Health Market

Whether traveling to the tropics for business or pleasure, you should be aware of possible dangers including tropical diseases. The following are recommendations to follow in order to avoid contracting a tropical disease.

Be sure to bring this list of recommendations to your doctor when you make your 6-week prior to leaving appointment. Your doctor can go over them and let you know which diseases are active in the area you will be traveling to.

The first step to take is to identify the tropical diseases in the area you will be traveling to. As an example – Yellow fever is a tropical disease found in tropical America south of Panama Canal and sub-Saharan Africa. Currently 11 countries in Latin America and 33 countries in Africa have active cases of yellow fever. Most of the cases of yellow fever occur in sub-Saharan Africa.

Receiving available immunizations is a preventative measure that your doctor can explain to you as well as give to you.

You will need to keep your International Certificate of Vaccination (ICV) in your passport to prove that you have been vaccinated. The vaccine should be administered no later than 10 days before entering an active country for that disease.

Malaria is one of the most common of the tropical diseases and can be contracted in both the rural areas as well as the cities.

Malaria is a highly curable disease if caught early on so detection, diagnosis and early treatment are important.

Here are some tips a traveler needs to follow to avoid malaria:

1. First, take the anti-malarial medication when you are in a risk-free zone

2. Avoid bites by using deet containing insect repellent

3. Wear long-sleeved clothing

4. Do not wear perfumes or colognes

5. Sleep inside in an air-conditioned room or if this is not possible sleep under a good quality mosquito net.

The World Health Organization (WHO) has a policy that states that immunization against Cholera is no longer required for travelers.

Tips for traveling safely in tropical diseased areas:

1. Take antimalarial pills

2. Avoid mosquito bites

3. Use sunblock when traveling to tropical climates to avoid burns as damaged skin can be entry points for disease causing agents.

4. Avoid ice, salads and reheated foods, uncooked shellfish and street vendor food should also be avoided as well as any food that has been left out unattended.

5. If you are traveling to the Caribbean, South America, Africa or the Middle East or

even Southeast Asia then do not swim in fresh water unless you know for sure it is free of biharzia (schistosomiasis)

6. Avoid walking around in bare feet as parasites can be contracted that way. This is actually good advice for any worldwide location not just the tropics.

7. Use condoms when having sex with foreigners and avoid anal-oral sex as this can expose you to diseases including tropical ones.

8. Use either air-conditioning when sleeping or a good quality sleeping net for protection from mosquitoes. It is also wise to spray all window screens with insect repellent.

Use these recommendations and any advice from your doctor and you should be able to prevent any tropical diseases from spoiling your trip.

If you are a celiac, your miracle cure is under way – being trialed in Melbourne Australia from April 2009! It could conceivably desensitize people with celiac disease to the point that the villi in their small intestine are not damaged by the gluten protein. However with the need for extensive testing in this three phase trial, the vaccine may not be ready for release for several years.

Before we go into the details of such a cure it should be noted that this vaccine might not be a ‘magic bullet’ that makes people permanently immune to the gluten protein, it might ‘only’ desensitize them. Also be aware that if you choose to undertake the ‘therapy’ there are no guarantees of how you will react, and the only way to regularly check to see if you have been ‘cured’ would be regular intestine biopsies. As it is known that some people take over two years to heal their intestines from gluten damage, how risky will this strategy be? It is expected that testing will be extensive so these questions may all sit under the ‘devil’s advocate’ category, and all may be well.

An even more philosophical question is what effect covering up the cause of your disease will have on your body. Books have been written that suggest that it is the increased gluten potency in wheat and other gluten grains as well as increased use in manufactured foods that has led to an overdose of gluten. Our bodies then pass a ‘tipping point’ where our genetic predisposition to CD turns into an active disease. If this is true, how wise would it be to continue ingesting unnaturally high levels of gluten, once ‘cured’ just because we can? Sure it would make life simpler not following a gluten free diet, however maybe we should wait for gluten to be decreased at the source, the growing fields, before we return to a gluten filled diet.

Different types of celiac disease identified

With all these issues under consideration, I am sure that every celiac would still be interested in a ‘cure’. A July 2007 article based on research conducted in Victoria, Australia, showed that “Celiac disease – is strongly associated with human leukocyte antigen (HLA) DQ2 and to a lesser extent with HLA DQ8.”

“HLA genes are part of the major histocompatibility complex (MHC), which plays a pivotal role in the immune system. HLA-DQ2 mediated celiac disease is common in people of European ancestry, with about 90 per cent of sufferers positive for DQ2. Another five per cent possess HLA DQ8. In China and East Asia, DQ2 genes are rare while DQ8 genes are as common as in Europe.”

So it appears that this preliminary research has been able to isolate two main versions of celiac disease. However the molecular workings of the immune response in the two antigens appear to be very different. The researchers discovered that T-cells in people with DQ8-associated celiac disease reacted quite differently to the small proteins in gluten than the T-cells in people with the DQ2 form of the disease.

“At the moment a gluten-free diet is the only treatment for celiac disease but nearly half the people on the diet still have damage to their small intestine. Consequently other therapies, including a vaccine and three different drugs, are in various stages of development. The research team believes celiac disease might be the first example of an immune disease where treatments are customized according to the genetic make-up of the patient.”

The celiac vaccine discovery

The discovery that lead to the creation of the vaccine was that the one critical part of wheat gluten protein that was toxic was the common genetic version (HLA DQ2) of celiac disease. “As much as the identity of the toxic component of gluten was important, it was the way in which it was found that has proven to be even more important. By eating gluten in wheat, rye, or barley for three days (even a single meal will suffice in some people), immune cells (T cells) that damage the small intestine are mobilized into blood for a few short days. The T cells in blood can be monitored and analyzed to define what part of gluten they recognize. The parts of gluten recognized by the vast majority of T cells involved in celiac disease can be condensed to a few “short” fragments of gluten that remain after its digestion in the gut. These gluten fragments can be synthesized using fairly standard chemistry and are the basis for the celiac vaccine.”

The Celiac Vaccine Trials

The original research began at Oxford England in 1997. The work continued in Australia in 2002 and by April 2009 Bob Anderson from the Walter and Eliza Hall Institute of Medical research (Melbourne, Australia) will commence the first world trials of a celiac vaccine that could reduce or eradicate the need for being gluten free. In fact Bob Anderson calls the vaccine a “next-generation desensitization therapy” that has been successful in mice and is soon to be tested on celiacs.

“The vaccine will be tested on 40 volunteers with celiac disease over 11 months to establish that it does not harm them. In a subsequent phase 2 trial, which is designed to find out if the treatment is effective, volunteers will receive the treatment and then be challenged with foods containing gluten. Their immune response and intestines will then be examined to see if a tolerance to gluten has developed. The therapy involves repeatedly injecting solutions of gluten at increasing concentrations. The aim is to desensitize the subjects slowly, in a similar way to hay fever and dust allergy desensitization treatments.”

Testing process

“For a new drug to be accepted for use in people in Australia, Europe, or North America it must have progressed successfully from Phase 1 (safety) studies usually involving up to about 30 volunteers, to Phase 2 (efficacy) studies to show that “it works” in people with the medical condition of interest (typically about 200 volunteers in several locations around the world), and to Phase 3 (similar to Phase 2 but involving several thousand volunteers in many sites around the world).”

The celiac vaccine future

Due to difficulties in funding, Bob Anderson (Walter and Eliza Hall Institute) co-founded a commercial company called Nexpep to develop the vaccine. Nucleus Network, Centre for Clinical Studies (CCS) in the Alfred Hospital in Melbourne, will be conducting the Phase 1 clinical trial.

The difficulty he has faced, besides the technical issues, is the low diagnosis level of celiac disease and the mass of associated symptoms has made a vaccine cure unattractive to traditional pharmaceutical companies. These companies always prefer well defined markets to accurately forecast payback periods for their R&D and marketing expenses.

The facts are that for this vaccine to prove financially viable, The US will need to approve the drug and doctors and celiacs will need to accept the treatment. One report estimates that only 600,000 people are diagnosed with celiac disease (out of the 5 million with celiac disease in North America and Europe).  

Compounded to the funding challenges is that previously, globally, there have only been three “randomized, controlled” studies of the gluten free diet – one in children and two in adults – the largest with 57 participants.”

The assessment of the vaccine treatment will require repeated endoscopy and collection of small intestine biopsies which are expensive and un-enjoyable for volunteers. However a recent trial in Italy has shown that biopsies are still the only ‘almost’ guaranteed method of assessing gluten damage. The study findings showed that “two years after adopting a gluten free diet, about half those people diagnosed with cel

iac disease continued to have villous atrophy as severe as when they were first diagnosed. Only about one in five of those with severe intestinal damage (villous atrophy) on a gluten free diet had raised (abnormal) blood levels of transglutaminase antibody, meaning that standard blood tests to monitor disease activity were relatively ineffective.”

So while the development of this vaccine is an important step in potentially eradicating celiac disease, philosophical questions still remain as issues for the long term efficacy of the vaccines. As an Australian first, this research is applauded by the gluten free community. We wish the researchers and medical staff all of the best in demystifying this illusive disease.

Article references are available on the gluten free pages website. 

Level of undiagnosed “Celiac Disease” people in America

One references estimates that “1 in 133 people in the US have celiac disease” It also cites a study that was conducted to “assess the number of undiagnosed cases of celiac disease due to a lack of awareness and inadequate training among primary care physicians. Researchers found that when doctors tested all of their patients with symptoms associated with celiac disease the diagnostic rate increases 32- to 43-fold” (ref 6).

“The projected number of people in the United States with celiac disease could be as high as three million, yet only a small fraction of these cases has been correctly diagnosed and treated”. (ref 6)

Another article written in 2004 suggests that the average time from symptoms to diagnosis in America was ten years. It cites variances in the number of celiacs (diagnosed and undiagnosed) in difference countries – Italy celiac disease is suggested to be as 1 in 250 people, while Ireland only 1 in 300 people. However it is “estimated that only one in 4,700 people in America are actually diagnosed with celiac disease. Yet according to evidence researched by the NIH report, prevalence may be as high as 1 in 105 people!”(ref 7). This would suggest that five years ago that only 2.2% of celiacs were diagnosed in America.

This lower level of diagnosis could be the reason that in a previous articles on the gluten free pages site estimated adjusted celiac searches in America at 2.7 searches per celiac per month – much less than Australia’s value of 4.2.

Level of Diagnosis in Australia

In Australia the celiac society states that 1% of the population has celiac disease. Although they suggest that only 20% of these people have been diagnosed. (ref 1). The Australian Gastroenterology institute states that in Australia the diagnosis level is somewhere between one in 500 to one in 2000 people (ref 4). Taking the higher level of 20% diagnosis, this means that in Australia (population 21,550,000, Jan 2009) that 215,000 people are most likely celiac but 170,000 people don’t know it. Note that gluten intolerant people may increase the amount of people seeking Gluten Free solutions by a factor of three or four times the Total Celiac values.

In December 2008, the top 200 search terms on Google Australia, related to gluten free products was 470,000 searches. With 79% internet usage and 65% Google share, this converts to an estimated 911,000 searches per month. If there are only 35,000 diagnosed celiacs (20% of total celiacs) in Australia this would mean that they perform 26 searches each per month each!

As the 1 in 100 statistic takes into account celiac babies, the elderly and people who do not use the internet (but have access) the number of celiacs actually searching is less than those diagnosed. So the ones that actually search perform an even higher search than the average estimated. But 26 searches per month (or higher) by celiacs is most likely unrealistically high. It is more likely that this number is reduced by the searches performed by gluten free businesses and gluten intolerant people.

At the Melbourne gluten free shown in October 2008 approximately 10,000 people attended over three days. Yet from the above estimates, only about 8,000 people in Melbourne are diagnosed celiacs. Empirically (from our stand at the show) it is likely that family members without CD and ‘gluten intolerant’ people may have made up to 80% of the visitors to the show. If this is the case, then the number of diagnosed celiac people online searches each month should be reduced by about 80% to account for gluten intolerant people and business searches. This reduces diagnosed celiac to 26 x 20% = 5.2 searches per month.

Using Google data estimates the Australian adjusted celiac searches per month at 4.2 searchers per month. When the e-demand of various countries is compared to a country’s ‘GDP per person’ a logarithmic relationship exists between demand and wealth. Higher wealth also most likely being associated with higher diagnosis.

UK level of un-diagnosed Celiac disease

In the GFP Global Matrix article, The UK was estimated to have a celiac search value of 2.2 searches per celiac per month, which while lower than America and Australia is still well ahead of Germany (0.3), France (0.8) and Italy (0.9).

One reference estimates that “at least 1 in 100 people in the UK suffers from celiac disease. However, only 12.5% of people with the disease are actually being correctly diagnosed. Recent research showed that the average length of time taken for someone to be diagnosed with celiac disease from the onset of their symptoms is 13 years. (ref

All of these facts suggest a massive global under-diagnosis of celiac disease. Other original articles on this site suggest that the long term symptoms of this disease greatly distroy the quality of life for those who acquire it. Fast and accurate diagnosis is critical, and if you suspect that you suffer from some of the symptoms, diagnosing or ruling out the disease is vital. Please see our article on Symptoms and our article on Diagnosis options if you believe you may need help. 

For similar articles please visit www.glutenfreepages.com.au

Article by:  Bruce Dwyer – GoLeftfield Marketing