Dr Sarah Jarvis is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and the resident doctor for BBC Radio 2.
We are very lucky in the UK to be able to take clean, fresh water for granted. This is not the case in many countries, particularly low-income countries.
That’s why it’s well worth doing some research online into the risks of food and water contamination at your destination before you leave. In some situations, you may need a vaccination (more on that later) – you’ll need to get any vaccines at least 4-6 weeks before you travel, so look into it well in advance.
If your findings suggest the safety of water can’t be guaranteed, you’ll want to stock up on chemical treatments +/- a water filter to take with you.
What are the Biggest Risk Factors for Food Poisoning?
Yuck alert! You may not want to hear it, but most traveller’s diarrhoea is transmitted via the faecal-oral route. In other words, you get infected when you take something in through your mouth that has been contaminated by infected faeces (poo).
This could include an infection that’s got onto your hands, so do get into the habit of washing your hands regularly and thoroughly with soap and water. Clean hands are especially important before you eat – if you can’t find a hygienic place to wash your hands, alcohol-based hand sanitiser gel is a good alternative.
The two biggest factors that determine your chance of ending up with traveller’s diarrhoea are where you go and the places you eat at while you’re there. However, the time of year you go, as well as your age and sex, also make a difference.
You’re also at higher risk if you’re older, frail or have a long-term medical condition that could affect your ability to fight off infection. This includes cancers or treatments that affect your immune system, along with chronic heart/kidney/liver disease, inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and diabetes. Babies and young children are also more vulnerable.
Lots of people with these conditions can holiday abroad safely, but it’s worth checking with your doctor if you’re considering a trip to a low-income country.
READ MORE: Travelling with a Medical Condition
Water, Water Everywhere
You don’t just drink water – you use it to brush your teeth, take your tablets and more. If you can’t rely on water safety at your destination, you’ll need a clean supply for any of these activities.
You can disinfect water by bringing it to a rolling boil. This means tea and coffee, as long as they’re served steaming hot, are usually fine. So are canned or bottled drinks with intact seals. Watch out for counterfeit cans and bottles – they’re more often sold at unlicensed stalls and may have faulty labelling or a seal that has been tampered with.
You can buy small elements to add to a cup of water to boil it. You can also buy portable UV light disinfectant devices – although the water needs to look completely clear before you use them.
READ MORE: Which Fluids are Safe to Drink on Holiday?
Alternatively, there are many safe chemical disinfection treatments available to buy in the UK. Always follow the instructions carefully. You may want to combine this with a water filter with a filter size of ≤0.2 µm to 1.0 µm, to remove minuscule specks of dirt and parasites.
Don’t forget that the pristine bottled drink you sip on the terrace could be a bad move if you’ve added ice made from contaminated water. Freezing doesn’t remove all germs, so ask for your drink chilled, not with added ice.
The Water-food Link
Some foods, like shellfish, can be contaminated with tummy-bug-causing germs even if they’re washed in clean water. Many other foods can become contaminated during preparation.
If you can’t rely on the safety of drinking water, that means you can’t guarantee that food washed in that water will be safe either. Freshly cooked, piping hot food is usually fine – as are peeled fruits (especially if you peel them yourself just before you eat them).
But to minimise your chance of food poisoning abroad, steer clear of:
- Salads and raw vegetables (or unpeeled fruit)
- Buffet food that has been left out uncovered (the combination of the warm temperature, where germs thrive, and flies landing on the food is a recipe for disaster)
- Food from street vendors that isn’t cooked right in front of you and served piping hot. Remember that even if it is, there could be a risk from dirty crockery or cutlery.
- Raw or undercooked seafood (particularly shellfish)
- Milk, yoghurt, ice cream or cheese unless you can guarantee it’s made from pasteurised milk.
Can Vaccines Protect Me from Food Poisoning Abroad?
Vaccines can protect against many infections commonly spread through contaminated food and water. Some, such as hepatitis A, primarily affect your gut rather than your gut. However, typhoid can cause very severe watery diarrhoea, as well as more severe complications. If you’re going to a high-risk area, you may be eligible for vaccination- the vaccine may be offered in injection or vaccine form and lasts for 3 years. Cholera can also cause severe diarrhoea. There is a vaccine for it, given as a drink, but it’s only recommended if:
- You’re travelling to a very remote area where cholera is common, and you won’t have access to medical care
- You’re an aid or disaster relief worker, and the area you’re working in is at risk of a cholera outbreak.
READ MORE: What Vaccines Do I Need for Travel?
What Do I Do if I Get Food Poisoning Abroad?
The good news is that as tourism and prosperity have increased, so have hygiene standards in some countries. That means rates of traveller’s diarrhoea due to food and drink have gone down. Unfortunately, they definitely haven’t gone away: up to 3 in 5 people from high-income countries visiting low-income countries get some form of upset tummy.
Keeping your fluid intake up is crucial to avoid dehydration, one of the main risks of traveller’s diarrhoea. If you’re vomiting, take small sips very regularly. If you have diarrhoea, you’ll need about 200ml (a cup of liquid) every time you have a runny poo, in addition to your usual fluid intake. Don’t forget that while most people need 1.5-2L (6-8 cups) of fluid a day, this is higher in hot countries or if you’re doing a lot of exercise.
READ MORE: How to Find Medical Care Abroad
When Do I Need to See a Doctor for Traveller’s Diarrhoea?
Many cases of traveller’s diarrhoea will settle on their own. However, you should seek medical help if your symptoms haven’t settled within 3 days, or if you have a long-term illness that could make you more vulnerable. Pharmacists at your destination may be able to advise on oral rehydration sachets/drinks, or sometimes antibiotics.
In addition, see a doctor if you are unable to keep any fluids down or have:
- Persistent fever (38°C)
- Blood or mucus in your poos or vomit
- Very severe tummy pain
- Jaundice (yellowing of the skin or whites of the eyes)
- Confusion or drowsiness
- Not passing urine for most of a day
For this and many other reasons, it’s essential to take out adequate travel insurance before you leave for your trip. Using a specialist provider such as Medical Travel Compared means you’ll be covered no matter what.
For more travel tips, visit our blog.