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Staying Healthy While Vacationing: Avoiding Montezuma and All His Wrath

(October 2001)

Traveling can do a number on your body. Standing in long lines, running to catch a bus, or breathing in recycled airplane air—all this puts your immune system to the test. However, most travelers dread one particular malady more than others, and most will suffer its wrath at some point in their travels. Montezuma's Revenge, Delhi Belly, Malta Dog: no other illness has been described in such colorful terms as travelers' diarrhea (TD). We have learned to joke about it, but no one laughs for real when TD takes up several days of an expensive vacation.

For many years, this ailment was attributed to too much sun, change in routine, spicy foods, etc. However, we now know that TD is a result of a failure in sanitation, leading to bacterial contamination of food or water. The affliction can affect up to 50 percent of travelers visiting high-risk areas. The Center for Disease Control (CDC) in Atlanta estimates that over 80 percent of the time, TD is caused by bacteria such as salmonella, shigella, e. coli, campylobacer, and staphylococcus. Besides being an unpleasant experience or even ruining a long-planned vacation, it can, in some cases, lead to serious medical complications if dehydration occurs.

The following tips are recommended to reduce the risk of acquiring this unwelcome travel souvenir.

  • Avoid ice and all tap water, even to brush your teeth. (Exception: ice cubes with holes like a donut are made with heated water and are considered safe.) When selecting beverages, choose ones that are bottled and preferably carbonated. Carbonation is an indicator that the beverage has been bottled at a plant and is not simply rebottled, local tap water. If carbonated beverages are not available, choose bottled beverages that are sealed.

  • Don't drink non-pasteurized milk. In some parts of the world, milk is diluted with local water (which may be impure). In addition, fruit juices might be reconstituted with local water, making them unfit for consumption.

  • Don't eat raw or undercooked shellfish

  • Avoid foods washed in water, such as leafy, uncooked vegetables. Any food washed in water might harbor residual bacteria or parasites and could therefore cause diarrhea.

  • Fruit that can be peeled with clean hands should be safe for eating.

  • Foods that are freshly cooked and served piping hot are safest. Cooking kills bacteria. Avoid buffets unless you can be sure the food has not been sitting out for a long time.

  • Avoid roadside stands and street vendors. There is a notoriously high risk of TD associated with food from these sources.

  • When in doubt, heed the old saying, "Boil it, cook it, peel it - or forget it."
By following these measures, travelers can minimize the risk of TD; unfortunately, the risk never can be completely eliminated.

Fortunately, if you do suffer, it is possible to treat yourself. The key is to keep hydrated. Dehydration can be serious, especially for infants, children, and the elderly. To avoid dehydration, drink plenty of non-alcoholic fluid (if you are passing plenty of pale-colored urine, you are well hydrated; if there's not much of it, and it's a dark color, you need to drink more). Eat what you can, but avoid dairy products.

Many people try to stop diarrhea as soon as it develops. Diarrhea is the body's way of getting rid of whatever food, virus, or bug that is causing it. If you are staying in one place for a few days, it's best to let nature take its course. However, that's not always possible, especially if you are touring. Try one of the over-the-counter anti-diarrheal medicines such as Kaopectate®, Pepto-Bismol®, or Imodium AD®, which can slow down diarrhea and enable you to resume normal activities sooner. Just follow the instructions on the label. These medications coat the stomach and intestinal linings, which may block absorption of prescription drugs rendering them ineffective. Children, anyone with a medical condition, and anyone taking prescription medication should seek their doctor's advice before taking these remedies. Caution should be used when giving bismuth subsalicylate (the active ingredient in Pepto-Bismol®) type medications to children due to a potential risk of Reye's syndrome.

Unfortunately, there are no vaccines that are effective against TD. There are prescription medications your doctor can prescribe to help fight off TD; however, they are not for everyone because of possible side effects. Nonetheless, there have been controlled studies showing that bismuth subsalicylate does decrease the incidence of diarrhea by about 60 percent. Apparently, bismuth subsalicylate coats the lining of the stomach, which in turn can help block bacterial absorption. I can personally vouch for this approach. After consulting my doctor, I've found that taking Pepto-Bismol® tablets a few days before going on a trip really does help. This held true last year on our family vacation to Mexico; I was the only one in my family not to get TD.

For More Information:

Center for Disease Control (CDC): Provides important information on destination-specific health risks. You can also call them at 877-FYI-TRIP.

highway to health (HTH): A service that helps customers get and pay for medical care when they're traveling. Customers pay an annual membership fee, which is valid for any trips taken that year. This service also provides non-members with phone numbers for emergency assistance, hospitals, and clinics for more than 500 cities.

U.S. State Department Medical Information for Americans Traveling Abroad: Helps locate appropriate medical services for U.S. citizens traveling abroad. You can call their 24-hour Overseas Citizen Services at 202-647-5225.

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