Food and Water Precautions
Introduction
In areas of the world where sanitation and hygiene are of a poor quality, food and drinking water can become contaminated with harmful organisms (living creatures including bacteria and viruses) or toxins (poisonous substances) if it has not been hygienically produced, prepared or stored safely. Eating or drinking contaminated food and water can cause you to become unwell.
There are lots of illnesses that are caused by eating and drinking unsafe food and water such as hepatitis A, typhoid, giardia or more commonly travellers' diarrhoea which can cause symptoms such as a high temperature (fever), diarrhoea or vomiting, and sometimes dehydration. You can also become unwell from swallowing unsafe water when swimming, brushing your teeth or using the shower.
Infections of the skin, ears or eyes might occur from using swimming pools, hot tubs, water playgrounds or spas where the water has not been properly treated with chemicals. Therefore, is important to know how to protect yourself from food and water-borne illnesses during travel abroad.
Risk during travel
Illnesses caused by food and water are most common in countries that have low levels of hygiene and sanitation. Older people, pregnant women, young children, those with conditions affecting their immune system, and those on certain medications to reduce stomach acid are at a higher risk of developing complications from food and water-borne illnesses.
You should check with your GP or specialist if you think you might be at increased risk of developing complications and find out if there are any additional precautions you might need to take during your travel.
Your risk of developing travellers’ diarrhoea and other food and water-borne illnesses can be reduced if you practice good general hygiene, food hygiene and water hygiene precautions.
Before travel
Arranging a consultation with a travel specialist at least 6-8 weeks before your trip will allow you to discuss any potential risks relating to your itinerary and complete any recommended vaccination schedules.
You may wish to consider taking a first aid kit to include medications to treat diarrhoea and dehydration. Be aware that if you should develop symptoms of blood or mucous in your poo, a high fever, or severe pain in your stomach, you should not take anti-diarrhoeal medications and should seek medical advice instead.
During travel
General hygiene:
Wash your hands thoroughly using soap and clean water often, and particularly before handling food; eating and drinking; and after using the toilet or changing nappies.
If hand washing facilities are not available, use an alcohol based sanitiser (containing at least 60% alcohol) as an alternative.
Be aware that hand sanitiser is not very effective when your hands are greasy or visibly dirty and it may not be completely effective against some organisms or viruses such as the ones which cause and norovirus.
Wash your hands thoroughly after visiting food markets and particularly after touching live animals or raw meat.
Avoid close contact with live animals and their environments as much as possible as these can transmit a number of diseases including avian influenza (“bird flu”).
Wash all your dishes, cups and utensils thoroughly before and after use with soap and clean water. Alcohol wipes can be used to clean them if you have no access to soap and water.
Food Hygiene
Preparation and storage:
Cooking is one of the most effective ways to make your food safe. Harmful bacteria are killed when all parts of the food reaches 70C in the cooking process.
Food should be served fresh and whilst still steaming hot (above 60C).
Avoid pre-prepared foods from buffets, street vendors, markets or restaurants which are not kept hot, kept refrigerated or kept cool on ice (below 5C). Bacteria can multiply quickly when food is kept at room temperature.
You should avoid reheating leftovers.
Meat and seafood:
Avoid eating seafood which is raw; poultry meat that is still red or with pink juices or meat that is still pink or raw as these may still contain harmful bacteria.
Fish and shellfish can be hazardous even if it has been well cooked. Local advice about seafood should be sought, but when in doubt it is best avoided.
Dairy:
Only consume milk or dairy products which have been pasteurised.
Unpasteurised milk should be boiled before use.
Cheeses and ice cream are sometimes made from unpasteurised milk. These should only be eaten when purchased from larger well-established companies or when the quality can be assured.
Dishes containing raw or undercooked eggs, such as mayonnaise, some sauces or desserts (e.g. mousse) should be avoided.
Fruit and vegetables:
Salads and fresh herbs (including garnishes in drinks) may have been washed in contaminated water, therefore should be avoided in destinations where drinking water may be unsafe.
Peel all fruits and vegetables, including tomatoes if they are to be eaten raw. Avoid types that cannot be peeled.
Berries, in particular raspberries, may be a source of cyclospora. They are difficult to wash and best avoided.
Water Hygiene
Even if water appears clear and colourless, tap and bottled water may not be safe if it has not been produced under proper conditions.
Water should only be used for drinking, making ice cubes or cleaning teeth if it is:
known to come from a pure source
stored in a clean container
bottled or canned by a known manufacturer with an intact tamperproof seal
boiled and cooled properly
chemically disinfected or passed through a reliable water filter.
Hot tea and coffee is usually safe if boiled water is used.
Beverages such as beer and wine; carbonated drinks from sealed cans and bottles and pasteurised juices are usually safe
Fresh milk should be boiled unless you are sure that it has been pasteurised.
Freshly squeezed fruit juice may have been made with unwashed fruit so choosing fruit juice from sealed cartons is preferable.
Be aware that ice cubes may be made using unsafe water.
If you are travelling with a baby or infant who is formula fed, you will need to consider how you will make up bottles with safe and sterile water during travel.
Bottled water is not usually sterile (free from bacteria) and can sometimes contain too much salt (sodium) or sulphate for babies and infants.
If you are using bottled water to make up formula feeds:
check the bottled water has an intact seal and is labelled correctly
check the bottled water contains less than 200mg/L of sodium (Na), and less than 250mg/L of sulphate (SO4/SO)
boil the water at a temperature of at least 70C and allow it to cool before mixing with the formula milk
Bottled water might still be safer than tap water for infants to drink whilst travelling if there is no alternative.
Water Purification:
If you are concerned about the safety of water, you can consider using a method to treat and purify the water to make it safe to drink.
Further information about methods of treating water can be found on the Water purification page.
After travel
If you return home after travel with continuous diarrhoea, develop blood or mucous in your poo accompanied with a high fever or severe pain in your tummy, you should contact a GP and make them aware of your travel history.
Resources
Disclaimer: This information has been developed for educational purposes only. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, please consult your healthcare professional.