Advice on avoiding food and h2o-borne diseases

Food and water hygiene

Advice on avoiding food and water-borne diseases Food and water hygiene

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Key Messages

Contaminated food and h2o can transmit a number of different infectious diseases such as cholera, hepatitis A, travellers' diarrhoea and typhoid. Travellers' diarrhoea is specially common in those visiting low-income countries.
It can be difficult to avoid contaminated nutrient and water, but travellers can try and reduce their run a risk past post-obit the steps below.
A factsheet on travellers' diarrhoea is available. This includes information on how to manage symptoms and when to get medical help.
Sure travellers need to take detail care every bit they are at increased risk of complications. This includes older people, those with a weak immune system, young children and those taking medication to reduce stomach acid.
Occasionally travellers experience illness from ingesting toxins from fish and other seafood.

Overview

Contaminated nutrient and h2o tin transmit a number of different infectious diseases, the run a risk is higher in low income regions [ane]. In that location is a wide range of infectious diseases that are transmitted by contaminated nutrient and water. Many are caused past pathogens (bacteria, viruses or parasites) transmitted via the faecal-oral route (consumption of food and drinks contaminated with faeces).

Swallowing or inhaling contaminated water in inadequately treated pond pools, hot tubs and spas can also transmit pathogens that can cause diarrhoea, vomiting, or infection of the ears, eyes, skin, or the respiratory organisation [2].

Vaccinations can prevent only a small number of these diseases (such as cholera, hepatitis A, polio and typhoid). Although contaminated food and water is difficult to avoid in areas with poor sanitation, it is sensible for travellers to try and reduce their risk by following the information below.

Poisoning from ingesting marine toxins can occur worldwide. In the tropics, certain fish are more probable to exist contaminated as they concentrate toxins produced by algae or bacteria. Depending on the toxin ingested, afflicted individuals may accept allergic blazon symptoms or neurological, gastrointestinal and/or cardiovascular symptoms; some of these tin can result in long-term illness or expiry.

Risk for travellers

Standards of hygiene have improved in some areas with increasing economies and in improved tourism infrastructure [1]. The incidence rates of travellers' diarrhoea (TD) and other diseases transmitted by contaminated nutrient and water have reduced equally a outcome [1, 3]. Nevertheless, TD remains a common illness affecting 20-60 percent of travellers from high-income countries, visiting low-income areas of the world [four, 5]. In recent years, an increase in cases of a parasite called cyclospora has been reported in Britain travellers coinciding with the summer holiday period [vi].

There are several risk factors for TD including: diet, gender, historic period, host, genetics, destination, season of travel and choice of eating house [four, vii]. Destination and choice of eating establishment are the well-nigh important determinants of risk [iv].

The effects of diseases transmitted by contaminated food and water, such as TD, may be greater in the very young, the elderly and the delicate. Vulnerable travellers, such as pregnant women and those with immune suppression, inflammatory bowel disorders, chronic kidney or heart disease should likewise take particular care to avert contaminated food and h2o, and be prepared to manage TD symptoms. Weather condition that reduce breadbasket acerbity increment risk of contracting infections with acrid-sensitive organisms such as Salmonella and Campylobacter [8-9].

There are no data on the number of UK travellers affected by marine toxins abroad.

Before travel

Travellers should seek information on the risks of contaminated nutrient and water at their destination in advance of travel. The Country Data pages on our website evidence details of the vaccine preventable risks where relevant. Ideally, travellers should run across their healthcare provider at least 4-6 weeks before travel for advice on vaccinations (if appropriate) and nutrient and water precautions. However, even if travelling at short notice, pre-travel advice is withal important and worthwhile. Travellers should consider taking a diarrhoea treatment pack, farther details can be constitute in our travellers' diarrhoea factsheet.

Pregnant women, those with very young infants and travellers with pre-existing medical conditions such as significant bowel disease or immune suppression should talk over the suitability of travel with their specialist or GP practice before booking.

Travellers should consider obtaining other items to assist reduce their hazard from contaminated food and water. Alcohol gel can be helpful for hand hygiene where hand washing facilities are not available. Those who may not take admission to rubber water at their destination should consider taking appropriate equipment such a water filter or chemical treatments (see details in the 'during travel' section).

During travel

Travellers should wash their hands after visiting the toilet, changing nappies and before preparing or eating food. Alcohol gel is helpful when hand-washing facilities are non available.

It is difficult to eliminate the risk from contaminated nutrient [1] merely it is sensible for travellers to endeavour and avoid higher risk food and drinks where possible.

Water and other drinks

Drinks served in unopened, factory produced cans or bottles with intact seals such equally carbonated drinks, commercially prepared fruit drinks, water and pasteurised drinks by and large tin can be considered safe. Drinks made with boiled water and served steaming hot, such every bit tea and java are also usually rubber.

In countries with poor sanitation, it is not advisable to drink tap water or apply it to clean teeth, unless information technology has been treated. Water ice should also be avoided. Water can exist disinfected by bringing it to a rolling eddy [ten-11]. Although humid is a reliable method of disinfection, information technology may non always be convenient.

Chemical treatments can be used to disinfect water. However, the effectiveness of these treatments can be reduced by low h2o temperatures and suspended matter in the water. Travellers should follow the instructions carefully to obtain the best results. Chlorine preparations are usually effective, simply protozoan parasites such equally Cryptosporidium and Giardia are not always inactivated by these agents [12]. Studies have shown chlorine dioxide to be more effective at inactivating parasites [xiii]. Post-obit a European Marriage (European union) directive, iodine is no longer sold or supplied for use in disinfecting drinking water.

Using a water filter that has a filter size of ≤0.2 µm to 1.0 µm earlier using a chemic disinfectant is helpful as h2o filters can remove suspended matter and parasites if they work correctly [xi].

Portable, battery-operated devices using UV light can be used to disinfect water. However, water must be gratuitous of particulate fabric before treating. This method may not be practical if large quantities of h2o need disinfecting.

More often than not bottled water is not recommended to make upward formula feeds for infants [14]. This is because it may contain as well much table salt, or sodium (likewise written as Na) sulphate (also written every bit And so or SO4), and is usually not sterile. When travelling, however, bottled water may be safer to drink than tap h2o. If it is to be used, bottled h2o should contain:

  • less than 200 milligrams (mg) a litre of sodium
  • no more than 250mg a litre of sulphate

Natural mineral water is unremarkably not recommended for infant feeds considering its contents frequently exceed the maximum recommended levels to a higher place [14].

In the UK there are regulations on the legal requirements for the production and labelling of natural mineral, spring and bottled water [15]. Like requirements may not exist in place in other countries. Parents should exist enlightened of false bottled h2o and ensure the seal has not been tampered with at the time of purchase.

As bottled h2o is usually non sterile, it should be boiled, like tap water, to at least seventy°C [sixteen] and allowed to cool before mixing with the formula in preparation for a feed.

Nutrient

Recently prepared, thoroughly cooked nutrient that is served piping hot, fruit that can exist peeled by the traveller (such as bananas and oranges), and pasteurised dairy produce such as yoghurts, milk and cheese are expert options for travellers.

Certain foods are prone to contamination and where possible should exist avoided:

  • Salads
  • Uncooked fruit and vegetables (unless washed and/or peeled past the traveller)
  • Fresh or cooked food that has been left uncovered in warm environments, exposed to flies, such buffets
  • Unpasteurised dairy products, like milk, cheese, ice foam and yoghurt
  • Raw or undercooked meat, fish or shellfish, including oysters
  • Nutrient from street traders unless thoroughly cooked in front of the traveller and served hot on clean crockery

See our travellers' diarrhoea factsheet for details on the management of travellers' diarrhoea.

Reducing the gamble of marine poisoning

Travellers should avoid eating pufferfish and other loftier risk fish such as barracuda, moray eel and other reef fish [17,18].

Shellfish poisoning is more like during or shortly after algal blooms which may exist referred to every bit 'cherry-red tides' or 'brown tides', travellers should accept notice of whatsoever posted warnings on this. Ideally, those visiting developing countries should avert eating all shellfish as they can too be contaminated with bacteria and viruses [17].

Unfortunately, marine toxins cannot exist destroyed by cooking. Further information on risk areas and prevention of marine poisoning can exist found on the The states Centers for Illness Control website.

After travel

Travellers returning with diarrhoea should seek medical intendance if symptoms do non improve within three days. They should seek medical care immediately if they have a fever of 38°C or more, blood and/or mucous in the stool or other worrying symptoms such as contradistinct mental condition, severe abdominal pain, jaundice or rash.

Medical advice should be sought earlier for the elderly, children and other vulnerable travellers if they are not tolerating fluids or are showing signs of dehydration.

An algorithm for the investigation and management of diarrhoea is available from Public Wellness England in Managing suspected infectious diarrhoea [19].

  1. Steffen, R., Hill, D.R., DuPont, H.L. Traveler'due south diarrhea a clinical review. JAMA. 2015; 313 (one): 71-80. [Accessed July 2018]
  2. Jacobsen KH, Koopman JS. The effects of socioeconomic development on worldwide hepatitis A virus seroprevalence patterns. Int J Epidemiology. 34:600-9, 2005. [Accessed July 2018]
  3. Griffin PM, Hlavsa MC, Yoder JS, Nutrient and water precautions. In: Centers for Illness Command and Prevention. Health Information for International Travel 2018. Atlanta, CDC. [Accessed July 2018]
  4. Hill DR, Beeching NJ. Travelers' diarrhea. Cur Opin Infect Dis. 2010; 23: 481-vii. [Accessed July 2018]
  5. Health Protection Agency. Foreign travel-associated affliction – a focus on travellers' diarrhoea. 2010 written report. London: Health Protection Bureau; 2010 [Accessed July 2018]
  6. Public Health England. Cyclospora outbreak related to travel to Mexico. Wellness Protection Report vol 10, 25. 5 August 2016, updated sixteen December 2016. [Accessed July 2018]
  7. Swaminathan A, Torresi J, Schlagenhauf P et al A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers, J Infect. 2009; 59(one):nineteen-27.
  8. Bavishi C, Dupont HL Systematic review: the utilise of proton pump inhibitors and increased susceptibility to enteric infection, Aliment Pharmacol Ther. 2011 December;34(11-12):1269-81. doi: 10.1111/j.1365-2036.2011.04874.x. Epub 2011 Oct 17.
  9. National Institute for Health and Care Excellence (Squeamish) Diarrhoea prevention and advice for travellers, May 2013 [Accessed July 2018]
  10. Globe Health Organization. Preventing Travellers' Diarrhoea: How to Make Drinking H2o Safe. WHO/SDE/WSH/05.07. Geneva 2005 [Accessed July 2018]
  11. Backer H. H2o disinfection for international travellers.Ch.6. In: Keystone JS (Ed). Travel Medicine. Third Edition 2013; Elsevier (Saunders).
  12. Carpenter C, Fayer R, Trout J, Beach MJ. Chlorine disinfection of recreational water for Cryptosporidium parvum. Emerg Infect Dis 1999; 5:579-584 [Accessed July 2018]
  13. The states Environmental Protection Agency Guidance Transmission, Alternative Disinfectants and Oxidants, April 1999. [Accessed July 2018]
  14. NHS Choices. Can I use bottled water to make up baby formula (babe formula)? 22 June 2016. [Accessed July 2018]
  15. Food Standards Agency, UK. The Natural Mineral Water, Spring H2o and Bottled Drinking Water Regulations 2007, Revised July 2010 [Accessed July 2018]
  16. Department of Health. Advice on preparation of formula milks restated. 23 January 2013. [Accessed July 2018]
  17. Ansdell VE., Food poisoning from marine toxins in Centers for Disease Command and Prevention 'Yellow book 2020' Health data for international travel, Chapter two. [Accessed 29 August 2019].
  18. Sobel J. Painter J. Illness caused past marine toxins. Clinical Infectious Diseases, Vol 41, Event 9. November 2005, 1290-1296. [Accessed 29 August 2019].
  19. Public Health England. Managing suspected infectious diarrhoea. January 2015. [Accessed July 2018]

First Published :04 Jan 2018
Last Updated :29 Aug 2019

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