philippines travel diarrhea

Philippines Travellers' Diarrhea

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Description.

The term Travellers' Diarrhea is used to describe gastrointestinal infections affecting travellers caused by ingesting bacteria, viruses, and protozoa. These microorganisms are found worldwide and are typically transmitted from person to person via the fecal-oral route – an infected person who does not practice proper hand or body hygiene passes on the infection to another person when handling food and water. Travellers' Diarrhea is one of the most common illness among travellers.

Travellers' Diarrhea can happen when:

• Eating raw, under cooked, unwashed, or improperly handled meat, poultry products, dairy products, fruits, vegetables, shellfish, and seafood.
• Drinking contaminated water or beverages.
• Inadvertently ingesting fecal matter, protozoa eggs, or viruses by touching the mouth with dirty or improperly washed hands.
• Eating in restaurants, from buffets, or from street vendors where food handling and hygienic practices are not followed properly.

The golden rule to prevent gastrointestinal infections is: Boil it, Cook it, Peel it, or Forget it! However, it’s not just about what you eat, it’s also important to consider where you eat. It’s not always easy to know if a restaurant or food vendor follows proper food handling and hygienic practices (such as separating raw from cooked ingredients, properly cleaning cutting boards and utensils, washing their hands, and correctly refrigerating food). Avoid restaurants and food vendors that appear unclean or that don’t have many customers. Be cautious of food that has been stored uncovered, has been improperly refrigerated, or has been standing out for a long time such as buffets.

If you are unsure about the tap water quality, bring the water to a rolling boil. Boiling water destroys pathogens that can cause Travellers’ Diarrhea and other gastrointestinal infections. If you cannot boil your water, opt for treated or bottled water instead.

The risk of Travellers’ Diarrhea can also be minimized by following good hygiene practices. Make sure to wash your hands for at least 20 seconds with warm water and soap, especially before preparing or eating food and after using the bathroom. If water and soap are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Managing Travellers’ Diarrhea

At the first sign of diarrhea, drink an oral rehydration solution (ORS), a mixture of salt and sugar designed to replenish electrolytes and treat dehydration. Antimotility agents like loperamide can also be used to reduce symptoms, but they do not treat the gastrointestinal infection. Traveller’s diarrhea is usually a self-limiting infection (it resolves itself), but if it persists and becomes worse after 2 or 3 days, you may want to consider taking an antibiotic for treatment.

If you are on high blood pressure medication watch for signs of dehydration since it can become an emergency very quickly.

Before you go, consult your doctor for the best diarrhea treatment options. Travellers who have pre-existing health conditions and are more susceptible to gastrointestinal infections may consider taking preventive medication.

For more information on preventing Travellers' Diarrhea, check out these resources from IAMAT:

• Food and water safety
• How to prevent Travellers' Diarrhea
• How to prevent illness by washing your hands

Information last updated: February 23, 2021. 

• Velarde JJ, Levine MM, Nataro JP,Escherichia coli Diarrhea. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 9 th ed. New York: Saunders Elsevier; 2013: 442-447.
• Wolfe MS. Traveler’s Diarrhea. In: Jong, E; Stevens, D, eds. Netter’s Infectious Diseases. New York: Saunders Elsevier; 2012: 390-393.
• Virk A. Amebiasis, Giardiasis, and Other Intestinal Protozoan Infections. In: Jong, E; Sanford, C. eds. The Travel and Tropical Medicine Manual, 4 th ed. Waltham, Elsevier; 2008: 448-466. 
• Centers for Disease Control and Prevention: Yellow Book, Traveler’s Diarrhea
• Committee to Advice on Tropical Medicine and Travel, PHAC: Statement on Travellers' Diarrhea

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How to avoid and treat travelers' diarrhea

Eating is a fun way to explore a place and culture, but it poses the risk of spending part of a trip doubled over after eating or drinking something contaminated by bacteria, viruses or parasites. Most people are exposed to some amount of contaminated foods, but travel often exposes us to new ones or higher doses that can defeat the immunity we have already built up. And it's not a rare occurrence — 30% to 70% of travelers come down with what's known as travelers' diarrhea, according to the Centers for Disease Control and Prevention.

What's worse is that a bout of diarrhea might not be the end of it. One in 10 cases of traveler's diarrhea develop into irritable bowel syndrome, a gastrointestinal disorder, according to Dr. Mark Pimentel, the executive director of the medically associated science and technology program at Cedars-Sinai in Los Angeles. An estimated 1 in 6 people in the United States experience IBS, with symptoms varying from constipation to nausea and ranging from mild to severe. It's a long-term condition with no known cure.

Much of the risk depends on where and when you travel, but Pimentel said some general precautions can keep most stomachs healthy and happy.

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Mind the water

Contaminated water is a major source of bacteria that can sicken even the healthiest individuals. It's common in developing countries — you can check the CDC website to see if a particular destination has safe drinking water . If not, rely on bottled water for drinking and brushing your teeth. If you want to avoid plastic, there are reuseable water bottles with filtration built in that remove bacteria and viruses. While out and about, beware of ice cubes and drinks like smoothies that may have water or ice as a hidden ingredient.

Occasionally, restaurants refill water bottles locally and put new caps on. If that looks to be the case, order sparkling water, which can't be easily refilled. The carbonation is also acidic enough to kill bacteria. And there is always the option to skip water entirely and stick with soda, beer or wine, which Pimentel said are safe bets.

Related: How you can safely drink the tap water anywhere in the world

Avoid raw fruits and veggies

If you're in a place where water is an issue, fresh fruits and vegetables have to be chosen with care. If you are craving fruit, pick something you can peel so you remove the part that was washed with water. Fresh salads, while usually healthy, are filled with vegetables that get doused in local water. Consider this tip as a doctor's note to pick a greasier (and cooked) option.

Choose your street food wisely

For destinations like Mumbai and Bangkok with a rich street food culture, it's a shame to miss out on delicious regional eats. One tip from the late and great Anthony Bourdain is to follow the locals. Spots that rely on repeat customers instead of one-off tourists are places that need to keep people healthy.

Related: The cheapest Michelin-starred meals around the world

Pimentel also suggests looking for food that is extremely hot and well cooked. If you can, get the food right off the burner when it's hottest. And skip the garnishes, like herbs or fruits and veggies, which for the aforementioned reasons could be the Achilles' heel of an otherwise safe meal.

Start your caution on the plane

Being kind to your belly starts on the way to your destination if you're flying. The pressurization on a plane lets the gas in your gut build up and it can take hours to dissipate. If you want to get off the plane ready to travel and eat comfortably, skip foods that will make you gassy, like beans and processed carbs. Carbonated drinks like soda can also cause the gas to build up and should be avoided. Instead, stick with lean meats, nuts and vegetables such as lettuce, tomatoes, zucchini and avocados.

Related: It's not just you: Why everyone gets gassy and bloated on airplanes

Travel with supplies

Taking care of traveler's diarrhea early can help prevent IBS from developing, according to Pimentel. Before traveling, sensitive people should consult with a doctor who might prescribe antibiotics, like rifaximin and ciprofloxacin. The International Society of Travel Medicine has a list of travel clinics where people can search for a local option.

But it's not a bad idea for everyone to stock up on charcoal tablets, which can calm your digestive system and reduce gas, as well as something with bismuth in it like Pepto Bismol, which provides relief along with its antibacterial properties. One thing that doesn't work? Probiotics. They can cause bloating and distension, making you feel much worse.

Related: Rx for jail? What to know before taking your meds abroad

If it does happen, keep calm and hydrated

Despite best efforts, travelers can still pick up a bug. In that unfortunate event, it's important to stay hydrated , and for comfort, it's probably best to stick close to a bathroom. Many issues clear up after a day, but if it lasts more than a few days or there is blood in the stool, see a doctor.

Bottom line

Getting traveler's diarrhea is no fun, but there are steps you can take to avoid it. Depending on where you go, consider sticking with bottled water, skipping uncooked veggies and fruits, and when it comes to street foods, pick the hottest food available at the busiest stalls. If you are at a higher risk of getting sick, make sure to consult a doctor before going abroad. And if all else fails, take some time off and stay hydrated (with bottled water).

• Patient Care & Health Information
• Diseases & Conditions
• Traveler's diarrhea

Traveler's diarrhea may get better without any treatment. But while you're waiting, it's important to try to stay hydrated with safe liquids, such as bottled water or water with electrolytes such as an oral rehydration solution (see below). If you don't seem to be improving quickly, several medicines are available to help relieve symptoms.

Anti-motility agents. These medicines — which include loperamide and drugs containing diphenoxylate — provide prompt but temporary relief by:

• Reducing muscle spasms in your gastrointestinal tract.
• Slowing the transit time through your digestive system.
• Allowing more time for absorption.

Anti-motility medicines aren't recommended for infants or people with a fever or bloody diarrhea. This is because they can delay clearance of the infectious organisms and make the illness worse.

Also, stop using anti-motility agents after 48 hours if you have stomach pain or if your symptoms worsen and your diarrhea continues. In such cases, see a doctor. You may need blood or stool tests and treatment with an antibiotic.

• Bismuth subsalicylate. This nonprescription medicine can decrease the frequency of your stools and shorten the length of your illness. However, it isn't recommended for children, pregnant women or people who are allergic to aspirin.
• Antibiotics. If you have more than four loose stools a day or severe symptoms, including a fever or blood, pus or mucus in your stools, a doctor may prescribe a course of antibiotics.

Before you leave for your trip, talk to your doctor about taking a prescription with you in case you get a serious bout of traveler's diarrhea.

Avoiding dehydration

Dehydration is the most likely complication of traveler's diarrhea, so it's important to try to stay well hydrated.

An oral rehydration salts (ORS) solution is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose to enhance absorption in the intestinal tract.

Bottled oral rehydration products are available in drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration salts, labeled World Health Organization (WHO)- ORS , at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package.

If these products are unavailable, you can prepare your own rehydrating solution in an emergency by mixing together:

• 3/4 teaspoon table salt.
• 2 tablespoons sugar.
• 1 quart uncontaminated bottled or boiled water.
• Sugar-free flavor powder, such as Crystal Light (optional).

You or your child can drink the solution in small amounts throughout the day as a supplement to solid foods or formula, as long as dehydration persists. Small amounts reduce the likelihood of vomiting. Breastfed infants also can drink the solution but should continue nursing on demand.

If dehydration symptoms — such as dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness — don't improve, seek medical care right away. Oral rehydration solutions are intended only for urgent short-term use.

Lifestyle and home remedies

If you do get traveler's diarrhea, avoid caffeine, alcohol and dairy products, which may worsen symptoms or increase fluid loss. But keep drinking fluids.

Drink canned fruit juices, weak tea, clear soup, decaffeinated soda or sports drinks to replace lost fluids and minerals. Later, as your diarrhea improves, try a diet of easy-to-eat complex carbohydrates, such as salted crackers, bland cereals, bananas, applesauce, dry toast or bread, rice, potatoes, and plain noodles.

You may return to your normal diet as you feel you can tolerate it. Add dairy products, caffeinated beverages and high-fiber foods cautiously.

Preparing for your appointment

Call a doctor if you have diarrhea that is severe, lasts more than a few days or is bloody. If you are traveling, call an embassy or consulate for help locating a doctor. Other signs that you should seek medical attention include:

• A fever of 102 F (39 C) or higher.
• Ongoing vomiting.
• Signs of severe dehydration, including a dry mouth, muscle cramps, decreased urine output, dizziness or fatigue.

If you have diarrhea and you've just returned home from a trip abroad, share that trip information with your doctor when you call to make an appointment.

Here's some information to help you get ready, and what to expect.

Information to gather in advance

• Pre-appointment instructions. At the time you make your appointment, ask whether there are immediate self-care steps you can take to help recover more quickly.
• Symptom history. Write down any symptoms you've been experiencing and for how long.
• Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medicines, vitamins or supplements you're currently taking.
• Questions to ask your health care professional. Write down your questions in advance so that you can make the most of your time.

The list below suggests questions to ask about traveler's diarrhea.

• What's causing my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatment approach do you recommend?
• Are there any possible side effects from the medicines I'll be taking?
• Will my diarrhea or its treatment affect the other health conditions I have? How can I best manage these conditions together?
• What is the safest way for me to rehydrate?
• Do I need to follow any dietary restrictions and for how long?
• How soon after I begin treatment will I start to feel better?
• How long do you expect a full recovery to take?
• Am I contagious? How can I reduce my risk of passing my illness to others?
• What can I do to reduce my risk of this condition in the future?

In addition to the questions that you've prepared, don't hesitate to ask questions as they occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• Have you traveled recently?
• Where did you travel?
• Have you taken any antibiotics recently?
• Have your symptoms been getting better or worse?
• Have you noticed any blood in your stools?
• Have you experienced symptoms of dehydration, such as muscle cramps or fatigue?
• What treatments have you tried so far, if any?
• Have you been able to keep down any food or liquid?
• Are you pregnant?
• Are you being treated for any other medical conditions?
• Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.
• LaRocque R, et al. Travelers' diarrhea: Microbiology, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Ferri FF. Traveler diarrhea. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed April 28, 2023.
• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
• Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.
• LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Khanna S (expert opinion). Mayo Clinic. May 29, 2021.

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Traveler’s Diarrhea

, MD, Lewis Katz School of Medicine at Temple University

More Information

Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification.

Traveler's diarrhea can be caused by bacteria, parasites, or viruses.

Organisms that cause the disorder are usually acquired from food or water, especially in countries where the water supply may be inadequately treated.

Nausea, vomiting, abdominal cramping, and diarrhea can occur with any degree of severity.

The diagnosis is usually based on the doctor's evaluation, but sometimes stool is tested for organisms.

Treatment involves drinking plenty of safe fluids and sometimes taking antidiarrheal medications or antibiotics.

Preventive measures include drinking only bottled carbonated beverages, avoiding uncooked vegetables or fruits, not using ice cubes, and using bottled water to brush teeth.

Traveler’s diarrhea occurs when people are exposed to bacteria, viruses, or, less commonly, parasites to which they have had little exposure and thus no immunity. The organisms are usually acquired from food or water (including water used to wash foods).

Traveler’s diarrhea occurs mostly in countries where the water supply is inadequately treated.

Travelers who avoid drinking local water may still become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food that is improperly handled or washed with local water. People who take medications that decrease stomach acid (such as antacids, H2 blockers, and proton pump inhibitors) are at risk of developing a more severe illness.

Symptoms of Traveler’s Diarrhea

The following symptoms of traveler's diarrhea can occur in any combination and with any degree of severity:

Intestinal rumbling

Abdominal cramping

These symptoms begin 12 to 72 hours after ingesting contaminated food or water. Vomiting, headache, and muscle pain are particularly common in infections caused by norovirus. Rarely, diarrhea is bloody.

Most cases are mild and disappear without treatment within 3 to 5 days.

Diagnosis of Traveler’s Diarrhea

A doctor's evaluation

Rarely stool tests

Diagnostic tests are rarely needed, but sometimes stool samples are tested for bacteria, viruses, or parasites, typically in people who have fever, severe abdominal pain, and bloody diarrhea.

Treatment of Traveler’s Diarrhea

Medications that stop diarrhea (antidiarrheal medications)

Sometimes antibiotics or antiparasitic medications

When symptoms occur, treatment includes drinking plenty of fluids and taking antidiarrheal medications such as loperamide .

These medications are not given to children under 18 years of age with acute diarrhea. Antidiarrheal medications are also not given to people who have recently used antibiotics, who have bloody diarrhea, who have small amounts of blood in the stool that are too small to be seen, or who have diarrhea and fever.

Antibiotics are not necessary for mild traveler's diarrhea.

However, if diarrhea is more severe (3 or more loose stools over 8 hours), antibiotics are often given. Adults may be given ciprofloxacin , levofloxacin , azithromycin , or rifaximin . Children may be given azithromycin . Antibiotics are not given if a virus is the cause.

Antiparasitic medications are given if a parasite is identified in the stool.

Travelers are encouraged to seek medical care if they develop fever or blood in the stool.

Prevention of Traveler’s Diarrhea

Safe consumption of food and water

Travelers should eat only in restaurants with a reputation for safety and should not consume any food or beverages from street vendors. Cooked foods that are still hot when served are generally safe. Salads containing uncooked vegetables or fruit and salsa left on the table in open containers should be avoided. Any fruit should be peeled by the traveler.

Travelers should drink only bottled carbonated beverages or beverages made with water that has been boiled. Even ice cubes should be made with water that has been boiled.

Buffets and fast food restaurants pose an increased risk of infection.

Preventive antibiotics are recommended only for people who are particularly susceptible to the consequences of traveler’s diarrhea, such as those whose immune system is impaired, those who have inflammatory bowel disease, those who have HIV, those who have received an organ transplant, and those who have severe heart or kidney disease. The antibiotic most commonly given is rifaximin . Some travelers instead take bismuth subsalicylate rather than an antibiotic for prevention.

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Centers for Disease Control and Prevention (CDC): Choose Safe Food and Drinks When Traveling

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Traveler's Diarrhea

• Conditions Basics

What is traveler's diarrhea?

Traveler's diarrhea is a common medical problem for people traveling from developed, industrialized countries to developing areas of the world.

High-risk areas for traveler's diarrhea include developing countries in Africa, Asia, the Middle East, and Latin America. Low-risk areas include the developed countries of North America, Central Europe, Australia, and Japan.

What causes it?

Traveler's diarrhea is usually caused by a bacterial infection. Bacteria such as Escherichia coli (E. coli) , Campylobacter , Shigella , or Salmonella are the most common causes. These bacteria are in water contaminated by human or animal stools. Drinking water, water used to wash food, or irrigation water may be affected. When the traveler drinks this water or eats contaminated food, he or she is likely to get diarrhea.

Common sources of bacteria that cause diarrhea are undercooked or raw foods, contaminated food, or contaminated water (including ice cubes).

What are the symptoms?

Traveler's diarrhea can be mild to severe. Most people who develop traveler's diarrhea experience symptoms within the first 2 weeks, and often within 2 to 3 days, of arriving in a developing area. Symptoms include:

• Abdominal cramps.
• Mild to severe dehydration .
• General lack of energy, nausea, and vomiting.
• Fever, vomiting, and stools with blood or mucus. These symptoms mean you have serious diarrhea, which is more likely to lead to problems with dehydration. Dehydration may alter the effect of any medicines being taken, such as oral contraceptives or antimalarials.

How is traveler's diarrhea treated?

Treatment for traveler's diarrhea includes drinking fluids to avoid dehydration, taking nonprescription medicines, and in some cases, antibiotics and intravenous (I.V.) fluids.

• Take frequent, small sips of bottled or boiled water or a rehydration drink .
• If possible, drink a solution made with World Health Organization (WHO) oral rehydration salts. Packets of the salts are available at stores and pharmacies in most developing countries. Add one packet to boiled or treated water, making sure to read the instructions regarding the proper amounts of salts and water. Drink the solution within 12 hours if kept at room temperature, or within 24 hours if refrigerated.
• Let your stomach rest. Start to eat small amounts of mild foods if you feel like it. After your diarrhea is gone, you may eat a regular diet again.

Children 2 years old or younger are at high risk of dehydration from diarrhea. If your child has diarrhea:

• Give your child a solution of WHO rehydration salts in addition to your child's regular food as long as diarrhea continues. If your baby has trouble keeping the liquids down, try giving frequent sips by spoon.
• Continue breastfeeding normally. Bottle-fed babies should continue their usual formula.
• Feed your child starches, cereals, yogurt, fruits, and vegetables.
• Seek medical help immediately if you or your child has bloody diarrhea, fever, or persistent vomiting, and give rehydration fluids in the meantime.
• Your doctor may recommend an over-the-counter medicine. These may include bismuth subsalicylate (Pepto-Bismol) or loperamide (Imodium). Read and follow all instructions on the label. Do not use these medicines if your doctor does not recommend them.
• Be safe with medicines. If your doctor recommends prescription medicine, take it as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• If your doctor prescribes antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

How can you help prevent it?

The best way to prevent traveler's diarrhea is to avoid food or water that may be contaminated. Eating raw or uncooked seafood and meat puts you at higher risk for getting sick. Also avoid foods like salads, uncooked vegetables, and raw fruits that don't have a peel. Dry foods, such as breads, or fruits that you can peel are safe to eat.

Avoid drinking local water where you are traveling. Beverages that are usually safe to drink include:

• Tea and coffee if made with boiled water.
• Carbonated bottled water or soda pop.
• Bottled beer and wine.

Water also can be filtered or treated with iodine to make it safe to drink.

Also, be aware that contaminated water may be used to wash fruits and vegetables, clean utensils and plates, and make ice cubes. Brushing your teeth with untreated water also may increase your risk of infection.

Avoid eating food from street vendors where flies can transmit bacteria and poor hygiene practices are more likely to contaminate foods. If you purchase food at an outdoor market, make sure you boil it, cook it thoroughly, or peel it before you eat it.

Good hand-washing is important in preventing the spread of infectious diseases. Washing with treated water or using alcohol wipes or antibacterial gels to disinfect your hands are good ways to reduce your risk of getting an infectious disease.

Talk with your doctor about antibiotics you can carry with you on your trip and instructions on when to use them just in case you should develop diarrhea.

Other information sources

In the United States, the Centers for Disease Control and Prevention (CDC) maintains current information on infectious diseases around the world. Local health departments can access this information to help you determine what prevention measures-such as vaccines, antimalarial medicine, or supplies to treat water-are appropriate for the area of the world you are traveling to. The CDC website (www.cdc.gov/travel/default.aspx) also updates information for travelers.

Resources for medical care in a foreign country include embassies or consulates and major hotels. For English-speaking travelers, multinational corporations or credit card companies also may have referrals for local medical care in the foreign country.

• Related Information
• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Travel Health

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Author: Healthwise Staff Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Author: Healthwise Staff

Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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Traveler's Diarrhea in Foreign Travelers in Southeast Asia: A Cross-Sectional Survey Study in Bangkok, Thailand

The effect of origin and destination country on traveler's diarrhea incidence rates in Southeast Asia is poorly understood, and research generally only addresses diarrhea in travelers from the developed world. This study evaluated the attack rate and effects of traveler's diarrhea by origin and destination and analyzed key risk factors. A self-administered questionnaire was provided to foreign travelers departing Southeast Asia from Suvarnabhumi Airport, Bangkok, Thailand. It evaluated traveler demographics, relevant knowledge and practices, experiences of diarrhea, and the details and consequences of each diarrheal episode. A total of 7,963 questionnaires were completed between April 2010 and July 2011. Respondents were 56% male (mean age 35) with a mean and median duration of stay of 28 days and 10 days, respectively. Most respondents were from Europe (36.8%) or East Asia (33.4%). The attack rate of traveler's diarrhea was 16.1%, with an incidence rate of 32.05 per 100 person months. Travelers' origin and destination countries significantly related to diarrhea risk. Oceanians had the highest risk (32.9%) and East Asians the lowest (2.6%). Vietnam and Indonesia were the highest risk destinations (19.3%). Other significant factors were youth, trip duration, number of countries visited, and frequently drinking beverages with ice.

Introduction

Traveler's diarrhea is the most common health problem reported by travelers' visiting developing countries. 1 The incidence rate is estimated to be around 20–60% per month of stay in developing countries. 1 The risk of traveler's diarrhea varies greatly according to the destination, nationality of travelers, duration of stay, season, travel style, eating behaviors, and type of food consumed. 2 – 5 The relationship between traveler nationality and traveler's diarrhea is poorly studied, and most previous studies on traveler's diarrhea have focused on travelers from developed countries visiting developing countries. Neither is known about the incidence of diarrhea among travelers from developing countries visiting other developing countries, nor about intra-regional travelers within developing countries, including Asian travelers visiting a different Asian country.

In this study, we focus on Southeast Asia because it is a fast-growing region for travel, with more than 84 million tourist arrivals in the year 2012. 6 Information regarding the incidence rate and risks of traveler's diarrhea in Southeast Asia, especially relating to traveler nationality, is still limited. Therefore, the primary objective was to determine the incidence and attack rate of traveler's diarrhea in Southeast Asia and the effect of nationality on these factors by surveying travelers from all continents in the world. The secondary objective was to assess the risk factors associated with traveler's diarrhea.

Materials and Methods

This was a cross-sectional questionnaire-based study. Foreign travelers in the international departure hall of Suvarnabhumi Airport (Bangkok, Thailand) were invited to fill out the questionnaire. Inclusion criteria were adult travelers who had completed their trips and were departing for a destination outside Southeast Asia. Travelers of Southeast Asian nationality or travelers who were in transit were excluded. The study questionnaire was drafted, tested, and revised before data collection. The final version of the questionnaire comprised three parts: general information about the travelers, perceptions and practices related to the risk of traveler's diarrhea, and the details of any diarrhea experienced. The questionnaires were written in English and translated into Chinese, Japanese, and Korean.

The necessary sample size was calculated before the study using the incidence rate of traveler's diarrhea from a previous study done on foreign travelers visiting Phuket and Chiang Mai, and using data on the number and nationality of travelers visiting Thailand obtained from the Thai Immigration Department. 5 Because incidence rates varied from 1.6% to 15.7% depending on traveler nationality, we used the lowest previously detected incidence rate of 1.6% to calculate the sample size. 3 To achieve α = 0.05 two tailed, we required at least 7,389 travelers. Quota sampling was implemented by calculating the number of participants from each continent using the actual proportion of travelers visiting Thailand. 5

During data collection, investigators and trained assistants invited any eligible travelers in the departure hall to fill out a self-administered questionnaire. The investigating team was available to help if they had questions or needed clarification. For this study, traveler's diarrhea was defined as passing three or more loose stools in a 24-hour period.

Statistical analysis.

Statistical analysis was performed using SAS version 9.2 (SAS Institute Inc., Cary, NC). Mean and standard deviation were calculated for normally distributed continuous data. Categorical data were described using numbers and percentages. Because one traveler can have multiple diarrhea episodes, the incidence rate was calculated by dividing the total number of diarrhea episodes by the total duration of stay (in months) of all travelers (time at risk). To determine factors associated with diarrhea, the prevalence of diarrhea was calculated as the proportion of all travelers who experienced diarrhea. Crude prevalence ratios and 95% confidence intervals (CIs) for diarrhea were estimated using a Poisson regression model (PROC GENMOD). Variables that were statistically significant at P < 0.05 or considered as having clinical significant were included in a multivariate analysis to estimate adjusted prevalence ratios and 95% CIs. Multicollinearity between variables were also explored, a variable that showed strong colinearity was excluded from the final model.

Ethics statement.

The research protocol and questionnaire were approved by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University (Approval No. MUTM 2010-015-02). Because this study was a voluntary, anonymous survey among adults that was nonexperimental in nature, the Ethics Committee waived the written consent requirement, determining that filling the questionnaire represented a subject's consent to participate. No participant-identifiable data were recorded in the questionnaire to maintain confidentiality. The investigative team was granted permission to conduct the study in Suvarnabhumi Airport by the Airport Authority of Thailand.

Demographics.

The study data were collected from April 2010 to July 2011. Approximately 70% of travelers were willing to participate in this study. Overall, 7,963 questionnaires were completed and analyzed. Participants' mean age was 35 years; 56% were male. The participants were mostly from Europe (36.8%) followed by East Asia (33.4%). Tourism was the most common reason for traveling (85.2%), followed by business and visiting friends and relatives. Most participants (86.5%) had visited Southeast Asia for the first time, and most had only visited one country. The mean duration of stay was 28 days, and the median duration of stay was 10 days. A total of 41% of participants traveled for less than a week. The complete demographic data are shown in Table 1 .

Participant demographic information ( N = 7,963)

SD = standard deviation.

Incidence, characteristics, and impact of diarrhea.

In total, 1,284 participants (16.1%) had diarrhea during their trip, reporting 1,964 episodes of diarrhea in total. The overall incidence rate of diarrhea was 32.1 per 100 person months. Most participants with diarrhea had only one episode of diarrhea (68.7%) with 3–4 bowel movements per day. Most diarrheal attacks (65.8%) occurred within the first 7 days of the trip and lasted for 1–2 days. Half of the participants who had diarrhea bought medication over the counter to treat diarrhea by themselves, while 6.4% visited a doctor. Only 3.6% were admitted to a hospital. Complete diarrhea characteristics and impacts are shown in Table 2 .

Diarrhea characteristics

Travelers' attitudes and practices regarding traveler's diarrhea.

The majority of travelers (73%) sought travel health information before their trip. The most common sources of information among participants were travel clinics (49%), general practitioners (36%), the Internet (31%), and guidebooks (23%). Most travelers were aware of the risk of traveler's diarrhea during this trip. Approximately one third of travelers felt that they had an “intermediate risk” (10–20% chance to get diarrhea), while 22.9% and 17.4% felt that they had “high risk” (30–50% chance) and “very high risk” (> 50% chance), respectively. Only 7.6% reported that they “don't know.”

Travelers who sought travel–health information from travel clinics reported significantly fewer instances of diarrhea than those who did not (11.9% versus 20.2%; P < 0.001), whereas the rate of diarrhea in travelers who sought information from other sources did not significantly differ from those who did not. Travelers who estimated that their risk of traveler's diarrhea was very high reported the highest rate of diarrhea (42.3%), significantly higher than others.

The reported practices among travelers that significantly predicted an increased incidence of traveler's diarrhea were carrying medication for diarrhea, washing hands before eating food, washing hands before handling food, drinking beverages with ice, eating salad vegetables, and buying food from a street vendor ( Table 3 ). Travelers who frequently ate food left over from a previous meal, ate raw or uncooked meat, or drank tap water did not have a significantly different rate of traveler's diarrhea than those who did not.

Perceptions and practices related to the risk of traveler's diarrhea

Attack rate of traveler's diarrhea in each country in Southeast Asia.

The overall prevalence of traveler's diarrhea among visitors to Southeast Asia was 16.14% (95% CI: 15.33–16.95). Travelers to Vietnam and Indonesia had the highest attack rate of diarrhea (19%), followed by Lao People's Democratic Republic (PDR) (17%), and the Philippines (15%). The lowest attack rate of diarrhea (2%) was found in Singapore. Among travelers who only visiting Thailand, the attack rate of travelers' diarrhea among the group was 10.9% (657/6,025). Details are shown in Table 4 .

Prevalence of traveler's diarrhea by country visited

CI = confidence interval.

Risk factors of traveler's diarrhea.

The prevalence of diarrhea differed among travelers from different continents of origin. Travelers from Oceania had the highest attack rate of diarrhea (32.9%), followed by travelers from North America (27.8%) and Europe (27%). Travelers from South America and south Asia had the lowest rate of diarrhea (2.6%). Travelers who went to Southeast Asia for education or research purposes had the highest rate of diarrhea (27.9%), while travelers who went for business purposes had the lowest rate (12%). The association between diarrhea and the purpose of the trip was not significant after adjusted by the multivariate analysis.

The attack rate of diarrhea increased with the number of countries visited (one country, 10.9%; two countries, 26.9%; three countries, 35.5%; greater than three countries, 45%). Travelers who stayed for longer than 28 days had a rate of diarrhea that was greater than 10 times higher than travelers who stayed 1–7 days (35% versus 2.8%).

Detailed multivariate analysis was performed to determine the risk factors of traveler's diarrhea. Duration of stay was clearly the independent risk factor, with a dose response relationship: only 2.8% of travelers with a duration of stay less than 7 days developed diarrhea, while 16% of travelers who stayed 8–14 days and 26% of travelers who stayed 15–21 days developed diarrhea. However, adjusted prevalence ratio of this variable was not estimated due to variable colinearity. The number of countries visited was also a strong risk factor. Travelers who visited more than three countries in Southeast Asia had triple the chance of developing diarrhea compared with travelers who visited only one country (adjusted prevalence ratio 3.39, 95% CI: 2.62–4.40).

The region of origin of travelers was an independent risk factor for diarrhea. Travelers from Europe, North America, and Oceania had significantly higher rate of diarrhea, with adjusted prevalence ratios of 8.24, 8.88, and 11.67, respectively, when compared with travelers from East Asia. Other factors that significantly associated with diarrhea were seeking travel–health information before trip, drinking beverages with ice or ice cubes, and washing hand before handling food. Age more than 25 years is the only factor that associated with lower rate of diarrhea compared with age 18–25 years. Complete multivariate analysis is shown in Table 5 .

Risk factors of traveler's diarrhea

In this study, the overall attack rate of traveler's diarrhea among travelers in Southeast Asia in our sample was 16.1%. This number is comparable with several previous studies done in Southeast Asia that report the rate being between 1.6% and 30.7%. 3 , 4 , 7 , 8 It was impossible to compare this attack rate directly with previous studies because there were substantial differences in our sample, including population characteristics, destination, duration of stay, and travel style. However, several important points should be noted.

We demonstrated that the attack rate of diarrhea significantly differed by traveler nationality. Travelers from developing countries had a lower attack rate than travelers from developed countries. For example, travelers from East Asia, the Middle East, South Asia, and South America had very low attack rate (less than 5%), whereas travelers from Oceania (Australia, New Zealand), North America, and Europe had much higher attack rates (33%, 28%, and 27%, respectively). This finding suggests that the greater the similarity between the country of origin and the destination, the lower the risk of diarrhea. This finding may be explained by 1) previous immunity (travelers from developing countries might have greater immunity to some enteropathogens due to natural immunity acquired in their host countries 2 , 9 ) and 2) the similarity of the food and eating habits might also lessen the risk of noninfectious diarrhea—for example, diarrhea caused by food allergies or food intolerance.

We did not include Southeast Asian nationals traveling within this region in the study sample. However, we could logically infer that their risk would be low, following the results discussed above that suggest the attack rate of diarrhea will be low if the origin and destination are similar. Our previous study found that the attack rate of traveler's diarrhea among Thai travelers to Laos was only 1.2%. 10

The destination of travelers at a country level also affected the risk of diarrhea. Individual countries in Southeast Asia presented different levels of health risk. We found that the attack rate of traveler's diarrhea varied from the lowest (2.3%) in Singapore to the highest (19.31%) in Vietnam. Because of this variation in risk by country, travel medicine practitioners should consider detailed itineraries at the country level, not only the regional level.

The duration of stay and the number of countries visited were identified as significant risk factors in our study: the longer the duration of stay and the more countries visited, the higher the risk. This finding replicates several previous studies. 4 , 11 , 12 However, the relationship between the attack rate of diarrhea and duration of stay is not linear throughout the trip. The early phase of the trip seems to have the highest risk of diarrhea. 2 , 3 , 13 Our study confirmed this observation, since approximately 2/3 (66%) of travelers with diarrhea in our study developed diarrhea in the first week of their trip. It has been postulated that the longer that travelers stay at a destination, the greater the likelihood that they acquire natural immunity against enteropathogens. 3

We also assessed the relationship between travelers' practices and the risk of diarrhea. The results of the univariate model were inconclusive and contradictory to the basic knowledge in some parameters. For example, we found that travelers who ate salad regularly had an increased risk of diarrhea. This finding was logically sound. But we also found that travelers who washed their hands regularly had a higher attack rate of diarrhea. In multivariate analysis, drinking beverages with ice and washing hand before handling foods were related to a higher attack rate. It is important to note that, as in all cross-sectional studies, we could not assess the causal relationship between parameters. Even some prospective studies have failed to show the protective effect of these sensible practices against risk of diarrhea. 14 , 15

The majority of diarrhea episodes in this study were mild and self-limiting. Most diarrheal episodes consisted of only 3–4 bowel movements per day and lasted only 1–2 days. Only 3.6% of travelers with diarrhea needed hospitalization. These characteristics of diarrhea are consistent with many previous reports on travelers to Asia, Africa, or Central and southern America. 3 , 4 , 11 , 16 , 17 Although the clinical course of traveler's diarrhea in many parts of the world was relatively similar, the etiologic agents of diarrhea in various destinations may differ. 2 It should be noted that pathogen-negative diarrhea was also common in travelers. 2 , 16 , 18 Food poisoning or food intolerance might be another cause of diarrhea among this group.

Our study had some limitations. First, it was impossible to eliminate recall bias from this type of survey, because we collected data from participants on the final day of their trip to Southeast Asia. Participants were asked to recall whether they experienced diarrhea and to remember other related risk factors. The perceived risk factors and ability to recall risk factors for diarrhea may be different between those with and without diarrhea; this could bias the estimations. In addition, the report on diarrhea occurrence in this study could be either over or underestimated, because the results were based on self-reported. However, this variation might be small, because diarrheal episodes are relatively obvious and should be easy to recognize and recall. Second, we collected the data from only one airport in Southeast Asia (Suvarnabhumi Airport, Bangkok). Although this is a major regional airport hub and we surveyed 7,945 participants, it is not ideal to use data from a single airport to assess diarrhea throughout the region. A multi-airport, multi-country study would provide more comprehensive data. Finally, according to the nature of travelers' diarrhea and the complex itinerary of some travelers; the country where diarrhea occurred may not be the country of exposure. Moreover, because there was no follow-up in this study, so it was possible that some travelers may develop diarrhea after leaving Southeast Asia.

Our study shows that traveler's diarrhea remains an important health risk among travelers in Southeast Asia, including travelers from the developing world. Apart from known risk factors including age and duration of stay, we confirmed that the nationality of travelers and the countries visited significantly related to the risk of developing traveler's diarrhea.

ACKNOWLEDGMENTS

We thank the staff of the Port Health Office at Suvarnabhumi Airport for their help during data collection. We also thank the Department of Disease Control, the Ministry of Public Health, and the Airport Authority of Thailand for their support of this research.

Disclaimer: This study, in part, was presented as a poster (PO03.05) at the Conference of the International Society of Travel Medicine (CISTM13) Maastricht, The Netherlands, May 19–23, 2013.

Financial support: This study was funded by the Faculty of Tropical Medicine, Mahidol University.

Authors' addresses: Chatporn Kittitrakul and Watcharapong Piyaphanee, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: [email protected] and [email protected] . Saranath Lawpoolsri, Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: [email protected] . Teera Kusolsuk, Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: [email protected] . Jutarmas Olanwijitwong, Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand, E-mail: [email protected] . Waraluk Tangkanakul, Department of Disease Control, Bureau of General Communicable Diseases, Ministry of Public Health, Nonthaburi, Thailand, E-mail: moc.liamg@wcodpah .

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Traveler's diarrhea diet

Traveler's diarrhea causes loose, watery stools. People can get traveler's diarrhea when they visit places where the water is not clean or the food is not handled safely. This can include developing countries in Latin America, Africa, the Middle East, and Asia.

This article tells you what you should eat or drink if you have traveler's diarrhea.

Patient Education Video: Vacation health care

Alternative names.

Diet - traveler's diarrhea; Diarrhea - traveler's - diet; Gastroenteritis - traveler's

Bacteria, parasites, and other substances in the water and food can cause traveler's diarrhea. People who live in these areas don't often get sick because their bodies are used to the bacteria or parasites.

You can lower your risk of getting traveler's diarrhea by avoiding water, ice, and food that may be contaminated. The goal of the traveler's diarrhea diet is to make your symptoms better and prevent you from getting dehydrated .

Side Effects

Traveler's diarrhea is rarely dangerous in adults. It can be more serious in children.

Recommendations

How to prevent traveler's diarrhea:

WATER AND OTHER DRINKS

• Do not use tap water to drink or brush your teeth.
• Do not use ice made from tap water.
• Use only boiled water (boiled for at least 5 minutes) for mixing baby formula.
• For infants, breastfeeding is the best and safest food source. However, the stress of traveling may reduce the amount of milk you make.
• Drink only pasteurized milk.
• Drink bottled drinks if the seal on the bottle hasn't been broken.
• Sodas and hot drinks are often safe.
• Do not eat raw fruits and vegetables unless you peel them. Wash all fruits and vegetables before eating them.
• Do not eat raw leafy vegetables (e.g., lettuce, spinach, cabbage) because they are hard to clean.
• Do not eat raw or rare meats.
• Avoid uncooked or undercooked shellfish.
• Do not buy food from street vendors.
• Eat hot, well-cooked foods. Heat kills the bacteria. But do not eat hot foods that have been sitting around for a long time.
• Wash hands often.
• Watch children carefully so they do not put things in their mouth or touch dirty items and then put their hands in their mouth.
• If possible, keep infants from crawling on dirty floors.
• Check to see that utensils and dishes are clean.

There is no vaccine against traveler's diarrhea.

Your doctor may recommend medicines to help lower your chances of getting sick.

• Taking 2 tablets of Pepto-Bismol 4 times a day before you travel and while you are traveling can help prevent diarrhea. Do not take Pepto-Bismol for more than 3 weeks.
• Most people do not need to take antibiotics every day to prevent diarrhea while traveling.
• People who are at risk for more dangerous infections (such as chronic bowel diseases, kidney disease, cancer, diabetes, or HIV) should talk to their doctor before traveling.
• A prescription medicine called rifaximin can also help prevent traveler's diarrhea. Ask your doctor if a preventive medicine is right for you. Ciprofloxacin is also effective but has several negative effects when used for this purpose.

If you have diarrhea, follow these tips to help you feel better:

• Drink 8 to 10 glasses of clear fluids every day. Water or an oral rehydration solution is best.
• Drink at least 1 cup (240 milliliters) of liquid every time you have a loose bowel movement.
• Eat small meals every few hours instead of three big meals.
• Eat some salty foods, such as pretzels, crackers, soup, and sports drinks.
• Eat foods that are high in potassium, such as bananas, potatoes without the skin, and fruit juices.

Dehydration means your body does not have as much water and fluids as it should. It is a very big problem for children or people who are in a hot climate. Signs of severe dehydration include:

• Decreased urine output (fewer wet diapers in infants)
• Few tears when crying
• Sunken eyes

Give your child fluids for the first 4 to 6 hours. At first, try 1 ounce (2 tablespoons or 30 milliliters) of fluid every 30 to 60 minutes.

• You can use an over-the-counter drink, such as Pedialyte or Infalyte. Do not add water to these drinks.
• You can also try Pedialyte frozen fruit-flavored pops.
• Fruit juice or broth with water added to it may also help. These drinks can give your child important minerals that are being lost in the diarrhea.
• If you are breastfeeding your infant, keep doing it. If you are using formula, use it at half-strength for 2 to 3 feedings after the diarrhea starts. Then you can begin regular formula feedings.

In developing countries, many health agencies stock packets of salts to mix with water. If these packets are not available, you can make an emergency solution by mixing:

• 1/2 teaspoon (3 grams) of salt
• 2 tablespoons (25 grams) sugar or rice powder
• 1/4 teaspoon (1.5 grams) potassium chloride (salt substitute)
• 1/2 teaspoon (2.5 grams) trisodium citrate (can be replaced with baking soda)
• 1 liter of clean water

Get medical help right away if you or your child has symptoms of severe dehydration, or if you have a fever or bloody stools.

Ananthakrishnan AN, Xavier RJ. Gastrointestinal diseases. In: Ryan ET, Hill DR, Solomon T, Aaronson NE, Endy TP, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases . 10th ed. Philadelphia, PA: Elsevier; 2020:chap 3.

Centers for Disease Control and Prevention website. Travelers' diarrhea. wwwnc.cdc.gov/travel/page/travelers-diarrhea . Updated October 8, 2019. Accessed January 25, 2022.

Lazarciuc N. Diarrhea. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; 2018:chap 28.

Riddle MS. Clinical presentation and management of travelers' diarrhea. In: Keystone JS, Kozarsky PE, Connor BA, Nothdurft HD, Mendelson M, Leder, K, eds. Travel Medicine . 4th ed. Philadelphia, PA: Elsevier; 2019:chap 20.

Related specialties

• Family Medicine
• Gastroenterology
• Infectious Disease

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COVID-19: travel health notice for all travellers

Philippines travel advice

Latest updates: The Health section was updated - travel health information (Public Health Agency of Canada)

Last updated: March 13, 2024 15:22 ET

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Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, philippines - exercise a high degree of caution.

Exercise a high degree of caution in the Philippines due to crime, terrorism, civil unrest and kidnapping.

Sulu archipelago - Avoid all travel

Western and central mindanao - avoid all travel.

• Lanao del Sur
• Maguindanao
• Lanao del Norte
• Misamis Occidental
• Misamis Oriental
• South Cotabato
• Sultan Kudarat
• Zamboanga del Norte
• Zamboanga del Sur
• Zamboanga Sibugay

Eastern Mindanao - Avoid non-essential travel

• Agusan del Norte
• Agusan del Sur
• Dinagat Islands
• Surigao del Norte, excluding Siargao Island
• Surigao del Sur
• Davao de Oro
• Davao del Norte
• Davao del Sur, excluding Davao City
• Davao Occidental
• Davao Oriental

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Southern Philippines

Extremists have been active in the southern Philippines for several years.

Sulu archipelago

There is a serious threat of terrorism, kidnapping, and piracy in the Sulu archipelago, including in the waters south of the island of Palawan.

In recent years, bombing incidents have caused several casualties and property destruction in Jolo.

Mindanao island

There’s a risk in Mindanao island of terrorist attacks and kidnappings, especially in the following regions:

• Bangsamoro Autonomous Region in Muslim Mindanao
• Northern Mindanao
• Soccsksargen
• Zamboanga Peninsula

Bombs causing deaths, injuries, and property destruction have exploded in public areas of major centres, including the cities of:

• General Santos

Clashes may occur between insurgent groups and security forces. 

There’s a risk of being in the wrong place at the wrong time. The Government of Canada's ability to provide consular assistance is limited if you get stranded in this area.

If you chose to travel in the southern Philippines despite this advisory:

• remain indoors as much as possible
• be aware of your surroundings at all times
• avoid crowded places
• always travel with identification
• expect an increased security presence in public areas, especially around malls and transportation hubs
• stop at security checkpoints
• monitor local media
• follow the advice and instructions of local authorities

There is a threat of terrorism. Several terrorist groups are active in the Philippines. They have carried out several attacks throughout the country, including in major cities and places visited by foreigners. They have used occasions such as religious holidays and sporting events, and public celebrations to mount attacks.

Terrorist attacks are far more frequent in Western Mindanao, where government forces and rebel groups frequently clash.

Further attacks are likely. Targets could include:

• government buildings, including military and police installations
• places of worship
• airports and other transportation hubs and networks
• public areas such as tourist destinations, restaurants, bars, coffee shops, shopping centres, markets, hotels and other sites frequented by foreigners

Always be aware of your surroundings when in public places.

There is a threat of kidnapping across the country, especially in the southern islands. Kidnappings are conducted by both terrorist and rebel groups. They may also be opportunistic.

The threat of kidnapping varies according to the location, but it’s particularly high in:

• western and central Mindanao
• the Sulu archipelago
• the coastal waters of Palawan island in the Sulu Sea
• the coastal waters of the Celebes Sea

Kidnappers are most active in coastal areas where they target individuals on private boats, in marinas and resorts. They have also kidnapped cargo vessel crews.  

While in the Philippines:

• maintain a high level of vigilance and personal security awareness at all times
• stay in reputable accommodation with adequate security measures
• report any suspicious behaviour to security forces
• if you are abducted, comply with the kidnappers’ demands and do not resist

Although local authorities have reported a decrease in crime rates for a few consecutive years, criminality remains a serious concern throughout the country.

Organized crime

The security situation in the Philippines has suffered from the war on drugs initiated by the local government in 2016. Gunfights between security forces and criminals are frequent, and bystanders are often caught in such incidents.

Militant and rebel groups are active, in particular in northern and central Luzon, as well as in the islands of:

Gangs are also active in Manila, including in the central business district of Makati and the Tondo port area.

• Stay away from slum areas in Manila
• Be aware of your surroundings if you travel on rural roads

Violent crime

Violent crime, such as armed robbery, sexual assault, and murder, occur regularly. The possession of guns and other weapons is common and poorly regulated. Criminals have attacked foreigners. 

Violent incidents may increase around elections.

Petty crime

Petty crime, such as pickpocketing, swarming and bag snatching, occurs, especially in urban areas.

• Ensure that your belongings, including your passport and other travel documents, are secure at all times
• Be careful in crowded shopping malls and other public places
• Avoid showing signs of affluence
• Avoid carrying large sums of money
• Keep valuables in safe place
• Keep backpacks and bags away from traffic, as motorcyclists may grab them from pedestrians, sometimes causing injury
• Beware of friendly strangers offering to take you around town or on an excursion

Spiked food and drinks

Some criminals have drugged and robbed tourists travelling alone after an invitation to visit a tourist attraction.

Never leave your food or drinks unattended or in the care of strangers. Be wary of accepting snacks, beverages, gum or cigarettes from new acquaintances. These items may contain drugs that could put you at risk of sexual assault and robbery.

Credit card and ATM fraud occurs frequently. Illegal electronic devices are sometimes attached to ATM card readers, enabling them to record information such as the user’s PIN.

 Be cautious when using debit or credit cards:

• pay careful attention when your cards are being handled by others
• use ATMs located in well-lit public areas or inside a bank or business
• avoid using card readers with an irregular or unusual feature
• cover the keypad with one hand when entering your PIN
• check for any unauthorized transactions on your account statements

Overseas fraud

Online financial scams

Internet is frequently used to initiate financial scams. Scammers often use fake profiles to target Westerners and steal from them. Once they succeed in building a virtual relationship, they ask for money for various purposes. This could include business or financial opportunities such as:

• money transfers
• lucrative sales
• gold purchase
• inheritance notices
• bank overpayments

If you intend to do business in the Philippines:

• ensure that any business opportunity is legitimate before leaving
• don’t travel to the Philippines with the intention to obtain restitution after losing money to a fraud

Internet romance

Internet romance is also common. Victims of this type of scams have lost thousands of dollars. Before travelling to the Philippines to visit someone you met online:

• keep in mind that you may be the victim of a scam
• inform yourself about the country’s customs and laws on conjugal relations and marriage
• be sure to retain possession of your return plane ticket, money, and passport

Child abuse

Locals with children may befriend single male tourists and then accuse them of child abuse to extort money from them.

Report any incident of crime or scams to local police before you leave the country.

Women’s safety

Women travelling alone may be subject to some forms of harassment and verbal abuse.

Advice for women travellers

Demonstrations

Demonstrations take place regularly, including in Manila. Clashes often occur between security forces and demonstrators, especially in Mindanao and remote areas of northern Luzon.

Filipino law prohibits political activities by foreigners. Participating in demonstrations may result in being detained or deported.

Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

• Avoid areas where demonstrations and large gatherings are taking place
• Follow the instructions of local authorities
• Monitor local media for information on ongoing demonstrations

Mass gatherings (large-scale events)

Water activities

Coastal waters can be dangerous. Riptides are common. Several drownings occur each year.

Most of the time, lifeguards are not present to supervise swimmers. Many beaches don’t offer warnings of dangerous conditions.

Water pollution is also a concern.

• Seek local advice before swimming
• Avoid swimming if red flags are flown

Scuba diving

Diving schools and rescue services may not adhere to Canadian standards.

• Use only reputable dive companies
• Make sure the company offers proper safety equipment
• Verify the location of the closest decompression chamber with your dive company

Water safety abroad

Road safety

Road conditions are poor throughout the country. Most roads, including major highways, are poorly maintained, and traffic is congested.

Many drivers don’t respect traffic laws. They are extremely reckless. They often drive at excessive speeds or way below the speed limit on highways. Accidents causing fatalities are common.

Driving conditions are hazardous at all times. During the rainy season, metro centres may become impassable due to flash floods.

Even minor road incidents can escalate quickly and lead to violent assaults.

If driving in the Philippines:

• avoid travel outside urban areas or tourist centres after dark
• stay on national highways and paved roads
• avoid any confrontation

Most people travel using mopeds. Fatal scooter accidents involving tourists are common.

If renting a scooter or moped:

• be vigilant while driving
• avoid renting from operators who don’t provide a helmet with the rental
• avoid driving on roads in disrepair

Public transportation

The safety and reliability of public transportation are poor.

Minibuses, known as jeepneys, and large buses are often old, poorly maintained, and overcrowded. Pickpocketing and armed robberies are frequent, especially in large cities such as Manila and Cebu. 

Some interurban buses have also been involved in fatal accidents.

Motorcycles

Motorcycle transportation is prevalent throughout the country, whether by habal-habal or tricycle.

Habal-habal are motorcycles with extensions, which can carry several passengers at a time. They are illegal and dangerous.

Tricycles are rather a safe option as they don’t drive very fast. However, vehicles may be in poor condition. They aren’t metered and can be hailed anywhere.

• Don’t use habal-habal
• Avoid using tricycles at night on country roads
• Agree on a fare with the tricycle driver before departing to avoid scams 

Although most taxi services are safe and reliable, there have been extortion incidents from taxi drivers.  

To minimize your risks:

• avoid hailing a taxi on the street
• only enter metered taxis from a reliable company and insist the meter be turned on
• prefer hotel transportation, official airport taxis, or a ridesharing app
• never share taxis with strangers
• ask for the windows being rolled up and doors locked at all times
• record the taxi’s licence plate and provide the information to a relative/friend

Ferry accidents occur. Some vessels are poorly maintained and overcrowded. Accidents are more prevalent during the rainy season as storms can develop quickly. As a result, local authorities may suspend ferry services on short notice when a storm signal is raised, even if the weather is clear. You could get stranded at ports for several days.

If travelling by sea:

• use only a reliable company
• don’t board vessels that appear overloaded or unseaworthy
• make sure you have access to a life jacket
• plan for extra time, especially during the rainy season

Pirate attacks and armed robbery targeting ships occur in coastal waters. You may face an elevated threat of kidnapping in waters:

• around Mindanao
• in the Sulu Sea
• in the Celebes Sea
• south of Palawan Island
• south of Negros Island
• around Siquijor Island

Mariners should take appropriate precautions.

Live piracy report  - International Maritime Bureau

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from the Philippine authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for the duration of your stay.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: not required for stays of up to 30 days Business visa: not required for stays of up to 30 days Student visa: required

If you need to extend your stay above the 30-day visa-free period, you must require the proper authorization from local authorities before this period ends.

The visa that immigration officials issue upon your arrival in the Philippines takes precedence over any visa you may have obtained from a Philippine embassy or consulate abroad.

If you’re leaving the Philippines using a temporary passport issued inside the country, consult the Philippine Bureau of Immigration to obtain the required exit stamps.

Bureau of Immigration – Republic of the Philippines

Registration

Foreign nationals staying in the Philippines for longer than 59 days must register with the local authorities.

You must present yourself to a Bureau of Immigration office to register your biometrics, such as fingerprinting, and obtain a special security registration number. 

Bureau of Immigration offices – Republic of the Philippines

Other entry requirements

Customs officials may ask you to show them a return or onward ticket.

Boracay Island

Local authorities are restricting visitors to Boracay Island.

You may need proof of accommodation in an accredited hotel to be allowed entry.

Exit requirements

Travel pass.

Foreign nationals travelling on a visa issued by one of the following authorities must present a travel pass to leave the country:

• the Department of Justice
• the Board of Investments
• the Philippine Retirement Authority
• the Philippine Economic Zone Authority
• the economic zones

Travel pass  – Bureau of Immigration, Republic of the Philippines

Emigration clearance certificate

If you’ve been in the country for 6 months or more, you must obtain an emigration clearance certificate (ECC), also known as an exit clearance, and pay applicable fees at least 72 hours before your expected departure.

This also applies to children born in the Philippines who are leaving the country for the first time on a foreign passport.

Emigration clearance certificate – Bureau of Immigration, Republic of the Philippines

Medical screening

You may be subject to a body temperature check when entering the Philippines. This may result in isolation and treatment.

Children and travel

Children under 15 years travelling alone need a Waiver for Exclusion Ground to enter the Philippines.

• Waiver for Exclusion Ground – Bureau of Immigration, Republic of the Philippines
• Travelling with children

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• Zika virus: Advice for travellers - 31 August, 2023
• COVID-19 and International Travel - 13 March, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

Japanese encephalitis is a viral infection that can cause swelling of the brain.  It is spread to humans through the bite of an infected mosquito. Risk is very low for most travellers. Travellers at relatively higher risk may want to consider vaccination for JE prior to travelling.

Travellers are at higher risk if they will be:

• travelling long term (e.g. more than 30 days)
• making multiple trips to endemic areas
• staying for extended periods in rural areas
• visiting an area suffering a JE outbreak
• engaging in activities involving high contact with mosquitos (e.g., entomologists)

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Malaria  is a serious and sometimes fatal disease that is caused by parasites spread through the bites of mosquitoes.   There is a risk of malaria in certain areas and/or during a certain time of year in this destination. 

Antimalarial medication may be recommended depending on your itinerary and the time of year you are travelling. Consult a health care professional or visit a travel health clinic before travelling to discuss your options. It is recommended to do this 6 weeks before travel, however, it is still a good idea any time before leaving.    Protect yourself from mosquito bites at all times:  • Cover your skin and use an approved insect repellent on uncovered skin.  • Exclude mosquitoes from your living area with screening and/or closed, well-sealed doors and windows. • Use insecticide-treated bed nets if mosquitoes cannot be excluded from your living area.  • Wear permethrin-treated clothing.    If you develop symptoms similar to malaria when you are travelling or up to a year after you return home, see a health care professional immediately. Tell them where you have been travelling or living. 

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is no risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is required if you are coming from or have transited through an airport of a country   where yellow fever occurs.

Recommendation

• Vaccination is not recommended.
• Discuss travel plans, activities, and destinations with a health care professional.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of your trip to arrange for vaccination.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

In this destination, rabies is carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by an animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. Rabies treatment is often available in this destination. 

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Cholera is a risk in parts of this country. Most travellers are at very low risk.

To protect against cholera, all travellers should practise safe food and water precautions .

Travellers at higher risk of getting cholera include those:

• visiting, working or living in areas with limited access to safe food, water and proper sanitation
• visiting areas where outbreaks are occurring

Vaccination may be recommended for high-risk travellers, and should be discussed with a health care professional.

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

There is a risk of schistosomiasis in this destination. Schistosomiasis is a parasitic disease caused by tiny worms (blood flukes) which can be found in freshwater (lakes, rivers, ponds, and wetlands). The worms can break the skin, and their eggs can cause stomach pain, diarrhea, flu-like symptoms, or urinary problems. Schistosomiasis mostly affects underdeveloped and r ural communities, particularly agricultural and fishing communities.

Most travellers are at low risk. Travellers should avoid contact with untreated freshwater such as lakes, rivers, and ponds (e.g., swimming, bathing, wading, ingesting). There is no vaccine or medication available to prevent infection.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

• In this country,   dengue  is a risk to travellers. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites . There is no vaccine or medication that protects against dengue.

Zika virus is a risk in this country. 

Zika virus is primarily spread through the bite of an infected mosquito. It can also be sexually transmitted. Zika virus can cause serious birth defects.

During your trip:

• Prevent mosquito bites at all times.
• Use condoms correctly or avoid sexual contact, particularly if you are pregnant.

If you are pregnant or planning a pregnancy, you should discuss the potential risks of travelling to this destination with your health care provider. You may choose to avoid or postpone travel. 

For more information, see Zika virus: Pregnant or planning a pregnancy.

There is a risk of chikungunya in this country.  The risk may vary between regions of a country.  Chikungunya is a virus spread through the bite of an infected mosquito. Chikungunya can cause a viral disease that typically causes fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times. There is no vaccine available for chikungunya.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

Medical services and facilities

Good medical services and facilities are limited in availability, especially outside major urban areas. Public medical clinics often lack basic resources and equipment.

Quality of care varies greatly throughout the country.  Most hospitals will require a down payment of estimated fees at the time of admission. They may also require additional payments during hospitalization. 

Some hospitals require patients to have a full-time caregiver. You may have to hire one if you’re travelling alone.

Emergency services are not widely available. Time response can be slow.

If you become seriously ill or injured, you may require evacuation to a destination with appropriate facilities.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

Some medication that can be purchased over-the-counter in Canada is illegal in the Philippines. If you bring some medicines with you, you’re responsible for determining their legality before departing. If you enter the country with drugs locally considered illegal, including prescription drugs, you may be fined or detained.

• Make sure your medicines are legal in the Philippines before departure
• Bring your own medicines, but only in quantities sufficient for the duration of your stay
• Seal and declare a separate quantity of prescription drugs before departing the Philippines if you’re travelling onward to another country
• Always keep your medication in the original container
• Carry a copy of your prescriptions as well as a letter from your physician stating the dosage and your relevant medical condition
• Pack your medicines in your carry-on luggage

Air pollution

Air pollution can be severe in several major cities. It may affect people suffering from respiratory ailments.  

During periods of high pollution:

• consult your doctor before traveling to see if the situation could affect you
• limit your activities outdoors
• follow the instructions of local authorities

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Judicial processes may last several years. Foreign nationals are often held in harsh conditions without the possibility of bail.  

Some crimes carry penalties harsher than those in Canada. For examples, a conviction for:

• sexual assault can result in life imprisonment
•  “swindling” or “bad debts” can result in a prison sentence of up to 20 years
• bomb threat can result in a prison sentence of up to 5 years, a fine, or both

Penalties for possession, use, trafficking or importation, including through e-commerce, of illegal drugs are severe. Convicted offenders can expect life imprisonment and heavy fines.

Many drugs considered as legal in Canada are illegal in the Philippines. This includes cannabis, regardless of quantity and purpose of use, as well as some over-the-counter medicine and prescription drugs.

Drugs, alcohol and travel

Child sex tourism

Penalties for pedophilia are severe. Under Philippine law, a child is defined as a person under 18.

Police may investigate any adult who is with:

• an unrelated child 12 years of age or younger, or 10 years or more his/her junior
• an unrelated child under age 18 inside the room of a house, hotel, or other similar establishments, vehicle, or other secluded location, and is suspected of having the intention to exploit the child sexually

Child Sex Tourism: It’s a Crime

Photography

The government prohibits any photography of official buildings or military installations that is intended for publication.

If you wish to marry in the Philippines, ensure that you’re well informed regarding legal requirements. Visit the Embassy of Canada to the Philippines website for information on documents and procedures.

• Embassy of Canada to the Philippines
• Marriage overseas factsheet

To protect the environment, local authorities restrict access to Boracay Island. As a result, some activities are prohibited, including:

• the consumption of alcohol and tobacco in public places, including White Beach
• Water sports, including diving

If you plan to visit Boracay, make sure you know about its rules and regulations before leaving.

Filipino law prohibits political activities by foreigners.

Attending any protest, demonstration, or political rally as a foreign national may lead to detention and deportation.

Identification

Foreigners must carry identification at all times.

A photocopy of the identification page of your passport is acceptable.

Dual citizenship

Dual citizenship is legally recognized in the Philippines.

If you are a Canadian citizen, but also a citizen of the Philippines, our ability to offer you consular services may be limited while you're there. You may also be subject to different entry/exit requirements .

Travellers with dual citizenship

Dual citizens must obtain a certificate of recognition from Philippine authorities to ensure the legal recognition of both citizenships.

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and the Philippines.

If your child was wrongfully taken to, or is being held in the Philippines by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in the Philippines to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children’s Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre.

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country’s judicial affairs.

• International Child Abduction: A Guidebook for Left-Behind Parents
• Canadian embassies and consulates by destination
• Emergency Watch and Response Centre

You can drive in the Philippines with a valid Canadian driver’s licence for up to 90 days. After that period, you must apply for a local driving permit.

You should carry an international driving permit.

International Driving Permit

The currency in the Philippines is the peso (PHP).

ATMs are available in larger cities but may be scarce in rural areas. Make sure to have access to cash in local currency if you’re travelling outside larger urban areas.

You may enter the Philippines with:

• up to PHP 50,000;
• up to US$10,000 or other currency equivalent

You need a written authorization from local authorities for greater amounts.

Typhoons and monsoons

The rainy or monsoon season extends from May to December, but storms can occur throughout the year. The Philippines experiences around 20 typhoons per year, mostly between June and November.

Seasonal flooding can hamper overland travel and reduce the provision of essential services. Roads may become impassable and bridges damaged. Flooding and mudslides are frequent following heavy rains, even in Manila.

If you decide to travel to the Philippines during the rainy season:

• know that you expose yourself to serious safety risks
• be prepared to change your travel plans on short notice, including cutting short or cancelling your trip
• stay informed of the latest regional weather forecasts
• carry emergency contact information for your airline or tour operator
• Tornadoes, cyclones, hurricanes, typhoons and monsoons
• Philippine Weather Services & Warnings  – Philippine Atmospheric, Geophysical and Astronomical Services Administration
• Nationwide Operational Assessment of Hazards  – University of the Philippines

Seismic activity

The Philippines is located on the Pacific Ring of Fire and experiences regular seismic activity.

There are several active and potentially active volcanoes in the Philippines, mainly on Luzon island.

Taal is one of the main active volcanoes in Batangas on Luzon Island. It continuously shows signs of a possible eruption. The Philippine Institute of Volcanology and Seismology is constantly monitoring the Taal Volcano. Local authorities may raise alert levels and issue evacuation orders on short notice.

Volcanic activity may escalate suddenly. Volcanic ash clouds may cause disruptions to domestic and international flights.

If you are near active volcanoes:

• monitor levels of volcanic activity through the local media
• pay careful attention to all warnings issued
• follow the advice of local authorities, including evacuation orders
• be prepared to modify your travel arrangements or even evacuate the area on short notice
• Taal Volcano Bulletin - Philippine Institute of Volcanology and Seismology
• Volcano Bulletin - Philippine Institute of Volcanology and Seismology

Earthquakes

The Philippines is located in an active seismic zone. Earthquakes occur regularly and strong aftershocks may occur after the initial quake.

Familiarize yourself with earthquake security measures in public and private buildings, including airports.

The Philippines is prone to tsunamis.

A tsunami can occur within minutes of a nearby earthquake. However, the risk of a tsunami can remain for several hours following the first tremor.

If you’re staying on the coast, familiarize yourself with the region’s evacuation plans in the event of a tsunami warning. 

• Earthquakes – What to Do?
• Philippine Institute of Volcanology and Seismology  – Department of Science and Technology
• Nationwide Operational Assessment of Hazards  – University of the Philippines

Local services

In case of emergency, dial 911.

Consular assistance

For emergency consular assistance, call the Embassy of Canada to the Philippines, in Manila, and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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• Outbreak News Radio
• Drugs and antibiotics

Traveling to the Philippines: preventing infection

The Philippines is an archipelago consisting of 7100-plus islands located in the western Pacific Ocean. The country brings in foreign travelers for a diverse number of reasons ranging from the cool climate of Baguio in the mountains to the pristine beaches of Boracay; from the ecotourism opportunities to the nightlife of Manila.

As beautiful as the country is, there are some serious infectious disease risks for the international traveler and education and preparation are a necessity to prevent getting seriously ill.

If you are planning to travel to the Philippines, you should see your personal physician, or preferably a travel medicine physician at least 4 weeks prior to departure but preferably 6-8 weeks prior.

When you see the travel medicine specialist, ensure you give this professional, detailed information about your trip including immunization history, any underlying health issues, what areas of the Philippines you plan on visiting and specific activities you will partake. Given this information, your travel medicine specialist will be able to best determine what you’ll need to protect yourself from a plethora of infectious agents.

I will go over some key diseases, activities and preventive measures that can help you before you travel to the Philippines.

Food and Water

Traveler’s diarrhea (TD) is the most common medical issue that people complain of while traveling in less developed countries.

A number of pathogens are associated with TD including bacteria, parasites and viruses. Vaccination can protect against certain infections like hepatitis A and typhoid fever.

Your travel medicine specialist may prescribe prophylactic antibiotics and antidiarrheals for your trip. However, taking prophylactic antibiotics are not recommended for routine use in preventing TD except in certain circumstances (immunocompromised). However, these drugs should be started if significant diarrhea happens.

Less commonly known parasites can be contracted through eating raw or undercooked foods. The roundworm, Capillaria philippinensis can cause severe intestinal problems and even death. You are infected with this parasite through raw and undercooked fish.

The oriental lung fluke, Paragonimus westermani is also seen in the Philippines and people are infected through eating raw or undercooked crabs.

In addition to the use of vaccination and antibiotics, tropical and travel medicine expert Dr. Elaine Jong offers the following ten tips for selecting safe food and water:

1. Drink purified water or bottled carbonated water.

2. Eat foods that are thoroughly cooked, and served piping hot.

3. Eat fruits that have thick skins (they should be peeled at the table by the traveler).

4. Do not use ice cubes in any beverages including alcohol.

5. Only eat or drink dairy products that have been pasteurized.

6. Avoid salads made with raw vegetables, in particular, leafy greens.

7. Avoid shellfish, and raw or undercooked seafood.

8. Do not buy or eat food sold by street vendors.

9. If canned beverages are cooled by submersion in a bucket of ice water or a stream, ensure you dry the outside of the container before drinking.

10. Use purified water for brushing teeth and taking medications.

Immunizations

According the US Centers for Disease Control and Prevention (CDC) the vaccines that are recommended prior to traveling to the Philippines include:

1. Routine vaccines such as measles, mumps and rubella (MMR), diphtheria/pertussis/tetanus (DPT), polio and influenza.

2. Hepatitis A and B

3. Typhoid if you are visiting smaller towns and villages where exposure may occur via food and water.

4. If you are planning to visit rural areas, the Japanese encephalitis vaccine might be recommended.

5. Rabies for travelers who will be involved in outdoor activities like camping or hiking.

Malaria is endemic in Luzon, Mindanao, Mindoro and Palawan in rural areas less than 600m.

Your travel medicine specialist, depending on where you will visit, will recommend prophylactic antimalarials.

The CDC says the following drugs can be used as prophylaxis for malaria in the Philippines: Atovaquone-proguanil, doxycycline, or mefloquine.

The CDC specifically notes that Chloroquine is not an effective antimalarial to take prior to traveling to the Philippines.

In addition, it is strongly advised to buy your antimalarial drugs prior to travel due to counterfeit drugs.

Antimalarials should be used in combination with using insect repellents, sleeping in screened rooms or using bednets. This will not only help in preventing malaria, but also other mosquito-borne diseases found in the Philippines such as dengue fever and lymphatic filariasis.

The website MD Travel Health offers the following recommendations in insect protection:

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don’t sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.

Swimming, kayaking and other fresh water recreational activities should be avoided due to schistosomiasis. Schistosoma japonicum is still endemic in parts of the Philippines. According to the CDC, because there is no practical way for the traveler to distinguish infested from noninfested water, travelers should be advised to avoid wading, swimming or other contact with freshwater in disease-endemic countries.

In addition to the above risks, there are many others including leptospirosis (waterborne), strongyloides and sexually transmitted infections.

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MICAH PIPPIN, MD, AND LOIS BULLER, MD, MS, Louisiana State University Health Sciences Center–Shreveport Family Medicine Residency, Alexandria, Louisiana

Am Fam Physician. 2021;103(2):113-114

Author disclosure: No relevant financial affiliations.

A 33-year-old patient presented with a rash that developed two days earlier and was preceded by fever, headache, nausea, and arthralgias. The rash was worse on the limbs. The medical history was unremarkable, but the patient had recently traveled to the Philippines.

Physical examination revealed a diffuse, erythematous, maculopapular rash on the arms and legs ( Figure 1 ) . Findings on a tourniquet test were positive ( Figure 2 ) . Laboratory testing was positive for leukopenia and thrombocytopenia. A chest radiograph showed right-sided pleural effusion.

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Acute HIV infection

B. Chikungunya virus infection.

D. Malaria.

E. Zika virus infection.

The answer is C: dengue, a common mosquito-borne disease encountered in more than 100 tropical and subtropical countries in North and South America, Africa, the Middle East, Asia, and the Pacific Islands. The incidence is increasing, and outbreaks are becoming more common, including in the Caribbean and the Big Island of Hawaii. 1 The disease is caused by one of four dengue viruses transmitted by Aedes aegypti and Aedes albopictus mosquitos. Most cases in the United States are travel-related, except in Puerto Rico where dengue is endemic. 2

Humans are the primary reservoirs for dengue. Patients with the disease may be asymptomatic or have mild to severe or life-threatening symptoms. Common presenting symptoms include high-grade fever, headache, retroorbital pain, myalgias/arthralgias, nausea, vomiting, and rash. The disease progresses to severe dengue in one out of 20 patients. 1 Severe dengue follows three phases: febrile, critical, recovery. The critical phase occurs after 72 hours of fever and is distinguished by increased vascular permeability, fever, hemorrhagic manifestations, and marked thrombocytopenia.

Diagnosis of dengue is based on clinical signs and symptoms. The tourniquet test is commonly used. 3 To perform this test, a blood pressure cuff is inflated on the arm, then removed. After two minutes, petechiae are counted below the antecubital fossa. The test is positive if there are 10 or more petechiae per 1 square inch ( Figure 2 ) . The Centers for Disease Control and Prevention recommends testing symptomatic patients with a history of travel to endemic areas. 4

Acute HIV infection, also known as primary HIV infection or acute retroviral syndrome, is the period just after initial HIV infection, generally before seroconversion. 5 Symptoms are characterized as mononucleosis-like or flulike, with the most prevalent symptoms being fever, fatigue, myalgias/arthralgias, rash, pharyngitis, lymphadenopathy, and mucocutaneous ulcerations. 5

Chikungunya virus infection and dengue have similar symptoms and are transmitted by the same mosquito vectors. 6 Chikungunya virus infection is characterized by fever and intense joint pain but lacks leukopenia and thrombocytopenia. Headache, myalgias, and rash are also possible. 7 The laboratory diagnosis of Chikungunya virus infection is based on viral isolation. 6

Malaria is a parasitic infection. In the United States, malaria mainly occurs in travelers who have returned from endemic regions. 8 Fever and splenomegaly are the most common physical examination findings. 8

Zika virus infection also presents similarly to dengue and is transmitted by the same mosquito vectors. 9 Unlike dengue, Zika virus infection is commonly associated with conjunctivitis. 9 The disease is diagnosed through serology or reverse transcriptase–polymerase chain reaction testing. 10

Centers for Disease Control and Prevention. Dengue. Accessed November 12, 2020. https://www.cdc.gov/dengue/index.html

Huntington MK, Allison J, Nair D. Emerging vector-borne diseases. Am Fam Physician. 2016;94(7):551-557. Accessed November 12, 2020. https://www.aafp.org/afp/2016/1001/p551.html

CDC. Tourniquet test. Accessed November 12, 2020. https://www.cdc.gov/dengue/training/cme/ccm/page73112.html

Centers for Disease Control and Prevention. Dengue. Testing guidance. Accessed November 12, 2020. https://www.cdc.gov/dengue/healthcare-providers/testing/testing-guidance.html

Daar ES, Pilcher CD, Hecht FM. Clinical presentation and diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS. 2008;3(1):10-15.

da Cunha RVD, Trinta KS. Chikungunya virus: clinical aspects and treatment - a review. Mem Inst Oswaldo Cruz. 2017;112(8):523-531.

Lee VJ, et al. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Negl Trop Dis. 2012;6(9):e1786.

Feder HM Jr., Mansilla-Rivera K. Fever in returning travelers. Accessed November 12, 2020. https://www.aafp.org/afp/2013/1015/p524.html

Igbinosa II, Rabe IB, Oduyebo T, et al. Zika virus: common questions and answers. Am Fam Physician. 2017;95(8):507-513. Accessed November 12, 2020. https://www.aafp.org/afp/2017/0415/p507.html

Sharp TM, Fischer M, Muñoz-Jordán JL, et al. Dengue and Zika virus diagnostic testing for patients with a clinically compatible illness and risk for infection with both viruses. MMWR Recomm Rep. 2019;68(1):1-10.

The editors of  AFP  welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at  https://www.aafp.org/afp/photoquizinfo . To be considered for publication, submissions must meet these guidelines. Email submissions to  [email protected] .

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz . 

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Philippines Healthy Travel Packing List

Pack items for your health and safety.

• You may not be able to purchase and pack all of these items, and some may not be relevant to you and your travel plans. Talk to your doctor about which items are most important for you.
• This list is general and may not include all the items you need. Check our Traveler Information Center for more information if you are a traveler with specific health needs, such as travelers who are pregnant, immune compromised, or traveling for a specific purpose like humanitarian aid work.
• Remember to pack extras of important health supplies in case of travel delays.

Prescription medicines

• Your prescriptions
• Travelers' diarrhea antibiotic
• Suture/syringe kit Kit is for use by local health care provider & requires a letter from your doctor on letterhead stationery
• Altitude sickness medicine
• Medicine to prevent malaria

Medical supplies

• Glasses Consider packing spare glasses in case yours are damaged
• Contact lenses Consider packing spare contacts in case yours are damaged
• Needles or syringes (for diabetes, for example) Requires a letter from your doctor on letterhead stationery
• Suture kit Kit is for use by local health care provider & requires a letter from your doctor on letterhead stationery
• Diabetes testing supplies
• Epinephrine auto-injectors (EpiPens)
• Medical alert bracelet or necklace

Over-the-counter medicines

• Antihistamine
• Motion sickness medicine
• Cough drops
• Cough suppression/expectorant
• Decongestant
• Medicine for pain and fever Examples: acetaminophen, aspirin, or ibuprofen
• Mild laxative
• Mild sedative or other sleep aid
• Saline nose spray

Supplies to prevent illness or injury

• Hand sanitizer or wipes Alcohol-based hand sanitizer containing at least 60% alcohol or antibacterial hand wipes
• Water purification tablets See CDC recommendations: Water Disinfection .
• Water purification tablets May be needed if camping or visiting remote areas
• Insect repellent Select an insect repellent based on CDC recommendations: Avoid Bug Bites
• Permethrin Permethrin is insect repellent for clothing. It may be needed if you spend a lot of time outdoors. Clothing can also be treated at home in advance.
• Bed net For protection against insect bites while sleeping
• Sunscreen (SPF 15 or greater) with UVA and UVB protection. See Sun Exposure .
• Sunglasses and hat Wear for additional sun protection. A wide brim hat is preferred.
• Personal safety equipment Examples: child safety seats, bicycle helmets
• Latex condoms

First-aid kit

• 1% hydrocortisone cream
• Antifungal ointments
• Antibacterial ointments
• Antiseptic wound cleanser
• Aloe gel For sunburns
• Insect bite treatment Anti-itch gel or cream
• Bandages Multiple sizes, gauze, and adhesive tape
• Moleskin or molefoam for blisters
• Elastic/compression bandage wrap For sprains and strains
• Disposable gloves
• Digital thermometer
• Scissors and safety pins
• Cotton swabs (Q-Tips)
• Oral rehydration salts
• Health insurance documents Health insurance card (your regular plan and/or supplemental travel health insurance plan) and copies of claim forms
• Proof of yellow fever vaccination If required for your trip, take your completed International Certificate of Vaccination or Prophylaxis card or medical waiver
• Copies of all prescriptions Make sure prescriptions include generic names. Bring prescriptions for medicines, eye glasses/contacts, and other medical supplies.
• Family member or close contact remaining in the United States
• Health care provider(s) at home
• Lodging at your destination
• Hospitals or clinics (including emergency services) in your destination
• US embassy or consulate in the destination country or countries

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More From Forbes

Billionaire lucio tan’s philippine airlines to expand fleet after posting record profit.

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Lucio Tan III, PAL Holdings director and grandson of Philippine Airlines' chairman Lucio Tan Sr., ... [+] with Stanley Ng, president and chief operating officer of PAL.

Philippines Airlines —controlled by billionaire Lucio Tan —said Monday it will expand and upgrade its fleet after the flag carrier posted record profits in 2023 amid a post-pandemic travel rebound.

The company had signed an order for nine A350-1000 long-haul aircraft from Airbus, valued at $3.2 billion, in June 2023 at the Paris Air Show. The first aircraft deliveries are expected next year, enabling the airline to beef up its presence in North America and other destinations.

PAL said its net profit jumped 92% to $379 million in 2023, bolstered by the continued recovery in air travel. It transported 14.7 million passengers in 2023, up 58% from the previous year, boosting its passenger load factor to 80.8%.

“To preserve the gains we achieved, we must not rest on our laurels,” Stanley Ng, PAL president and chief operating officer, said in a statement. PAL’s corporate transformation continues. “We are taking in new aircraft, retrofitting cabins of current aircraft, upgrading airport lounges and introducing more product innovations.”

As travel demand returns, PAL had last year resumed flights to more than 10 domestic destinations and introduced thrice weekly flights between Manila and Perth to cater to increasing demand in Australia, one of the carrier’s key markets. It currently has a fleet of 78 aircraft and operates across 33 destinations in the Philippines and 39 overseas routes around Asia, North America and the Middle East.

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PAL—Asia’s oldest airline— returned to the black in 2021 after canceling $2 billion in debt, retrenching about 30% of its workforce, and downsizing its fleet. The carrier exited the U.S. Chapter 11 bankruptcy proceedings at the end of 2021, just three months after filing a restructuring plan, helped by fresh capital injection from Tan.

Apart from the airline, Tan also has interests in banking, beer, spirits, tobacco and real estate through his publicly listed LT Group. With a net worth of $2.6 billion, Tan ranked No. 10 when the list of Philippines’ richest was last published in August 2023.

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