Food Safety When Traveling

As primary care doctors, we often encounter patients interested in preventive health measures prior to going on vacation. They also often want to know how to treat illnesses they acquired during travel. In our practice, we generally classify travel-related health problems into two categories: Infectious and Non-infectious. Though infectious diseases can be spread through several mechanisms, this article focuses on those that are transmitted through food, known as food-borne illnesses. Food-borne illnesses involve a wide spectrum of conditions, ranging from simple food poisoning and traveler’s diarrhea, to chronic debilitating diseases, including Typhoid, and life-threatening complications, such as Botulism or Guillain-Barré syndrome.

The majority of organisms that cause these conditions fall into three categories: Bacteria, Viruses and Parasites. Bacteria can be either non-invasive or invasive. Non-invasive bacteria cause food poisoning by producing a toxin. The treatment for this is simple hydration, drinking water and other fluids, as the body will rid itself of the toxin by vomiting and diarrhea. Potentially more dangerous, invasive bacteria cause systemic illness including bloody diarrhea, fever and, in some cases, kidney failure. Viruses are commonly responsible for three food-borne illnesses: Diarrhea and Hepatitis A or E. Food or water-related parasite infections typical in travelers include Giardia, Cyclospora and Cryptospora. Parasites can sometimes be detected by examination at a hospital.

Despite the complexity of all possible causes for food-related illnesses, the general principle of prevention is actually quite simple. The following can help you make educated choices in food and drink selection during your travels:

1. Do not drink tap water; drink bottled water only and also use it to brush your teeth.
2. Do not use ice in drinks; ask for drinks in the bottle, without ice. Ice is usually made from local tap water, and freezing does not kill organisms that cause diseases. Thus, ice in drinks is not safe unless made from adequately boiled or filtered water.
3. Alcohol does not sterilize water or ice; mixed drinks may still be contaminated.
4. Do not eat fruits unless they have a peel and you have peeled them yourself.
5. Always wash your hands before eating, and eat with clean utensils instead of your fingers.
6. Outbreaks of diarrheal diseases have been associated with bottled beverages only on rare occasions. However, the presence of carbonation when a bottle is opened (e.g., carbonated water or soft drinks) can reassure the traveler that the drink was processed in a proper fashion and is usually safe.
7. Fruit salad, lettuce, or chicken salad are examples of unwise food choices; the ingredients may have been improperly washed and/or may have been sitting out for some time without proper refrigeration.
8. Steam table buffets are risky as the temperature of the food can promote the growth of bacteria.
9. Condiments left on tables can frequently become contaminated, including salsa, guacamole and ketchup.
10. A simple rule to remember when eating or drinking in developing or tropical countries is “cook it, boil it, peel it, or forget it.”

Before leaving on your journey, consider packing simple health aids. Oral rehydration salt packs are small, lightweight and inexpensive. If you require rehydration, simply pour a sachet into a 500 -1,000 ml of bottled water and drink. A bottle of alcohol gel, such as Purell, may be used to wash your hands before a meal if you have serious concerns over the sanitary conditions of the nearest toilet or its door knob.

The use of antibiotics to prevent illness is not recommended unless the complications of diarrhea or an underlying medical condition make the consequences of dehydration so severe that the benefits of using it outweigh the risks. Prolonged use of antibiotics has numerous potential side effects, including sun sensitivity, allergic reactions, altered intestinal flora with colonization of antibiotic-resistant bacteria, yeast infections and the risk of C. Difficile colitis. An exception can be made for pre-existing diseases which might be exacerbated by food-borne illness.

Can a traveler bring antibiotics in case diarrhea occurs? Yes, however such medications must first require a prescription and it should be clearly understood when to take it and when to seek medical care. In general, antibiotics should be taken if a traveler experiences loose stools more than four times a day, if they develop a fever, or see blood, pus, or mucous in their stool. Medical care should be sought if the fever increases or persists beyond 10 to 14 days, or abdominal pain, bloody diarrhea, or vomiting ensues. Happy travels!

Resources: 

www.cdc.gov/travel/page/diseases.htm
www.nathnac.org/travel/misc/travellers_food.htm
www.who.int/ith/en/