PREVENTING TRAVELER’S DIARRHEA, AND OTHER FOOD-BORNE DISEASES

Traveler's often fear food-borne diseases when they travel, and with good reason. The most common affliction is "traveler's diarrhea," which is not actually a specific disease. Diarrhea can have a viral cause, with watery bowel movements four or five times a day, or a bacterial cause, with four or five movements an hour!

In addition, travelers in less sanitized environments than our own can be exposed to hepatitis A, typhoid, cholera, and polio, among others. With this handout we want to highlight was you can prevent your contracting these diseases. While we will be discussing these issues with you at your visit, you might want to read the following articles on the internet in preparation for the visit: Mayo Clinic : Traveler's Diarrhea Info and CDC : Traveler's Diarrhea Info.

Immunization

There is no immunization for either viral or bacterial diarrhea. But happily there are vaccines for hepatitis A, typhoid, and polio. All three of these vaccines are available at Bayside offices.

• Hepatitis A vaccine – one shot now, a second one in 6-18 months. This vaccine confers lifelong immunity and no common side effects. Taking just the first shot will usually be protective for your travel.
• Typhoid vaccine – We generally use the oral vaccine, which is cheaper than and equally effective as the injectable vaccine. We do use the injectable vaccine if your visit is less than 8 days before your departure. This vaccine offers ten years of protection, and has few side effects.
• Polio vaccine – Most everyone has been fully immunized to polio already, but we recommend an additional injectable polio vaccine dose for travelers to Africa or the Indian subcontinent. There are no notable side effects.

Avoidance of hazards

By combining your own common sense with an awareness of risk, overseas travelers can minimize risk of exposure to infectious disease. Your individual risk will depend on your specific type of travel. A short term visitor at first class hotels will run less risk than one who restructures latrine pits for the Peace Corps in a small jungle village! We will consider and discuss your specific risk at your visit.

The single most important thing you can do to protect against gastrointestinal disease when traveling is to watch what you eat and drink.

Here are general guidelines:

• Wash your hands before eating.
• Do not drink tap water.
• Avoid things made with tap water, such as ice cubes.
• Avoid things washed in tap water.
• Don't use tap water in brushing your teeth.
• Don't eat salads or raw vegetables. "If you can't PEEL IT or BOIL IT, FORGET it."
• If you are camping or hiking, use either bottled water, a water filter, or water purification tablets.
• Eat hot foods HOT, eat cold foods COLD.
• Do not eat from street vendors. They are generally unsanitary, and cannot keep hot food hot enough to kill bacteria, nor cold food cold enough to prevent bacterial growth.
• If you are really "off the beaten track," avoid dairy products that may be unpasteurized. Substitute powdered milk mixed with purified water.

Medications

We no longer use antibiotics (such as Cipro) to prevent infections, both because they don’t work and because they increase the development of resistant bacteria. We do sometimes recommend Pepto Bismol tablets, which have some antibacterial activity. Take one tablet before each meal, and one before bed. Pepto Bismol will turn your stools black, so don't panic when you see that!

For viral diarrhea we recommend Imodium, which is an over-the-counter medicine which reduces gut motility and thus decreases the number of stools you have. For bacterial diarrhea we recommend consultation with a physician on site, or self-treatment with Cipro or another appropriate antibiotic. We will discuss these issues with you in our visit.

In any case of diarrhea, we recommend you drink plenty of fluids to prevent dehydration.