One of the joys (?) of foreign travel is an illness known as traveler’s diarrhea, AKA Montezuma’s revenge or the trots.

You arrive in your hotel, and a few days later, get cramps and diarrhea that lasts a few days. Usually you aren’t too sick, and often you don’t have blood in the diarrhea or a fever (both signs of serious infection), so you grab your diarrhea medicine and your bottled water, go to bed, and figure your vacation is now a waste of money.

But once in awhile, people get so sick that they end up in a local hospital.

There are several reasons one gets this diarrhea, including Salmonella (as was found on the surface of tomatoes causing a minor epidemic in the US), Campylobacter, Amoebas (E. Histolytica and Giardia) and viruses. But the cause of most mild cases is a germ called E.Coli, AKA Escherichia Coli.

Now, E.Coli is a common germ that lives in everyone’s large intestines, and is often found on the skin of the perineum (i.e. under the underpants area). Ordinary E.Coli, for example, is a common cause of urinary tract infection when it migrates into the bladder and sometimes up to the kidney or prostate gland. It can also cause pneumonia and skin infections, especially in the old, the young, and people with poor immune systems (HIV, malnutrition, alcoholism, old age, infants).

But most people live with the germ without any problem, and one of the reasons we docs don’t like to give unnecessary antibiotics to people is that it kills off some of the E Coli, and later if you get an infection with it, the germ can’t be killed with ordinary antibiotics.

Some E Coli, however, are BAD GERMS. LINK. These “black sheep” of the E.Coli family include the ones that kill you if they get into hamburger and you don’t cook it enough,and it includes the germs that cause most of the common diarrhea in travelers.

The way it does this is the germ produces a toxin.

So now, a British medical journal The Lancet reports that a vaccine patch used a few weeks prior to going on vacation might prevent or cause less serious symptoms for travelers. In the Phase II part of the study, only 2% of travelers got severe diarrhea, as compared to 11 percent of those who were given placebo; for moderate diarrhea the numbers were 5% versus 21%.

So it works, not perfectly but fairly well.

The other interesting part about the vaccine is that it uses a patch rather than an injection.

There has been lots of research into giving vaccines so that people don’t need to be injected, both because people avoid “shots”.

Scientists are also working on a patch to stop influenza.

The diarrhea patch, however, is only phase II: Next step, a larger trial with a lot more people, which checks for rare side effects. So don’t expect it to be on the market for a couple of years.

So if you are traveling, just remember: Wash your hands, no fruit or salad, drink only bottled water, bottled beer/softdrinks, or HOT tea/coffee.

Yes, there are antibiotics to take that lower your risk of getting traveler’s diarrhea, but they have side effects and few doctors advise taking them to prevent diarrhea, although taking antibiotics when you get sick might shorten how long you are sick.

The CDC has advice on it’s website for travelers, reminding them to check where they are going for malaria, rabies and other dangers.

When you travel, carry your usual medicines, and don’t forget the ordinary things for ordinary illnesses: colds, cuts, blisters, and constipation (!).

And if you plan to drive, don’t forget to buckle your seatbelts.

I was once in a rollover in rural Africa, and we all made it out alive because I nagged the driver and the passengers to buckle their seatbelts.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket.

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