Travellers

Travel Health Information Sheets

Food and water hygiene

 

Key messages:

• Did you know that travellers’ diarrhoea is the most common health problem to affect travellers abroad?

• Between 20-60% of travellers are affected.Contaminated food and water can spread a number of different diseases such as typhoid, hepatitis A and cholera.

• It can be difficult to avoid contaminated food and water, but it is sensible to try and reduce your risk by following the steps below.

• This information sheet highlights safer food and drinks you can choose where possible on your travels and provides other tips for reducing your risk from contaminated food and water.

• A separate information sheet is available on travellers’ diarrhoea which discusses how you can manage the symptoms if you do get ill, it is sensible to be prepared!

• Certain travellers need to take particular care as they are at increased risk from contaminated food and water including older travellers, those with a weak immune system, young children and those taking medication to reduce stomach acid.

 

Regular hand washing

Always wash your hands after: using the toilet, changing nappies, any contact with animals or sick people and before preparing or eating food. Alcohol gel can be helpful when hand-washing facilities are not available.

 

                                                      Image courtesy of NHS Photo Library 

 

Avoiding contaminated water

In some parts of the world, tap water is not available or is unsafe to drink. Drinks made with boiled water and served steaming hot are generally safe such as tea and coffee. Drinks served in unopened, factory produced cans or bottles such as carbonated drinks, commercially prepared fruit drinks, water and pasteurized drinks generally can be considered safe.

                     

Beware fake bottled water: avoid any product that you suspect may have been tampered with.

 

Avoid ice in your drinks as this could have been made from tap water.  Use safe water (such as boiled or bottled) to brush your teeth also.

If you need to disinfect water, boiling it for a least one minute will kill all of the common water borne bugs. This may not always be practical for some travellers, depending on the facilities available.

Chemical treatments can be used to disinfect water. However, the effectiveness of these treatments can be reduced by low water temperatures and suspended matter in the water. Follow the instructions carefully to obtain the best results. Chlorine preparations are usually effective, but parasites such as Cryptosporidium and Giardia are not always inactivated by these agents [1]. Studies have shown chlorine dioxide to be more effective at inactivating parasites [2]. This treatment can now be found as drops or tablets in a number of camping and walking shops.

Using a water filter that has a filter size of ≤0.2 µm to 1.0 µm before using a chemical disinfectant is helpful as water filters can remove suspended matter, bacteria and parasites if they are functioning correctly.   Domestic water filters, designed to stop limescale build-up in hard water areas of the UK, are not suitable. Even quality water filters do not always remove viruses from the water so combining their use with a chemical treatment is sensible.

 

The European Union recommends that iodine is no longer sold or supplied for disinfecting water.

 

 

Portable, battery-operated devices utilising UV light can also be used to disinfect water. Water must be free of particulate material before treating. This method may not be practical if large quantities of water need to be disinfected.

Due to potentially high salt and mineral content, bottled water may  not be suitable for babies and bottle feeds should be made up with boiled, cooled water.

 

 
 

                                                  Image courtesy of NHS Photo Library

Avoiding Contaminated Food

Choose food that has been freshly prepared and served piping hot where possible. Select fruit that you can peel yourself such as bananas and oranges. Ensure dairy produce such as yoghurts, milk and cheese has been pasteurised.

Many countries use human waste (often called “night soil”) to fertilise their crops. Some foods, especially those growing near the ground, can become contaminated with harmful bacteria if this type of manure is used. Flies, insects and rodents can also spread diseases.

 

 

                                                       Image courtesy of NHS Photo Library

 

Where possible avoid the following potentially unsafe foods:

  • Salads
  •  Raw fruit and vegetables, unless you wash and peel them yourself.
  •  Food left exposed to flies.
  •  Food shared with lots of people, such as buffets.
  •  Undercooked or raw fish, meat or shellfish.
  •  Reheated food – especially fish, meat or rice.
  •  Takeaways and street food – unless thoroughly cooked in front of you.
  •  Unpasteurised milk, cheese, ice cream and other dairy products.
  •  Fresh or cooked food that has been allowed to stand at room temperature in warm environments.

‘Boil it, cook it, peel it, or forget it’!

 

References

1. Carpenter C, Fayer R, Trout J, Beach MJ. Chlorine disinfection of recreational water for Cryptosporidium parvum. Emerg Infect Dis 1999; 5:579-584

2. EPA Guidance Manual, Alternative Disinfectants and Oxidants, April 1999 [Accessed 14 November 2013]. Available at: http://www.epa.gov/ogwdw/mdbp/pdf/alter/chapt_4.pdf

 

More Information:

CDC: Keeping your hands clean on a cruise.

Public Health England: Travellers’ Diarrhoea.

NaTHNaC: Travellers’ Diarrhoea.

NHS Choices: Food Poisoning.

NHS Choices: Norovirus.

World Health Organization: Food Safety.

 

Reviewed November 2013