IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

IAMAT - The International Association for Medical Assistance to Travellers

Mind Your Food and Water Abroad

The recent illnesses and deaths caused by the E.coli outbreak in Europe, remind us of the complexities of food systems and that you don’t have to travel to get sick: Food- and water-borne illnesses happen in our own backyard.

Gastro-intestinal infections can happen in any country. Getting food to your plate involves a variety of players including growers, transportation companies, processors, retailers, food handlers, consumers, and government regulations. While food coming from a local source may get to your table faster than food grown far away, both conventionally and organically grown products are susceptible to carrying pathogens like E. coli and salmonella. Unsanitary farming conditions, poor food processing and handling practices, lack of food and import surveillance inspectors, and non-transparent self-regulated food processing companies are some of the culprits that have made people sick. In Canada, for example, health experts believe that approximately 38% of the population gets a food-borne illness every year.

Why Do We Get Sick With E.coli?

E. coli, also known as Escherichia coli, is a bacteria that naturally resides in our gasto-intestinal system. There are multiple strains of E. coli, but the harmful ones (of which E. coli [O104:H4] was responsible for the outbreak in Germany and France) produce toxins that can be lethal to humans.

Travel increases the chance of getting sick partly due to the physical and psychological stress of being in a different place. Your immune system tends to get weaker. Add to the mix, the difficulty of choosing safe food since we usually don’t know the source or the trajectory it took to get to your plate.

How To Avoid Food and Water Illnesses

It’s so tempting to buy food from a street vendor selling noodle soup or fresh fruit when you’ve been sightseeing the whole day or are invited to a restaurant to try the local delicacy ? raw seafood. You remind yourself that part of the travel adventure is trying what the locals eat. Yet, you’ve heard the stories of friends, or even you have one, where most of the trip was spent in a bathroom or in bed.

Here are 3 simple steps to ensure that you don’t get sick away from home:

1. Wash your hands thoroughly!
Simple hand hygiene is a proven method to reduce the spread of bacteria and viral infections. Wash with soap and water for at least two minutes before eating, after using the toilet, touching publicly used surfaces such as door handles, hand rails, elevator buttons, and currency, or if they’re dirty. If you don’t have access to soap and water, an alcohol-based hand sanitizer is an alternative.

2. Repeat and practice the mantra: BOIL IT, COOK IT, PEEL IT, OR FORGET IT.
Easy to say, but hard to do sometimes due to lack of convenience. At all times though, make sure you only eat well cooked foods or fruits that you can peel. Stay away from shellfish, eggs, meat, and dairy products that have been out for a long time. Also avoid unpasteurized products, including milk, cheese, ice cream, juice, and cider.

3. Drink purified water.
The best is boiling your water since it destroys bacteria like E. coli. Keep it at a roiling boil for 10 minutes. Hotel rooms usually have a kettle in each room. If not, ask for one so that you can boil the water and cool it overnight to pour into your water bottle before heading out for the day. Water bottles are also an option, but there are environmental implications and it may be outdated or tampered with. If you are going to drink bottled water, make sure that the cap is properly sealed and check the best before date. If you are going to remote areas, choose a water filter best suited for your type of travel, or bring along iodine or chlorine tablets. Follow purification instructions properly.

E. Coli Infection Symptoms

Symptoms of E.coli infection usually start appearing within hours, but sometimes it can take up to 10 days to approximately one month to show up. Food poisoning symptoms may include sharp stomach cramps, nausea, vomiting, diarrhea, and fever. In severe cases, patients will have bloody diarrhea, low red blood cell counts (hemolytic uremic syndrome), low platelet counts (thrombocytopenia), and kidney failure. Children, pregnant women, the elderly, and persons with compromised immune systems are at higher risk of developing complications. Some people however, never develop symptoms but are E. coli carriers and spread the infection unknowingly.

If you suspect E. coli infection or food poisoning, seek immediate medical attention. It’s important to drink lots of fluids to prevent dehydration. Water is best if you have access to a clean source.

IAMAT’s travel health information includes food and safety information for all countries. See also our eLibrary for more advice on food and water illnesses, traveller’s diarrhea, and hand hygiene.