What causes travelers' diarrhea?

Travelers' diarrhea is most commonly caused by enterotoxigenic E. coli (ETEC), but also by other bacteria like Campylobacter and Shigella, and sometimes by viruses or parasites. Infection occurs through consumption of contaminated food or water in areas with poor sanitation practices. The risk varies significantly by destination.

How long does travelers' diarrhea typically last?

Most cases of travelers' diarrhea resolve on their own within 3-5 days with proper hydration. However, symptoms can last longer depending on the cause. Symptoms include 3 or more loose stools per day, abdominal cramps, nausea, and sometimes fever. Staying hydrated is critical to prevent complications.

Is the Dukoral vaccine effective?

Dukoral is an oral cholera vaccine that also provides protection against enterotoxigenic E. coli (ETEC), which causes the majority of travelers' diarrhea cases. It is approximately 60% effective at preventing ETEC-caused diarrhea. Our physicians can assess whether Dukoral is appropriate for your travel plans.

What food and water precautions should I take?

Follow the rule "boil it, cook it, peel it, or forget it." Avoid tap water, ice, raw vegetables, undercooked meat, and unpasteurized dairy. Drink bottled or boiled water, eat hot cooked foods, and consume fruits you peel yourself. Be cautious with street food and food from restaurants with questionable sanitation.

Travellers' Diarrhea Prevention

Travellers' diarrhea affects 30-70% of travelers to high-risk destinations. Learn how to prevent this most common travel illness with vaccination and practical strategies.

What Is Travellers' Diarrhea?

Travellers' diarrhea is the most common illness affecting international travelers. It is caused by bacterial, viral, or parasitic pathogens found in contaminated food or water. Approximately 30-70% of travelers to high-risk destinations experience this condition, making prevention a critical part of travel health planning.

Common Causative Agents

Enterotoxigenic E. coli (ETEC): Accounts for 30-50% of cases; causes watery diarrhea
Campylobacter: Can cause more severe, dysentery-like symptoms
Shigella: Often causes bloody diarrhea and cramping
Viruses & Parasites: Account for smaller percentages but can cause prolonged illness

Symptoms

The hallmark symptom is 3 or more loose stools per day, often accompanied by abdominal cramps, nausea, and sometimes fever. Symptoms typically begin 1-3 days after exposure and resolve within 3-5 days without treatment. However, symptoms can last longer depending on the cause and individual factors.

Impact on Travel

Even though the illness is usually self-limiting, it can significantly disrupt travel plans, cause dehydration, and leave travelers feeling weak and fatigued. This makes prevention far preferable to treatment after infection.

Who Is at Risk?

All travelers to certain regions face significant risk of travellers' diarrhea:

High-Risk Destinations

• South Asia (India, Bangladesh, Pakistan)
• Sub-Saharan Africa
• Central America
• Southeast Asia (outside major tourist areas)
• Middle East and North Africa
• Parts of South America

Higher-Risk Travelers

• Adventure travelers and backpackers
• Those eating street food
• Travelers staying in budget accommodations
• People with reduced stomach acid
• Those with inflammatory bowel disease

How to Prevent Travellers' Diarrhea

1. Dukoral Vaccination

Dukoral is an oral cholera vaccine that also protects against enterotoxigenic E. coli (ETEC), the leading cause of travelers' diarrhea. It is approximately 60% effective at preventing ETEC-caused diarrhea and is given as an oral liquid vaccine.

Dosing: Two doses taken 1-6 weeks apart, with the last dose at least one week before travel.

Effectiveness: 60% effective against ETEC; provides no protection against other causes of diarrhea.

Learn more about Dukoral →

2. Food and Water Safety ("Boil It, Cook It, Peel It, or Forget It")

Safe Foods and Drinks

• Bottled water (including for brushing teeth)
• Hot, freshly cooked foods
• Fruits and vegetables you peel yourself
• Boiled or pasteurized milk and dairy
• Hot beverages (tea, coffee)

Avoid

• Tap water and ice
• Raw vegetables and salads
• Undercooked meat and seafood
• Unpasteurized milk and dairy
• Raw shellfish
• Wet foods (soups) from questionable sources
• Food from street vendors with poor hygiene

3. Hand Hygiene

• Wash hands frequently with soap and clean water
• Use hand sanitizer when soap and water are unavailable
• Avoid touching your face before washing your hands
• Always wash hands before eating

4. Additional Precautions

• Avoid tap water for brushing teeth; use bottled water
• Be cautious with beverages containing ice
• Choose accommodations with good sanitation
• When in doubt, avoid the food

Our Travellers' Diarrhea Prevention Service

Peel Travel Clinic provides comprehensive travellers' diarrhea prevention consultations. Our physicians assess your risk based on your destination and travel style, and recommend the most appropriate preventive strategies.

Our Comprehensive Approach Includes:

• Dukoral vaccination (if appropriate for your itinerary)
• Practical guidance on food and water safety
• Recommendations for antimotility agents and antibiotics (if appropriate)
• Hydration and rehydration strategies
• Post-travel follow-up if symptoms develop

40+

Years of Clinical Experience

ISTM

Travel Medicine Society Member

CAME

Transport Canada Designated

YF Centre

Yellow Fever Designated Centre

550 Matheson Blvd W, Unit 107, Mississauga, Ontario L5R 4B8 · (905) 890-2757

Protect Yourself Before You Travel

(905) 890-2757

Disclaimer: Vaccine requirements and health recommendations vary by itinerary, medical history, and current health advisories. The information on this page is for general guidance only and does not replace a personalized travel health consultation. Please book an appointment with our physician for advice specific to your trip.