Infectious Disease: Protection during Overseas Travel
Guest: Dr. Bob Cantey – Infectious Disease, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Bob Cantey, who is Professor of Internal Medicine and an expert in infectious disease. We’re going to be talking, right now, about some of the infectious disease concerns that people have when they come to the MUSC Travel Clinic. Dr. Cantey, if I came to the clinic, what would be some of the first basic questions you would ask?
Dr. Bob Cantey: Well, for me to make a plan to protect you from infectious risk at your destination, I need to know, of course, where you’re going. I would need to know what your itinerary is going to be in that country, whether you’ll be spending your time in the city, in rural areas, whether you’ll be staying at hotels, whether you’ll be staying in, say, a mission setting; which many of our travelers from Charleston do, with families in rural areas. I’ll need to know even such things as the elevation, taking into account insect diseases that you can acquire in these areas.
Once we know the logistics, essentially, of your travel, using a web-based software, we can assess what your risk will be for the variety of diseases you can encounter, offer vaccinations to prevent those diseases that are preventable, and then tell you things that you can do otherwise; beyond vaccines, beyond medications, to help prevent you from getting these diseases, whether they be food-borne, insect-borne, or person-to-person spread.
Dr. Linda Austin: So, let’s take those one by one. You started off with food-borne illnesses. What are some typical examples of those?
Dr. Bob Cantey: The classic situation is so-called Montezuma’s Revenge. At least that’s what it’ called in Mexico. It has other names, some of which we probably wouldn’t want to mention. It consists of watery diarrhea, maybe a little bit of fever. It could go on for a day, or it could go on for your entire visit. And, in fact, untreated, it could go on for several weeks; up to six weeks, after you return. In some countries, you’re almost guaranteed to get it if you don’t have certain food and water practices in mind when you go there.
Water in some places is safe, and some places not. And we would know that somewhat by knowing the country that you’re going to. But, the typical recommendation would be to drink bottled water, or water that you treat, or boil yourself, depending on the country. Some places, you have to be a little careful. There’s an industry in India, for example, entrepreneurs. They buy their own bottling equipment, and unclean water appears to be clean, but it’s not. It’s a nice plastic bottle with a proper cap and labels. So, in some countries, even that can’t be guaranteed. Although, in most instances, if you buy one that you’ve seen in the U.S., it will be okay. Unusual labels will get you. So, even bottled water cannot always be considered safe.
Beyond water, you can forget ice. Ice is very unreliable. And this includes four and five star hotels in Mexico. No matter what they tell you, they cannot guarantee food and water sanitation to the degree that you would expect in the U.S. And, as you know, from recent reports of food problems in the U.S., you can’t even guarantee it here. So, consider how any hotel could do that. So, don’t believe what they tell you. Don’t eat the ice. And don’t think that alcohol or wine is going to sterilize the water, because it’s not.
Dr. Linda Austin: What are some precautions that one can take with food?
Dr. Bob Cantey: Food, it’s a little easier. And I’ve had some person experience with this in Vietnam. You just cannot trust fresh foods. Traveling in third world, underdeveloped, areas is not the place to be eating fresh vegetables that are uncooked. The saying is that if you can peel it, it’s probably okay; if you peel it yourself. And that probably is true. However, if you break open a melon, you can’t rely on that necessarily because those are sold by weight sometimes. With turkey shoots in the U.S. in the early 20th century, the turkey you got home with, after the turkey shoot, was often about 50 percent water, which had been injected before the turkey shoot; you paid by the pound as you left. And they do that with melons, and that kind of product, in many parts of the world to increase the sales value. So, you can forget melons. But, if you can peel it like a banana, it’s probably okay, because it would be hard to inject water into those and not know it.
Then, for cooked food, what we tell people is if it’s hot and steamy when it comes to the table, it’s okay. That’s the only way you can be certain. As a sideline, we’ll tell them not to buy food from vendors in the street. Usually, they don’t keep it hot enough for cooking; well enough for you to be sure it’s okay to eat.
So, bottled water and hot, steaming food, if you can stick to that regimen, you’ll be safe. And then, as a back-up, we usually give a small amount of an antibiotic to take by mouth if diarrhea should occur. If you have it, that antibiotic will stop the diarrhea in one to three days, usually.
Dr. Linda Austin: That certainly is good to know. Now, how about insect-borne diseases? What precautions can one take?
Dr. Bob Cantey: This is equally as important. Depending on where you’re going, some of these diseases are life-threatening. Some don’t come on until after you get back to the U.S. There are many diseases that are insect-borne, but in this setting, you’re concerned about viral infections in particular. Dengue fever, or Break-Bone fever, as it is known, is widespread throughout South America and the Caribbean. It’s mosquito-borne; by mosquitoes that bite all day, and all night.
The second most important would be malaria. It’s mosquito-borne by mosquitoes that bite in the evening and at dawn. So, unfortunately, you, most of the time, have to protect yourself from mosquitoes all day, using mosquito repellant; deet, usually. Thirty percent or higher in concentration would be preferred. And you have to remember that deet has to be reapplied a couple times during the day. Although, there are a couple of products that will make it through the day; a couple of new products that can be applied once a day. Keep your sleeves down and wear long pants, and as much protection you can stand, according to the heat and humidity, to prevent mosquitoes from getting you someplace that you haven’t prepped, or your deet wears off. So, avoid all mosquito contact if you can, by any means you can.
Dr. Linda Austin: It sounds like it’s really important to be scrupulous, as much as possible.
Dr. Bob Cantey: With you food, water, and covering your body.
Dr. Linda Austin: Dr. Cantey, thank you so much.
Dr. Bob Cantey. Thank you.
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