Millions of international travellers heading overseas this year could find themselves spending more time in the bathroom than exploring their destinations, with medical experts warning that up to 70 per cent of travellers to certain regions will experience stomach problems during their trips.
Attack rates range from 30% to 70% of travelers during a 2-week period, depending on the destination and season of travel. The condition, commonly known as traveller’s diarrhoea, strikes particularly hard in regions with hot, humid climates and can transform a dream holiday into a medical emergency within hours of arrival.
Dr Bradley Connor, who co-authored the CDC’s latest travel health guidelines, stated that “bacterial pathogens account for 75 to 90 per cent of cases”, with symptoms typically appearing within the first few days of travel. The expert panel’s findings reveal that tourists visiting popular destinations across Asia, Africa, and Latin America face the highest risks.
Scale of the Problem Reaches Crisis Levels
Recent epidemiological studies paint a sobering picture for international travellers. Among travelers from developed countries who visit developing countries, >60% may experience traveler’ diarrhea, accounting for 40,000 travelers daily or >15 million travelers annually.
The financial impact extends far beyond ruined holidays. Medical treatment abroad can be devastating, with “treatment for a stomach bug or infection in the USA, plus flights home, could cost £100,000” (approximately $125,000), according to insurance industry estimates, highlighting the critical importance of proper travel insurance coverage.
Military personnel and long-term travellers face even greater challenges. A cohort of expatriates residing in Kathmandu, Nepal, experienced an average of 3.2 episodes of TD per person during their first year, demonstrating the persistent nature of the threat.
Contaminated Food and Water: The Hidden Culprits
The primary sources of infection paint a clear picture of risk. Bacteria are the predominant enteropathogens and are thought to account for ≥75%–90% of cases. The most common culprits include enterotoxigenic Escherichia coli, followed by Campylobacter jejuni, Shigella species, and Salmonella.
Intestinal viruses account for at least 10%–25% of illnesses, whilst parasitic infections, though less common, can cause prolonged symptoms lasting weeks or even months after travellers return home.
Dr Daniel Caplivski, director of the Mount Sinai School of Medicine Travel Medicine Program, explained that “food poisoning is a generic term that refers to the more than 250 different foodborne diseases that are caused by different microbes and pathogens”.
The CDC’s latest food safety guidelines emphasise that “contaminated food or drinks may cause travelers‘ diarrhea and other diseases”, with particular risks from street vendors, lukewarm buffets, and untreated tap water in developing nations.
Regional Risk Variations Shock Researchers
The latest Global Travelers’ Diarrhea study, funded by the US Department of Defense, revealed striking regional variations in risk levels. The highest incidence experienced by travelers to SE Asia (41 cases per 100 person-months), Latin America/Caribbean (39.4), and the Middle East (35.2).
During October 2018–April 2023, a total of 512 participants who met the acute diarrhea or acute gastroenteritis case definitions were enrolled in the GTD study in Honduras (21%), Peru (3%), Egypt (3%), Djibouti (39%), Nepal (26%), and Georgia (8%), with 79 per cent testing positive for at least one pathogen.
High-Risk Foods and Drinks: What to Avoid
Travel medicine specialists have identified specific danger zones for travellers. The CDC strongly advises against consuming:
- Raw vegetables and salads that may have been washed in contaminated water
- Street food, particularly in areas with poor sanitation
- Tap water and ice cubes in developing countries
- Unpasteurised dairy products
- Lukewarm food from buffets
“Food should be served cold, and hot food should be served hot. If you’re selecting food from a buffet or salad bar, make sure the hot food is steaming and the cold food is chilled.” Germs grow rapidly when food sits in the danger zone between 40°F and 140°F.
Prevention Strategies That Actually Work
Hand Hygiene: Your First Defence
“Always wash hands with soap and water before eating and before prepping food. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol.”
Probiotics Show Promise
Recent meta-analyses have demonstrated that specific probiotic strains can reduce traveller’s diarrhoea risk. Saccharomyces boulardii CNCM I-745 showed a significant reduction in TD incidence (RR = 0.79, 95% C.I.), offering travellers a potential preventive option to discuss with their healthcare providers.
Essential Vaccinations
The CDC and WHO recommend several vaccines for international travellers, including:
- Hepatitis A: “If you’re planning to travel internationally, talk to your doctor about getting vaccinated against hepatitis A”, particularly for destinations in Asia, Africa, and Latin America
- Typhoid: “Typhoid vaccine is recommended for travelers to parts of the world where typhoid is common”, with protection beginning approximately 14 days after administration
Ideally, travelers should seek medical advice at least 4-6 weeks before departure, as many vaccines require multiple doses/visits”, according to Dr Wilbur Chen, Director of the University of Maryland Traveler’s Health Clinic.
Emergency Kit Essentials: What Every Traveller Needs
Medical experts recommend packing a comprehensive travel health kit including:
Rehydration Solutions
“In serious cases of travelers’ diarrhea, oral rehydration solution—available online or in pharmacies in developing countries—can be used for fluid replacements.” These WHO-formulated salts help restore electrolytes lost through diarrhoea and vomiting.
Anti-Diarrhoeal Medications
“Several drugs, such as loperamide, can be bought over-the-counter to treat the symptoms of diarrhea. These drugs decrease the frequency and urgency of needing to use the bathroom”, making them essential for emergency situations during travel.
Antibiotics for Severe Cases
Whilst not recommended for routine use, travellers should discuss antibiotic options with their doctors before departure, particularly for high-risk destinations.
When to Seek Medical Help: Warning Signs
Travellers must recognise when stomach issues require professional medical attention. “If you’re suffering with a fever, serious abdominal cramps, or blood in your stool or vomit, those can signal a bacterial infection” requiring immediate medical care.
Additional warning signs include:
- Severe dehydration (dizziness, reduced urination, dry mouth)
- Persistent vomiting preventing fluid intake
- High fever above 39°C (102°F)
- Symptoms lasting more than 48 hours without improvement
- Signs of severe dehydration in children or elderly travellers
Travel Insurance: Critical Financial Protection
The importance of comprehensive travel insurance cannot be overstated. “If you do not have appropriate insurance before you travel, you could be liable for emergency expenses, including medical treatment, which may cost thousands of pounds.”
Insurance experts recommend ensuring policies specifically cover:
- Emergency medical treatment abroad
- Medical evacuation if required
- Pre-existing digestive conditions (must be declared)
- Trip cancellation due to illness
“Seven in 10 told us that they had declared a medical condition” when purchasing travel insurance, with most finding only minor impacts on coverage availability, though premiums may increase.
Latest Research and Future Developments
Scientists continue working on preventive solutions. Vaccine developers are currently testing norovirus vaccines, which could protect against one of the most common viral causes of traveller’s diarrhoea affecting 700 million people annually worldwide.
The US Food and Drug Administration is launching new Food Traceability Rules in 2026, designed to reduce foodborne illness by making it easier to trace contaminated foods throughout the supply chain.
Expert Recommendations for 2025 Travel Season
Travel medicine specialists emphasise that prevention remains the best strategy. Dr Christian Arbelaez from Brigham and Women’s Hospital advises travellers to “think about food as a carrier for illness”, particularly in countries without stringent food safety regulations.
The International Society of Travel Medicine’s latest guidelines recommend a risk-based approach, matching preventive measures to destination risk levels and individual traveller health status.
For travellers heading to high-risk destinations this year, experts recommend:
- Schedule travel health consultations 4-6 weeks before departure
- Complete all recommended vaccinations
- Pack comprehensive medical kits including rehydration salts
- Purchase adequate travel insurance with medical coverage
- Practice strict food and water precautions throughout the journey
As international travel continues to rebound in 2025, understanding and preventing travel-related stomach illnesses has never been more critical. With proper preparation, vaccination, and adherence to food safety guidelines, travellers can significantly reduce their risk of spending their holidays in misery.
The message from health experts is clear: whilst the risk of traveller’s diarrhoea remains significant, particularly in developing regions, informed travellers who take appropriate precautions can dramatically reduce their chances of illness and enjoy their international adventures safely.
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