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Staying healthy if travelling abroad this summer.

17 April 2024

As the summer holiday season approaches, many people are preparing to travel abroad. Health risks vary between country to country. The individual risk to each traveller will depend on their destination(s), any stopover(s), overall health, length of stay and planned activities, and can be determined by undertaking a comprehensive risk assessment. Below is a summary of the general travel health advice which should be considered for all travellers prior to travelling abroad this summer. Advice for ... View Full Article

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Current popular advice pages:

• Staying Healthy if Travelling Abroad this Summer
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Steamtown national historic site announces 2024 train schedule.

Contact: Megan Stevens , 272-770-1315

Scranton, PA – All aboard! Steamtown National Historic Site (NHS) train rides resume for the 2024 season on Saturday, May 4. The Steamtown rail experience varies from short 30-minute trips exploring the park’s historic railroad yard to full-day trips along the Pocono or Carbondale lines. Our short train rides will begin on Saturday, May 4 and the first excursion trip of the season will head to Gouldsboro, PA on Saturday, May 25. Beginning Saturday, April 20:

• Tickets for our autumn excursions (Oct.-Dec.) will be released online for advance purchase through recreation.gov  on Saturday, July 6

Beginning Saturday, May 4:

Our short train rides will operate Saturdays and Sundays. Departure times are: 10:30am, 11:30am, 1:15pm, and 2:30pm.

Beginning Saturday, June 1:

• Our short train rides will operate Fridays, Saturdays, and Sundays. Departure times are: 10:30am, 11:30am, 1:15pm, and 2:30pm.

Tickets for short train rides are $6 for passengers over the age of 5; $1 for passengers aged 5 and under. Tickets are valid all day for the date of visit and may be used for multiple short train ride experiences. For all short train rides, seating availability is first come, first served. We recommend getting in line 15-20 minutes ahead of scheduled departure time. Visitors may also purchase any of our tickets on-site at the Information Kiosk, credit card only. 2024 Summer Excursions: tickets available beginning April 20

Saturday, May 25 – Gouldsboro: Craft Show, Kids Activities, and Local Author Reading

Sunday, June 16 – Jessup: Father’s Day event (in partnership with the Iron Horse Society)

For tickets, email: [email protected]

Thursday, June 20 – Olyphant: Third Thursday

Sunday, June 30 – Cresco: Museum, Food Trucks, Live Music, and Antique Cars

Saturday, July 20 – Moscow: Grand Reopening (in partnership with the Iron Horse Society)

Saturday, July 27 – Moscow: Country Street Fair

Sunday, August 4 – Moscow: Ice Cream Express (in partnership with the Iron Horse Society)

Saturday, August 17 – Carbondale: Pioneer Nights

Saturday, September 14 – Moscow: Cork & Rail (in partnership with the Iron Horse Society)

Saturday, September 21 – Carbondale: Scarecrow Festival

2024 Autumn Excursions: tickets available beginning July 6

Saturday, October 5 – East Stroudsburg: Pickle Me Poconos

Saturday, October 12 – Tobyhanna: Fall Foliage and Blueberries

Sunday, October 13 – Cresco: Fall Foliage, Museum, Food Trucks, Live Music, and more

Saturday, October 19 – Delaware Water Gap: Fall Foliage

Sunday, October 20 – Carbondale: Outdoor Train

Saturday, October 26 – Gouldsboro: Ghoulsboro Halloween

Friday, November 29 – Moscow: Holiday Express

Saturday, November 30 – Moscow: Holiday Express

Sunday, December 1 – Moscow: Holiday Express

NOTICE: Train rides are subject to cancellation due to mechanical issues, inclement weather, or crew availability. Located in downtown Scranton, Pennsylvania, Steamtown NHS is open 10:00am to 4:00pm, daily. Beginning Sunday, April 21, 2024, Steamtown NHS will be open 9:30am to 5:00pm, daily. From Interstate-81 follow exit 185 (President Biden Expressway, formerly known as Central Scranton Expressway); then follow the brown and white signs to the park entrance at Lackawanna Avenue and Cliff Street (GPS: N 41.41, W 75.67). General park information is available by visiting the park website anytime.

Last updated: April 17, 2024

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The Maya Train Will Get You to All of Yucatán’s Best Spots. But Not Yet.

In December, the train began running on its first route through Mexico’s Yucatán Peninsula. On a five-day journey a few months later, the author encountered enthusiasm, and scheduling hiccups.

By Elisabeth Malkin

Elisabeth Malkin has been visiting the Yucatán Peninsula for three decades.

I stepped off the platform at the gleaming new Maxcanú train station, eager to see the magnificent Maya archaeological site of Uxmal. All I needed was a taxi to take me there, a trip of about 30 miles away.

There are no taxis, said the stationmaster, as we stood on the polished limestone floors of the high-ceilinged station, which was cool and breezy despite the brilliant late-morning sun outside. And I was the third person in two weeks to get off at Maxcanú expecting to reach Uxmal, he said.

I was midway through a five-day trip to explore the brand-new Maya Train and several of its destinations in the Yucatán Peninsula of Mexico . Designed to run 965 miles (1,554 kilometers) around a loop of 34 stations when completed, the train will whisk passengers in cool comfort through colonial cities, archaeological sites, splashy resorts and tropical forests.

Now I was stunned. Wrangling a taxi has never been a problem in Mexico. But the drivers gathered in the main square of Maxcanú offered only beat-up vans that hopscotch through small towns, where I might or might not find a taxi to Uxmal. The next van was leaving in 45 minutes.

Yucatán’s layers of history have long held me spellbound. During earlier car trips, I have clambered up deserted Maya temples and palaces, stepped into the cool naves of massive 16th-century churches and visited restored haciendas, testaments of the ostentation — and hardship — of the peninsula’s 19th-century plantation economy. Traveling by train, I thought, would allow me to steep myself in more of that history.

But as I found in Maxcanú, a train won’t necessarily get you to where you want to go.

During my February trip, I traveled on the only route then available, an east-west leg that opened in December and runs from Cancún to Mérida, and then south through the port city of Campeche to the Maya site of Palenque (a short route between Cancún and Playa del Carmen opened last month, with three trains a day). I encountered scheduling confusion, unfinished stations and a dearth of trains — just two operating daily each way between Cancún and Campeche, and only one to Palenque. Overnight sleepers and special dining trains seem years away.

President Andrés Manuel López Obrador considers the Maya Train his showcase development project, and wants to inaugurate the rest of the train before he leaves office on October 1. Based on my experience, that goal seems elusive.

A $29-billion route through the jungle

I started my journey in Cancún, where in the pre-dawn gloom the station hovered like a glowing spaceship. An attendant scanned the ticket I had bought online and a half-dozen more pointed me toward my tourist-class car, which was about a quarter full. I planned to go to Campeche, about 300 miles away, stopping once each day. At 120 kilometers (about 75 miles) an hour, the train covers the route in about six hours, the same as a car. (When construction is complete, the train’s speed should increase to 160 kilometers an hour.)

The car’s wide windows looked out at a wall of low jungle. The blue-green seats were comfortable and there was ample space between the rows. I bought a very good cappuccino at the snack bar, but declined the plastic-wrapped sandwiches. The rest of the merchandise was fruit cups, milk boxes and junk food.

The train will ultimately cost much more than the $29 billion budgeted so far, and it’s not the first time ambitious planners have alighted on the region. Cancún was once a tiny fishing village, selected half a century ago as a tourist hub. Last year 10 million international tourists flew into its airport, more than the airports of Mexico City, Los Cabos and Puerto Vallarta combined.

But uncontrolled growth has stressed the Caribbean coast’s fragile environment. The Maya Train, scientists warn , will push those problems south, threatening the area’s water supply, its unique system of underground limestone caves and its vast nature reserves.

Mr. López Obrador has charged ahead, handing the train over to the military , and arguing that it will spread Cancún’s wealth and attract new visitors. Mexico received more than 42 million overseas tourists last year and they spent almost $31 billion .

Local governments see an opportunity. “The train will allow people to disperse throughout the peninsula,” said Michelle Fridman, the tourism secretary for Yucatán state, which promotes dozens of attractions far beyond highlights like Mérida and Chichén Itzá .

Now that the train is operating, transport companies will begin to connect stations with lesser-known sites nearby, she said.

It’s fair to ask whether the train is the most effective way to develop the peninsula’s tourism. Tour companies already run trips to many sites from major cities, which are well served by buses. Driving a rental car through most of the area is considered safe , according to U.S. State Department travel guidance .

Route of Mexico’s Maya Train

Canceled trip.

It took two hours (and one time-zone change) to reach Valladolid, a colonial city of handsome streets and ancient churches, where I bought the rest of my tickets at the station. A tourist-class ticket from Cancún to Valladolid costs 472 pesos (around $28) for foreigners and 355 pesos (around $21) for Mexicans. First class, with wider seats, costs 755.50 pesos and 566.50 pesos, and discounts are available for older travelers and residents of the five states along the train’s route. (A first-class bus from downtown Cancún to Valladolid costs between 222 and 344 pesos, depending on the time of day, and takes half an hour longer.)

It was impossible to run the new Maya Train tracks into dense city centers and the Valladolid station, like the rest, was outside the urban core. A waiting bus took disembarking passengers downtown, a 15-minute ride for 35 pesos.

That day I toured Ek Balam , the site of a ninth-century Maya kingdom that is dominated by a 100-foot palace distinguished by a facade of carvings depicting winged warriors, stylized animal features and geometric patterns bordered by giant fangs. Admission to the site includes entry to the X-Canché cenote, one of thousands of limestone sinkholes that were sacred to the Maya.

Later that afternoon, I was wandering through the Museum of Ethnic Clothing, a private collection of traditional dress, embroidery and hats, when a WhatsApp message from the ticket office blinked on my phone. My train scheduled for the following day was canceled.

I decided to deal with the problem in the morning and enjoy the city. As I wandered past the antique shops and boutique hotels of the elegant Calzada de los Frailes, it was clear that Valladolid’s tourism, and the infrastructure to handle it, was well established. The Maya Train is simply an alternative way to reach a city that tourists discovered years ago.

‘We’re on the Tren Maya!’

In the morning, I found that my train had not been canceled, but the station for which I had a ticket, Tixkokob, was closed. I got off instead one stop earlier at Izamal, known for its ocher streets and the giant Franciscan convent of San Antonio de Padua, built atop the ruins of a pyramid.

During the 90-minute ride, I heard widespread enthusiasm among fellow travelers who expressed a willingness to give the train time to work out the kinks. “We’re an experiment,” said Oliva Escobedo Ochoa, 64, who was vacationing from her home in central Mexico.

Leticia Iliassich, 57, who is Mexican, was traveling with her Croatian husband along with relatives from Mexico and Croatia. They had initially been scheduled on an earlier train to Mérida that had been canceled. “We knew that it was a new project,” she said. “We don’t mind.”

The group had already sent a video to friends declaring, “We’re on the Tren Maya!”

At the Izamal station I hitched a 15-minute ride into the town center with a man who had asked me to take his photo alongside the train and his father. From there I negotiated a taxi to Hacienda San Lorenzo Aké, a working hacienda that still turns the fiber from an agave plant called henequén into coarse rope. Global demand for henequén, known as Yucatán’s “green gold,” brought fantastic wealth to the region in the mid-19th century, speckling the peninsula with more than 1,000 haciendas. ( Many are now sumptuous hotels.)

Where geometry, nature and the divine merge

It was during my third day that I found myself stuck in Maxcanú, after a 90-minute train ride from Izamal. The stationmaster, an army captain, offered me a ride to Uxmal, just as he had to the stranded tourists before me.

Eying Uxmal’s 4 p.m. final ticket sale, I accepted.

My situation made it clear just how distant the Maya Train’s promises are for tourists seeking to explore more of Yucatán. In time, that will change, said Ms. Fridman, the tourism secretary. “The idea is to have more hotels along the train line,” she said. “That will happen little by little.”

But Uxmal , among the most stunning of the Maya sites, made up for the inconvenience. Uxmal’s grand buildings are faced with intricate decorative masks as well as friezes in which geometry, nature and the divine merge. New plaques at each structure offer detailed information in English and Spanish, part of the government’s investment in improving displays at Maya sites for the train project.

Most tourists either take day trips by car or bus to Uxmal from Mérida or stay at one of three nearby hotels. As I finished dinner at my hotel, the dining room began to fill up: 47 Polish tourists had arrived.

Panama hats and a cramped van

My plan for the day was to go by taxi to Bécal, a town where Panama hats are woven in limestone caves to keep the fibers soft, and then pick up the afternoon train in nearby Calkiní for the port city of Campeche.

But I spent so much time watching the hat-making demonstration and then fitting my new hat and buying gifts that we set off with little time to reach the station. To my chagrin, I missed the train, the last one of the day.

On Calkiní’s central square, I found a van that was leaving for Campeche. Cost: 65 pesos. Time: about 1 hour and 20 minutes, similar to what I would have spent on the train. Of course, I was trapped in a cramped seat and had to listen to the driver’s choice of sentimental ballads, but I was dropped off in downtown Campeche, close to my hotel.

The next day, I toured the Museum of Maya Archaeology , an expertly curated collection that included haunting jade funeral masks, glyphs and delicate ceramic figures.

José Madrigal, 45, an engineer from Fremont, Calif., was trying to make Maya pottery interesting for his twin sons. The boys had just turned 5 and their birthday present had been a ride on the Maya Train. “They love trains,” Mr. Madrigal said. Then the family moved on, keeping up a brisk clip through the museum. They had another train to catch.

Should you take the train?

Yes, if you are traveling between larger stations. The train also offers a way to get to Palenque, which is harder to reach and has roads with security concerns. Travelers can stow bicycles on board.

To see train times, check the destinations on the website . You cannot buy tickets online more than a week in advance. But when you finally board, the ride is smooth — and the coffee is excellent.

Follow New York Times Travel on Instagram and sign up for our weekly Travel Dispatch newsletter to get expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places to Go in 2024 .

Open Up Your World

Considering a trip, or just some armchair traveling here are some ideas..

52 Places:  Why do we travel? For food, culture, adventure, natural beauty? Our 2024 list has all those elements, and more .

Mumbai:  Spend 36 hours in this fast-changing Indian city  by exploring ancient caves, catching a concert in a former textile mill and feasting on mangoes.

Kyoto:  The Japanese city’s dry gardens offer spots for quiet contemplation  in an increasingly overtouristed destination.

Iceland:  The country markets itself as a destination to see the northern lights. But they can be elusive, as one writer recently found .

Texas:  Canoeing the Rio Grande near Big Bend National Park can be magical. But as the river dries, it’s getting harder to find where a boat will actually float .

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Traveller's diarrhoea

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Amoebiasis Giardia

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. It is caused by consuming food and water, contaminated by germs (microbes) including bacteria, viruses and parasites. Other symptoms can include high temperature (fever), being sick (vomiting) and tummy (abdominal) pain. In most cases it causes a mild illness and symptoms clear within 3 to 4 days. Specific treatment is not usually needed but it is important to drink plenty of fluids to avoid lack of fluid in the body (dehydration). Always make sure that you get any advice that you need in plenty of time before your journey - some GPs offer travel advice but if yours doesn't then you may need to go to a private travel clinic.

In this article :

What is traveller's diarrhoea, what causes traveller's diarrhoea, are all travellers at risk, what are the symptoms of traveller's diarrhoea, how is traveller's diarrhoea diagnosed, when should i seek medical advice for traveller's diarrhoea, how is traveller's diarrhoea in adults treated, how is traveller's diarrhoea in children treated, side-effects of traveller's diarrhoea, how long does traveller's diarrhoea last, how can i avoid traveller's diarrhoea.

Continue reading below

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. Diarrhoea is defined as: 'loose or watery stools (faeces), usually at least three times in 24 hours.'

Traveller's diarrhoea is caused by eating food, or drinking water, containing certain germs (microbes) or their poisons (toxins). The types of germs which may be the cause include:

Bacteria: these are the most common microbes that cause traveller's diarrhoea. Common types of bacteria involved are:

Escherichia coli

Campylobacter

Viruses: these are the next most common, particularly norovirus and rotavirus.

Parasites: these are less common causes. Giardia, cryptosporidium and Entamoeba histolytica are examples of parasites that may cause traveller's diarrhoea.

Often the exact cause of traveller's diarrhoea is not found and studies have shown that in many people no specific microbe is identified despite testing (for example, of a stool (faeces) specimen).

See the separate leaflets called E. Coli (VTEC O157) , Campylobacter, Salmonella, Cryptosporidium , Amoebiasis (dysentery information), Shigella and Giardia for more specific details on each of the microbes mentioned above.

Note : this leaflet is about traveller's diarrhoea in general and how to help prevent it.

Traveller's diarrhoea most commonly affects people who are travelling from a developed country, such as the UK, to a developing country where sanitation and hygiene measures may not meet the same standards. It can affect as many as 2 to 6 in 10 travellers.

There is a different risk depending on whether you travel to high-risk areas or not:

High-risk areas : South and Southeast Asia, Central America, West and North Africa, South America, East Africa.

Medium-risk areas : Russia, China, Caribbean, South Africa.

Low-risk areas : North America, Western Europe, Australia and New Zealand.

Sometimes outbreaks of diarrhoea can occur in travellers staying in one hotel or, for example, those staying on a cruise ship. People travelling in more remote areas (for example, trekkers and campers) may also have limited access to medical care if they do become unwell.

By definition, diarrhoea is the main symptom. This can be watery and can sometimes contain blood. Other symptoms may include:

Crampy tummy (abdominal) pains.

Feeling sick (nausea).

Being sick (vomiting).

A high temperature (fever).

Symptoms are usually mild in most people and last for 3 to 4 days but they may last longer. Symptoms may be more severe in the very young, the elderly, and those with other health problems. Those whose immune systems are not working as well as normal are particularly likely to be more unwell. For example, people with untreated HIV infection, those on chemotherapy, those on long-term steroid treatment or those who are taking drugs which suppress their immune system, for example after a transplant or to treat an autoimmune condition

Despite the fact that symptoms are usually fairly mild, they can often mean that your travel itinerary is interrupted or may need to be altered.

Traveller's diarrhoea is usually diagnosed by the typical symptoms. As mentioned above, most people have mild symptoms and do not need to seek medical advice. However, in some cases medical advice is needed (see below).

If you do see a doctor, they may suggest that a sample of your stool (faeces) be tested. This will be sent to the laboratory to look for any microbes that may be causing your symptoms. Sometimes blood tests or other tests may be needed if you have more severe symptoms or develop any complications.

As mentioned above, most people with traveller's diarrhoea have relatively mild symptoms and can manage these themselves by resting and making sure that they drink plenty of fluids. However, you should seek medical advice in any of the following cases, or if any other symptoms occur that you are concerned about:

If you have a high temperature (fever).

If you have blood in your stools (faeces).

If it is difficult to get enough fluid because of severe symptoms: frequent or very watery stools or repeatedly being sick (vomiting).

If the diarrhoea lasts for more than 5-7 days.

If you are elderly or have an underlying health problem such as diabetes, inflammatory bowel disease, or kidney disease.

If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, or HIV infection.

If you are pregnant.

If an affected child is under the age of 6 months.

If you develop any of the symptoms listed below that suggest you might have lack of fluid in your body (dehydration). If it is your child who is affected, there is a separate list for children.

Symptoms of dehydration in adults

Dizziness or light-headedness.

Muscle cramps.

Sunken eyes.

Passing less urine.

A dry mouth and tongue.

Becoming irritable.

Symptoms of severe dehydration in adults

Profound loss of energy or enthusiasm (apathy).

A fast heart rate

Producing very little urine.

Coma, which may occur.

Note : severe dehydration is a medical emergency and immediate medical attention is needed.

Symptoms of dehydration in children

Passing little urine.

A dry mouth.

A dry tongue and lips.

Fewer tears when crying.

Being irritable.

Having a lack of energy (being lethargic).

Symptoms of severe dehydration in children

Drowsiness.

Pale or mottled skin.

Cold hands or feet.

Very few wet nappies.

Fast (but often shallow) breathing.

Dehydration is more likely to occur in:

Babies under the age of 1 year (and particularly those under 6 months old). This is because babies don't need to lose much fluid to lose a significant proportion of their total body fluid.

Babies under the age of 1 year who were a low birth weight and who have not caught up with their weight.

A breastfed baby who has stopped being breastfed during their illness.

Any baby or child who does not drink much when they have a gut infection (gastroenteritis).

Any baby or child with severe diarrhoea and vomiting. (For example, if they have passed five or more diarrhoeal stools and/or vomited two or more times in the previous 24 hours.)

In most cases, specific treatment of traveller's diarrhoea is not needed. The most important thing is to make sure that you drink plenty of fluids to avoid lack of fluid in your body (dehydration).

Fluid replacement

As a rough guide, drink at least 200 mls after each watery stool (bout of diarrhoea).

This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above '200 mls after each watery stool' is in addition to this usual amount that you would drink.

If you are sick (vomit), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.

You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.

Note : if you suspect that you are becoming dehydrated, you should seek medical advice.

For most adults, fluids drunk to keep hydrated should mainly be water. However, this needs to be safe drinking water - for example, bottled, or boiled and treated water. It is best not to have drinks that contain a lot of sugar, such as fizzy drinks, as they can sometimes make diarrhoea worse. Alcohol should also be avoided.

Rehydration drinks

Rehydration drinks may also be used. They are made from sachets that you can buy from pharmacies and may be a sensible thing to pack in your first aid kit when you travel. You add the contents of the sachet to water.

Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available; however, they have to be made carefully, as too much salt can be dangerous. Rehydration drinks are cheap and readily available in the UK, and are the best treatment. Note that safe drinking water should be used to reconstitute oral rehydration salt sachets.

Antidiarrhoeal medication

Antidiarrhoeal medicines are not usually necessary or wise to take when you have traveller's diarrhoea. However you may want to use them if absolutely necessary - for example, if you will be unable to make regular trips to the toilet due to travelling.You can buy antidiarrhoeal medicines from pharmacies before you travel. The safest and most effective is loperamide.

The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your gut's activity.

You should not take loperamide for longer than two days. You should also not use antidiarrhoeal medicines if you have a high temperature (fever) or bloody diarrhoea.

Eat as normally as possible

It used to be advised to 'starve' for a while if you had diarrhoea. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food. Plain foods such as bread and rice are good foods to try eating.

Antibiotic medicines

Most people with traveller's diarrhoea do not need treatment with antibiotic medicines. However, sometimes antibiotic treatment is advised. This may be because a specific germ (microbe) has been identified after testing of your stool (faeces) sample.

Fluids to prevent dehydration

You should encourage your child to drink plenty of fluids. The aim is to prevent lack of fluid in the body (dehydration). The fluid lost in their sick (vomit) and/or diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.

Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop acute diarrhoea. Breast feeds or bottle feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.

If you are travelling to a destination at high risk for traveller's diarrhoea, you might want to consider buying oral rehydration sachets for children before you travel. These can provide a perfect balance of water, salts and sugar for them and can be used for fluid replacement. Remember that, as mentioned above, safe water is needed to reconstitute the sachets.

If your child vomits, wait 5-10 minutes and then start giving drinks again but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.

Note : if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.

Fluids to treat dehydration

If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. A doctor will advise about how much to give. This can depend on the age and the weight of your child. If you are breastfeeding, you should continue with this during this time. It is important that your child be rehydrated before they have any solid food.

Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a 'nasogastric tube'. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not 'starve' a child with infectious diarrhoea. This used to be advised but is now known to be wrong. So:

Breastfed babies should continue to be breastfed if they will take it. This will usually be in addition to extra rehydration drinks (described above).

Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above). Do not water down the formula, or make it up with less water than usual. This can make a baby very ill.

Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important consideration and food can wait until the appetite returns.

Loperamide is not recommended for children with diarrhoea. There are concerns that it may cause a blockage of the gut (intestinal obstruction) in children with diarrhoea.

Most children with traveller's diarrhoea do not need treatment with antibiotics. However, for the same reasons as discussed for adults above, antibiotic treatment may sometimes be advised in certain cases.

Most people have mild illness and complications of traveller's diarrhoea are rare. However, if complications do occur, they can include the following:

Salt (electrolyte) imbalance and dehydration .

This is the most common complication. It occurs if the salts and water that are lost in your stools (faeces), or when you are sick (vomit), are not replaced by you drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild and will soon recover as you drink.

Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, your kidneys may be damaged . Some people who become severely dehydrated need a 'drip' of fluid directly into a vein. This requires admission to hospital. People who are elderly or pregnant are more at risk of dehydration.

Reactive complications

Rarely, other parts of your body can 'react' to an infection that occurs in your gut. This can cause symptoms such as joint inflammation (arthritis), skin inflammation and eye inflammation (either conjunctivitis or uveitis). Reactive complications are uncommon if you have a virus causing traveller's diarrhoea.

Spread of infection

The infection can spread to other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if diarrhoea is caused by salmonella infection.

Irritable bowel syndrome is sometimes triggered by a bout of traveller's diarrhoea.

Lactose intolerance

Lactose intolerance can sometimes occur for a period of time after traveller's diarrhoea. It is known as 'secondary' or 'acquired' lactose intolerance. Your gut (intestinal) lining can be damaged by the episode of diarrhoea. This leads to lack of a substance (enzyme) called lactase that is needed to help your body digest the milk sugar lactose.

Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the intestinal lining heals. It is more common in children.

Haemolytic uraemic syndrome

Usually associated with traveller's diarrhoea caused by a certain type of E. coli infection, haemolytic uraemic syndrome is a serious condition where there is anaemia, a low platelet count in the blood and kidney damage. It is more common in children. If recognised and treated, most people recover well.

Guillain-Barré syndrome

This condition may rarely be triggered by campylobacter infection, one of the causes of traveller's diarrhoea. It affects the nerves throughout your body and limbs, causing weakness and sensory problems. See the separate leaflet called Guillain-Barré syndrome for more details.

Reduced effectiveness of some medicines

During an episode of traveller's diarrhoea, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or being sick (vomiting) mean that reduced amounts of the medicines are taken up (absorbed) into your body.

Examples of such medicines are those for epilepsy, diabetes and contraception . Speak with your doctor or practice nurse before you travel if you are unsure of what to do if you are taking other medicines and develop diarrhoea.

As mentioned above, symptoms are usually short-lived and the illness is usually mild with most people making a full recovery within in few days. However, a few people with traveller's diarrhoea develop persistent (chronic) diarrhoea that can last for one month or more. It is also possible to have a second 'bout' of traveller's diarrhoea during the same trip. Having it once does not seem to protect you against future infection.

Avoid uncooked meat, shellfish or eggs. Avoid peeled fruit and vegetables (including salads).

Be careful about what you drink. Don't drink tap water, even as ice cubes.

Wash your hands regularly, especially before preparing food or eating.

Be careful where you swim. Contaminated water can cause traveller's diarrhoea.

Regular hand washing

You should ensure that you always wash your hands and dry them thoroughly; teach children to wash and dry theirs:

After going to the toilet (and after changing nappies or helping an older child to go to the toilet).

Before preparing or touching food or drinks.

Before eating.

Some antibacterial hand gel may be a good thing to take with you when you travel in case soap and hot water are not available.

Be careful about what you eat and drink

When travelling to areas with poor sanitation, you should avoid food or drinking water that may contain germs (microbes) or their poisons (toxins). Avoid:

Fruit juices sold by street vendors.

Ice cream (unless it has been made from safe water).

Shellfish (for example, mussels, oysters, clams) and uncooked seafood.

Raw or undercooked meat.

Fruit that has already been peeled or has a damaged skin.

Food that contains raw or uncooked eggs, such as mayonnaise or sauces.

Unpasteurised milk.

Drinking bottled water and fizzy drinks that are in sealed bottles or cans, tea, coffee and alcohol is thought to be safe. However, avoid ice cubes and non-bottled water in alcoholic drinks. Food should be cooked through thoroughly and be piping hot when served.

You should also be careful when eating food from markets, street vendors or buffets if you are uncertain about whether it has been kept hot or kept refrigerated. Fresh bread is usually safe, as is canned food or food in sealed packs.

Be careful where you swim

Swimming in contaminated water can also lead to traveller's diarrhoea. Try to avoid swallowing any water as you swim; teach children to do the same.

Obtain travel health advice before you travel

Always make sure that you visit your GP surgery or private travel clinic for health advice in plenty of time before your journey. Alternatively, the Fit for Travel website (see under Further Reading and References, below) provides travel health information for the public and gives specific information for different countries and high-risk destinations. This includes information about any vaccinations required, advice about food, water and personal hygiene precautions, etc.

There are no vaccines that prevent traveller's diarrhoea as a whole. However, there are some other vaccines that you may need for your travel, such as hepatitis A, typhoid, etc. You may also need to take malaria tablets depending on where you are travelling.

Antibiotics

Taking antibiotic medicines to prevent traveller's diarrhoea (antibiotic prophylaxis) is not generally recommended. This is because for most people, traveller's diarrhoea is mild and self-limiting. Also, antibiotics do not protect against nonbacterial causes of traveller's diarrhoea, such as viruses and parasites. Antibiotics may have side-effects and their unnecessary use may lead to problems with resistance to medicines.

Probiotics have some effect on traveller's diarrhoea and can shorten an attack by about one day. It is not known yet which type of probiotic or which dose, so there are no recommendations about using probiotics to prevent traveller's diarrhoea.

Further reading and references

• Bourgeois AL, Wierzba TF, Walker RI ; Status of vaccine research and development for enterotoxigenic Escherichia coli. Vaccine. 2016 Mar 15. pii: S0264-410X(16)00287-5. doi: 10.1016/j.vaccine.2016.02.076.
• Travellers' diarrhoea ; Fitfortravel
• Riddle MS, Connor BA, Beeching NJ, et al ; Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl_1):S57-S74. doi: 10.1093/jtm/tax026.
• Giddings SL, Stevens AM, Leung DT ; Traveler's Diarrhea. Med Clin North Am. 2016 Mar;100(2):317-30. doi: 10.1016/j.mcna.2015.08.017.
• Diarrhoea - prevention and advice for travellers ; NICE CKS, February 2019 (UK access only)

Article History

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 9 Feb 2028

10 feb 2023 | latest version.

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