Travel health pt 2 - Traveller’s diarrhoea, dehydration etc

Question 1

Traveller’s diarrhoea - what is it
treatment??
how long do symptoms last, what do symptoms include
what’s a complication of diarrhoea

Answer 1

Food & water borne disease
usually self limiting
2-4 days of symptoms normally
Loss of appetite, nausea, vomiting, abdominal cramps, flatulence, bloating
Complications such as post-infection IBS may persist for months afterwards

Question 2

Traveller’s most at risk of travellers diarrhoea

Answer 2

Visiting friends and relatives
Young children
Older people
Immunosuppressed patients
Those with bowel disease (i.e. Crohn’s disease and ulcerative colitis)
Those taking medication that reduces gastric acid secretion (i.e. people taking PPIs)

Question 3

Prevention of travellers diarrhoea

Answer 3

Avoid high risk foods/drinks: salads, raw/undercooked meat, fish/shellfish, ice, unpasteurised dairy products

Eat freshly cooked piping hot food i.e. avoid buffets

Wash hands before eating and after going to the bathroom

Carry antibacterial hand gel for when inadequate hand washing facilities

Drink ‘safe’ water: Bottled water, check seal is intact, carbonated water may be more reliable in this sense, avoid ice in drinks

Use ‘safe’ water to clean teeth and wash fruit

Make ‘un-safe’ water ‘safe’ by boiling, iodine-resin water purifier, or water filter alongside chlorine treatment

Question 4

Treatment & Advice - travellers diarrhoea

Answer 4

If hungry, they should eat but stick to bland foods

Oral rehydration solution (i.e. Dioralyte) are especially important for adults with severe diarrhoea or no appetite, and all traveller’s who are children or elderly

Loperamide capsules

Ciprofloxacin where available and not contraindicated (500mg BD for one day in travellers aged 16 and over)

Question 5

OTC Treatment - travellers diarrhoea

indication, dose, important points

Answer 5

Loperamide 2mg Caps:
Treatment of acute diarrhoea, in adults and children over 12, and that associated with (diagnosed) IBS in adults over 18
Take 2 capsules straight away then 1 after every loose bowel motion
Do not take more than 8 capsules in 24 hours
Do not take for more than 3-4 days, if not stopped refer to GP

Oral rehydration therapy (ORT)
Dose Infant: 1-1½ times usual feed
Child: 200ml after every loose bowel motion
Adult: usually 200-400ml after every loose bowel motion
Discard any unused solution no later than an hour after preparation, unless kept in fridge, when it can be kept up to 24 hours

Question 6

Alternatives to ORT

Answer 6

Diluted fruit juice
Flat/de-carbonated soft drinks (not ‘diet’)
Soup
Make your own ORS!
1 level teaspoon of salt
6 level teaspoons of sugar
Dissolve in 1 litre of ‘safe’ water

Question 7

When to Seek Medical Attention for travellers diarrhoea

Answer 7

TD lasting 4 or more days
Unable to drink/keep down drinks at all (especially child/elderly)
Showing signs of significant dehydration (especially child/elderly)
Warning symptoms present:
Blood/mucus present in stools
TD accompanied by fever or altered mental state i.e. confusion
Abdominal pain
Jaundice
Rash
Persistent vomiting
Weight loss

Question 8

Dehydration signs

Answer 8

Irritability, tiredness
Sometimes confusion
Sunken eyes
Cold extremities
Not passing urine for 8 hours
Weak pulse and rapid heart rate
Dry skin that returns slowly back to position when pinched

Question 9

Other food and water-borne diseases

Answer 9

Hepatitis A
Typhoid
Cholera
Polio (part of UK childhood vaccination schedule)

Question 10

What is hepatitis A , transmission, symptoms, treatment, vaccine

Answer 10

Inflammation of the liver
Transmission
Through ingestion of contaminated food and water or through direct contact with an infectious person
Transmitted primarily by the faecal-oral route
Symptoms
The incubation period is usually 14-28 days
range from mild to severe and include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice.
Not all symptoms will be present in an infected individual
Almost everyone recovers fully with lifelong immunity, however in a small proportion it results in mortality
No treatment is available
Prevention
Vaccine
Improved sanitation & hygiene practices

Question 11

Typhoid - transmission, symptoms, treatment, vaccine

Answer 11

Life-threatening infection caused by the bacteria Salmonella Typhi
Transmission
Contaminated food or water
Transmitted primarily by the faecal-oral route
Symptoms
Develop over 1 or 2 weeks after transmission
prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea
Some patients have a rash
Severe cases can lead to death (110 000 people die from it every year)
Treatment
Antibiotics – WHO recommends azithromycin, ciprofloxacin or ceftriaxone
Prevention
Vaccine
Improved sanitation & hygiene practices

Question 12

Cholera transmission, symptoms, treatment, vaccine

Answer 12

There are many Vibrio Cholerae strains
Transmission
Contaminated food or water
Symptoms
Severe acute watery diarrhoea
12 hours to 5 days after transmission for symptoms to show
Results in mortality within hours if untreated
Treatment
Oral rehydration therapy
Prevention
Vaccine
Improved sanitation & hygiene practices

Question 13

Polio transmission,

Answer 13

Virus
Affects mainly children under the age of 5, but anyone unvaccinated can contract the disease
Part of childhood vaccination programme in the UK
Transmission
Contaminated food or water
Transmitted primarily by the faecal-oral route
Symptoms
Initially fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs
Invades nervous system and can cause paralysis within hours of transmission
1 in 200 infections leads to irreversible paralysis, with 5-10% mortality in this group
No treatment is available
Prevention
Vaccination