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Contaminated food and drink are common sources for the introduction of infection into the body. Among the more common infections that travelers may acquire from contaminated food and drink are Escherichia coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, and hepatitis A. Other less common infectious disease risks for travelers include typhoid fever and other salmonelloses, cholera, infections caused by rotaviruses and Norwalk-like viruses, and a variety of protozoan and helminth parasites (other than those that cause giardiasis and cryptosporidiosis). Many of the infectious diseases transmitted in food and water can also acquired directly through the fecal-oral route.
Water that has been adequately chlorinated, using minimum recommended waterworks standards as practiced in the United States, will afford significant protection against viral and bacterial waterborne diseases. However, chlorine treatment alone, as used in the routine disinfection of water, may not kill some enteric viruses and the parasitic organisms that cause giardiasis and amebiasis. In areas where chlorinated tap water is not available, or where hygiene and sanitation are poor, travelers should be advised that only the following may be safe to drink:
Beverages, such as tea and coffee, made with boiled water
Canned or bottled carbonated beverages, including carbonated bottled water and soft drinks
Beer and wine
Where water may be contaminated, ice (or containers for drinking) also should be considered contaminated. Thus, in these areas ice should not be used in beverages. If ice has been in contact with containers used for drinking, the containers should be thoroughly cleaned, preferably with soap and hot water, after the ice has been discarded.
It is safer to drink directly from a can or bottle of a beverage than from a questionable container. However, water on the outside of cans or bottles of beverages might be contaminated. Therefore, wet cans or bottles should be dried before being opened, and surfaces which are contacted directly by the mouth in drinking should first be wiped clean. Where water may be contaminated, travelers should avoid brushing their teeth with tap water.
Boiling is by far the most reliable method to make water of uncertain purity safe for drinking. Water should be brought to a vigorous boil and allowed to cool to room temperature -- do not add ice. At very high altitudes, for an extra margin of safety, boil for several minutes or use chemical disinfection. Adding a pinch of salt to each quart, or pouring the water several times from one container to another will improve the taste.
Chemical disinfection with iodine is an alternative method of water treatment when it is not feasible to boil water. Two well-tested methods for disinfection with iodine are the use of tincture of iodine (5 drops 2% tincture per quart clear water {10 drops for cloudy water}), and the use of tetraglycine hydroperiodide tablets (Globaline, Potable-Agua, Coghlan's, etc.). The tablets are available from pharmacies and sporting goods. The manufacturer's instructions should be followed.
There are a variety of portable filters currently on the market which according to the manufacturer's data will provide safe drinking water. Although the iodide-impregnated resins and microstrainer type filters will kill and/or remove many microorganisms, very few published reports in the scientific literature deal both with the methods used and the results of the tests employed to evaluate the efficacy of these filters against water-borne pathogens. Until there is sufficient independent verification of the efficacy of these filters, the Center for Disease Control makes no recommendation regarding their use.
As a last resort, if no source of safe drinking water is available or can be obtained, tap water that is uncomfortably hot to touch may be safer than cold tap water, however proper disinfection or boiling is still advised.
To avoid illness, food should be selected with care. All raw food is subject to contamination. Particularly in areas where hygiene and sanitation are inadequate, the traveler should be advised to avoid salads, uncooked vegetables, unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot, or fruit that has been peeled by the traveler. Undercooked and raw meat, fish, and shellfish may carry various intestinal pathogens. Cooked food that has been allowed to stand for several hours at ambient temperature may provide a fertile medium for bacterial growth and should be thoroughly reheated before serving.
Some species of fish and shellfish can contain poisonous biotoxins, even when well cooked. The most common type of fish poisoning in travelers is ciguatera fish poisoning. Barracuda is the most toxic fish and should always be avoided. Red snapper, grouper, amberjack, sea bass, and a wide range of tropical reef fish contain the toxin at unpredictable times. The potential for ciguatera poisoning exists in all subtropical and tropical insular areas in the West Indies, Pacific, and Indian Oceans where the implicated fish species are consumed.
Recently, cholera cases have occurred among persons who ate crab brought back from Latin America by travelers. Travelers should not bring perishable seafoods with them when they return.
Excerpted from:U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. HHS Publication No. (CDC) 94-8280. June, 1994. pgs. 161-163
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