20 Aug 2016

Planning a Healthy Honeymoon

Our minds, thoughts, and actions are preoccupied with our wedding day and honeymoon plans. Countless decisions need to be made before the quickly accelerating time arrives, ready or not! We strive to make these experiences delightful, carefree, and memorable.

While on our honeymoon we plan to forget the cares of the world and focus on each other and our experiences. The following information can help you have peace of mind and body while traveling in many parts of the world.

Increasingly more couples are honeymooning in the developing nations of the world such as Mexico, the Caribbean, Brazil, and Peru.

On average, 30%-50% of travelers to high-risk areas will develop traveler’s diarrhea (TD) during a 1- to 2-week stay. Based on the annual figure of 50 million travelers to developing countries, this estimate translates to approximately 50,000 cases of TD each day.

The most important determinant of risk is travel destination, and there are regional differences in both the risk and etiology of diarrhea. The world map is generally divided into three grades of risk: high, intermediate, and low. (See map 4-11 on this CDC website linkhttp://www.cdc.gov/travel/destinat.htm).

Low-risk countries include:

• The USA, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe.

Intermediate-risk countries include:

• Eastern Europe, South Africa, and some of the Caribbean islands.

High-risk areas include:

• Most of Asia, the Middle East, Africa, and Central and South America.

Some destinations that were previously considered high risk have now been classified as low or intermediate risk, including parts of Southern Europe and some of the Caribbean islands.

There are options to prevent and treat TD. Both sides will be addressed here, but as the old saying goes ‘an ounce of prevention is worth a pound of cure.’ Actually since the price of prevention is cheap and the pain of non-preparedness steep make that a ¼ teaspoon vs. a gallon of water.

Causes:
Bacteria are the most common cause of TD. In studies of etiologic agents at various destinations, bacteria are responsible for approximately 85% of TD cases, parasites about 10%, and viruses 5%.

Prevention
For travelers to high-risk areas, several approaches may be recommended, which can minimize but never completely eliminate the risk of TD. These include:

• Water filters/purification items rated to address microorganisms
• Instruction regarding food and beverage selection
• Over the counter medicines
• Use of prophylactic antibiotics

Water Filters/Purification Items
Products are available to purchase that are effective against the microorganisms in water, while being portable, and reasonably priced. For example, standard sized water bottles with filtering, purification devices sell for around $45-50. The author used one of the Katadyn water bottle products on his vacation to the Inca ruins in Peru. It came in handy; a nice option since bottled water was not always at hand.
Food and Beverage Selection
Care in selecting food and beverages for consumption may minimize the risk for acquiring TD. Travelers should be advised to eat foods that are freshly cooked and served piping hot and to avoid water and beverages diluted with water (reconstituted fruit juices, ice, milk) and foods washed in water, such as salads. Other risky foods include raw or undercooked meat and seafood and raw fruits and vegetables. Safe beverages include those that are bottled and sealed or carbonated. Boiled beverages can also be safely consumed. Studies of TD risk at high-risk destinations show that consumption of food or beverages from street vendors poses a particularly high risk, and some studies suggest certain food items such as reheated prepared foods or buffet items are also high risk.

Although food and water precautions continue to be recommended, travelers may have difficulty following this advice. Furthermore, many of the factors that ensure food safety are out of the traveler’s control.

Over the Counter Medicines
The primary agent other than antimicrobial drugs studied for prevention of TD is bismuth subsalicylate (BSS), which is the active ingredient in Pepto-Bismol. Studies from Mexico have shown this agent (taken as either 2 oz of liquid or two chewable tablets four times per day) to reduce the incidence of TD from 40% to 14%. BSS commonly causes blackening of the tongue and stool and may cause nausea, constipation, and rarely tinnitus. BSS should be avoided by travelers with aspirin allergy, renal insufficiency, and gout and by those taking anticoagulants, probenecid, or methotrexate. In travelers taking aspirin or salicylates for other reasons, the use of BSS may result in salicylate toxicity. Studies have not established the safety of BSS use for periods of greater than 3 weeks.

Prophylactic antibiotics
Prophylactic antibiotics have been demonstrated to be quite effective in the prevention of TD. However, 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 quite effective.

Treatment
Antibiotics are the principal element in the treatment of TD.

Antibiotics
Since bacterial causes of TD far outnumber other microbial etiologies, treatment with an antibiotic directed at the bacteria remains the best therapy for TD. The benefit of treatment of TD with antibiotics has been proven in a number of studies. 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 (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. 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. 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.

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. 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 unless a water filtration/purification method is being used with the water from other sources, i.e. tap, streams.

Summary
Addressing these details concerning food and water will provide us not only the health and strength we need for our honeymoon but also permit us to enjoy our time together. We then return home with good memories and experiences, and only Montezuma will feel left out of the fun.