Travellers diarrhoea: prevention and management

Size: px
Start display at page:

Download "Travellers diarrhoea: prevention and management"

Transcription

1 Travellers diarrhoea: prevention and management It has long been said that travellers diarrhoea could be prevented by a simple boil it, cook it, peel it, or forget it regime, but studies have found that people who follow these rules may still become ill. Most people affected experience symptoms within 2 3d of arrival at their foreign destination, with more than 90% of cases starting within the first 2w, turning a dream fortnight into a nightmare! NICE CKS 2013 offers us helpful guidance for prevention, treatment and management of travellers diarrhoea, which can affect up to 60% of travellers. Symptoms Acute watery diarrhoea, at least 3 loose to watery stools/24h. Blood may be present in stools. May be accompanied by one or more of these symptoms: abdominal pain and cramps affect 80% of sufferers fever nausea/vomiting. Always enquire about locations visited, and vaccinations undertaken prior to travel, when patients present with post-travel diarrhoea. Enteric fever (typhoid) may present as diarrhoea and high fever, more commonly in children than in adults. Public Health England quarterly statistics show 78 cases reported across England and Wales in July September 2015 alone. Typhoid is not as rare as you may think! (PHE, 2015). Cholera, which presents as severe watery diarrhoea, is less common, yet 42 confirmed cases were reported to PHE between 2011 and 2013, all of which emanated from foreign travel (PHE 2015). Ebola, high-profile news in 2015, can also present as diarrhoea and low-grade fever before its haemorrhagic phase. Cases have been thankfully few in the UK, but vigilance should be maintained. The management of suspected Ebola is not mentioned in CKS 2013, but I have included a link to PHE advice for primary care in the Practical tools box at the end of this article. Prognosis In most cases, travellers diarrhoea is non-serious and self-limiting: Untreated bacterial diarrhoea, for most people, lasts around 3 5d. Viral diarrhoea symptoms last for 2 3d. Protozoal diarrhoea can persist for weeks to months if not treated. However, around 1.5% of people who experience travellers diarrhoea then go on to develop irritable bowel syndrome. Infants, elderly people and the immunocompromised can have more severe effects from travellers diarrhoea. Emergency admission is warranted if the patient is vomiting and unable to retain fluids, or if there are features of severe dehydration. Causes Cause is ingestion of contaminated food/water and the causative organism partly depends on the country of travel. Bacteria account for 80 90% of cases, most common bacterial causes are: E. coli, Campylobacter, Shigella and Salmonella. Enterotoxigenic E. coli (ETEC), mostly in Latin America and Africa, but is also seen globally. Campylobacter, in people visiting South Asia and South East Asia. Viral causes account for 15 20% of cases of TD: Norovirus and rotavirus are most commonly implicated. Norovirus outbreaks are commonly seen in holiday resorts or on cruise ships. Parasites are responsible in 2 10% of cases: Giardia intestinalis and Cryptosporidium are typically associated with long-term travel or travel to endemic areas such as Eastern Europe, Italy, St Petersburg, Bangladesh and Ethiopia. Protozoans such as Giardia are a common causative organism in those with illness lasting >10d, symptoms starting after return from travel or Illness associated with weight loss ( Toxins in uncooked food account for 5% of cases: Usually Staph. aureus, Bacillus cereus or Clostridium perfringens.

2 These tend to cause sudden onset of nausea, vomiting and diarrhoea. Cholera is an uncommon cause of diarrhoea in travellers returning to the UK (NaTHNaC, 2011). Assessing risk before travelling To assess the risk of acquiring travellers diarrhoea find out the following. Which country the person is going to visit Low risk zones (<7%): western Europe, USA, Canada, Japan, Australia, and New Zealand. Intermediate risk zones (<20%): southern Europe, Israel, South Africa, Caribbean islands and the Pacific. High risk zones (>20%): Africa, Latin America, the Middle East, and most parts of Asia. Individual countries where strict food, water, and personal hygiene precautions should be practised are listed on Assess for other risk factors Infants, elderly people, those with severe cardiac or renal disease, people who are immunocompromised. Areas with poor sewage facilities, hand washing facilities, or access to safe drinking water. Campers, adventurers, and passengers on cruise ships. Peak incidence is summertime and, in South Asia, the hot months preceding the monsoon season. Consider whether a prescription for stand by antibiotic treatment (to use if affected) is a suitable alternative if prophylaxis is not indicated, if the person is travelling to particularly high-risk locations where medical assistance is poor or unavailable (see section on Prophylactic medication and stand-by antibiotics, below). Prevention The incidence of travellers diarrhoea has not significantly fallen in the last decade. Information leaflets on food safety and drinking water are available on the World Health Organization website see Practical tools box at the end of this article. Hygiene measures Alcohol sanitising hand rub, where s the evidence? Well, there isn t masses of hard evidence, but a preliminary study of 257 international travellers returning from abroad concluded that the use of hand sanitiser is associated with a significant reduction (CI 0.04) in the incidence of travellers diarrhoea 17% of those who had used hand rub were affected, compared to 30% in those who had not (Travel Med Infectious Dis 2014;12:494). Hand rub has got to be worth a go! Hands should always be washed before eating, and before handling food particularly after contact with raw meat and uncooked food. Foodstuffs to avoid CKS suggests avoiding: Tap water and ice cubes. Shellfish, mussels, oysters, and clams (filter feeders) because they can concentrate pathogens and toxins. Food that is not thoroughly cooked, and steaming hot prior to serving. Food from buffets, markets, and street vendors, unless kept piping hot, or well-refrigerated. Homemade mayonnaise and uncooked eggs. Cooked food that has been in contact with raw food, or with uncooked eggs. Leafy greens including lettuce, and uncooked fruit and veg with damaged skin. Unpasteurised dairy products, including ice cream. Drinking water Bottled water is the safer choice for drinking water. The seal must not have been tampered with. Water should be boiled (for at least 1min) if in doubt. Where there is no access to safe water, micropore filtering and chlorine preparations are a second-best option. Advise patients that, during an episode of diarrhoea: Increase fluid intake to prevent dehydration particularly important in young children and elderly people. For infants, breast-feeding should not be interrupted. Avoid alcohol and other beverages with a diuretic effect such as coffee and tea. Prophylactic medications and stand-by antibiotics Antibiotic prophylaxis, although effective, should not be routinely prescribed because: It offers no protection against non-bacterial causes. For most, the condition is mild and self-limiting.

3 Prophylaxis can give a false sense of security and lead to neglect of food and water precautions. The increasing prevalence of antibiotic resistance is of concern. Antibiotic treatment can lead to harms. C. difficile infection risk is increased in people taking longer courses of antibiotics, such as for prophylaxis. Other adverse effects associated with antibiotics include gastrointestinal symptoms (such as diarrhoea), allergic reactions, vaginal thrush, and sun sensitivity (associated with quinolones). Antibiotic chemoprophylaxis is ONLY for use in special circumstances, e.g. those with a colostomy. If you must prescribe prophylaxis for travellers diarrhoea, CKS suggests the following regime: Ciprofloxacin 500mg once daily (off-label use, requiring private prescription) for up to 3w (but in South and South East Asia there is significant resistance to ciprofloxacin). Ciprofloxacin should not be prescribed for children, adolescents, pregnant or breast-feeding women. Azithromycin is not suitable for prophylaxis. Probiotics: evidence of prevention of travellers diarrhoea is limited, and their use is not recommended by CKS as prophylaxis. Bismuth subsalicylate 525mg (2 tablets) chewed four times daily: Offers about 60% cover, but adverse effects are common at the most effective doses. Not to be given if on long-term salicylates or warfarin. Interferes with absorption of doxycycline (malaria prophylaxis). Blackens stools and tongue so is not widely used! Stand-by treatment of travellers diarrhoea (to be taken if needed) CKS advise the following: Ciprofloxacin 500 mg twice daily for 3d (licensed indication, requiring private prescription). Advise the person to evaluate their response after 24h of taking the antibiotic and to complete the 3d course if they are still unwell, or stop sooner if they are improved. Ciprofloxacin should not be prescribed for children, adolescents, pregnant or breast-feeding women, or for people in whom quinolones are contraindicated. For adults, and for children >45kg body weight, azithromycin 500mg daily for 3d (off-label use) may be prescribed as stand-by treatment. Treatment Hydration is critical. In mild illness this is all that is required. Be particularly careful to maintain hydration in infants and children, the elderly, and those with chronic disease. There is no good evidence that oral rehydration solution (ORS) is better than anything else. Bismuth subsalicylate reduces nausea and loose stool frequency. Seldom used in UK but available OTC overseas. It must NOT be used in children <16y, due to link between salicylates and Reye's syndrome. Loperamide may be more effective than bismuth in more severe diarrhoea, and helps with cramps. Onset of action is quicker than bismuth, with benefit seen at 4h. It must NOT be used in children (fears over intestinal obstruction), nor if fever >38.5 C, or if gross blood in stools. Antibiotics can shorten duration of illness by 1 2d compared with placebo, but may cause side-effects. If in the UK, confirm infection so that targeted treatment is possible. If overseas, a single dose or 3 days of treatment will give benefit within h. The suggestion is to take stat dose and review 12 24h later if improvement seen then stop treatment, if not continue for 3d. Ciprofloxacin 750mg stat orally, or 500mg bd for 3d, is the commonest treatment used, but is less effective in South and South East Asia. Azithromycin 1000mg stat orally, or 500mg bd for 3d can be used in place of ciprofloxacin. Beware of nausea with 1000mg dose). Loperamide is safe to take in conjunction with antibiotics. Patients should be advised to seek medical assistance if: Stools are blood-stained, or if there is persistent fever. It is difficult to maintain adequate hydration, because of frequent, watery stools, or repeated vomiting. Diarrhoea persists for more than 3 4d. Children show signs of irritability, sunken eyes, reduced skin elasticity. Remember that salads may have been washed, and ice cubes made up, with water from contaminated water supplies. Brush teeth using bottled water. Boil it, peel it, cook it or forget it, still goes a long way in preventing travellers diarrhoea!

4 Travellers diarrhoea Common, and usually resolves spontaneously within 3 4d, but 10% have symptoms for more than a week and 2% have symptoms for more than 1m. In prolonged illness (>10d) or onset after return from travel or if associated with weight loss think of parasitic infections such as Giardia. Boil water or treat it with chlorine/iodine AND filtered with a filter diameter of 1µm. Protozoan parasites are relatively resistant to chlorine and iodine. Wash your hands before eating. Avoid 'high risk' foods: 'Wash it, peel it, boil it, cook it or forget it!'. Antibiotics, probiotics and bismuth subsalicylate can be used as prophylaxis, but antibiotics are only recommended in specific circumstances. Treatment is with hydration +/ antidiarrhoeal agents +/ antibiotics. Professional development Do you, and others in your practice, Read-code Travellers diarrhoea? Try doing a search. Could it be helpful, to individual patients and in infection control, to Read-code Travellers diarrhoea more accurately? Do you have patients who travel to visit relatives in Ebola-endemic areas brush up on advice for primary care from Public Health England: on_for_primary_care_managing_patients_who_require_assessment_for_ebola.pdf Practical tools WHO Food and Drink safety leaflet: Ensuring safe drinking water, WHO advice leaflet: WHO travel advice: The Foreign and Commonwealth Office offers advice on travel including health advice plus other issues (visas, security risks, local laws and customs, risks of natural disasters, how to register on arrival, what to do if things go wrong):

5 The one-day course for all nurses in general practice Swamped with new clinical information and latest guidance? Too much for you to read and too little time to read it? Need to give evidence-based advice to patients, carers and colleagues? Want help meeting NMC revalidation requirements? We trawl through all the relevant journals to bring you right up to speed on the issues, literature, research and guidelines relevant to nursing in general practice. We are the only update course for Nurses that is completely free from pharmaceutical company sponsorship so you ll get an independent, unbiased view of all of the latest evidence. What will be covered? This is a dynamic and engaging one-day course that offers a wide-ranging, evidence-based programme, including all you need to know about: NMC Revalidation Long-term conditions important to primary care nurses, inc. diabetes, atrial fibrillation and liver disease Respiratory conditions: preventing asthmas deaths, management of acute exacerbation Lipids and statins Gastroenterology Sexual health, inc. FGM & the Law Suspected cancer and latest guidelines Vaccinations plus top-to-toe topics from rhinitis to vaginal discharge to verrucas! Who is this course for? All General Practice Nurses. 98% of the nurses who attended our Spring GPN Update course would recommend it to a colleague. Practice Nurses and Nurse Practitioners said: Probably the best course I have been on for a long time Highly informative and warranted time out of practice The Handbook will become my bible! We know how important it is that nurses and doctors share knowledge and skills to improve care. Our course is both written and presented by our resident ANP Debra Sprague and GP Sharon Dixon. Matt/The Daily Telegraph 2016 Telegraph Media Group Ltd What s not included: This course contains no theorists, gurus or sponsors. It is brought to you by real-life nurses and doctors, who will be back at the coal face once the course has finished!

6 What will you get on our course? Updates on the latest clinical evidence and guidance across a wide range of chronic and acute conditions. Great practical tips and tools to improve patients engagement with their long-term conditions. Loads of ideas, guidance and reassurance on making CPD a part of your everyday practice. Tools tailored to meet NMC requirements, to help you with your Revalidation evidence. Ways to move things forward in your practice area. Tips to help you and your team work together effectively Expertise and practical tools to share with your practice and support patients in managing their health. Guidance in managing clinical risk, with suggested activities to help you easily audit aspects of clinical safety Lots of humour and fun to help get through everything in one day without compromising the content of course! The GPN Update Handbook Delegates receive a copy of the 340-page GPN Update Handbook. This fully-referenced, evidence-based handbook covers the most important research, policy and guidance relevant to primary care nursing over the last 5 years. GPN CPD You ll also get one year s FREE subscription to GPN-CPD.com - a purpose built tool giving you a really easy way to track your CPD for NMC Revalidation and the entire course handbook online. No need to pay extra for these valuable resources! Who are we? Red Whale is one of the leading providers of primary care medical and nursing education in the UK with over 13,000 primary care practitioners attending our courses each year. We specialise in producing courses that are evidence-based, highly relevant to everyday practice and full of actions that delegates can take away and implement immediately. You may well have already heard great things about the GP Update Course from your GP colleagues. The GPN Update Course keeps that fast-moving and fun format, with material focused on the priorities for nursing in primary care: to support YOU in supporting your patients. For more details, go to The GPN Update Course dates Exeter Leeds Birmingham Fri 14 Oct Fri 4 Nov Sat 5 Nov Price: 195 DISCOUNT CODE: Enter GPN2016A45 code at checkout or when booking on the phone and receive 45 discount on any GPN Update autumn course dates To book: Online at or use the form below or call us on I would like to come on the following GPN Update Course (please write legibly!): Course location... Course date... Name... Address Discount Code... (Please write your address clearly as we ll use it to send your confirmation letter and receipt.) I can t attend a course, but I would like to order the 2016 GPN Handbook and 12 months access to GPN CPD. 150 Please send this form with your cheque payable to GP Update Limited to: GP Update, The Science and Technology Centre, Earley Gate, Whiteknights Road, Reading RG6 6BZ GP Update Limited, registered in England and Wales No Registered Office: Prospect House, 58 Queens Road, Reading RG1 4RP Full terms and conditions are available at GPN/0916 Relevant challenging and fun!

(Data from the Travel Health Surveillance Section of the Health Protection Agency Communicable Disease Surveillance Centre)

(Data from the Travel Health Surveillance Section of the Health Protection Agency Communicable Disease Surveillance Centre) Travellers Diarrhoea Introduction Travellers diarrhoea (TD) is a syndrome that commonly affects travellers caused by one of several different organisms, the most common being enterotoxigenic Escherichia

More information

Acute diarrhoea. What are the mechanisms of acute diarrhoea? What are the causes of acute diarrhoea?

Acute diarrhoea. What are the mechanisms of acute diarrhoea? What are the causes of acute diarrhoea? In association with: Primary Care Society for Gastroenterology INFORMATION ABOUT Acute diarrhoea www.corecharity.org.uk What are the mechanisms of acute diarrhoea? What are the causes of acute diarrhoea?

More information

Infectious Disease Outbreaks in confined spaces

Infectious Disease Outbreaks in confined spaces Infectious Disease Outbreaks in confined spaces Dr Andrew Ebringer Senior Medical Director, Medical Services - Australia International SOS 1 2013 AEA International Holdings Pte. Ltd. All rights reserved.

More information

Smoking cessation. Useful statistics. Smoking cessation advice. Assessing nicotine dependence

Smoking cessation. Useful statistics. Smoking cessation advice. Assessing nicotine dependence There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

GASTROENTERITIS. What you need to know BECAUSE...CARING COMES NATURALLY TO US

GASTROENTERITIS. What you need to know BECAUSE...CARING COMES NATURALLY TO US GASTROENTERITIS What you need to know BECAUSE...CARING COMES NATURALLY TO US Why should Gastroenteritis be treated Dehydration is an important sign of advanced and/or untreated gastroenteritis. Severe

More information

Advisory on Gastroenteritis

Advisory on Gastroenteritis 10 December 2018 Advisory on Gastroenteritis Background Singapore has seen a spate of four food poisoning outbreaks since November 2018, affecting more than 400 people. The most serious involved a fatality,

More information

Algorithms & Information Sheets

Algorithms & Information Sheets Minor Ailment Scheme Algorithms & Information Sheets Acute Diarrhoea Diarrhoea is an increased frequency, fluidity or volume of the bowel movements with the passage of soft and watery stools as compared

More information

33. I will recommend this primer to my colleagues. A. Strongly Agree D. Disagree B. Agree E. Strongly Disagree C. Neither agree nor disagree

33. I will recommend this primer to my colleagues. A. Strongly Agree D. Disagree B. Agree E. Strongly Disagree C. Neither agree nor disagree 27. The primer increased my ability to recognize foodborne illnesses and increased the likelihood that I will consider such illnesses in my patients. 28. The primer increased my knowledge and skills in

More information

What is cryptosporidiosis? How is cryptosporidiosis spread?

What is cryptosporidiosis? How is cryptosporidiosis spread? What is cryptosporidiosis? Cryptosporidiosis is a diarrheal disease caused by microscopic parasites of the genus Cryptosporidium. Once an animal or person is infected, the parasite lives in the intestine

More information

Epidemiology of Food Poisoning. Dr Varun malhotra Dept of Community Medicine

Epidemiology of Food Poisoning. Dr Varun malhotra Dept of Community Medicine Epidemiology of Food Poisoning Dr Varun malhotra Dept of Community Medicine Definition Public Health Importance Epidemiology of Food poisoning Investigation of an Outbreak Prevention & Control Measures

More information

Food Borne Diseases Complete List: Symptoms & Preventions

Food Borne Diseases Complete List: Symptoms & Preventions Food Borne Diseases Complete List: Symptoms & Preventions Food borne diseases are acute illnesses caused by harmful bacteria or toxins that usually develop within hours of consuming contaminated or poisonous

More information

Diarrhoea: travellers' diarrhoea

Diarrhoea: travellers' diarrhoea There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

Cholera Table of Contents

Cholera Table of Contents Subsection: Cholera Page 1 of 11 Cholera Table of Contents Cholera Fact Sheet Cholera and Other Vibrio Illness Surveillance Report (CDC 52.79) Subsection: Cholera Page 2 of 11 Cholera Overview (1,2) Although

More information

Coping with tummy bugs. Advice for parents/carers on dealing with an episode of diarrhoea and/or vomiting

Coping with tummy bugs. Advice for parents/carers on dealing with an episode of diarrhoea and/or vomiting Coping with tummy bugs Advice for parents/carers on dealing with an episode of diarrhoea and/or vomiting www.dettol.co.uk www.unitetheunion.org/cphva Looking after your child, Healthy hygiene With over

More information

National Digestive Diseases Information Clearinghouse

National Digestive Diseases Information Clearinghouse Diarrhea National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health and Human Services

More information

Affects 3.5% of pregnancies in the UK. Risk of developing type 2 diabetes is estimated at between 2 and 70%(!!!) depending on the population tested.

Affects 3.5% of pregnancies in the UK. Risk of developing type 2 diabetes is estimated at between 2 and 70%(!!!) depending on the population tested. There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

Administration of Hepatitis A and B Vaccine

Administration of Hepatitis A and B Vaccine PRACTICE: Ref No: PGD/ONEL/2011/006 Valid from December 2011 Valid to December 2013 Supersedes PGD: Any previous PGD used to administer Twinrix Adult and Paediatric vaccine Professional groups covered

More information

Biological Hazards Module 3

Biological Hazards Module 3 1 - Objectives - Describe salmonellosis and typhoid fever (salmonella) Recognize symptoms of exposure Describe treatments available Develop a response plan 2 - Salmonellosis Definition - Severe lower GI

More information

Cushing s syndrome is a consequence of chronic exposure to excess glucocorticoids regardless of their origin.

Cushing s syndrome is a consequence of chronic exposure to excess glucocorticoids regardless of their origin. There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

ACUTE DIARRHOEA FUNDING RESEARCH INTO DISEASES OF THE GUT, LIVER & PANCREAS

ACUTE DIARRHOEA FUNDING RESEARCH INTO DISEASES OF THE GUT, LIVER & PANCREAS ALL YOU NEED TO KNOW ABOUT ACUTE DIARRHOEA FUNDING RESEARCH INTO DISEASES OF THE GUT, LIVER & PANCREAS THIS FACTSHEET IS ABOUT ACUTE DIARRHOEA Most healthy people open their bowels between three times

More information

Laboratory Investigation of. Infectious Diarrhoea. Quiz Feedback. bpac nz better medicine

Laboratory Investigation of. Infectious Diarrhoea. Quiz Feedback. bpac nz better medicine Laboratory Investigation of Infectious Diarrhoea Quiz Feedback bpac nz better medicine GP Review Panel: Dr Janine Bailey, Motueka Dr Stephen Kuzmich, Wellington Dr Randall Sturm, Auckland Dr Neil Whittaker,

More information

Viral gastroenteritis Gastrointestinal infections caused by viruses are the most common and the most contagious.3

Viral gastroenteritis Gastrointestinal infections caused by viruses are the most common and the most contagious.3 CMA Today Quick Clinic May/Jun 2017 (Issue 3/Volume 50) GI woes Gastroenteritis affects patients at home and abroad By Nancy Solomon We expect patients to come into the office a few times a year with that

More information

https://www.travax.com/travinfo/showarticlesummary.aspx?docid=typhoid

https://www.travax.com/travinfo/showarticlesummary.aspx?docid=typhoid Page 1 of 5 Traveler Information TYPHOID GENERAL INFORMATION Introduction Typhoid fever and paratyphoid fever are bacterial infections of the intestinal tract. Typhoid is caused by Salmonella typhi and

More information

Management of Outbreaks Care Homes IPC Study Day

Management of Outbreaks Care Homes IPC Study Day Management of Outbreaks Care Homes IPC Study Day Sue Barber Infection Prevention & Control Lead AV & Chiltern CCG s Diarrhoea and/or vomiting May be bacterial or viral May be non-infectious in origin but

More information

OST. Gain a healthy respect for the risks of typhoid, before you. The only oral vaccine for protection against typhoid fever 1,2

OST. Gain a healthy respect for the risks of typhoid, before you. The only oral vaccine for protection against typhoid fever 1,2 Gain a healthy respect for the risks of typhoid, before you ET OST (Typhoid Vaccine Live Oral Attenuated Ty21a) 1 Typhoid fever affects about 21.5 million people each year in the developing world 3 Are

More information

Winter vomiting disease (norovirus)

Winter vomiting disease (norovirus) Southend University Hospital NHS Foundation Trust Patient Information Service Winter vomiting disease (norovirus) SOU2128_085413_0117_V1.indd 1 13/06/2017 09:53 SOU2128_085413_0117_V1.indd 2 13/06/2017

More information

Shoulder pain: examining the painful shoulder

Shoulder pain: examining the painful shoulder There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

Typhoid Fever. Information from

Typhoid Fever. Information from Typhoid Fever Information from http://kidshealth.org/en/parents/typhoid.html# Typhoid fever is a serious and sometimes life-threatening infection that mostly affects people in developing countries, where

More information

First steps for managing an outbreak of acute diarrhoea

First steps for managing an outbreak of acute diarrhoea GLOBAL HEALTH SECURITY WORLD HEALTH ORGANIZATION E P I D E M I C A L E R T A N D R E S P O N S E First steps for managing an outbreak of acute diarrhoea THIS LEAFLET AIMS AT GUIDING YOU THROUGH THE VERY

More information

Gastroenteritis in Adults

Gastroenteritis in Adults Gastroenteritis in Adults Page 1 of 5 Gastroenteritis is an infection of the gut (intestines). It causes diarrhoea and may also cause you to be sick (vomit), and have tummy (abdominal) pain and other symptoms.

More information

Marte McCadden, ARNP. University of Washington Employee Health Travel Medicine Primary Care June 2013

Marte McCadden, ARNP. University of Washington Employee Health Travel Medicine Primary Care June 2013 Marte McCadden, ARNP University of Washington Employee Health Travel Medicine Primary Care June 2013 Water & food precautions are necessary for anyone traveling to less developed countries. Studies have

More information

Foodborne Disease in the Region of Peel

Foodborne Disease in the Region of Peel Foodborne Disease in the Region of Peel HIGHLIGHTS The incidence of selected foodborne diseases was generally higher in Peel than in Ontario between 1993 and 22. A higher incidence was observed in Peel

More information

National Digestive Diseases Information Clearinghouse

National Digestive Diseases Information Clearinghouse Diarrhea National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is diarrhea? Diarrhea is loose, watery stools. Having diarrhea

More information

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011 August 2011 Campylobacteriosis Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) August 2011 August 2011 October 2005 Case

More information

Travellers Diarrhea Update: From Prevention to Self-Treatment. Michael Payne November 4 th, 2016

Travellers Diarrhea Update: From Prevention to Self-Treatment. Michael Payne November 4 th, 2016 Travellers Diarrhea Update: From Prevention to Self-Treatment Michael Payne November 4 th, 2016 Outline 1. Epidemiology of travellers diarrhea 2. Prevention Behavioral Vaccination Medications 3. Self-treatment

More information

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011 August 2011 Giardiasis Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) Case Definition August 2011 August 2011 October

More information

Hepatitis A. Fighting liver disease

Hepatitis A. Fighting liver disease Hepatitis A Fighting liver disease Hepatitis A The liver Your liver is your body s factory, carrying out hundreds of jobs that are vital for life. You only have one liver, but it is very tough. It keeps

More information

Vaginal discharge: normal or abnormal?

Vaginal discharge: normal or abnormal? Vaginal discharge: normal or abnormal? Pretty much on a daily basis GPNs see women concerned about unusual vaginal discharge. As GPNs, we need to remind ourselves that the most common reasons for altered

More information

Personal Injury TYPES OF HOLIDAY ILLNESSES.

Personal Injury TYPES OF HOLIDAY ILLNESSES. TYPES OF HOLIDAY ILLNESSES Whilst on holiday many different contractable illnesses exist, the list below contains the most common. This list is by no means exhaustive and if you have suffered from an illness

More information

INFORMATION ABOUT ACUTE DIARRHOEA IN ASSOCIATION WITH:

INFORMATION ABOUT ACUTE DIARRHOEA IN ASSOCIATION WITH: www.corecharity.org.uk INFORMATION ABOUT ACUTE DIARRHOEA IN ASSOCIATION WITH: ACUTE DIARRHOEA Most healthy people open their bowels between three times a day and three times a week. Normal stools are usually

More information

FIGHT INFECTIOUS BACTERIA AND VIRUSES MAKE HANDWASHING CONTAGIOUS!!!!!!!!!!!!!!!!!!!!!!!!!!!

FIGHT INFECTIOUS BACTERIA AND VIRUSES MAKE HANDWASHING CONTAGIOUS!!!!!!!!!!!!!!!!!!!!!!!!!!! FIGHT INFECTIOUS BACTERIA AND VIRUSES MAKE HANDWASHING CONTAGIOUS!!!!!!!!!!!!!!!!!!!!!!!!!!! It s contagious!! HANDWASHING TO ATTACK NOROVIRUS!! HELP FIGHT INFECTIOUS BACTERIA AND VIRUSES MAKE HANDWASHING

More information

Protecting Yourself Traveler s Health

Protecting Yourself Traveler s Health Protecting Yourself Traveler s Health Diane La May, BSN University of Colorado Hospital International Traveler s Clinic Outline Traveler vaccines Protection from food-borne illness Insect Precautions Safety

More information

GI Bacterial Infections (part-1)

GI Bacterial Infections (part-1) GI Bacterial Infections (part-1) Mohammed Abdulla Mehdi FIBMS (internal medicine), FIBMS (Gastroenterology & Hepatology) Acute diarrhea and vomiting Acute diarrhea, sometimes with vomiting, is the predominant

More information

Top 8 Pathogens. Print this document and study these pathogens. You will be better prepared to challenge the ADVANCED.fst exam.

Top 8 Pathogens. Print this document and study these pathogens. You will be better prepared to challenge the ADVANCED.fst exam. Top 8 Pathogens The top 8 pathogens outlined in this document often cause foodborne illness in Canada. Take particular note of the bolded/underlined sections, as they are especially important. Print this

More information

Drug dilemma: the risks of PPIs

Drug dilemma: the risks of PPIs Drug dilemma: the risks of PPIs Fracture risk: o The absolute risk increase is small (0.5 extra hip fractures/1000 person years in regular PPI users compared with non-users) AND WAS ONLY SEEN IN SMOKERS

More information

Epidemiology of Diarrheal Diseases. Robert Black, MD, MPH Johns Hopkins University

Epidemiology of Diarrheal Diseases. Robert Black, MD, MPH Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Homebased Microprocessor Recipe Form

Homebased Microprocessor Recipe Form Homebased Microprocessor Recipe Form Please fill in the form to draft a recipe for approval. Product Name Date Farm Name Name of person responsible for product Address City/State/Zip Telephone Email Ingredient

More information

Consumer Medicine Information TOPICIL. Please read this leaflet carefully before you start using Topicil Capsules.

Consumer Medicine Information TOPICIL. Please read this leaflet carefully before you start using Topicil Capsules. Clindamycin hydrochloride Capsules 150 mg What is in this leaflet Consumer Medicine Information TOPICIL Please read this leaflet carefully before you start using Topicil Capsules. This leaflet answers

More information

Risk Consultation and Assessment

Risk Consultation and Assessment Risk Consultation and Assessment Please find product Prescribing Information at the end of this presentation UK/VAC/0047/16b Date of preparation: July 2016 The pre-travel risk consultation When to do it?

More information

Preventing foodborne illnesses. aka FOOD POISONING

Preventing foodborne illnesses. aka FOOD POISONING TFJ3C Preventing foodborne illnesses aka FOOD POISONING Enzymes chemicals within foods that help them change Micro-organisms bacteria, yeast, mould, Oxidation exposure of food to oxygen Keep it Safe, Refrigerate!

More information

Faecal immunochemical testing and colorectal cancer

Faecal immunochemical testing and colorectal cancer There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

The 12 Most Unwanted Bacteria

The 12 Most Unwanted Bacteria The 12 Most Unwanted Bacteria Campylobacter jejuni Most common bacterial cause of diarrhea in the U.S. especially in young children. Raw milk, untreated water, raw and undercooked meat, poultry or shellfish.

More information

Giardiasis. Table of Contents

Giardiasis. Table of Contents Table of Contents Case Definition... Error! Bookmark not defined. Reporting Requirements... 2 Etiology... Error! Bookmark not defined. Clinical Presentation... Error! Bookmark not defined. Diagnosis...

More information

Nalini Brown Nurse Manager/Travel Health Specialist London Travel Clinic

Nalini Brown Nurse Manager/Travel Health Specialist London Travel Clinic Nalini Brown Nurse Manager/Travel Health Specialist nalini.brown@londontravelclinic.co.uk London Travel Clinic TOPICS Why do a travel risk assessment? Vaccines what s new? Advising patients when there

More information

Salmonella germs (bacteria) may be found in the gut of many animals, including wild animals, farm animals and

Salmonella germs (bacteria) may be found in the gut of many animals, including wild animals, farm animals and Salmonella Page 1 of 9 Salmonella are a group of germs (bacteria) that can cause food poisoning. Typically, food poisoning causes gastroenteritis - an infection of the gut (intestines) which leads to diarrhoea

More information

Influenza (flu) Infection Prevention and Control. What is influenza? What are the symptoms of influenza? What causes influenza?

Influenza (flu) Infection Prevention and Control. What is influenza? What are the symptoms of influenza? What causes influenza? What is influenza? Influenza (also known as flu) is a respiratory illness which is caused by the influenza virus. For most people influenza is just a nasty experience, but for some it can lead to illnesses

More information

2013 Disease Detectives

2013 Disease Detectives 2013 Disease Detectives Since the catastrophic earthquake that hit Haiti in January of 2010, there have been an alarming number of cases of Cholera, spread by the Vibrio cholera bacterium, reported within

More information

Cataract: Tamsulosin and cataract operations

Cataract: Tamsulosin and cataract operations There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

Protect the quality and safety of your food

Protect the quality and safety of your food Protect the quality and safety of your food Description of tool This tool provides useful information about protecting the quality and safety of food. School teachers can use this information while teaching

More information

DALACIN C PHOSPHATE Injection Clindamycin phosphate

DALACIN C PHOSPHATE Injection Clindamycin phosphate DALACIN C PHOSPHATE Injection Clindamycin phosphate Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about Dalacin C Phosphate injection. It does not contain

More information

Rotavirus. Children s Ward Macclesfield District General Hospital.

Rotavirus. Children s Ward Macclesfield District General Hospital. Rotavirus Children s Ward 01625 661080 Macclesfield District General Hospital www.eastcheshire.nhs.uk Leaflet Ref: 10941 Published: 07/15 Review: 07/18 Page 1 Rotavirus is a viral infection that can cause

More information

Superficial thrombophlebitis

Superficial thrombophlebitis There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

Norovirus. Causes. What causes infection with a norovirus? How is it spread?

Norovirus. Causes. What causes infection with a norovirus? How is it spread? - Fact sheet - Public Health Agency of Canada es are a group of viruses that cause gastroenteritis, an illness that usually includes diarrhea and/or vomiting. es are commonly found throughout North America

More information

F o O D T Y E. A Reference Guide For Employees that Handle and Prepare Food or Beverages

F o O D T Y E. A Reference Guide For Employees that Handle and Prepare Food or Beverages If you need further information on food safety, ask your manager to obtain the following booklets also brought to you by Brown-Nicollet-Cottonwood-Watonwan Environmental Health: Food Worker Registry Food

More information

Pathogen specific exclusion criteria for people at increased risk of transmitting an infection to others

Pathogen specific exclusion criteria for people at increased risk of transmitting an infection to others Appendix 2: disease March 2018 Exclusion/Restriction Cases of most enteric disease should be considered infectious and should remain off work/school until 48 hours after symptoms have ceased. Certain individuals

More information

Lesson 1.5. The Usual Suspects. Estimated time: Two 50 min periods. Instructional overview. Instructional objectives. Assessment

Lesson 1.5. The Usual Suspects. Estimated time: Two 50 min periods. Instructional overview. Instructional objectives. Assessment Lesson 1.5 The Usual Suspects Estimated time: Two 50 min periods Instructional overview Using information from peer presentations, students will identify the ten most common foodborne pathogens and recognize

More information

Paediatric Directorate

Paediatric Directorate Paediatric Directorate Dehydration Guidelines Primary cause of dehydration diarrhoea +/- vomiting. Approximately 10%Children < 5yrs present with gastroenteritis each year Diagnosis History - sudden change

More information

HAVRIX 1440 and HAVRIX Junior

HAVRIX 1440 and HAVRIX Junior HAVRIX 1440 and HAVRIX Junior Inactivated Hepatitis A Virus Vaccine Consumer Medicine Information Leaflet In this leaflet, HAVRIX refers to the use of both HAVRIX 1440 for adults and HAVRIX Junior for

More information

Frequently Asked Questions on Zinc and Suggested Responses

Frequently Asked Questions on Zinc and Suggested Responses Last edited: September 27, 2012 Zinc Treatment of Childhood Diarrhea Frequently Asked Questions Diarrhoea still remains a leading cause of morbidity and mortality in developing countries. Every year more

More information

Sep Frequently asked questions concerning Pandemic(Swine) Flu

Sep Frequently asked questions concerning Pandemic(Swine) Flu Frequently asked questions concerning Pandemic(Swine) Flu General Information 1. What are the symptoms of Swine Flu? 2. Where can I get more information on Swine Flu? 3. How can I help prepare in case

More information

CHOLERA. Kirsten Schmidt-Hellerau

CHOLERA. Kirsten Schmidt-Hellerau CHOLERA Kirsten Schmidt-Hellerau Reported Cases (WHO) 2010-2015: - 2015: 172 454 cases - estimated 1.4 to 4 million cases including 21 000-143000 deaths/year 37% 41% Cholera guidelines MSF Cholera guideline

More information

Guidance for obtaining faecal specimens from patients with diarrhoea (Background information)

Guidance for obtaining faecal specimens from patients with diarrhoea (Background information) Guidance for obtaining faecal specimens from patients with diarrhoea (Background information) Version 1.0 Date of Issue: January 2009 Review Date: January 2010 Page 1 of 11 Contents 1. Introduction...

More information

FACT SHEET. H1N1 Influenza phone

FACT SHEET. H1N1 Influenza phone www.cookcountypublichealth.org 708-492-2000 phone H1N1 Influenza FACT SHEET What is novel H1N1? Novel H1N1 (referred to as swine flu early on) is a new influenza virus causing illness in people. This new

More information

Hajj General Medical Advice. Mudammad Mian-Rehan General Practitioner (GP) Spencer Road Family Practice Huntingdale

Hajj General Medical Advice. Mudammad Mian-Rehan General Practitioner (GP) Spencer Road Family Practice Huntingdale Hajj General Medical Advice Mudammad Mian-Rehan General Practitioner (GP) Spencer Road Family Practice Huntingdale Preparing for Hajj Practice Regular Walking for few wks prior Ensure pre-existing medical

More information

KEY FACTS. Cholera is an acute disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

KEY FACTS. Cholera is an acute disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. KEY FACTS Cholera is an acute disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Symptoms: 75% of those affected have no visible signs/symptoms - they are still

More information

What is C difficile? (Clostridium difficile) Patient information leaflet

What is C difficile? (Clostridium difficile) Patient information leaflet What is C difficile? (Clostridium difficile) Patient information leaflet What is C difficile? C difficile is short for Clostridium difficile, a rod-shaped bug that lives in the bowel of less than 5% of

More information

Chapter 2 The Microworld

Chapter 2 The Microworld Chapter 2 The Microworld Major Foodborne Illnesses Caused by Viruses Viral Foodborne Illnesses Hepatitis A Norovirus gastroenteritis 2-2 Hepatitis A Illness: Hepatitis A Virus: Hepatitis A Commonly Linked

More information

Escherichia coli Verotoxigenic Infections

Escherichia coli Verotoxigenic Infections Revision Dates Case Definition Reporting Requirements Epidemiology/Public Health Management March 2011 May 2018 March 2011 Includes O157:H7 Case Definition Confirmed Case Laboratory confirmation of infection

More information

Clostridium difficile

Clostridium difficile Clostridium difficile Care Homes IPC Study Day Sue Barber Infection Prevention & Control Lead AV & Chiltern CCG s Clostridium difficile A spore forming Bacterium. Difficult to grow in the laboratory hence

More information

Food Hygiene Guidance For Childminders

Food Hygiene Guidance For Childminders Food Hygiene Guidance For Childminders Produced by the Food Safety Team, Public Health Services, Bristol City Council First Published January 2011 Revised February 2018 Food Law and you If you are a registered

More information

Gastroenteritis Outbreaks Including Norovirus. Module 7

Gastroenteritis Outbreaks Including Norovirus. Module 7 Gastroenteritis Outbreaks Including Norovirus Module 7 Learner Outcomes By the end of this module you will be able to: Outline the case definition for a gastroenteritis outbreak. Explain the difference

More information

Communicable diseases. Gastrointestinal track infection. Sarkhell Araz MSc. Public health/epidemiology

Communicable diseases. Gastrointestinal track infection. Sarkhell Araz MSc. Public health/epidemiology Communicable diseases Gastrointestinal track infection Sarkhell Araz MSc. Public health/epidemiology Communicable diseases : Refer to diseases that can be transmitted and make people ill. They are caused

More information

Section One: Background Material

Section One: Background Material Section One: Background Material What is the problem? Every day people all over the world get sick from the food they eat. This sickness is called foodborne disease and is caused by dangerous microorganisms

More information

ESCHERICHIA COLI. Pet Health Council Escherichia coli Updated November

ESCHERICHIA COLI. Pet Health Council Escherichia coli Updated November ESCHERICHIA COLI Introduction Escherichia coli 0157:H7 (E. coli 0157) is a cause of food borne illness. Infection may result in sickness and diarrhoea, which can often be severe and with blood. Complications

More information

Measles: in older children and adults

Measles: in older children and adults There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've

More information

E. coli O157. Information for you. Follow us on Find us on Facebook at Visit our website:

E. coli O157. Information for you. Follow us on Find us on Facebook at   Visit our website: E. coli O157 Information for you Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other formats What is

More information

Medication, Travel and You

Medication, Travel and You Medication, Travel and You Zahra demolitor Pharmacist Owner Shoppers Drug Mart, Upper Tantallon January 17, 2013 1 Outline Drug Plans & Vacation Supplies How to pack medications Days supply you can take

More information

Most people confuse influenza with a heavy cold; however influenza is usually a more severe illness than the common cold.

Most people confuse influenza with a heavy cold; however influenza is usually a more severe illness than the common cold. What is influenza? Influenza (also known as flu) is a respiratory illness which is caused by the influenza virus. For most people influenza is just a nasty experience, but for some it can lead to illnesses

More information

PATIENT GROUP DIRECTION. Oral (live attenuated) Typhoid Vaccine (Ty21a) (Vivotif )

PATIENT GROUP DIRECTION. Oral (live attenuated) Typhoid Vaccine (Ty21a) (Vivotif ) PATIENT GROUP DIRECTION Administration of: Oral (live attenuated) Typhoid Vaccine (Ty21a) (Vivotif ) By: Practice Nurses In: General Practice It is the responsibility of the professional working under

More information

Norovirus. Kristin Waroma. Michelle Luscombe. Public Health Inspector. Infection Control Nurse

Norovirus. Kristin Waroma. Michelle Luscombe. Public Health Inspector. Infection Control Nurse Norovirus Kristin Waroma Public Health Inspector Michelle Luscombe Infection Control Nurse Objectives of Presentation Clinical presentation of Norovirus disease Transmission of Norovirus Treatment of Norovirus

More information

Gastroenteritis in children Paediatric department

Gastroenteritis in children Paediatric department Gastroenteritis in children Paediatric department 01935 475 122 yeovilhospital.nhs.uk What is Gastroenteritis? Gastroenteritis (stomach bug) is an infection in the gut (intestines). It is common in all

More information

CLOSTRIDIUM DIFFICILE

CLOSTRIDIUM DIFFICILE Other useful information sources NHS Choices: www.nhs.uk NHS 111 (for urgent medical help that is not a 999 emergency) Public Health England: www.phe.gov.uk National Patient Safety Agency - www.npsa.nhs.uk/cleanyourhands

More information

Clostridium difficile

Clostridium difficile Clostridium difficile Infection Control Team Patient Information Leaflet What is Clostridium difficile? Clostridium difficile (sometimes called C. diff) is a type of bacteria. They live in the intestine

More information

Bacteria. Major Food Poisoning Caused by Bacteria. Most Important Prevention Measure. Controlling time. Preventing cross-contamination

Bacteria. Major Food Poisoning Caused by Bacteria. Most Important Prevention Measure. Controlling time. Preventing cross-contamination Bacteria Major Food Poisoning Caused by Bacteria Most Important Prevention Measure Controlling time and temperature Preventing crosscontamination Practising personal hygiene Bacillus cereus gastroenteritis

More information

REFERENCE NUMBER: NH.PMN.47 EFFECTIVE DATE: 11/11

REFERENCE NUMBER: NH.PMN.47 EFFECTIVE DATE: 11/11 PAGE: 1 of 5 RETIRED: REVIEWED: 11/11, 12/14, 08/16, 07/17 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough

More information

Thrombosis and Anticoagulation Team. Warfarin. Information for patients, relatives and carers

Thrombosis and Anticoagulation Team. Warfarin. Information for patients, relatives and carers Thrombosis and Anticoagulation Team Warfarin Information for patients, relatives and carers What is warfarin? Warfarin is an anticoagulant. Anticoagulants are drugs which prevent harmful blood clots forming

More information

Clostridium difficile (C. difficile or C. diff)

Clostridium difficile (C. difficile or C. diff) What is Clostridium difficile (C. difficile)? Clostridium difficile is a bacterium (germ) that can be found in the gut of about 3 in 100 people. Where there are small numbers of the bacterium it does not

More information

Aspirin: what do we know so far? What is new this week?

Aspirin: what do we know so far? What is new this week? Aspirin: what do we know so far? What is new this week? This article discusses the data published this week on the harms of low-dose aspirin, and particularly the harms with increasing age. It also looks

More information

Hepatitis E FAQs for Health Professionals

Hepatitis E FAQs for Health Professionals Hepatitis E FAQs for Health Professionals Index of Questions ± Overview and Statistics What is Hepatitis E? How common is Hepatitis E in the United States? Where is Hepatitis E most common? Are there different

More information

Acute Gastroenteritis

Acute Gastroenteritis Acute Gastroenteritis Definitions Epidemiology Clinical presentation Diagnostics Therapy Erdélyi, Dániel 2018.04.10. Definitions Acute gastroenteritis (AGE): Loose or liquid stools 3 times daily (better:

More information