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.
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.
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.
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 manufacturers
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.
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 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.
younger than 6 months should either be breast-fed or be given
powdered commercial formula prepared with boiled water.
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 (see the Destinations section).
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 (Central, East, North,
Southern, and West), the Middle East, and Central America. The
risk of infection varies by type of eating establishment the
traveler visitsfrom 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.
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.
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
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.
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.