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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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