Ask the Doc: How to Avoid the Stomach Bug on the A.T.

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Welcome to our new Ask the Doc feature. We will be posting regular updates from Dr. Sean Cook with questions pertaining to outdoor injuries and basic health and fitness. 

Hey Doc,

My husband and I are going camping for a week on the Appalachian Trail. Ten weeks ago we did the same trail and two days after we returned home both of us had a stomach bug for next five days. How can we avoid a repeat situation?


First, congratulations on the trip (not on the illness). An estimated 3 percent of outdoor adventurers will return home with more than memories of their trip. Wilderness associated diarrhea (WAD) is caused by bacteria or viruses though less commonly due to parasites. The time frame of exposure to onset of symptoms is usually no more than seven days. Most WADs require no management beyond hydration and replacement of electrolytes like salt and potassium. Imodium can be used to help decrease frequency of diarrhea. Warning signs to seek medical attention would be diarrhea persisting more than 5 days, if the diarrhea is accompanied by fever, abdominal pain, or if blood is noted in the stool.

WAD prevention is the key. Choose running water sources. Avoid water that is cloudy or run off water from nearby farms. Boiling water at 500 C (1600 F) for 30 minutes or 2-3 minutes at 900 C (1940 F) is adequate to kill all types of pathogens. If boiling water is not an option, using commercial filtration followed by iodine or chlorine tablets will work equally well. UV light devices have also become a popular alternative to chemical tablets. Be aware that colder temperatures and the amount of particles in the water will affect the purification efficiency UV light devices and chemical tablets.

When Sean Cook, M.D., is not tempting fate kayaking the Chattooga River, you can find him practicing infectious disease in Eastern Georgia and South Carolina.

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