International travel is a fun and exhilarating adventure . . . unless you get sick. You spend time planning a dream vacation and food sickness turns it into your worst nightmare. Trapped in your hotel bathroom, you are too sick to venture out. Unfortunately, this scenario happens far too often.
According to the Centers for Disease Control and Prevention (CDC), traveler’s diarrhea is the most predictable illness among international travelers. In fact, food poisoning affects 30% to 70% of travelers who consume food or water that is contaminated by infectious organisms such as bacteria, parasites, and viruses. It’s a dreadful experience, but it can really become an issue if you need medical care and don’t know where to get it.
Let’s take a look at the most common causes of food sickness overseas and the best ways to prevent them.
What Causes Food Sickness?
Food-related illnesses are caused by 31 major known pathogens, including salmonella, E. coli, norovirus, and giardia. They often fester on raw or undercooked meat, raw vegetables, food stored at unsafe temperatures, or food prepared in an unsanitary manner or with contaminated water.
Travelers’ diarrhea is a common illness that can cause you to suffer for a few hours or even a week. The main symptoms are vomiting, stomach cramps, body aches, and a fever.
“Each year, 1 in 6 Americans and nearly 1 in 10 people worldwide suffer from such illnesses caused by bacteria (E. coli, salmonella, listeria), viruses (norovirus, hepatitis A) or parasites (giardiasis, roundworms, tapeworms),” according to National Geographic. Food and water-borne illnesses can occur anywhere, but developing countries pose the highest risk.
This includes most countries in Asia (excluding Japan), as well as Africa, the Middle East, Central and South America, and Mexico. It’s best to review the Centers for Disease Control and Prevention (CDC) travel guidelines for your destination country to understand what you should and shouldn’t consume.
Is food sickness inevitable? Absolutely not! There are things you can do before and during your trip to reduce your risk.
Ways to Prevent Illness Before Your Trip
Research your destination: Anticipate food safety issues or other issues that could arise during your trip. Check if your destination has a drinkable water supply and medical care that is available in case you do become ill. The Centers for Disease Control and Prevention Travelers’ Health and U.S. Department of State Travel Information are two excellent resources. Check the altitude because some people become sick above 8,000 feet, especially children.
Visit a health care provider: Ask for recommendations on medications or vaccinations for your travel destination. For example, to help ward off diarrhea, experts at Mount Sinai recommend taking two Pepto-Bismol tablets, four times a day, before and during your trip.
Build up your immune system: A strong immune system can help you keep diarrhea and other problems away. To build immunity against bad food, you can help your system with fresh clementines, tuna salads, ginger tea, avocados, and many other food items. These not only help in fortifying your immune system, but also prove effective when you are down with flu or an upset stomach.
Pack Smart: Carry hand sanitizer and disinfectant wipes. Bring a travel health kit, and carry your health insurance card in your wallet. Get enough prescription drugs to allow for an extended trip and pack them in your carry-on luggage. Check the TSA website to determine what’s allowed on airplanes.
Pack electrolyte powders, water purification tablets, and filtered water bottles. Bring nonperishable food items in both your carry-on and checked luggage in case you need to eat before you find a safe food option.
Ways to Prevent Illness During Your Trip
Being cautious about choosing what you eat and drink can go a long way toward preventing food illness while traveling. Foods that are safe to eat are generally dry, packaged, or served while hot. Foods to be wary of are raw, served at room temperature, prepared by street vendors, or meats you haven’t eaten before.
Safe drinks are hot or steaming, or in factory-sealed containers. Drinks to avoid are tap water, ice, fountain drinks, or freshly squeezed juice. To be safe while traveling abroad, it’s best to follow the food safety practices recommended in the United States.
Here are some safety tips for each type of food or drink:
Dairy
Dairy is often the cause of food sickness and diarrhea because it contains live bacteria that can spoil. Here are a few things to watch for:
- How are the dairy goods stored? Are they kept cold or left at room temperature? How reliable is the refrigeration? Are power outages common?
- Check the consistency and the shape of the packaging to see if it appears to have melted and been re-frozen.
- How are the dairy goods served? Are they cold or lukewarm? Don’t drink milk or cream stored in open containers sitting at room temperature.
- Does it smell like it should? Do a taste test to see if it’s sour.
It’s best to buy pasteurized dairy products served cold from factory-sealed containers. If not available, you could cook it over heat at a certain temperature for a specific amount of time to remove the bacteria.
Meat and Seafood
Make sure the meat is being stored properly in a refrigerator or on ice and has not been at room temperature for very long. Notice if the meat is covered to keep the bugs off.
It’s important to cook meat at high temperatures to make sure it is fully cooked and no part of it is raw or even pink. When handling raw meat, you must prevent it from contaminating other foods in the kitchen.
Raw or undercooked fish and shellfish can be contaminated with pathogens, and some fish harvested from tropical waters can transmit toxins that survive cooking (see Sec. 4, Ch. 10, Food Poisoning from Marine Toxins). Avoid eating raw seafood, including items “cooked” with citrus juice, vinegar, or other acidic liquid.
Fruit and Vegetables
Because fruit and vegetables come from the soil and are traded in the streets in many countries, they are usually not clean on the outside. To avoid food sickness, it’s important to thoroughly clean the soil, feces, dust, and airborne bacteria off the outside of them. Be sure they are washed with bottled or disinfected water, and not tap water.
Any fruit or vegetable without peelable skin, such as lettuce, should be avoided altogether unless you see it being washed properly. This concern extends to condiments that are made from raw vegetables, such as salsa. Unpasteurized fruit juices should also be avoided.
Lukewarm food
Germs that cause food poisoning grow quickly when food is in the danger zone, between 40°F and 140°F. To avoid food sickness, hot food should be served hot and cold food should be served cold. Hot temperatures kill germs, so look for food items that are steaming or smoking. The safest foods are boiling hot, such as stews, soups, and teas. Deep-fried foods are also safe.
Dry/packaged goods
Most germs require moisture and oxygen to live, so foods that are dry, such as nuts, bread, and potato chips, are usually safe. Additionally, food in factory-sealed containers, such as canned tuna or packaged crackers, are usually safe if they were not opened or handled by another person.
Restaurant selection
It’s wise to dine at restaurants that are busy and where the locals go. A high degree of turnover with diners means that ingredients are being used and not sitting somewhere, so they should be fresher. A restaurant serving local people is usually healthier and well-visited. A long line is often a sign of good quality.
Street food
Eating food from street vendors is generally riskier than dining at a restaurant because street vendors aren’t held to the same food-safety standards. If you decide to eat street food, try to observe the food preparation area. Check if the kitchen looks clean, if the food handlers are wearing gloves, and if raw meat and vegetables are handled separately to prevent cross contamination.
Bushmeat
What is bushmeat? It’s local, wild game that is not typically eaten in the U.S. Animals such as bats, monkeys, rodents, and other bushmeat can be a source of animal-to-human diseases, like Ebola. To avoid food sickness, it’s best to avoid bushmeat altogether.
Drinking water
Drinking contaminated water is the primary cause of food sickness overseas for Westerners. However, taking a little precaution can go a long way.
In many parts of the world, particularly where water treatment, sanitation, and hygiene are inadequate, tap water can contain disease-causing agents, including bacteria, viruses, parasites, or chemical contaminants. According to the Centers for Disease Control and Prevention, more than 180 countries, including popular vacation spots like Mexico, Thailand, and Belize, have tap water considered unsafe for consumption.
You shouldn’t drink tap water (and fountain drinks mixed with tap water) in countries where it might be contaminated. Don’t brush your teeth with it, swallow water when showering, or rinse your contact lenses or sinuses with it. Be sure to follow the safe water practices recommended in the United States while you are overseas.
When the safety of your tap water is uncertain, you could treat your water to make sure it is safe to drink. One way to do this is to boil it for 1 minute and let it cool or invest in a portable water filter to purify it.
The safest approach is to use bottled water, make sure the factory seal is intact, and wipe it clean before putting your mouth on it. Carefully inspect the seal, because sometimes a drop of glue can be used to mimic it. Beverages made with water that has been boiled, such as tea or coffee, are generally safe to drink also.
Ice
Since ice is often made with tap water, it’s safest to ask that your beverages be served without ice. The only exception is if you are certain the ice is made with purified or bottled water. Don’t expect alcoholic drinks to kill the bacteria because their alcohol content may not be high enough.
Recreational water
Pathogens that cause gastrointestinal, respiratory, skin, ear, eye, and neurologic illnesses can be transmitted via contaminated recreational freshwater or marine water. Water from inadequately treated pools, hot tubs, spas, or water playgrounds, including splash pads or spray parks, can also be contaminated.
Even though it may look clear, recreational water may be contaminated by human feces from swimmers, animal waste, sewage, or wastewater runoff and contain disease-causing infectious or chemical agents. Ingesting even small amounts of such water can cause illness.
Travelers should not swim or wade near storm drains or in water that could be contaminated with human or animal feces, sewage, or wastewater runoff. Other places to avoid include lakes or rivers after heavy rainfall; in water that smells bad, looks discolored, or has algal mats, foam, or scum on the surface; in freshwater streams, canals, or lakes in areas of Africa, Asia, the Caribbean, and South America in water that might be contaminated with urine from animals infected with Leptospira; or in warm seawater or brackish water (mixture of fresh and sea water), particularly when they have wounds.
Handwashing
Travelers should always wash hands with soap and water before eating and prepping food, after using the bathroom or changing diapers, before and after caring for someone who is ill, and after contact with animals or animal environments.
If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. Hand sanitizer is not as effective as hand washing for removing some germs and does not work well when hands are visibly dirty or greasy. The Centers for Disease Control and Prevention (CDC) website Handwashing: Clean Hands Save Lives provides additional information.
Food poisoning detection
The Mayo Clinic lists symptoms of food poisoning, which include stomach cramps, nausea, stomach, vomiting, diarrhea, loss of appetite, fever, headache, weight loss, and muscle aches. The clinic suggests seeking out a health care professional or emergency care if more dire symptoms surface, such as little urination, irregular changes in behavior or thinking, blurred vision, muscle weakness, and black or bloody stools.
Food poisoning treatment
Here are a few ways to treat food poisoning:
Stay hydrated: Your body is losing salts and electrolytes, so it’s better to drink than eat. Not urinating often or urinating dark urine is a sign of dehydration. In addition to safe water, you could drink juice, coconut water, popsicles, or Gatorade/Powerade.
Rest and avoid alcohol: Take it easy and give your body time to heal. Alcohol is hard on your digestive tract, so avoid it.
Bland diet and no dairy: Avoid spicy and greasy foods that are harsh on weak stomachs. Instead, eat bland foods like bread, crackers, dry cereal, and rice. Diarrhea destroys the cilia in your intestines needed to break down foods like dairy, so avoid dairy products for a few days.
Add probiotics: Digestive illnesses remove good bacteria from your digestive system, so replacing them with probiotics can help you get back to normal.
You should seek medical attention if you experience the following:
- Diarrhea is bloody
- Diarrhea/vomiting does not resolve after a few days
- You cannot manage to stay hydrated orally
- You have severe signs of dehydration (e.g. sunken eyes, dry lips or mouth, concentrated urine &/or not urinating often, dizziness/blacking out, vomit is green/bile colored)
How travel insurance can help
Travel health insurance can come in handy if your illness becomes severe enough to medical attention. Instead of paying a big medical bill out of your own pocket, the right insurance plan will provide sufficient coverage and peace of mind.
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Good Neighbor Insurance staff have traveled and lived outside the U.S. for many years and know from experience what to do and not to do to keep from getting sick. In case we do need medical attention while overseas it is a wonderful thing to have travel medical insurance.
So, before you travel outside the U.S. make sure you grab one of our travel medical insurance plans by calling our agents at our toll free number 866.636.9100, or visit our website to find the best travel medical insurance plan for you.
If you are going to be overseas for longer than a year you may want to consider our career long term plans which are located here: https://www.gninsurance.com/health/.
