Worried about food poisoning on holidays? Rest easy with My Emergency Dr

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So you have been hanging out for that break away, work has been hectic and you are looking forward just to have time, your time, to do things at your pace or do nothing at all.

What happens however when you get on that holiday and you or a family member gets sick? It’s not always easy to know where to go or who to call. Should we use the local emergency department? Where can I get medical advice that I can trust?  With good internet access and My Emergency Dr on your smartphone, you can access specialist medical assessment within minutes, wherever you are in the world. (Asterisk here: only for Aussies OS and for travellers within Australia)

Unfortunately when on holiday, illness sometimes occurs. It take many forms: food poisoning is the commonest, followed by accidental injury from holiday activities or even what has been termed“ holiday heart syndrome”.  MED Blog  has some tips to help you reduce the likelihood of illness when away.

Studies from overseas show that 50% of travellers returning to Europe and North America from the tropics experience health problems related to their travel and that 8% consult doctors either abroad or on return. Figures are not available for Australian travellers but are probably similar. Over the last decade Australian travellers increasingly visit tropical and developing countries and hence can now present with infections that are rare in Australia.  For those heading to such countries, a visit to your GP beforehand is essential to receive the recommended vaccines for the region where the holiday is based, and other medication such as antimalarials. The need for travel insurance is also highly recommended.

Let’s look at the common illnesses and any preventive measures that can reduce their frequency.

 

Food Poisoning
This is the number 1 cause of holiday sickness and is caused by eating contaminated food. It can range in its presentation from mild stomach cramps to life threatening severe gastrointestinal losses from diarrhoea and/or vomiting.  In 2015 the World Health Organisation (WHO) compiled a report on foodborne illness and concluded that 550 million people a year develop a diarrhoeal illness. They noted that most foodborne diseases are preventable through good standard food hygiene, improvements in sanitation and risk assessments by food preparation staff.

While on holiday you may be unfamiliar with the hygiene standards of many of the restaurant’s kitchens that you visit. It can be hard for you to know if your food has been reheated, stored at the correct temperature or even left open for pests to contaminate.

So what can you do to reduce your risks?
– check your food is cooked through properly
– avoid drinks with ice and be careful with the local tap water
– avoid salads and any uncooked fruit and vegetables  that may have been handled unhygienically (this is more applicable to overseas destinations)
– wash your hands frequently before and after meal times and after using bathroom
– frequently use alcohol-based hand gel

 

How good are the alcohol-based hand gels?
The Centre for Disease Control (CDC) Guidelines for Hand Hygiene recommend alcohol based gels over washing your hands with soap and water!  This is because they are often more accessible, they kill many more germs and also are less drying to the skin. However if your hands are visibly dirty (eg soil contamination) then a soap-and-water wash is superior.

 

How good is soap and water?
As discussed above soap and water manages to remove visible dirt as alcohol based gels cannot degrade organic materials. It is important to ensure that your hands are washed adequately with soap and water if it is to be effective. The CDC recommends washing your hands thoroughly for at least 15 seconds ( if you don’t have a timer this is equivalent to singing “Happy Birthday” twice).

 

How do you treat food poisoning?
Oral Rehydration Therapy
irrespective of the cause or type of food poisoning, the most important treatment is to replace the excessive salt and water losses that occur.. Fluid and electrolyte replacement is key to preventing dehydration and worsening of a patient’s medical state. At its most extreme, acute kidney injury and even death can occur.

A number of oral rehydration therapies are available and providing they have the correct proportion of sugar and salt, they allow adequate rehydration. It is important to give oral fluids in small volumes to prevent stomach distension and reflex vomiting. They readily available over the counter at the local pharmacy. If you are not near to a pharmacy a homemade oral rehydration can suffice: 5 cups of sterile (eg boiled) water, 6 level teaspoons of sugar, half a teaspoon of salt mixed until all is dissolved.

Reduce exposure to agents that can exacerbate diarrhoea:
Magnesium supplements, antibiotics, sorbitol containing foods and drinks (often found in artificial sweeteners), alcohol and antibiotics.

Medications: Antidiarrhoeal Agents
If diarrhoea is persistent, medications can be used in adults to help reduce the frequency eg Loperamide. This drug slows the gut down a dose of 4mg is given to slow the diarrhoea down and a further dose may be required a few hours later if it returns.

Furthermore if severe cramping abdominal pains occur, Hyoscine (eg ‘Buscopan’) is an antispasmodic agent that sometimes helps reduce the pains severity. There are certain conditions where buscopan cannot be used eg glaucoma, myasthenia gravis and certain heart arrhythmias.

 

What organisms cause food poisoning?
From the WHO global report the infective agents that cause diarrhoea include 5 types of bacteria, 1 virus, 3 protozoa and 10 parasitic worms. In Australia the commonest causes are:

  • Bacteria: Campylobacter, Eshcerichia Coli, Salmonella, Listeria
  • Viruses: Norovirus, Norwalk virus
  • Protozoa: Giardia, cryptosporidium, amoeba

 

Campylobacter is one of the commonest causes of holiday sickness in Australia and abroad. Symptoms include vomiting and diarrhoea (often blood stained), stomach cramps, fever, muscle aches and headaches. It occurs when food is prepared in an unhygienic manner and is classically spread by food being left to cool in environments such as Hotel buffet areas. Campylobacter can incubate for between 2 and 10 days after the contaminated food has been eaten.

Warning
If diarrhoea is ongoing beyond a few days or if bloody and associated with a fever then medical attention should be sought. Furthermore young children and the elderly are much more susceptible to the ill effects of severe diarrhoea and acute dehydration should seek medical attention sooner.

 

Ear Infections: Swimmers Ear
On holidays we frequently swim daily and hence increase our susceptibility to a condition called swimmer’s ear. Swimmer’s ear is infection of the outer ear canal often brought on by ear remaining in your ear canal thereby providing a moist warm environment for bacteria to flourish. It is not contagious. Prompt treatment of this can prevent more severe infection and complications. It may start as itching in your ear canal and mild irritation.  When it progresses it becomes more itchy, more painful, hearing may become muffled, redness may be noted around the ear canal, a discharge may develop as may  fever.

Risk Factors: Swimming in water with elevated bacteria levels: a lake, some swimming pools if not regularly cleaned, a  narrow ear canal, aggressive cleaning of the ear canal with cotton buds, irritation from devices such as headphones or hearing aids.

Treatment: topical eg drops with antibiotics are often required plu additional preventive measures to stop recurrence eg getting rid of ear plugs that may be a potential source of reinfection

Prevention of Swimmer’s Ear
-Tip your head to the side and empty your ear canal of water after swimming
– some pliable ear plugs providing they fit your ear canal and keep it dry can be used, but ensure to change these regularly
– Avoid putting cotton wool or any materials into your ear canal

 

Accidents abroad

It is often on holiday that thrill-seeking behaviour is indulged. Skiing, water sports, horse riding, moped riding all seem more enticing when we are away and hence accidents are more likely to occur on holiday. Sadly accidents can occur on something even more trivial such as slipping on the edge of the swimming pool. Preventive measures seem obvious here and in retrospect we often wish we hadn’t indulged. It is in this situation that a My Emergency Dr specialist can asses whether you need to go to an emergency department, go to a radiology practice for an Xray or manage with simple measures such as ice pack and elevation.

 

“Holiday Heart Syndrome”

This term has been coined for the increased incidence of heart irregularities that occur when individuals are on holiday. It was first described in the 1970s when doctors noticed an increase incidence of heart rhythm abnormalities following public holidays and holidays. These patients were apparently healthy with no prior heart history but following binge drinking noticed a racing heart, shortness of breath and sometimes chest pain.

It mainly associated with what are known as supraventricular heart arrhythmias, with atrial fibrillation being the most common cardiac arrhythmia in this syndrome. However, other less frequent types of arrhythmias can also occur such as atrial flutter and extra ectopic heart beats. If these heart arrhythmias persist there is a potential risk of stroke and hence any symptoms should be investigated.

Holiday heart syndrome can occur in both regular and non-regular drinkers. It can occur due to excess alcohol but also is associated with some electrolyte  (salt abnormalities) or when someone has undiagnosed thyroid disease. It is more prevalent in the middle aged and elderly when on holiday. It would appear that while all alcohol leads to structural changes to the heart over time. One study has suggested that beer is more likely to cause rhythm disturbances than wine.

Prevention: Once the symptoms described occur, abstinence is the best treatment or at least avoidance of binge drinking. Chronic drinkers tend to drink more on their holidays and hence A patient should have a complete cardiac work up if these symptoms occur and hence see either their Gp or if unwell present to an emergency department.

In the elderly traveller forgetting your heart medication or forgetting to bring your medication can also make you heart more vulnerable to the effects of alcohol. Telehealth can allow you access to an urgent prescription if you have forgotten to pack you medications.

 

Summary

In summary, illness can occur when we are away on holidays sometimes for reasons out of our control but also may be as a result of our risk taking behaviour.  In the event sickness does occur, My Emergency Dr can provide you with the reassuring comfort of an Australian Specialist in Emergency Medicine to assess whether you can stay and be treated in your holiday home or need to attend the local emergency department.

 

References:

https://www.cdc.gov/handhygiene/patients/index.html

http://www.gastrohep.com/conreports/bangkok/JGHS3.pdf

https://www.mja.com.au/system/files/issues/181_10_151104/ell10338_fm.pdf

http://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/dxc-20201445

https://www.cdc.gov/healthywater/pdf/swimming/resources/pseudomonas-factsheet_swimmers_ear.pdf

Alcohol and Risk of Atrial Fibrillation : A Prospective Study and Dose Response Meta analysis https://www.ncbi.nlm.nih.gov/pubmed/25034065

Holiday Heart Syndrome Revisited after 34 years. Arq,Bras cardiol 2013: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998158/

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