Travel Medicine Centre
Food and Water and Diarrhea
An Advisory Committee Statement (ACS)
Committee to Advise on Tropical Medicine and Travel (CATMAT) and National Advisory Committee on Immunization (NACI)*†
Recommended Usage: Travellers’ Diarrhea DUKORAL
Indications for the oral BS-WC vaccine are limited because of the
- most episodes of travellers’ diarrhea are usually mild
- therapeutic options (oral rehydration, dietary
management, antimotility, and antibiotic treatment) are available
if prevention fails;
- < 50% (range 25% to 50%) of travellers’
diarrhea cases are caused by ETEC bacteria;
- the protection by
the vaccine against ETEC diarrhea is approximately 50%; and
- vaccinated travellers may gain a false sense of security and
possibly avoid being as strict in observing food and water
In summary, vaccination with the BS-WC (DURORAL)vaccine as a prevention strategy for travellers’ diarrhea is of limited value and cannot be routinely recommended for the majority of travellers.
BS-WC vaccine may be considered for the following selected
high-risk, short-term travellers who are aged > 2 years:
* with chronic illnesses for whom there is an increased risk of
serious consequences from travellers’ diarrhea (e.g., chronic
renal failure, congestive heart failure, insulin-dependent diabetes
mellitus, inflammatory bowel disease);
* with an increased risk of acquiring travellers’ diarrhea (e.g,.
gastric hypochlorhydria and young children aged > 2 years);
* who are immunosuppressed due to HIV infection or other
* with a history of repeated severe travellers’ diarrhea; or
* for whom a brief illness cannot be tolerated (i.e., elite athletes
or business or political travellers).
Conduct a detailed, individual travel-related risk assessment to
determine those travellers who may benefit most from BS-WC
vaccination as a prevention strategy for travellers’ diarrhea.