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Food & Water
Contaminated food and drink are
the major sources of stomach or intestinal illness while traveling. Intestinal problems due to poor sanitation
are found in far greater numbers outside the United States and other industrialized nations.
Water
In areas with poor sanitation,
only the following beverages may be safe to drink: boiled water, hot beverages (such as coffee or tea) made
with boiled water, canned or bottled carbonated beverages, beer, and wine. Ice may be made from unsafe water and
should be avoided. It is safer to drink from a can or bottle of beverage than to drink from a container that
was not known to be clean and dry. However, water on the surface of a beverage can or bottle may also be
contaminated. Therefore, the area of a can or bottle that will touch the mouth should be wiped clean and dry. In
areas where water is contaminated, travelers should not brush their teeth with tap water.
Treatment of Water
Boiling is the most reliable
method to make water safe to drink. Bring water to a vigorous boil, and then allow it to cool; do not add ice.
At high altitudes, allow water to boil vigorously for a few minutes or use chemical disinfectants. Adding a pinch
of salt or pouring water from one container to another will improve the taste.
Chemical disinfection can be achieved
with either iodine or chlorine, with iodine providing greater disinfection in a wider set of circumstances. For
disinfection with iodine, use either tincture of iodine or tetraglycine hydroperiodide tablets, such as Globaline®*
and Potable-Aqua®*. These disinfectants can be found in sporting goods stores and pharmacies. Read and follow
the manufacturer’s instructions. If the water is cloudy, then strain it through a clean cloth and double the number
of disinfectant tablets added. If the water is very cold, either warm it or allow increased time for disinfectant
to work.
CDC makes no recommendation as to
the use of any of the portable filters on the market due to lack of independently verified results of their efficacy.
As a last resort, water that is
uncomfortably hot to touch may be safe for drinking and brushing teeth after it is allowed to cool. However, many
disease-causing organisms can survive the usual temperature reached by the hot water in overseas hotels.
Food
Food should be selected
with care. Any raw food could be contaminated, particularly in areas of poor sanitation. Foods of particular concern
include salads, uncooked vegetables and fruit, unpasteurized milk and milk products, raw meat, and shellfish. If
you peel fruit yourself, it is generally safe. Food that has been cooked and is still hot is generally safe.
Infants younger than 6 months should
either be breast-fed or be given powdered commercial formula prepared with boiled water.
Some fish are not guaranteed to
be safe even when cooked because of the presence of toxins in their flesh. Tropical reef fish, red snapper, amber
jack, grouper, and sea bass can occasionally be toxic at unpredictable times if they are caught on tropical reefs
rather than in open ocean. The barracuda and puffer fish are often toxic, and should generally not be eaten. Highest
risk areas include the islands of the West Indies, and the tropical Pacific and Indian Oceans.
Travelers' Diarrhea
The typical symptoms of travelers’ diarrhea (TD) are diarrhea, nausea, bloating, urgency, and malaise. TD usually
lasts from 3 to 7 days. It is rarely life threatening. Areas of high risk include the developing countries of Africa,
the Middle East, and Central America. The risk of infection varies by type of eating establishment the traveler
visits—from low risk in private homes to high risk for food from street vendors.
TD is slightly more common in young
adults than in older people, with no difference between males and females. TD is usually acquired through ingestion
of fecal contaminated food and water.
The best way to prevent TD is by
paying meticulous attention to choice of food and beverage. CDC does not recommend use of antibiotics to prevent
TD because they can cause additional problems.
For treatment, oral fluids should
be administered to sufferers of diarrhea. Fruit juices, soft drinks (preferably without caffeine), and salted crackers
are advised. For severe dehydration, the use of an oral rehydration solution (ORS) is advised (see below). Avoid
dairy products and all beverages that contain water of questionable quality.
Antimicrobial drugs such as doxycycline,
and trimethoprim/sulfamethoxazole (Bactrim®, Septra®), and fluoroquinolones (Cipro®, Noroxin®)
may shorten the length of illness and may especially benefit persons with severe abdominal cramping, fever, and/or
bloody diarrhea. Notably, high levels of resistance in many parts of the developing world to doxycycline and trimethoprim-sulfamethoxazole
now limit the utility of these drugs for persons traveling to such areas. Consult your physician for prescription
and dose schedules. Antidiarrheals, such as Lomotil®* or Immodium®*, can decrease the number of diarrheal
stools, but can cause complication for persons with serious infections.
It is important for the traveler
to consult a physician about treatment of diarrhea in children and infants because some of the drugs mentioned
are not recommended for them. The greatest risk for children, and especially for infants, is dehydration. Prevention
of dehydration through administration of soups, thin porridges, and other safe beverages is advised. Infants with
diarrhea who exhibit signs of mild dehydration, such as thirst and restlessness, should be given an oral rehydration
solution (ORS) to drink. This is a packet of salt and carbohydrates that should be prepared following the package
instructions and using boiled or treated water. It is widely available abroad. If bloody diarrhea, dehydration,
fever in excess of 102° F, or persistent vomiting occurs, seek immediate medical help.
Most episodes of TD resolve in a
few days. As with all diseases it is best to consult a physician rather than attempt self-medication, especially
for pregnant women and children. Travelers should seek medical help if diarrhea is severe, bloody, or does not
resolve within a few days or if it is accompanied by fever and chills or if the traveler is unable to keep fluids
intake up and becomes dehydrated.
*The use of trademarks is for identification only and does not imply an endorsement by the Public Health Service
or the U.S. Department of Health and Human Services.
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