Travellers' diarrhoea – pros and cons of different prophylactic measures

Abstract

Travellers' diarrhoea is the most likely cause for disturbing travel arrangements. At an average, 30-40% of tourists are concerned, depending on the travel destination. Due to the high impact on the travellers' health this topic is still of utmost importance in travel medicine. A wide spectrum of enteropathogens can be accountable, with enterotoxigenic Escherichia coli being the major causing pathogen among other bacteria, parasites and viruses. Here we discuss advantages and disadvantages of different prophylactic measures against travellers' diarrhoea. The effectiveness but also the relevance of hygiene education, vaccination and antibiotic or probiotic application will be discussed in the context of the travellers' different risk profiles.

Traveller’s Diarrhoea and Intestinal Protozoal Diarrhoeal Disease

“…When taking only chemoprophylaxis, travellers may be at a lower risk of contracting traveller's diarrhoea but they are not 100 percent immune from a variety of pathogens likely to be responsible for the illness. Travellers would be thus in error if they assume that they are safe and pay no attention to hygiene and sanitation rules (Wagner & Wiedermann, 2009). There has been sustained research effort for a vaccine that would be effective against ETEC, the leading cause of traveller's diarrhoea, and reduce the duration and severity of the symptoms.…”

Clinical Implications of Enteroadherent Escherichia coli

“…Two chromosomally encoded ATs identified in ETEC were found immunogenic and protective in an animal model, possibly meaning that conserved ATs might contribute to the protective immune responses that follow natural ETEC infection and therefore, offering new potential targets for vaccine development [22]. In addition, other ETEC vaccines include one more candidate which is active against cholera toxin and confers cross protection against ETEC [23]. Finally, a recombinant, transdermal LT vaccine has also been recently evaluated [24]; however, this and other vaccines are available for clinical trials but are not commercially available.…”

Immunization in Travel Medicine

“…Attempts to select safe foods, such as those freshly prepared and served hot, can be counteracted by contamination introduced during preparation, storage, and handling. 45 Although many travelers want to experience local culture and cuisine, commonsense food and water precautions may help individuals to make safer choices. These precautions are harder to maintain in those VFRs, those staying in local homes or pursuing more adventurous travel, and those staying in highly contaminated areas for prolonged periods of time.…”