Travel-Related Illness: Montezuma's Revenge (cont.)

MEMBER QUESTION:
We'd like to take a cruise in the Caribbean, but hear reports of outbreaks of illness on ships. What is making people sick on these cruises? Can we avoid it? Would you take a cruise?

DUPONT:
Terrific questions. The chance of getting sick on a cruise is very small. Yes, I would take a cruise, and do take cruises. One suggestion, if you are worried about it, is to contact the cruise line and ask if a problem occurred in the recent past on that particular ship.

The problem on cruises is that a virus called Norwalk virus is spread between people onboard. It is hard to get it out of a boat once it's there. The bottom line, safe boats are safe and Norwalk-infested boats present a recurrent problem. If you are going to take a trip on a boat that has had a problem, my suggestion would be to load up on Pepto-Bismol, which appears to be useful in treating this virus infection.

MEMBER QUESTION:
Do smaller cruises with fewer people tend to be safer from outbreaks of viruses or food poisoning?

DUPONT:
I think in general smaller boats are going to have less of a problem, but the boats we were just talking about were large ships. When I say small, I'm talking 10 to 20 people. There's no reason to think a boat with 300 is any safer than 1500 people. I think when you have a larger number of employees and the need to bring water and food in from ports you're running the risk of these outbreaks.

I might also add that Norwalk virus that causes this problem does not cause serious illness, and this is really pretty trivial. Although no one feels that a 12- or 18-hour illness is trivial, it's not life threatening. I think we need to put it into proper context. It's pretty mild.

MEMBER QUESTION:
When we travel (usually islands in the Caribbean) we love to try the little out-of-the-way places where the locals eat. The food is amazing. We don't bother much with the hotels where the American tourists eat. Are we at any greater risk for illness by eating as the locals do? This is a fun part of travel for us. We are thinking of stretching our wings and exploring Asia. How about what we eat there?

DUPONT:
The risk of getting diarrhea in the Caribbean is island specific. If you're going to the U.S. Virgin Islands it's like going to New York or Dallas. If you go to Jamaica and some of the other less hygienic areas the chance of getting diarrhea when you eat at out of the way places is between 15 and 20 percent of cases, much lower than we see in countries like Mexico. You're running a slight risk by eating anywhere you wish if it's in an island like Jamaica, Dominican Republic, or Haiti.

In Asia, the traveler's diarrhea resembles more that of Mexico, in that the rate of illness approaches 40 percent. Here I would be more careful about the food that was consumed. You can eat at out of the way places if you eat the safe foods that I earlier outlined.

MEMBER QUESTION:
My wife and I recently returned from Cancun and she contracted diarrhea that hasn't seemed to resolve. Do you have any idea why this might be?

DUPONT:
Yes. There are several possibilities. If the diarrhea has only been lasting for a week or two it is likely to be an infectious agent that can be treated with an antibiotic. If it has lasted more than a month an infectious agent probably will not be identified and I would recommend being evaluated by a gastroenterologist.

In this latter category we have found, in our studies, that approximately 10 percent of patients experiencing travelers diarrhea develop a condition known as irritable bowel syndrome, or IBS. Unfortunately this can last for months to years, and it's the most important reason why we want to prevent this illness from occurring in the first place.

MEMBER QUESTION:
My husband has diabetes. What precautions should we take before traveling to Europe (Spain, France and Italy)?

DUPONT:
There are a couple of issues here. One is to make sure that the proper insulin products are taken with you and put into two different separate places in case one is lost.

The other problem is the change in duration of days. When we go from the US to Europe the day is 6 to 7 hours shorter; it could be even longer if you come from the West Coast. Insulin adjustments for diabetes is critical, and the best advice is to stay on your time in the U.S. with regard to eating and insulin usage, and slowly adjust once you get into the local area and try to re-equilibrate with insulin dosages. It's tricky, and probably is something that your husband should work out with his doctor.

MEMBER QUESTION:
I have MS and have to take 15 days of shots (Copaxone) along. Does MS lower your resistance to infections?

DUPONT:
MS, by itself, and the treatment that's being taken should be okay for travel as long as the neurologic issues are sufficiently stable. I'm not particularly worried about increased risk of infection. Any increased risk of infection based on the presence of MS (such as a urinary tract infection) would not be a travel issue, but is an MS issue. In other words, these complications would occur with travel or with staying home.