TRAVELER’S DIARRHEA Traveler’s diarrhea is the most common illness that affects those visiting Mexico, which is the highest­risk area for contracting the illness. Travelers can contract it by consuming water and food that has been prepared or handled in unhygienic conditions. The illness is most commonly caused by ingesting food and water contaminated with bacteria, parasites, viruses and toxins. Bacteria, such as E. Coli that releases toxins into the lining of the intestines, is one of the main causes of traveler’s diarrhea. Other causes include viruses and parasites found in food and water that can cause gastroenteritis, known as the stomach flu. Those who consume unpasteurized milk products and raw vegetables are most at risk for getting food poisoning, tuberculosis, amebiasis (a parasitic intestinal infection) and brucellosis (a bacterial infection) associated with traveler’s diarrhea. Travelers who eat raw or undercooked meats are also at a greater risk for getting a tapeworm infection. Travelers can reduce their risk of getting traveler’s diarrhea and other foodborne illnesses by taking the following precautions:

Frequently wash hands with soap and water, especially before eating and using the bathroom. If soap and water are not available, use hand sanitizer (with 70 percent alcohol).

Drink clean bottled or boiled water or carbonated beverages. Avoid tap water, water from natural springs and ice cubes. Use drinking water with mouthwash.

Peel and wash fruits and vegetables with purified drinking water. Be sure that food (meat, seafood and vegetables) is cooked completely through. Consume pasteurized milk. Avoid foods such as cheese, canned food, salami or other cold cuts prepared in

unhygienic conditions. Don’t eat food from street vendors. Avoid consuming foods that have been altered in way including at places that don’t

comply with health regulations. Recommendation: BOIL IT, COOK IT, PEEL IT OR FORGET ABOUT IT. Upon contracting traveler’s diarrhea, follow these guidelines for treatment:

Hydrate: Sip cold liquids to avoid vomiting. Drink mineral water, broth, sports drinks with electrolytes, and tea. Use oral rehydration salts labeled as such by the World Health Organization for those with consecutive bowel movements.

Maintain a diet of liquids bananas, rice, apples or applesauce and toast. In Mexico, noodles, polenta with oil and cheese, gelatin, roasted apple may be more readily available to incorporate into your diet for the first 24 hours. Slowly incorporate grilled, boiled or oven­cooked white meat.

If loose stool continues or fever occurs, take an antidiuretic with loperamide such as Imodium, Imodium A­D or Pepto Diarrhea Control (two tablets with the first bowel movement and continue taking one tablet with each consecutive bowel movement, with a maximum of eight pills per day).

When diarrhea contains mucus, pus or blood or a fever continues, antibiotic treatment is recommended in the form of ciprofloxacin (500 mg every 12 hours for 3­5 days) or azithromycin (500 mg every 24 hours for 1­3 days).

CONSULT A DOCTOR EARLY IF SYMPTOMS PERSIST

Considerations for children with traveler’s diarrhea

Children who travel no matter what age frequently get diarrhea. Preventing diarrhea is important especially in younger children who are more active and susceptible to dehydration. Follow the guidelines below: IN CASE OF DIARRHEA:

1. Be sure to get adequate hydration and balanced diet. Nursing mothers should continue to breastfeed.

1. Don’t give children medications with bismuth subsalicylate, antibiotics or antidiuretics without consulting a doctor.

2. In case of bloody, excessive diarrhea, fever or systemic symptoms, dehydration, vomiting or weakening of the immune system, consult a doctor immediately.

PREVENTION

1. Strict hand washing when preparing food. 2. Use purified drinking water to prepare food and baby formula. 3. Wash pacifiers, bottle nipples and children’s toys that have been on the floor or in

unhygienic conditions. 4. Parents should bring snack food and water for children to avoid purchasing it at

unsanitary places. 5. Give milk time to properly cool. 6. Consume well­cooked meats and other foods.

OTHER FOODBORNE ILLNESSES Typhoid fever and salmonella poisoning In 2003, Mexico’s Office of the Secretary of Health reported 31,790 cases of typhoid fever. The regions most affected were Tabasco, Coahuila, Chiapas and Quintana Roo. Salmonella poisoning caused the illness in 20 percent of the population. The risk of getting Salmonella poisoning varies in different areas of the country. Those most at risk are children around 5 years of age and adults around 60 years of age. Foods such as chicken and eggs are the common cause of salmonella poisoning. The seasonal peak for the illness is from May to August declining in September. The vaccine for typhoid fever is recommended for traveler’s most susceptible to typhoid fever and Salmonella poisoning unless the status if these illnesses changes during the games. Food poisoning by staph infection This condition is most common in the summer months. Between 1993 and 2003, 719 cases of staph infection were reported in Latin America. The enterotoxin produced by these bacteria is heat­stable, therefore it’s very important to consume hygienic foods and to remember to wash your hands before consuming them. Fish and shellfish poisoning Eating fish and other marine animals that have accumulated a certain amount of algae toxins in their skeletal tissues cause this form of poisoning. The most common species that cause this are bacteria attached to algae that certain fish eat. This bacteria causes gastrointestinal, neurological and cardiovascular illnesses. To prevent from ingesting this microorganism, you should avoid consuming fish guts and gonads, where the greatest concentration of toxins can exist, in the following species: piranha, catfish, barracuda, king fish, red snapper sea bass, eel and in some oysters and clams. We recommend you choose smaller fish prepared under hygienic conditions. Gnathostoma infection A gnathostoma infection is a parasitic infection acquired by the consumption of raw meat or undercooked sweet water and saltwater fish. Once ingesting the infected fish, the larvas of the parasitic worms eat through the stomach or esophageal lining and penetrate the liver and later the subcutaneous tissue (a protective layer of tissue that surrounds organs) before it reaches other organs. The larva has been found in fish in 15 Mexican states. Mexicans consume some of them such as bream, salmon, grouper, catfish and bass more frequently. A growing presence has been detected in the Laguna of Tres Palos in Acapulco; Agua Brava in Nayarit; Culiacán in Sinaloa and the Pantanos de Centla in Tabasco among other places. Consume these fish well cooked

because the larvas can’t survive in the heat but are resistant to lemon juice, vinegar and brine. Avoid consuming dishes like ceviche, sushi, sashimi and smofak. Hepatitis E Mexico is one of the countries that presents a high risk of contracting food­borne illnesses for travelers. There is no preventative vaccine.

MALARIA Malaria is a parasitic disease transmitted to humans by infected mosquitoes. Signs of malaria include flu­like symptoms, gastrointestinal upset, fever, fatigue, anemia and jaundice and can be fatal. In Mexico, the greatest risk of contracting malaria lies in rural areas throughout the year. The city of Guadalajara is free of malaria. Travelers are not at risk for contracting malaria in the following areas: the province of Jalisco, the U.S. border, tourist centers of the Caribbean Pacific and Gulf coasts (ie: Acapulco, Ixtapa, Mazatlánn, Cancún, Cozumel, Mérida) and in most archaeological sites. Travelers who limit their time in these areas do not need to take preventative measures. High­risk areas for contracting malaria include the following: the southern region of Oaxaca, including the archaeological site of Palenque and the suburbs of Tapachula and Tuxtla.