Traveler’s diarrhea can affect up to 50,000 travelers a day in high-risk countries. The risk of illness during travel to another country depends on the country visited, the length of stay, and the level of accommodation (5-star hotel versus back-packing). Most cases of traveler’s diarrhea are related to ingestion of contaminated food or water.
Prevention strategies include the following precautions:
- Do not drink untreated water from surface wells, lakes, rivers, springs, ponds and streams.
- Do not use untreated ice or drinking water when traveling in high-risk countries (see Traveler’s Diarrhea: Risk and associated pathogens).
- Do not use drinking water for brushing teeth, rinsing mouth or toothbrush.
- Do not swallow recreational water (e.g. swimming pools, lakes, etc.)
- Wash and/or peel all raw vegetables and fruits with uncontaminated water before eating.
- Avoid eating uncooked foods when traveling to high-risk countries.
- Consider an oral vaccine prior to travel in high-risk countries.
An oral vaccine (Dukoral) is available to protect against traveler’s diarrhea associated with the bacterial pathogens, E. coli 0157 and Vibrio cholerae. In consideration of travel to Eastern Africa last month, I asked my physician for a prescription for Dukoral. Although I accidentally challenged the vaccine on a few occasions (drinking a mojito with ice cubes, and rinsing my toothbrush with tap water) during my two week stay in Tanzania, I did not become ill. Whether or not this was due to vaccine effectiveness or luck on my part, I cannot say for certain; however, I felt much safer having taken the vaccine prior to my trip.
Dukoral is packaged in two doses, one which is taken at least two weeks before travel, and the second taken one week following the first dose. Protection takes approximately one week following the second dose (one week before travel). During extended exposure in high-risk areas, a repeat single booster does is recommended every 3 months.
The vaccine is a whitish suspension supplied in a glass vial that is mixed with sodium hydrogen carbonate effervescent granules dissolved in a glass of water. Dukoral is raspberry-flavored and pleasant tasting and must be taken on an empty stomach as its effectiveness may be impaired by food or drink that increase acid production in the stomach.
Dukoral induces an IgA antitoxic and antibacterial response in the gastrointestinal tract to protect against cholera and enterotoxigenic E. coli, which produces an enterotoxin that is structurally and immunologically similar to cholera toxin.
Dukoral is safe for use in adults and children 2 years of age and older. Side-effects following administration of Dukoral are uncommon and mild in nature with the most common complaints being abdominal pain and diarrhea. Fortunately, I did not experience adverse effects following either dose of vaccine.
Dukoral is not recommended for use in pregnant women and in children less than 2 years of age, and it effectiveness in the elderly has not be studied. If you are planning a trip to a country associated with a high-risk of traveler’s diarrhea, consult your physician on the need and appropriateness of oral vaccine.
Related content:
Traveler’s Diarrhea: Risk and associated pathogens.
Source:
Dukoral Package Insert. Aventis Pasteur Ltd. Toronto, Canada.
