traveled to a high-risk country recently.

How Tropical Diarrhea Diseases are Detected by this Symptom Checker

• These diseases can't be diagnosed over the phone. But, they can be suspected based on their symptoms. They are then referred to a medical setting where a diagnosis can be made.
• Cholera will be picked up by the Diarrhea or Vomiting guides. Diarrhea that lasts too long or is severe will refer the child to be seen. Dehydration is a health problem where the body has lost too much fluid. It can be a result of diarrhea and/or vomiting. This will also be picked up in these guides.
• Typhoid will be picked up by the Diarrhea guide. Diarrhea that lasts too long or is severe will refer the child to be seen. Bloody stools or fever lasting too long also refer the child to be seen.
• Traveler's diarrhea will be picked up by the Diarrhea or Vomiting guides. Diarrhea that lasts too long or is severe will refer the child to be seen. Dehydration will also refer the child to be seen.
• Travel to a high risk country should raise the concern. However, common diseases such as viral diarrhea also must be ruled out. They occur more commonly in these countries than the serious diseases. But, severe symptoms or symptoms that last too long make us think about these other diseases.

World-wide Causes of Death in Children Under Age 5

• 6.3 million children under the age of 5 died in 2013 worldwide.
• These 5 infections account for over 50% of all early child deaths:
  1. Pneumonia and other respiratory diseases 19%
  2. Diarrhea disease 18%
  3. Malaria 8%
  4. Measles 4%
  5. HIV/AIDS 3%
• Poor nutrition is a factor in over half who die older than one month of age.
• Over 80% of deaths occur in Africa and Southern Asia. India accounts for 21% of under-five deaths.
• More than half are due to diseases that we could prevent or treat.
• Resource: WHO report, September 2014

Tropical Countries

• Countries in the tropics are near the Equator. They have hot and humid climates.
• The tropics are also defined as regions without a cold season.
• Many diseases in these countries are spread by an insect bite.
• In the tropics, insects never hibernate. They are present in large numbers year round.
• Other diseases here are spread by germs that multiply in warm water. The water in the tropics usually stays warm.
• Tropical diseases occur in people who live in or travel to high-risk countries.
• Climate change is a factor that has allowed these diseases to spread.

Call 911 Now

• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Tropical disease suspected and fever present
• Tropical disease has been diagnosed and getting worse
• Tropical disease has been diagnosed and fever returns after gone for several days
• Tropical disease has been diagnosed and shaking chills return
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Tropical disease suspected, but no fever
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Questions about cholera
• Questions about typhoid fever
• Question about traveler's diarrhea (TD)
• Questions about preventing diarrhea during travel

Care Advice

Cholera Questions

1. What You Should Know About Cholera:
   • It is a severe diarrhea disease caused by a bacteria.
   • World Impact: There are over 4 million new cases per year. It causes over 100,000 deaths per year.
2. Symptoms:
   • Mild to severe diarrhea. About 5% develop severe watery diarrhea.
   • Without treatment, it can progress to severe dehydration and shock within 12 hours.
   • Other symptoms are vomiting, leg cramps and fever.
3. Cause:
   • Cholera is caused by the Vibrio cholera bacteria found in stool.
   • You get sick by swallowing food or drink made dirty with germs from stools.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 1-5 days.
5. Contagious Period:
   • The disease can be spread to others for 1-2 weeks if not treated with antibiotics.
6. Tests and Treatment:
   • Stool tests are needed to diagnose it.
   • It is treated with special electrolyte fluids by mouth or IV fluids. These fluids are life-saving.
   • Antibiotics may also be helpful.
7. What to Expect:
   • Good outcome if diarrhea losses are replaced promptly with fluid.
8. How to Prevent:
   • Vaccine: New cholera vaccines taken by mouth are very protective.
   • Good hand washing.
   • Avoid unsafe food and drink.
   • Drink only bottled or boiled water.
   • Eat only well-cooked food.
9. Countries with Cholera:
   • It is seen in Africa and other tropical countries.
   • Rarely is seen in US in Florida and other Gulf states. Cause in US: Shellfish that isn't cooked fully.
   • For more info and current high-risk countries, see the CDC website: Cholera.
10. Call Your Doctor If:
    • You have other questions or concerns

Typhoid Fever Questions

1. What You Should Know About Typhoid Fever:
   • It is a severe diarrhea disease caused by a bacteria.
   • World Impact: There are 20 million new cases each year. It causes over 200,000 deaths each year.
2. Symptoms:
   • Starts with fever, stomach pain and diarrhea.
   • The fever lasts for weeks.
   • The diarrhea worsens and can become bloody.
   • Feeling tired, weakness and loss of appetite are common.
   • A rash of small rose-colored spots may occur on the chest and stomach.
3. Cause:
   • Typhoid is caused by the Salmonella typhi bacteria found in stool.
   • You get sick by swallowing food or drink made dirty with germs from stools.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 6 to 30 days.
5. Contagious Period:
   • Can be prolonged if not treated with antibiotics.
   • Even those who are treated can become carriers.
6. Tests and Treatment:
   • Stool tests and blood tests are needed to diagnose it.
   • It is treated with special electrolyte fluids by mouth or IV fluids.
   • Antibiotics are given to kill the bacteria.
7. What to Expect:
   • With treatment, symptoms improve in 2 to 4 weeks.
   • Without treatment, the symptoms may last for months.
   • The disease may come back after treatment.
8. How to Prevent:
   • Vaccine: There is a typhoid vaccine.
   • Use good hand washing.
   • Avoid unsafe food and drink.
   • Drink only bottled or boiled water.
   • Eat only well-cooked food.
9. Countries with Typhoid:
   • It is common in Africa, Asia and Latin America.
   • It does occur in the US in low numbers. Mainly in travelers coming back to the US.
   • For more info and current high risk countries, see the CDC website.
   • Resource: Typhoid Travel Alert.
10. Call Your Doctor If:
    • You have other questions or concerns

Traveler's Diarrhea (TD) Questions

1. What You Should Know About Traveler's Diarrhea (TD):
   • It is a disease seen in travelers to developing countries in the tropics.
   • World Impact: In high-risk countries, TD affects up to 40% of travelers. There are about 20 million new cases each year. Mainly, it disrupts vacations. About 30% of people can't pursue planned activities. Deaths are very rare.
2. Symptoms:
   • Sudden onset of loose stools, twice or more the normal number.
   • Nausea is often present, but only 20% have vomiting.
   • May also include stomach cramps and an urgent need to pass a stool.
   • Fever occurs in 10%.
   • Blood in the stools occurs in 5% of cases. This means the infection has become more severe.
3. Cause:
   • Caused by germs from stools present in the water, food or drinks.
   • Over 80% is caused by E. coli bacteria. These bacteria are not harmful ones. But, they are new to the traveler's body and gut.
   • Sometimes, more serious bacteria such as Shigella are the cause.
   • Parasites cause 5-10%. Diarrhea from parasites has a more gradual onset.
4. Time Period to Get Sick:
   • The time from contact to symptoms is 1-3 days for bacteria.
   • Diarrhea from parasites takes 2-4 weeks to start.
5. Contagious Period:
   • TD can be passed to others until the stools are formed.
6. Tests and Treatment:
   • Most often, the diagnosis is based upon symptoms and recent travel history. Lab tests are not needed.
   • If the stools become bloody, stool tests may be done. If it lasts more than 2 weeks, parasite tests may be done.
   • It is treated with special electrolyte fluids by mouth. Less than 1% of people need IV fluids.
   • Probiotics (such as yogurt) may also be helpful.
   • Antibiotics are sometimes given to kill the bacteria. They are mainly used if fever, bloody stools, severe diarrhea or stomach cramps occur.
7. What to Expect:
   • TD is a self-limited illness.
   • Most people that aren't treated have diarrhea that lasts 3 to 5 days.
   • About 5% develop blood in the stools.
   • It is more severe and lasts longer in young children.
8. How to Prevent:
   • Wash Hands: Use good hand washing.
   • Diet: Avoid unsafe food and drink. Drink only bottled or boiled water. Eat only well-cooked food.
   • Medicines: In some cases, Pepto-Bismol 4 times a day is advised. Antibiotics to prevent TD are not advised for healthy people. Check with your doctor before you travel out of the country.
   • Vaccine: There is no vaccine for TD.
9. Countries at Risk:
   • High-risk countries are in Latin America, Africa and Southern Asia. About 40% of travelers there get diarrhea.
   • Moderate-risk countries are in Southern Europe, Middle East, China and Russia. About 15% of travelers will get it.
   • Low-risk countries are the US, Western Europe, Canada and Japan.
   • For more info and for current high risk countries, see the CDC website: Travelers' Diarrhea.
10. Call Your Doctor If:
    • You have other questions or concerns

Diarrhea Disease: How to Prevent

1. Safety Tips in All Countries:
   • Hand washing is the key to prevent the spread of infections.
   • Always wash the hands before eating, feeding or handling young children or cooking.
   • Always wash the hands after any contact with vomit or stools.
   • Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
   • Cook all poultry fully. Never serve chicken that is still pink inside. Reason: Poultry that isn't cooked all the way is a common cause of diarrhea.
2. Extra Safety Tips in Developing Countries:
   • Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
   • Eat foods that have been fully cooked and that are still hot.
   • Dry foods such as bread are usually safe.
   • Avoid salads and raw veggies. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
   • Avoid all meat and fish that isn't cooked all the way.
   • Avoid buying foods and drinks from street vendors. Reason: This is a common cause of traveler's diarrhea.
   • Formula for babies: Breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
   • Feeding babies: Wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
   • Brush your teeth with bottled or boiled water.
3. Call Your Doctor If:
   • You have other questions or concerns