Three major risks of island trips: infections, allergies, and drowning

　　Recently, the news of an 8-year-old boy from Beijing who died after being stung by a jellyfish while playing at Nandaihe has drawn widespread attention. It is reported that jellyfish stings frequently occur at beaches such as Beidaihe and Lianyungang. The number of jellyfish sting patients treated at Beidaihe People's Hospital has increased three to four times compared to last year’s entire summer season, and has now exceeded one thousand.

　　With the summer vacation nearing its end, "island enthusiasts" are still seizing the opportunity to travel to islands. However, many people are still not well-informed about the potential risks of island trips and how to handle emergencies. Experts in emergency medicine remind that the three most important risks to guard against during island trips are infections, allergies, and drowning.

　　Mr. Zhou, a 35-year-old travel enthusiast, took his son and family to visit Taiwan’s islands during this summer vacation. While diving, the ankle of his foot was accidentally scratched by coral. After getting ashore, Mr. Zhou checked the wound and thought it wasn’t too deep. Based on his extensive travel experience, he believed it wouldn’t be a big issue, so he simply covered the wound with a band-aid. However, in the middle of the night, Mr. Zhou began to feel unbearable pain in his entire leg and took a painkiller. When he woke up the next day, he found that the injured foot had swollen up completely, and a large blood blister had formed on the wound. He quickly sought treatment at a local clinic in Taiwan, where the doctor immediately said, “This is not a minor issue. It is very likely an infection with Vibrio vulnificus, causing necrotizing fasciitis. It cannot be delayed and requires immediate debridement treatment.”

　　Mr. Zhou said he was fortunate to have sought treatment at a local hospital early, and he recovered after just a few debridement procedures and antibiotic treatments. “I heard from the local doctor that they often treat cases of injuries caused by marine organisms, among which necrotizing fasciitis is the most common. Severe cases may even require fasciotomy or even amputation,” Mr. Zhou said. Just before his case, local media reported that a 70-year-old woman cut her foot while picking up shells by the sea. She developed a fever, nausea, vomiting, and swelling in her calf after returning home... She was diagnosed with a Vibrio vulnificus infection after being hospitalized and was admitted to the ICU. Eventually, she refused amputation and passed away 48 hours later.

　　It is reported that in Taiwan and eastern coastal cities in China, hospitals often admit cases of necrotizing fasciitis caused by trauma during the peak summer island travel season. Liang Zijing, Director of the Emergency Department at the First Affiliated Hospital of Guangzhou Medical University, said that necrotizing fasciitis is a soft tissue infection characterized by widespread and rapid necrosis of subcutaneous tissue and fascia, often accompanied by systemic toxic shock. It is mainly caused by bacterial infections.

　　Liang Zijing said that the beautiful and mysterious marine organisms actually harbor great dangers. Injuries caused by them, sometimes seemingly just a minor wound, can turn into amputations or even death within a few hours. Liang Zijing summarized that marine organisms can mainly cause the following two types of harm to humans:

　　1. Toxins. Marine organisms carry a variety of toxins, which can cause anything from numbness and pain to life-threatening cardiac and hemolytic toxicity. Some organisms may not be highly toxic but can still cause allergies.

　　2. Bacterial infections. These often lead to complications such as cellulitis and necrotizing fasciitis, resulting in tissue infections. Common bacteria include Streptococcus pyogenes, Staphylococcus aureus, and Vibrio vulnificus. “Among these, infections caused by Vibrio vulnificus are the most aggressive. The patient’s condition often deteriorates rapidly within a few hours—from redness and swelling of the wound to ulceration, and may even lead to septicemia and death.”

　　It is worth noting that Vibrio vulnificus can infect not only through skin wounds but also through the digestive tract. And almost all marine organisms carry these bacteria. “So seafood must be thoroughly cooked, and try to avoid eating it raw.”

　　Expert reminders:
　　Seek medical attention promptly if a wound from a marine organism becomes red and swollen

　　Liang Zijing reminds that once you are bitten, scratched, or punctured by marine organisms or plants at the beach, you must closely monitor the wound for changes. If redness and swelling occur, you should highly suspect necrotizing fasciitis and go to the hospital immediately without delay. “Generally, very few people would go to the hospital for a small wound, but if that wound becomes red and swollen, you must not take it lightly. Because if it is necrotizing fasciitis, by the time the wound develops from redness and swelling to small or even large blisters, the limb may already be infected, making treatment more difficult.”

　　It is understood that the fatality rate of necrotizing fasciitis caused by Vibrio vulnificus infection can be as high as 50%, and the disease progresses rapidly, requiring repeated surgical debridement, fasciotomy, antibiotics, hyperbaric oxygen, and other treatments.

　　In addition, when visiting islands, the public should wear appropriate footwear, and it is best to wear a wetsuit and dive shoes while diving to avoid skin abrasions. Do not provoke marine organisms. People with compromised immunity, such as diabetics, those undergoing chemotherapy, or those with liver dysfunction, should avoid activities involving contact with seawater. If you have any wounds on your body, do not go into the water.

　　It is understood that cases of fatal risks due to Vibrio vulnificus encountered in the sea are rare in Guangzhou, but skin allergies caused by touching certain organisms or plants in the sea are quite common.

　　Mr. Liu, a 40-year-old man, recently traveled to the Maldives with his wife. They stayed in an overwater villa at a luxury resort, where they could dive straight into the sea. However, during one of their snorkeling sessions, Mr. Liu wrapped his legs around a wooden post underwater in order to take an underwater photo. Mr. Liu also remembered that the wooden post had a lot of green, slippery things on it, resembling moss or algae. The next day, his thighs and calves, which had been in contact with the post, were covered with dense red rashes and blisters, and similar symptoms soon appeared on the rest of his body. Fortunately, Mr. Liu returned to Guangzhou that same day. He was diagnosed with allergic dermatitis and had to take anti-allergy medication and apply ointment for a whole week before the rashes completely subsided.

　　Sun exposure at the beach: Nine-day trip to Thailand causes skin bumps

　　Not long ago, Ms. Lu, an “island enthusiast,” happily went on a vacation to Thailand with her best friend. For nine days, the island scenery with blue skies, white clouds, clear water, and fine sand was very pleasant. However, towards the end of the trip, her entire body broke out in bumps that were red and itchy—even though she had previously suffered from solar urticaria.

　　“I actually took full sun protection measures. I applied plenty of sunscreen, and I wore long-sleeved shirts and pants when going out. I never expected to still get hit,” Ms. Lu said. She knew she had solar urticaria, but she always thought that as long as she took protective measures, nothing would happen. “I can only say the sunlight at the beach is too strong.”

　　“Various factors in the marine environment can cause discomfort for people with allergic constitutions. Those who are prone to allergies must be cautious when traveling to islands,” said Wang Zhengwei, Director of the Emergency Department at the Third Affiliated Hospital of Guangzhou Medical University. Strong sunlight can easily cause problems for sensitive skin, and some people may still have issues even if they apply sunscreen and wear long pants and long-sleeved shirts. “If exposed for too long, there is also a risk of skin cancer.”

　　He said that the osmotic pressure of seawater is relatively high, and the bacteria and substances in seawater are very different from those in freshwater, all of which may cause allergies. "In addition, even sea breeze can be an allergen."

　　Drowning
　　Typical case: A Beijing girl drowned while snorkeling in Saipan

　　In April this year, Beijing tourist Ma Rong traveled to Saipan with three classmates on a group tour. During free time, she decided to pay for a snorkeling trip on her own. She ended up drowning and was sent to a local hospital, where she was pronounced dead.

　　According to media reports, in 2011, at least six Chinese tourists drowned in the Maldives, several of whom were snorkeling at the time.

　　Expert: Never go into the water alone

　　Wang Zhengwei said that whether you're scuba diving or snorkeling, you must follow the buddy system outlined in diving regulations—never go into the water alone. Also, going into the water right after eating can cause food to back up into the throat and block the airway; drinking alcohol before entering the water causes the body to contract immediately, leading to tracheal spasms. Diving is also not suitable for people with cardiovascular diseases such as heart disease or high blood pressure.

　　"The danger in the sea that differs from other marine creatures is the harm caused by sea snakes," Wang Zhengwei said, because if you're bitten by a venomous sea snake, the toxin can enter the bloodstream and nervous system, with serious consequences.

　　Wang Zhengwei reminded that if you're bitten by a sea snake, since you can't be sure whether the snake is venomous, you shouldn't take it lightly to avoid serious outcomes.

　　"The treatment for sea snake bites follows two principles: use a tourniquet to stop bleeding and squeeze out the blood from the wound," he said. "The blood from the wound must be squeezed out to prevent the toxin from seeping into the body. We sometimes see on TV people sucking the venom out of a bite with their mouth. This can be used in emergencies, but only if the rescuer has no open wounds in their mouth, otherwise it could cause infection.

　　Also, when using a tourniquet to stop bleeding, make sure to tie it about 15 centimeters above the wound, but loosen it every 15 minutes or so—not for too long, otherwise it may lead to limb necrosis.

　　Many “foodies” who are keen on island trips come just to feast on seafood, but overindulging can lead to diarrhea.

　　Wang Zhengwei said that people who don’t usually eat much seafood should avoid overeating it when by the sea. First, seafood is high in protein, and eating too much can burden the body, leading to indigestion and diarrhea. In addition, seafood may be contaminated by bacteria during the selling process, and eating large amounts can also easily cause diarrhea. "So even if you want to eat it, it’s best to eat cooked seafood."

　　Diving activities on island trips are also a major draw for “island enthusiasts,” because whether it's snorkeling or scuba diving, the underwater world you can see is truly amazing.

　　"Going diving in the sea, especially scuba diving, requires extra caution," Wang Zhengwei said. When you’re at the bottom of the sea, the pressure increases, and many people can't handle it. Therefore, those with respiratory or lung conditions may experience bleeding in the respiratory tract or coughing up blood. Also, if water is accidentally inhaled and not expelled in time, it can obstruct lung function and cause breathing difficulties. In addition, those with otitis media or ear canal infections should also be wary of discomfort caused by diving.

　　Also, people with wounds on their bodies should avoid diving, because the seabed breeds various types of bacteria, and exposure of wounds to seawater can easily lead to infection.