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I was in Nepal two years ago and got the stomach flu. Last time I was only in Kathmandu and Pokhara and didn't do any trekking, so it was not critical, although it was very unpleasant.

Two years later, now, I am in Nepal again. I thought surely I would have developed some kind of immunity.

I was proven wrong when I reached Annapurna base camp and got the stomach flu there. Needless to say the next days trekking down where a pure nightmare.

When I got back in Kathmandu, feeling better, I got another version of the stomach flu again.

Can I expect to develop immunity against these diseases? I am planning on doing the Everest base camp expedition in another two years, but am now having doubts if this is a good idea. I really am not mentally prepared to walk sick for days like that again.

How do other people deal with this kind of problem? I had anti diarrhoea meds with me, but they did absolutely nothing for me.

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    Total layman here: Why should you develop an immunity when at home? I went traveling to Madagascar (probably some of the worst hygiene anywhere) and even after more than a month I immediately caught something when I ate food from roadside stalls. The friend I was with was working there since a year, and she got used to some stuff, but still didn't eat everything. What you really want to be thinking about is how to reduce the chance to pick something up. What you eat is an important part, but hand hygiene also plays a big role and is often neglected. – imsodin Oct 19 '17 at 13:47
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    I was thinkink that you develop immunity when you get sick and the body produces anti bodys or something like that. Hygiene is good, but since you have to wash yourself with water which is undrinkable I am not sure you can protect yourself 100%. On the mountain there are also no choices when it comes to food. – user1721135 Oct 19 '17 at 14:01
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    This is more a medical question. – paparazzo Oct 19 '17 at 14:38
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    "stomach flu" can be caused by a wide variety of pathogens. it is quite possible that you have now some resistance against two or three specific instances (and maybe can keep for some months or even years, but low-level exposure is key for some pathogens to keep immunity). there are probably a couple hundred to go.... – knitti Oct 19 '17 at 15:05
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    I think it is OK on TGO because the problem is acute while trekking. He also points out that he doesn't have choices when it comes to food while trekking. Presumably he could stay and eat all his meals in one of the better hotels in Kathmandu and avoid most of the problem. OTOH, he may receive more good advice on Travel. – ab2 Oct 20 '17 at 0:11
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I think it's highly unlikely that you will develop immunity with the long gaps between your trips and the large range of infectious agents you might be faced with.

The only practical solution is iron discipline around personal hygiene, food and water. Here's the approach I use - it's worked well for me.

  • The problems often start on the flight, where food can be stored at blood-heat for hours. I always take the veggie option - less chance of picking up a bug.

  • Always carry an effective filter, and always filter water. Don't trust bottled water or soda from down-market outlets - it's often fake and filled from the local river. In restaurants, always insist that bottled water is served with the seal unbroken.

  • Don't take ice in your drinks

  • Don't eat salads or unpeeled fruits

  • Disinfect your hands after toileting and before you eat. Be very wary of eating food handled by your companions - they may not be as careful as you are. Studies in the US have found that many issues on the trail are due to cross-infection from poor hygiene rather than to infected water.

  • Be wary of street food and of accepting hospitality from anyone who might have drawn their water from an unsafe supply.

I only relax these rules in upmarket hotels and restaurants, and even then I'm careful. The worst experience I've had was when a group of us ate in a fancy salad-bar in Mumbai. It was popular with local Westerners so we thought it would be OK, but boy were we wrong...

All this might seem killjoy, but the alternatives are not pleasant as you have discovered. And it can be worse - you can also pick up hep or even cholera.

On my first trip to Asia I was studying with the great yogi B K S Iyengar. He spotted me buying street food and pointed out very forcefully that I was being an idiot as I simply wouldn't have the immunity to get away with it. The lesson stuck.

In my experience people who try to be cool and go native inevitably end up getting ill - sometimes very ill. So be uncool and stay safe.

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  • Thanks. That's not very easy for me as I know a lot of people in Nepal and get invited to lots of homes. Maybe I should start my next trip on the mountain instead of spending time in the city first. – user1721135 Oct 21 '17 at 12:30
  • I am also starting to consider vaccines. It seems e coli is the main culprit in Asia. – user1721135 Oct 21 '17 at 12:32
  • You should be safe enough eating cooked food from friends with a piped water supply - just ask them to please boil any water they use as you don't have immunity. If they are real friends they should understand and not be insulted. It's when I'm invited into urban hutments or rural huts that I'm careful, as they often have to rely on poor water supplies and it's hard to know if their hygiene is OK. The same with roadside tea-stalls, street vendors and the like. It's just not worth the risk. – Tullochgorum Oct 21 '17 at 17:31
  • From what I have seen most natives in Nepal already only drink and cook with bottled / processed water. The piped water seems not to be drinkable in most cases. – user1721135 Oct 22 '17 at 6:20
  • @user1721135 : Visit a travel Doctor and order up all the vaccinations they recommend for the area you are visiting . Diptheria, Rabies, Hepatitis, Typhoid, Tetanus and Tuberculosis are all of concern in Nepal. – user5330 Oct 23 '17 at 20:22
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The answer from @Tullochgorum gave you excellent advice from a person with experience trekking in Asia. I don't have any experience in Asia outside major cities, nor am I an MD, but I think a few caveats are in order.

(1) If I were you, I'd not only go to a travel clinic, but see a specialist on GI disorders. You may be especially sensitive; what works for most people may not be enough for you. One thought: did your extreme reaction occur on your first trip, or did you have a few trouble-free trips at first? Do you have more problems than you'd like even at home (e.g., sickness with weakness and/or dehydration)? Whatever the answers to these questions, I advise seeing a specialist, because of caveat #2.

(2) There are many strains of e-coli, of which some Asian strains are really, really not nice, and are also highly resistant to antibiotics. See, for example, this very recent article from the LA Times. There are many other articles along this line, which come up when you Google for e-coli strains or drug resistant e-coli.

(3) As several comments mentioned, developing immunity naturally to every bug that could cause you trouble in Asia isn't going to happen, or will happen only after a lot of suffering on your part.

(4) You mention getting a vaccine. Again, I am not an MD or a biologist, but see my Point 2. Even one of the most common vaccines (flu, and that is a viral, not a bacterial disease) protects only against some strains. Not even the HPV vaccine protects against all strains of HPV. This is another reason to:

See a specialist! (Some doctors might want to follow up with you after the trip, especially if they've prescribed medication.)

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    Thank you for your answer, I will definitely consult my doc next time I see her. I indeed talked to her before my current trip because of my son (8 months old), but she said there are no additional vaccines necessary for him. When I am home I am never sick, never have any GI problems or even diarrhoea or anything like that. Maybe exhaustion and altitude contributed to my first round of the flu, because I got it on the evening we reached base camp. Second time my wife ate some street food and got sick, two days later I got sick as well. I also got sick like that on my first trip. This is my 2. – user1721135 Oct 22 '17 at 6:28
  • @user1721135, Since certain conditions can be due/aggravated by stress you have to be sure to distinguish that from anything caused by a bacteria, Things can overlap, or maybe in one case was a bacteria and in another it wasnt... Even sensitivities and allergies to certain foods can be things you want to be sure of... – Erik vanDoren Oct 23 '17 at 12:39

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