Foreign travel-associated illness - a focus on travellers' diarrhoea

Synopsis

Key findings

• Travellers’ diarrhoea (TD) is a common illness in travellers and may be caused by a number of bacterial, protozoal and viral organisms.
• In England, Wales and Northern Ireland (EWNI), Salmonella spp (non typhoidal) were the most commonly isolated organisms associated with foreign travel between 2004 and 2008. However, travel history reporting is better for Salmonella spp than for other organisms so this needs to be interpreted with caution.
• In 2008, travel to countries in North Africa and the Middle East, Asia, sub-Saharan Africa, South America, and the Caribbean were associated with higher rates of GI illness in travellers from EWNI compared to countries in Europe and North America. Egypt was identified as the highest risk destination for travellers from EWNI in 2008.

Recommendations

• Travel history reporting for GI illness in the UK needs to be improved, including positive reporting of no travel to enable improved ascertainment of travel and non-travel associated infections.
• Detection of different types of E. coli requires a combination of molecular methods based on virulence genes and culture. Surveillance of TD requires that these tests be available for use in diagnostic laboratories if the importance of E. coli is to be assessed in relation to cases of GI illness in EWNI.
• Further studies on TD, which are focused on UK travellers, are needed. Data that are currently available are based on travellers from other European and North American countries where foreign travel patterns may be slightly different to those in UK travellers.
• Established codes of practice regarding food and swimming pool hygiene published by tourism regulators such as the Federation of Tour Operators and Association of British Travel Agents should be adhered to in order to reduce the incidence of travellers’ diarrhoea in tourist resorts.
• Close working between the travel industry and travel health specialists is important to increase awareness of TD among travellers and to actively promote risk reduction behaviour.
• Health professionals advising travellers should continue to reinforce messages about personal hygiene measures to prevent acquisition of GI illness.

Additional information

Travel health webpage

National Travel Health Network and Centre

HPA press release

Last reviewed: 11 January 2011