We're traveling to Dahab/Red Sea next week and will be taking all of the precautions to prevent Pharoah's Revenge, BUT, if it should happen are you effectively "vaccinated" against recurrence? If so, for how long? Could we throw caution to the wind for the balance of the trip?
Pharaoh's Revenge
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Next week?! :11: Keep checking back for better replies from the medical professionals who post on this forum (I am NOT one), but here is some information that may help you in preparation from our Centers for Disease Control, Travel Advisories: Health Information for Egypt | CDC Travelers' Health
There is an extensive amount of information there, but to address your question...
and
fisherdvm
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I think you can get it irregardless of vaccination. The only vaccine that is worthwhile getting is salmonella, as far as prevention of traveler's diarrhea.
In addition to what Danny posted, I would also avoid eating fresh salad, and even fresh fruit salad. Salads are often used as decoration for your plate also. The only fruit I would eat is if I were to wash it myself, and peeled myself.
Even with proper precaution, and even if you ate only at 5 star hotels and restaurant... It is not always avoidable. Just remember that staffs at even the best restaurants don't always wash their hands. Just remember that studies done in hospitals have shown that doctors were the worst at not washing their hands, and that nurses are much better. I can tell you this from my observations of hand washing techniques observed at meetings. Can you imagine that the cook getting paid 2 bucks an hour will be better?
In addition to what Danny posted, I would also avoid eating fresh salad, and even fresh fruit salad. Salads are often used as decoration for your plate also. The only fruit I would eat is if I were to wash it myself, and peeled myself.
Even with proper precaution, and even if you ate only at 5 star hotels and restaurant... It is not always avoidable. Just remember that staffs at even the best restaurants don't always wash their hands. Just remember that studies done in hospitals have shown that doctors were the worst at not washing their hands, and that nurses are much better. I can tell you this from my observations of hand washing techniques observed at meetings. Can you imagine that the cook getting paid 2 bucks an hour will be better?
fisherdvm
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C. Leigh Culver, a survival expert, summerized the rehydration formulars as followed. I've purchased dry rehydration powder packages (WHO) in most countries I've been in. Gatorade is better than nothing, and you can purchase it in the US:
Rehydration
In most instances of traveler’s diarrhea, dehydration doesn’t become a serious issue; however, rehydration is important. In severe and prolonged diarrhea dehydration may occur very quickly, especially in children.
When experiencing diarrhea, it is also a good idea to avoid drinks with a high glucose or sugar content, such as sodas. Too high a glucose concentration in the stomach will inhibit water absorption and may draw more fluid into the intestine, making the diarrhea worse. Surprisingly, many commercially available sports drinks, which are regularly used for rehydration, actually have glucose contents that are not optimal. A solution with a percentage of glucose around 2.5% is optimal. Many sports drinks have glucose ranges that are 6% or higher. What you can do in this case is dilute them by adding safe water. A very good option, if available, are the oral electrolyte solutions such as Pedialyte. Pedialyte is typically used for children, but anyone can use it.
The World Health Organization (WHO) has an oral rehydration therapy formula that is sometimes available. It contains:
3.5 gms sodium chloride
2.9 gms trisodium citrate dihydrate (or 2.5 gms sodium bicarbonate)
1.5 gms potassium chloride
20 gms glucose (anhydrous)
Dissolve contents of packet in 1 liter (about 4 cups) of safe water.
Recently the WHO has recommend replacing 2.5 gms of sodium bicarbonate with 2.9 gms of trisodium citrate dihydrate. This new formula is supposed to provide for a longer shelf life and is also designed to correct acidosis and reduce stool volume.
Should you find yourself in a situation where oral rehydration is necessary, and your options for finding the above are nil, then you might need to create your own oral rehydration formula. Here are some suggestions:
Oral Rehydration Formula No. 1
One liter (about 4 cups) of water
2-3 tablespoons of honey or sugar
1 teaspoon of salt
This formula lacks bicarbonate and potassium; however, the solution is easy to prepare and will work in a pinch.
Oral Rehydration Formula No. 2
1 cup of orange juice (or other fruit juice)
3 cups of water
1 teaspoon of salt
Oral Rehydration Formula No. 3
1 liter (about 4 cups) of water
2-3 tablespoons of honey or sugar
½ teaspoon of salt or ¼ teaspoon of salt substitute (potassium chloride)
½ tablespoon of baking soda (bicarbonate)
2-3 tablespoons of sugar or honey
This formula is the best option of the three if all of the ingredients are available.
Rehydration
In most instances of traveler’s diarrhea, dehydration doesn’t become a serious issue; however, rehydration is important. In severe and prolonged diarrhea dehydration may occur very quickly, especially in children.
When experiencing diarrhea, it is also a good idea to avoid drinks with a high glucose or sugar content, such as sodas. Too high a glucose concentration in the stomach will inhibit water absorption and may draw more fluid into the intestine, making the diarrhea worse. Surprisingly, many commercially available sports drinks, which are regularly used for rehydration, actually have glucose contents that are not optimal. A solution with a percentage of glucose around 2.5% is optimal. Many sports drinks have glucose ranges that are 6% or higher. What you can do in this case is dilute them by adding safe water. A very good option, if available, are the oral electrolyte solutions such as Pedialyte. Pedialyte is typically used for children, but anyone can use it.
The World Health Organization (WHO) has an oral rehydration therapy formula that is sometimes available. It contains:
3.5 gms sodium chloride
2.9 gms trisodium citrate dihydrate (or 2.5 gms sodium bicarbonate)
1.5 gms potassium chloride
20 gms glucose (anhydrous)
Dissolve contents of packet in 1 liter (about 4 cups) of safe water.
Recently the WHO has recommend replacing 2.5 gms of sodium bicarbonate with 2.9 gms of trisodium citrate dihydrate. This new formula is supposed to provide for a longer shelf life and is also designed to correct acidosis and reduce stool volume.
Should you find yourself in a situation where oral rehydration is necessary, and your options for finding the above are nil, then you might need to create your own oral rehydration formula. Here are some suggestions:
Oral Rehydration Formula No. 1
One liter (about 4 cups) of water
2-3 tablespoons of honey or sugar
1 teaspoon of salt
This formula lacks bicarbonate and potassium; however, the solution is easy to prepare and will work in a pinch.
Oral Rehydration Formula No. 2
1 cup of orange juice (or other fruit juice)
3 cups of water
1 teaspoon of salt
Oral Rehydration Formula No. 3
1 liter (about 4 cups) of water
2-3 tablespoons of honey or sugar
½ teaspoon of salt or ¼ teaspoon of salt substitute (potassium chloride)
½ tablespoon of baking soda (bicarbonate)
2-3 tablespoons of sugar or honey
This formula is the best option of the three if all of the ingredients are available.
fisherdvm
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This is the CDC's comment concerning antibiotic prophylaxis... and also on treatment.
Prophylactic antibiotics have been demonstrated to be quite effective in the prevention of TD. Controlled studies have shown that diarrhea attack rates are reduced from 40% to 4% by the use of antibiotics. The ideal antibiotic is one to which the pathogenic bacteria are sensitive, which has changed over the past few decades as resistance patterns have evolved (16). Agents such as TMP-SMX and doxycycline are no longer considered effective antimicrobial agents against enteric bacterial pathogens. The fluoroquinolones have been the most popular and effective antibiotics for the prophylaxis and treatment of bacterial TD pathogens, but increasing resistance to these agents, initially among Campylobacter species and now among other TD pathogens, may limit their benefit in the future. A newly approved nonabsorbable antibiotic, rifaximin, is being investigated for its potential use in TD prophylaxis (17). At this time prophylactic antibiotics should not be recommended for most travelers. In addition to affording no protection against nonbacterial pathogens, they may also give the traveler a false sense of security, leading to neglect of the food and water precautions that might protect against other enteric diseases. In addition, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers, an unnecessary occurrence, as early self-treatment with antibiotics for established TD is still quite effective.
Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or are taking critical trips during which even a short bout of diarrhea could impact the purpose of their trip.
Treatment
Antibiotics are the principal element in the treatment of TD. Adjunctive agents used for symptomatic control may also be recommended.
ANTIBIOTICS
As bacterial causes of TD far outnumber other microbial etiologies, empiric treatment with an antibiotic directed at enteric bacterial pathogens remains the best therapy for TD (12). The benefit of treatment of TD with antibiotics has been proven in a number of studies. The effectiveness of a particular antimicrobial depends on the etiologic agent and its antibiotic sensitivity. Both as empiric therapy or for treatment of a specific bacterial pathogen, first-line antibiotics include those of the fluoroquinolone class, such as ciprofloxacin or levofloxacin. Increasing microbial resistance to the fluoroquinolones, especially among Campylobacter isolates, may limit their usefulness in some destinations such as Thailand and Nepal. An alternative to the fluoroquinolones in this situation is azithromycin. Rifaximin has been approved for the treatment of TD caused by noninvasive strains of E. coli (17).
The standard treatment regimens consist of 3 days of antibiotic, although when treatment is initiated promptly, shorter courses, including single-dose therapy, may reduce the duration of the illness to a few hours.
NONSPECIFIC AGENTS
Bismuth subsalicylate (BSS or Pepto-Bismol), taken as 1 oz of liquid or two chewable tablets every 30 minutes for eight doses, has been shown to decrease stool frequency and shorten the duration of illness in several placebo-controlled studies (14). This agent has both antisecretory and antimicrobial properties. BSS should be used with caution in travelers on aspirin therapy or anticoagulants or those who have renal insufficiency. In addition, BSS should be avoided in children with viral infections, such as varicella or influenza, because of the risk of Reye syndrome.
Other nonspecific agents, such as kaolin pectin, activated charcoal, and probiotics, have had a limited role in the treatment of TD.
ANTIMOTILITY AGENTS
Antimotility agents provide symptomatic relief and serve as useful adjuncts to antibiotic therapy in TD (12). Synthetic opiates, such as loperamide and diphenoxylate, can reduce bowel movement frequency and enable travelers to resume their activities while awaiting the effects of antibiotics. Loperamide appears to have antisecretory properties as well. These agents should not be used by travelers in diarrheal illness associated with high fever or blood in the stool, rather they should seek medical attention. Loperamide and diphenoxylate are not recommended for children <12 years of age.
ORAL REHYDRATION THERAPY
Fluid and electrolytes are lost in cases of TD, and replenishment is important, especially in young children or adults with chronic medical illness (18). In adult travelers who are otherwise healthy, severe dehydration resulting from TD is unusual unless vomiting is present. Nonetheless, replacement of fluid losses remains an important adjunct to other therapy. Travelers should remember to use only beverages that are sealed or carbonated. For more severe fluid loss, replacement is best accomplished with oral rehydration solutions (ORS), such as World Health Organization ORS solutions, which are widely available at stores and pharmacies in most developing countries. (See Table 4-20 for details.) ORS is prepared by adding one packet to the appropriate volume of boiled or treated water. Once prepared, solutions should be consumed or discarded within 12 hours (24 hours if refrigerated).
TREATMENT OF TD CAUSED BY PROTOZOA
The most common parasitic cause of TD is Giardia intestinalis, and treatment options include metronidazole, tinidazole, and nitazoxanide (10). Although cryptosporidiosis is usually a self-limited illness in immunocompetent persons, nitazox-anide can be considered as a treatment option. Cyclosporiasis is treated with TMP-SMX. Treatment of amebiasis is with metronidazole or tinidazole, followed by treatment with a luminal agent such as iodoquinol or paromomycin.
TREATMENT FOR CHILDREN
Children who accompany their parents on trips to high-risk destinations may be expected to have TD as well (19). There is no reason to withhold antibiotics from children who contract TD. In older children and teenagers, treatment recommendations for TD follow those for adults, with possible adjustments in dose of medication. Macrolides such as azithromycin are considered first-line antibiotic therapy in children, although some experts are using short-course fluoroquinolone therapy with caution for travelers younger than 18 years of age. Rifaximin is approved for use starting at age 12. Loperamide and diphenoxylate are not recommended for children younger than 12 years of age.
Infants and younger children are at higher risk for developing dehydration from TD, which is best prevented by the early use of ORS solutions. Breastfed infants should continue to nurse on demand, and bottle-fed infants should be offered full-strength lactose-free or -reduced formula. Older infants and children should continue their regular diets during the illness (see Chapter 8).
Prophylactic antibiotics have been demonstrated to be quite effective in the prevention of TD. Controlled studies have shown that diarrhea attack rates are reduced from 40% to 4% by the use of antibiotics. The ideal antibiotic is one to which the pathogenic bacteria are sensitive, which has changed over the past few decades as resistance patterns have evolved (16). Agents such as TMP-SMX and doxycycline are no longer considered effective antimicrobial agents against enteric bacterial pathogens. The fluoroquinolones have been the most popular and effective antibiotics for the prophylaxis and treatment of bacterial TD pathogens, but increasing resistance to these agents, initially among Campylobacter species and now among other TD pathogens, may limit their benefit in the future. A newly approved nonabsorbable antibiotic, rifaximin, is being investigated for its potential use in TD prophylaxis (17). At this time prophylactic antibiotics should not be recommended for most travelers. In addition to affording no protection against nonbacterial pathogens, they may also give the traveler a false sense of security, leading to neglect of the food and water precautions that might protect against other enteric diseases. In addition, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers, an unnecessary occurrence, as early self-treatment with antibiotics for established TD is still quite effective.
Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or are taking critical trips during which even a short bout of diarrhea could impact the purpose of their trip.
Treatment
Antibiotics are the principal element in the treatment of TD. Adjunctive agents used for symptomatic control may also be recommended.
ANTIBIOTICS
As bacterial causes of TD far outnumber other microbial etiologies, empiric treatment with an antibiotic directed at enteric bacterial pathogens remains the best therapy for TD (12). The benefit of treatment of TD with antibiotics has been proven in a number of studies. The effectiveness of a particular antimicrobial depends on the etiologic agent and its antibiotic sensitivity. Both as empiric therapy or for treatment of a specific bacterial pathogen, first-line antibiotics include those of the fluoroquinolone class, such as ciprofloxacin or levofloxacin. Increasing microbial resistance to the fluoroquinolones, especially among Campylobacter isolates, may limit their usefulness in some destinations such as Thailand and Nepal. An alternative to the fluoroquinolones in this situation is azithromycin. Rifaximin has been approved for the treatment of TD caused by noninvasive strains of E. coli (17).
The standard treatment regimens consist of 3 days of antibiotic, although when treatment is initiated promptly, shorter courses, including single-dose therapy, may reduce the duration of the illness to a few hours.
NONSPECIFIC AGENTS
Bismuth subsalicylate (BSS or Pepto-Bismol), taken as 1 oz of liquid or two chewable tablets every 30 minutes for eight doses, has been shown to decrease stool frequency and shorten the duration of illness in several placebo-controlled studies (14). This agent has both antisecretory and antimicrobial properties. BSS should be used with caution in travelers on aspirin therapy or anticoagulants or those who have renal insufficiency. In addition, BSS should be avoided in children with viral infections, such as varicella or influenza, because of the risk of Reye syndrome.
Other nonspecific agents, such as kaolin pectin, activated charcoal, and probiotics, have had a limited role in the treatment of TD.
ANTIMOTILITY AGENTS
Antimotility agents provide symptomatic relief and serve as useful adjuncts to antibiotic therapy in TD (12). Synthetic opiates, such as loperamide and diphenoxylate, can reduce bowel movement frequency and enable travelers to resume their activities while awaiting the effects of antibiotics. Loperamide appears to have antisecretory properties as well. These agents should not be used by travelers in diarrheal illness associated with high fever or blood in the stool, rather they should seek medical attention. Loperamide and diphenoxylate are not recommended for children <12 years of age.
ORAL REHYDRATION THERAPY
Fluid and electrolytes are lost in cases of TD, and replenishment is important, especially in young children or adults with chronic medical illness (18). In adult travelers who are otherwise healthy, severe dehydration resulting from TD is unusual unless vomiting is present. Nonetheless, replacement of fluid losses remains an important adjunct to other therapy. Travelers should remember to use only beverages that are sealed or carbonated. For more severe fluid loss, replacement is best accomplished with oral rehydration solutions (ORS), such as World Health Organization ORS solutions, which are widely available at stores and pharmacies in most developing countries. (See Table 4-20 for details.) ORS is prepared by adding one packet to the appropriate volume of boiled or treated water. Once prepared, solutions should be consumed or discarded within 12 hours (24 hours if refrigerated).
TREATMENT OF TD CAUSED BY PROTOZOA
The most common parasitic cause of TD is Giardia intestinalis, and treatment options include metronidazole, tinidazole, and nitazoxanide (10). Although cryptosporidiosis is usually a self-limited illness in immunocompetent persons, nitazox-anide can be considered as a treatment option. Cyclosporiasis is treated with TMP-SMX. Treatment of amebiasis is with metronidazole or tinidazole, followed by treatment with a luminal agent such as iodoquinol or paromomycin.
TREATMENT FOR CHILDREN
Children who accompany their parents on trips to high-risk destinations may be expected to have TD as well (19). There is no reason to withhold antibiotics from children who contract TD. In older children and teenagers, treatment recommendations for TD follow those for adults, with possible adjustments in dose of medication. Macrolides such as azithromycin are considered first-line antibiotic therapy in children, although some experts are using short-course fluoroquinolone therapy with caution for travelers younger than 18 years of age. Rifaximin is approved for use starting at age 12. Loperamide and diphenoxylate are not recommended for children younger than 12 years of age.
Infants and younger children are at higher risk for developing dehydration from TD, which is best prevented by the early use of ORS solutions. Breastfed infants should continue to nurse on demand, and bottle-fed infants should be offered full-strength lactose-free or -reduced formula. Older infants and children should continue their regular diets during the illness (see Chapter 8).
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Fisherdvm has given you extensive answers
but to address you question as to whether you can afford to be less careful if you survive an initial bout with food poisoning there: Nope! The pathogens you're guarding against are very basic organisms with a wide variety of populations in the wild I am sure, so you could incur infections from different strains at different times. In addition to avoiding fruit that you didn't peel yourself, I think I'd add raw fruits grown at ground level like tomatoes and especially watermelon. I suspect they can become contaminated deeper than just on the skins. I think I'd probly stick with...- well cooked foods served very warm, with tree fruits you peel yourself - like bananas - as potassium replacement is important;
- bottle drinks with which you break the seal yourself - after inspecting the seal;
- pickled foods as vinegar seems to be a good preservative; and
- washing your hands with the alcohol based hand sterilizer before eating - and if you smoke, don't light up while your hands are still moist from that.
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fisherdvm
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Chlorox bleach or iodine tablets can kill most agents of dysentaria (except for parasites, protozoas like amoeba, etc).
When I was in the army, the preventative medicine guy goes around testing the water buffalos (tanks) for chlorine level. Apparently, sabotages have been taken place by folks putting feces in the tanks.
Soaking fresh salad in such solution as iodine and bleach is not fail safe, as the small cracks and crevices can harbor dried fecal material. And also parasites can not be irridicated.
"Whether you use Clorox Bleach in an emergency or for everyday chores, it's always an environmentally sound choice. After its work is done, Clorox Bleach breaks down to little more than salt and water, which is good news anytime.
*Ratio of Clorox Bleach to Water for Purification
2 drops of Regular Clorox Bleach per quart of water
8 drops of Regular Clorox Bleach per gallon of water
1/2 teaspoon Regular Clorox Bleach per five gallons of water
If water is cloudy, double the recommended dosages of Clorox Bleach.
(Only use Regular Clorox Bleach (not Fresh Scent or Lemon Fresh). To insure that Clorox Bleach is at its full strength, replace your storage bottle every three months.) "
When I was in the army, the preventative medicine guy goes around testing the water buffalos (tanks) for chlorine level. Apparently, sabotages have been taken place by folks putting feces in the tanks.
Soaking fresh salad in such solution as iodine and bleach is not fail safe, as the small cracks and crevices can harbor dried fecal material. And also parasites can not be irridicated.
"Whether you use Clorox Bleach in an emergency or for everyday chores, it's always an environmentally sound choice. After its work is done, Clorox Bleach breaks down to little more than salt and water, which is good news anytime.
*Ratio of Clorox Bleach to Water for Purification
2 drops of Regular Clorox Bleach per quart of water
8 drops of Regular Clorox Bleach per gallon of water
1/2 teaspoon Regular Clorox Bleach per five gallons of water
If water is cloudy, double the recommended dosages of Clorox Bleach.
(Only use Regular Clorox Bleach (not Fresh Scent or Lemon Fresh). To insure that Clorox Bleach is at its full strength, replace your storage bottle every three months.) "
-Phoenix-
Registered
You shouldnt just take antibiotics to prevent illness when on vacation. Many antibiotics have diarrhea as side effect.
Besides, the most common way of getting ill from food isnt from the bacteria but from the cytokines. (If bacteria bug you, you will get sick the day after while usually the puking and illness after a few hours comes from the cytokines).
Hope this helps a bit.
Yours,
Rob
Besides, the most common way of getting ill from food isnt from the bacteria but from the cytokines. (If bacteria bug you, you will get sick the day after while usually the puking and illness after a few hours comes from the cytokines).
Hope this helps a bit.
Yours,
Rob
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