Travellers' Diarrhea (Dukoral)

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Available Immunizations

  • DUKORAL™ is a raspberry-flavoured vaccine that you drink.
  • Each dose comes in a small glass vial along with a packet of white effervescent granules
  • Use only water (about 5 ounces or 150mL) and no other beverage to prepare the vaccine.
  • Do not eat or drink anything for 1 hour before and 1 hour after taking the vaccine.

    • Follow these steps for preparing the vaccine:

    1. Dissolve the effervescent granules in a glass of water.
    2. Shake the small glass vial of vaccine.
    3. Add the vaccine in the vial to the solution in the glass. Stir well and drink. The mixture should be drunk within 2 hours.
    4. For children 2 to 6 years, pour away half of the liquid.

  • 2 doses booster recommended after 3 months
  • Doses must be taken at least 1 week apart, but not more than 6 weeks apart.
  • If more than 6 weeks pass between doses, the dosing schedule should be re-started.
  • Protection against travellers' diarrhea begins about 1 week after taking the final dose.

    • Trials have been done to make sure that DUKORAL™ is generally well tolerated. In these trials, no serious adverse reactions were reported. Although some people reported diarrhea or abdominal pain, the number of adverse reactions was similar in vaccine and non-vaccine patients. In countries where DUKORAL™ is sold, gastrointestinal symptoms and fever have been very rarely reported.

    What is it?

    When Canadians travel in the developing world, travellers' diarrhea is a common problem. During a two week vacation, up to 50% of people will have one or more episodes of travellers' diarrhea. Travellers' diarrhea often begins suddenly, and can be hard to manage in a remote or unfamiliar place.

    Travellers' diarrhea usually lasts 3-5 days. One person in five will need to stay in bed for a day. Severe cases can cause serious dehydration and last two weeks or more, in about 10% of cases.

    Common symptoms include:

  • Abnormally frequent, loose bowel movements
  • Abdominal cramps
  • Nausea
  • Bloating
  • Urgency
  • Fever
  • Feeling uncomfortable
  • Vomiting

    • The most common cause of travellers' diarrhea is food contaminated with bacteria called enterotoxigenic E. coli (ETEC). However, travellers' diarrhea can also be caused by contaminated water.

    Where is it?

    Where Travellers' Diarrhea can be found
    People usually get travellers' diarrhea on trips to Latin America, the Caribbean, Southeast Asia, Africa, Eastern or Southern Europe. As the map shows, the risk varies with your destination. Even travellers on cruise ships are at risk, as recent outbreaks have shown.

    Prevention Tips

  • DUKORAL™ is the only vaccine available in Canada to prevent travellers' diarrhea caused by ETEC. DUKORAL™ also protects people from cholera. It is a raspberry flavoured liquid that you drink before leaving on your trip.
  • In a clinical trial, DUKORAL™ was shown to protect people against travellers' diarrhea for 3 months. DUKORAL™ worked best against severe diarrhea. Studies show that protection starts about a week after taking the final dose. Remember, it only protects against travellers' diarrhea caused by ETEC, and cholera. It is still important to choose your food and drink wisely, to avoid food poisoning.

    • Food Precautions


    Travelers should:

     

  • Eat at establishments that are known to cater to foreigners or that are known by other foreigners to be safe.
  • Eat foods that are well-cooked and served steaming hot.
  • Eat breads, tortillas, crackers, biscuits, and other baked goods.
  • Eat fruits, nuts and vegetables with thick skins, peels or shells that you remove yourself.
  • Eat canned foods.
  • Always wash your hands with soap before eating and after using the toilet.

    • Travelers should not:

  • Eat any food from street vendors or market stalls.
  • Eat leafy or uncooked vegetables and salads. Some organisms in soil and water are not destroyed by normal cleaning methods.
  • Eat undercooked, raw, or cold meat, seafood, or fish.
  • Eat large carnivorous fish, especially from reef areas (barracuda, red snapper, amberjack, surgeon fish, parrot fish, mullet, sea bass, grouper, or moray eels). Many contain concentrated toxins.
  • Eat or drink unpasteurized dairy products such as cheese, yogurt, or milk. Be particularly wary of ice cream and other frozen confection that may have been made or stored in contaminated containers.
  • Eat cold sauces such as mayonnaise, salad dressing, chutneys, or salsas, which are usually raw and made by hand.
  • Eat buffet foods such as lasagna, casseroles, and quiches - unless you know they are fresh (not reheated) and have been kept steaming hot. Avoid buffets where there are no food covers or fly controls.
  • Eat creamy desserts, custards, or sauces that may not have been adequately refrigerated.

    • Beverage Precautions
    In developed countries, clean drinking water is available right out of the tap and breakdowns in the system are rare. Developing countries, however, don't always have the resources needed to ensure a pure water supply, and consequently tap water is not safe to drink. Even if the people who live there can drink the water, travelers should not assume that they can. Local residents have built up immunity to organisms in the water, but visitors have not. As a result, tap water can make travelers sick.

    When traveling through areas with less than adequate sanitation or with water sources of unknown purity, you can reduce the chance of illness by following these precautions.

    Travelers should:

  • Use only water that is sealed and bottled or chemically treated, filtered, or boiled - for drinking and brushing teeth.
  • Drink beverages made only with boiled water whenever possible (such as hot tea and coffee). Water boiled for any length of time (even 1 minute), at any altitude, is safe to drink.
  • Drink canned, boxed, or commercially bottled carbonated water and drinks. International brands are safest. Beware of unsealed containers that may have been re-filled.
  • Safely drink beer and wine; however, alcohol added to beverages does not render them safe.
  • Purify your own water (see "Treating Water" below) if one of these options is not available. Decide which method to use for water purification and bring along the appropriate equipment.
  • Carry safe water with you if you are going out for the day and safe water is not assured.
  • Breast-feeding is the safest food source for infants who are still nursing. If formula is used, it must be prepared with boiled water and sterilized containers.

    • Travelers should not:

  • Drink tap water.
  • Rinse toothbrush in tap water.
  • Use ice unless it is made from boiled, bottled, or purified water. Freezing does not kill the organisms that cause diarrhea.
  • Assume that water is safe because it is chlorinated. Chlorination does not destroy all the organisms that can make you ill.
  • Drink from wet cans or bottles - the water on them may be contaminated. Dry wet cans/bottles before opening and clean all surfaces that will have contact with the mouth.
  • Drink fruit juice unless it comes directly from a sealed container; otherwise it may have been diluted with tap water.

    • Treating Water
    Boiling: Urban travelers may choose an immersion coil for boiling water (a plug adapter and current converter might be necessary).

    Chemical disinfection: If it is not possible to boil water, chemical disinfection is an alternative. Most (but not all) diarrhea pathogens are susceptible to being killed by iodine or chlorine dioxide (Pristine), which can be used to disinfect water, leafy vegetables and fruits.