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Dr Duncan

Gastroenteritis

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The long hot summer continues and with it has come an increase in the amount of ‘gastro’ in the community.

Gastro-enteritis literally means inflammation of the Gastro-enteric tube (AKA the intestines or the gut tube) and is often caused at this time of year by eating poorly prepared or incorrectly stored food, or by drinking contaminated water. As most infections are started by faecal/oral contamination, then it’s obvious that good personal hygiene is imperative: in other words always wash your hands effectively after using the toilet and especially before preparing or handling any foodstuffs.

The causes of gastro are nearly always either viral or bacterial in origin, and there are lots of those germs out there. In the viral camp are the Noroviruses. These are particularly hardy organisms and can survive extremes of temperature, can survive on surfaces for extended periods of time - including the skin - and are highly contagious too. They are the usual suspect in outbreaks in nursing homes, day care centres and cruise ships. Currently, the Norovirus is not a notifiable disease which means that accurate figures for the numbers of people infected are hard to come by but according to the Victorian Health Dept, the numbers of outbreaks are increasing.

The Rotavirus has in the past been a major cause of gastro in children worldwide, and has caused the deaths of tens of thousands of children who were already suffering from malnutrition. Thankfully there is now a vaccine against this particular virus and the number of infections caused by it here in Australia has been dropping since its introduction.

Another success story has been the incidence of Hepatitis A in our Indigenous communities. Since the introduction of targeted immunisation programs, the number of cases has fallen to just one in 2010.

The other major class of infective organisms that cause gastroenteritis are bacteria, and there are a number of organisms in this group that continue to cause severe illnesses and hospitalisation. Campylobacter continues to be the most frequently notified cause of gastro under surveillance here in Australia, despite not being notifiable in New South Wales. The number of annual notifications has fluctuated between 14,000 and 17,000 annually over the past 10 years. It’s the commonest cause of food born infections and in 30% of those cases poultry has been found to be the common link.

And whilst on the subject of chickens, eggs are another common factor in the spread of another bacterial cause of gastro, but this time the organism is Salmonella - not the typhoid variety, but a close cousin of it. And it’s not just the consumption of the eggs themselves that may lead to an infection, but foods such as desserts which are commonly made with raw eggs, and would include chocolate mousse, tiramisu, sauces (mayonnaise, aioli), milkshakes and cake mixture

So how does all this start to increase at this time of year?

School lunch boxes are often prepared early in the day and can sit in school bags for prolonged periods before they are eaten in places where the ambient temperature can reach 36 degrees. Chicken and egg products are a common finding in school lunch boxes and are a frequent breeding ground for gastro germs. Also, in school canteens, strict care must be taken with not only re-heated foods, but also with fruits such as melon and pre-prepared fruit salads. Even though they are stored at low temperatures, they can still provide ideal conditions for the growth of another Gastro causing bacteria - Listeria.

Backyard pools of all shapes and sizes, especially those small inflatable ones, have the potential to be turned into a wonderful soup of bacteria if not checked once or twice daily. Be very aware that little children are not always as hygienic as adults and there is a real risk of faecal/oral spread, resulting in diorrhoea and vomiting. The same goes for pets in pools - it’s not a good mix at any time of year.

For those travelling overseas, it’s always well worth a visit to your GP to discuss the possible infections you may be exposed to and take appropriate precautions. The three preventable gastro infections most commonly associated with travel overseas are Typhoid (97% of cases), Hepatitis A (55% of cases) and Salmonella (88% of cases). There are effective vaccinations against all of these but the immunisation program does need to be started some months before your departure. So plan early and reduce your risks.

What to do?

For those infections where there is a known vaccine then get immunised: especially when traveling overseas.

Good personal hygiene is essential in all situations. And that means not only EFFECTIVE HAND WASHING but also being aware of what you put in your mouth - forks, spoons, and drinking utensils.

Should you get gastro, then the major challenge to the system is fluid loss, and with that fluid loss comes electrolyte loss too - especially the salts sodium and potassium - which leaves you feeling weak and washed out. So water replacement is vital. And do make sure that the water is safe water and add appropriate electrolytes/salts to it to help replaced those “down the pan”.

Various over the counter medications for the symptomatic relief of abdominal cramps can be purchased at most pharmacies (but please check with the pharmacist if you are taking any other medications or have any other health issues).

If the gastro persists longer than 48 hours or if the symptoms are getting worse, then call your doctor or visit your local after hours doctor or go straight to the Emergency Department.

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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