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 are 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.  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 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.

For disinfections with iodine, use either tincture of iodine or tetraglycine hydroperiodide tablets, such as Globaline, Potable-Aqua, and others.  These disinfectants can be found in sporting goods stores and pharmacies.  Read and follow the manufacturer’s instructions.  If the water is cloudy, 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.  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.  For infants less than 6 months of age, breast-feed or give powdered commercial formula prepared with boiled water.

Some fish may not be safe even when cooked because of the presence of toxins in their flesh.  Tropical reef fish - red snapper, amberjack, grouper, and sea bass - can occasionally be toxic at unpredictable times, if they are caught on tropical reefs rather than open-ocean.  The barracuda and puffer fish are often toxic and should generally not be eaten.  Highest risk areas for unsafe fish include the islands of the West Indies and the tropical Pacific and Indian Oceans.

PREVENTION OF TRAVELER’S DIARRHEA: 
The typical symptoms of traveler’s diarrhea are diarrhea, nausea, bloating, urgency and malaise.  Traveler’s diarrhea 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 Latin 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.  The best way to prevent traveler’s diarrhea is by paying close attention to choice of food and beverage.  Some people may want to take Pepto-Bismol tablets (chewable) four times a day.  This has been shown to prevent at least some cases of diarrhea.  We do not recommend use of antibiotics to prevent traveler’s diarrhea because they can cause additional problems themselves.  However, we do recommend antibiotics for treatment of traveler’s diarrhea once it starts.

TREATMENT OF TRAVELER’S DIARRHEA:
The most important part of treatment is oral fluids.  We advise fruit juices, soft drinks (preferably without caffeine), and salted crackers.  For severe dehydration, we advise the use of an oral rehydration solution (see below).  Avoid dairy products and all beverages that contain water of questionable quality.

We advise the use of a combination of antibiotics and antispasmodics to shorten the course of traveler’s diarrhea.  We will give you prescriptions for these medications to carry with you and to use at the outset of diarrhea.

You should seek medical help if diarrhea is: severe, bloody, or does not stop or slow down within a few days; if it is accompanied by fever and chills; if you are unable to keep up fluid intake and become dehydrated.

Oral rehydration formula: First glass:  Orange, apple or other fruit juice - 8oz., Honey or corn syrup - 1/2 tsp., Table salt - 1 pinch Second glass:  Boiled or carbonated water – 8 oz.,   Baking soda – ¼ tsp.

Drink alternately from each glass until thirst is quenched.

Adapted from Center for Disease Control, May 1995