I happened upon a conversation the other day between a GP and a patient – the patient was heading to remote lands and was interested in what precautions and / or vaccinations would be required.
Now, the GP was a practical chap and was able to describe (in some detail) what the risks were for various ailments and what impact said diseases would have on the patient. All were dismissed as being remote possibilities or low risk. All, that is, except for the mythical (if you haven’t had it) and terrifying (if you have): “Delhi belly”. That, he claimed, was almost a dead certain and was something that would certainly impact on travel plans and enjoyment. The subtext was that sometimes it is better to stay at home.
This got me scratching my head. If it is certain that the so-called travellers diarrhoea or Montezuma’s revenge (there are many euphemisms for the runs) is going to afflict you on your journey why do we travel? And, equally is this actually a travellers phenomenon only associated with developing nations?
- There are differences between nations It also begs the question … how do food handling practices differ between nations? In the US, where the population hovers around the 326 million mark, the cost of foodborne illness each year is estimated to be $15.6 billion with 1 in 6 people getting ill each year (which is much worse than the global rate of 1 in 10 people). In India, population 1.339 billion, the cost of foodborne illness is estimated by the World Bank to be around $28 billion and, according to the World Health Organisation somewhere between 1 in 9-12 people get sick each year. There are obviously differences in food, health and reporting systems between the two countries. However, the risk for a tourist is supposedly greater in India than it is in the US yet the rate of illness in the US is considerably higher.
Travellers’ diarrhoea is a stomach and intestinal infection; the reason it afflicts travellers more than locals is that locals have often developed a natural immunity to the pathogens that cause us to double over or be confined to our hostels. It is said to affect 20-50% of people traveling to developing countries and to pass (sorry, bad pun) without too much long-term effect. The difficulty, of course, is the fact that you are traveling and don’t have access to the normal medical support that you would expect in your home country.
- You can take precautions So, is it something to be feared? No, but it is something to understand and to take sensible precautions. The golden rule of not eating anything washed in tap / local water is a good one – including things such as watermelon or cantaloupe that may have been washed and then cut (the cutting can transfer bacteria from the outside of the fruit to the flesh). Drinking bottled water and good handwashing / hygiene are a good foundation to safe travel (and of course, good handwashing and hygiene should not be limited to only when you are traveling). It is also often recommended that you venture into the unknown with appropriate medications. To be forewarned is to be forearmed.
the potential for foodborne illness is present everywhere
It is easy to dismiss travellers’ diarrhoea as something that afflicts only those travelling in developing nations and to use it as a reason to avoid those countries. I take a different approach – the potential for foodborne illness is present everywhere and the precautions required to avoid it are fairly universal. What does differ is the extent of our local knowledge (where has a good reputation, where to avoid etc) and our ability to be independent with food (cook or prepare foods ourselves).
- It’s not all land based: the cruisers’ curse There are some occasions when it is not possible to self-cater; on cruise ships, for example. Norovirus, the word you don’t want to hear while cruising the seven seas, is highly contagious and spread through contaminated food or water. It is also possible to become infected through proximity to an infected person. Which means that when it strikes a cruise ship if often makes the headlines as cruises are often cut-short and passengers are quarantined. Projectile vomiting and diarrhoea are not desirable on the high seas and in cramped environments. While the symptoms usually last for 1-3 days (and onset happens 12-48 hours after exposure) recovery can be difficult for some people (particularly the very young or old and those with underlying illnesses).
The risk of contracting norovirus is considerably greater on land
Reports from the CDC show that around 10-15 cruises a year suffer from an infectious outbreak and while these are often well publicised the risk of contracting norovirus is considerably greater on land – especially in crowded environments such as schools, hospitals, and old-folks homes.
Foodborne Illness happens everywhere The upshot is… it actually doesn’t matter where you holiday this coming holiday season – without the correct precautions for food safety you are exposed to risk of foodborne illness. While the likelihood may increase in places where sanitation is more challenging (back street food markets, for example) the risk is always present whenever food is served.
That being said, I think if I am going to be holed up unwell in bed I would prefer it was my own and not while confined to a cabin on a rollicking sea.
As was Published in the NZ Herald on 9th of March 2020 https://www.nzherald.co.nz/travel/how-to-avoid-delhi-belly-and-other-illnesses-on-holiday/THD7QPXNVWJPCAJXLJRQG25P7U