TORONTO — As the days grow shorter and warnings of frost and the fluffy white stuff make their way into the weather forecast, die-hard sun seekers begin checking for travel deals.
But if the whole idea is to become rejuvenated, then a gurgling, churning stomach that necessitates mad dashes to the washroom can easily wreck a mid-winter vacation.
A little planning and awareness of risk factors can go a long way, says Dr. Mark Wise, who runs The Travel Clinic in Toronto. Research on the Internet or at the library can help, and — especially for more exotic locales — it doesn’t hurt to consult a doctor before departure.
He urges people to find out what the risks are at their particular destination.
“It might depend on exactly where they’re going or the style in which they’re staying or the duration of time that they’re going to be there.”
“The average trip is a week to Cuba, a week to the Dominican Republic or a week to Mexico and they’re all, I’d say, moderately risky,” he said.
Twenty to 30 per cent of people going for a week or two will probably get some sort of stomach upset, he said, and a small number of those will get a bad case of diarrhea that totally wipes out their trip.
There’s an even higher likelihood of getting sick in places like India, Bangladesh, Pakistan or West Africa, “where the food and water and hygiene is that much worse, poverty is that much worse,” said Wise.
Most travellers’ diarrhea is caused by the bacteria Enterotoxigenic E. coli, or ETEC.
Dr. Gregory Glenn of Intercell USA Inc., a pharmaceutical company that’s working to develop a vaccine patch for travellers’ diarrhea, called the ailment a “major disease.”
“If you did a bubble of things that travellers come down with, travellers’ diarrhea is a giant balloon and everything else is kind of a dot,” he said from Gaithersberg, Md.
“It’s a major medical need — it’s been a very challenging field in which to make a vaccine.”
But until medical science comes up with a pill or needle or patch that will fully deliver the goods, Wise urges travellers to learn some rules: “Boil it, bottle it, peel it, cook it, or forget it.”
“You just can’t go down to these places and drink the tap water and eat undercooked eggs and maybe the salads that have been washed in water, and expect them all to be clean.”
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He said he doesn’t want to generalize and say that all the fruits and salads in the Caribbean would be a problem every day at every resort.
“But I do say you’re only as good as the last person or the last fly that landed on your salad or that touched your food.”
Drink bottled water, beer and wine, but be suspicious of the ice cubes, he said.
Make sure that meat is well cooked, he added.
“And I say you don’t want to be the last one at the buffet for the lemon meringue pie that’s been sitting out for four hours in the sun.”
Glenn said people who come down with travellers’ diarrhea can end up with post-infectious irritable bowel syndrome or dysfunctional stooling, where it hurts to go.
“Someone will come and say, you know I went to Mexico, I had a big bout of Montezuma’s revenge, and it kind of never went away. It lasts for years. So there’s a lot of value in preventing the initial event of diarrhea, therefore preventing the irritable bowel syndrome.”
In terms of prevention, Wise said an oral cholera vaccine called Dukoral, which costs about $75, will lower the risk of getting travellers’ diarrhea by 30 or 40 per cent. The cholera toxin is similar to the toxin produced by ETEC.
Two doses are taken, and the vaccine needs to be finished at least a week before travelling, he said.
“So it’s not perfect, but if you feel that you want to get that protection or you have a drug plan that will pay for that protection, then it’s not a bad idea to lower your risk of getting diarrhea,” he said.
The vaccine that Intercell (IOMAI Corp., until a recent merger) is working on contains Escherichia coli toxins. A trial of the patch on healthy adults aged 18 to 64 who travelled to Mexico or Guatemala was reported in the medical journal the Lancet in June, and found 76 per cent protective efficacy against moderate diarrhea, and 84 per cent protective efficacy against severe disease.
“The way we deliver it to the surface of the skin, it is not absorbed into the body — it’s taken into the outer layer of the skin, and in that layer there are immune cells which form a network barrier of cells,” Glenn explained.
“So the safety profile of having the immune cells delivered into the body allows you to have very controlled delivery, and so it makes it safe. So we can use the most potent antigen, most potent vaccine protein.”
A pivotal trial will be held in the summer of 2009 in which researchers hope to confirm the earlier findings, Glenn said. From there, the company would hope to apply for licensure.
But Wise said that no matter how much someone prepares, there will be people who get sick, and they need to know what to do.
“Keep replacing your fluids, which can be done with locally available things like tea with sugar, or soup with salt, or oral rehydration salts,” he said.
Travellers may want to pack Pepto-Bismol, an antidiarrheal medication such as Imodium, or have a prescription filled ahead of time in case they need an antibiotic, he said.
“We know that when people get sick, especially when they get very sick with diarrhea, that it’s usually a bacterial infection, so we usually send people with an appropriate antibiotic to use for a couple of days if they’re very sick, and if they’re uncomfortable and they want to get better faster,” he said.
But he certainly doesn’t want to “instil the fear of God into people” and dissuade anyone from travelling.
“I do try to tell them the ways that you can get sick and what you might want to avoid,” he said.
“Go prepared, and have fun.”
http://www.canoe.ca/Travel/Caribbean/2008/10/22/7166826.html
Topic: Avoid illness on vacation (Read 2579 times)