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Health News: A Vaccine May Prevent Travelers’ Diarrhea

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It is the fear and the scourge of travelers into the Third World. People have to eat and may even enjoy eating. However, the ever-present fear of travelers’ diarrhea in places like Mexico and Guatemala as well as Africa and Asia could be controlled by a vaccine according to the Johns Hopkins Bloomberg School of Public Health.

Napo Pharmaceuticals is ready to launch “the first Third World blockbuster drug”. This newly discovered chemical from a traditional medicinal plant could provide a new way to protect the millions of children in the poorer parts of the world from an ailment that kills more than one million children each year. The company is also testing to see if it will help people with irritable bowel syndrome. Besides offering hope for many, it is the first time a drug company has targeted the poor in its expensive search for a new drug.

Fittingly, this medication was found with the help of indigenous people in South America who use”… the bark of the South American tree croton lechleri, which is known by locals as dragon’s blood because a machete to its bark brings a blood-like ooze.” Some helps them with the affliction. Too much makes the sufferer sicker. Research isolated the molecule so that it can be offered in larger, more effective doses.

As a resident and traveler in Mexico where food contamination continues to be a major problem, I offer some important tips to keep you safe while traveling here and in other developing nations. These same tips should also be considered in the US which is not immune from food-borne illnesses and is now importing many foods from other countries.

First, eat cooked foods in restaurants. Ceviche and other raw foods are dangerous. Where possible, eat foods that have been peeled. When you prepare your own foods, disinfect them with an iodine solution or a diluted amount of chlorine. Remember that expensive restaurants are not necessarily more careful even though the table may be set better. Do, however, look for general cleanliness. Dirty floors and tables indicate a lack of concern that may be mirrored in the kitchen. Street food is best avoided everywhere, no matter how tempting the smells. Except, perhaps, for something like hot chestnuts in Central Park. They are cooked and peeled and served very hot. I miss them.

In Mexico Microdyne is the brand name of the leading disinfectant and is found in supermarkets and farmacias all over the country.

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Cloro or chlorine bleach is also available in almost every small and large store. Even Clorox is available in Mexico. Avoid the perfumed versions. Microdyne has instructions on it with pictures. Submerge foods for 10 minutes in a solution of 8 drops per liter of water (I prefer using purified water). This can also be used for utensils and preparation surfaces. Treat water with one drop per liter and let stand 15 minutes. It is not necessary to rinse but, if you do, please use purified water for the rinse as well. It can also be applied to cuts and bites in an emergency.

Chlorine bleach requires 2 drops per liter of water and a 15 minute wait. Foods need 10 drops per liter with a 5 minute wait. My bottle of Cloralex says there is no need to rinse but a medical professional in the US who originally suggested it for all foods there said that bleach should be rinsed.

When you find an explanation for travelers’ diarrhea that says it is only because you are not used to the food, ate too many chiles or drank too much, smile and continue being careful. If it goes on to tell you that putting lime juice on foods will disinfect them, go right ahead. It tastes good and you get lots of vitamin C. It does not disinfect.

The C.D.C. offers a website with a separate page on water treatment. When it comes to travelers’ diarrhea, they offer a map of risk zones and this statement:

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).

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Low-risk countries include the USA, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe. Intermediate-risk countries include those in 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. On average, 30%-50% of travelers to high-risk areas will develop 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. In more temperate regions, there may be seasonal variations in diarrhea risk. In South Asia, for example, during the hot months preceding the monsoon, much higher TD attack rates are commonly reported.

The Mayo Clinic offers this more precise set of rules to prevent the disease group:

Watch what you eat. The general rule of thumb is this: Boil it, cook it, peel it or forget it. Unfortunately, most travelers don’t stick to these guidelines 100 percent of the time. Remember these tips:
* Don’t buy food from street vendors.
* Avoid unpasteurized milk and dairy products, including ice cream.
* Avoid raw or undercooked meat, fish and shellfish.
* Steer clear of moist food at room temperature, such as sauces and buffet offerings.
* Eat foods that are well cooked and served hot.
* Munch on dry foods — like breads — and high-sugar-content foods, such as jellies and syrups.
* Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and unpeelable fruits, such as grapes and berries.
Don’t drink the water.
When visiting high-risk countries, keep the following tips in mind:
* Avoid unsterilized water — from tap, well or stream. If you need to consume local water, boil it for five to ten minutes.
* Avoid ice cubes or fruit juices made with tap water.
* Beware of sliced fruit that may have been washed in contaminated water.
* Don’t swim in water that may be contaminated.
* Keep your mouth closed while showering.
* Feel free to drink canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
* Use bottled water to brush your teeth.
* Use bottled or boiled water to mix baby formula.
* Order hot beverages, such as coffee or tea, and make sure they’re steaming hot.

“The Poop On Diarrhea Vaccine” was distributed on Wired News RSS .

The study by Johns Hopkins was based on a “rigorous test” on U.S. students in Mexico and Guatemala.

Traveler’s diarrhea is the leading cause of illness among visitors to developing countries, striking an estimated 20 million international travelers a year. While there are numerous causes, the chief culprit is bacteria called enterotoxigenic E. coli, or ETEC. It is spread through contaminated food and water, and while rarely life threatening to the otherwise healthy traveler, it can cause up to a week of misery.

The drug was found accidentally while testing a cholera drug in Bangladesh. It also seems to help fight E coli infection. 1406 students studying Spanish were given the drug or a placebo. The study showed an 84% success rate in blocking severe infection and 63% effectiveness in blocking mild cases. It was considered safe enough to send to the students by mail.

The head of defunct Napo Pharmaceuticals which planned to be a “bioprospecting” company during the ’90s, Lisa Conte, wanted to search the rainforest and other natural sources for effective plants which could then be developed as FDA approved medications (remember Sean Connery in Medicine Man?). The company went bankrupt from the costs of FDA testing. She returned with Shaman Pharmaceuticals and has made a deal with an Indian company to develop and market “Crofelemer as a pediatric and acute infectious diarrhea treatment.” There is a similar program in China.

Indigenous people “led us to a situation where we could make and improve a pharmaceutical product as far as safety and efficacy and get it back to the population that provided the information,” Conte said.

Kristen Philipkoski originally published the story of this new drug from the resurrected company on Wired.com in July.

Is all this important? If you have traveled and suffered the ill-effects of the ailment — you better believe it. This article is also found on my new blog, Health Reports.

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