How long until I develop immunity to stomach flu / travelers' disease?
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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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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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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