Eating and drinking safely while traveling is essential to reduce the risk of foodborne illnesses. This guide outlines the importance of personal hygiene, safe drinking water practices, making informed choices about food and drink, and how to handle food-related illnesses when traveling.

Personal Hygiene: The Foundation of Food Safety

Personal hygiene plays a crucial role in minimizing the risk of travel-related illnesses. Prioritize handwashing with soap and water after using the toilet and before eating or preparing food. Be extra cautious if traveling with young children. Use disposable wipes or alcohol-based hand sanitizers without clean water to maintain hygiene levels.

Ensuring Safe Drinking Water

Hydration is essential when traveling, but water safety should not be compromised. To ensure water is safe for drinking, adopt the following practices:

• Drink bottled water from a reliable source and check that the seal is intact.
• Use bottled water for brushing your teeth.
• Boil tap water to a rolling boil (where large bubbles are visible).
• Use a water purifier.
• Disinfect water with iodine-based drinking water tablets.
• Avoid ice cubes unless made from safe bottled water, as freezing water preserves bacteria.

Smart Eating and Drinking Choices

Make informed decisions about food and drink to protect yourself from foodborne illnesses:

• Opt for food cooked at high heat, which is generally safe.
• Be cautious of warm or room temperature food, such as buffets.
• Apply the same rule to hot drinks – steaming hot is preferable.
• Dry, packaged, and factory-sealed food (e.g., bread, potato chips, canned tuna) is usually safe if the packaging is intact.
• Avoid raw food, including cut-up fresh fruit and vegetables, salads, raw meat, and uncooked seafood, as they are more likely to contain harmful bacteria.
• Opt for steaming hot food straight off the grill when choosing street food.
• Pregnant individuals or those with weakened immune systems should avoid unpasteurized dairy products like milk, yogurt, and cheese.

Managing Food-Related Illnesses

If you experience traveler’s diarrhea or food poisoning, follow these steps for recovery:

1. Rest and stay hydrated with clean water or oral rehydration drinks.
2. Use anti-diarrhea or anti-vomiting medication like loperamide-based medicines (e.g., Imodium).
3. Gradually reintroduce simple foods like toast, crackers, bananas, and rice as your body recovers.

Top Ways to Prevent Foodborne Illness

Follow these guidelines to stay safe from foodborne illnesses:

1. Wash your hands frequently and thoroughly.
2. Properly handle raw animal products to prevent cross-contamination.
3. Clean and sanitize utensils, equipment, and surfaces.
4. Use food before it expires.
5. Keep animals away from food and food preparation areas.

By adhering to these food safety tips and maintaining good personal hygiene, travelers can minimize the risk of foodborne illnesses and enjoy a healthy journey.

Recruitment and Population Characteristics

The study analyzed data from short-term visitors to developing countries, with a high response rate to the questionnaire showing that most travelers are aware and concerned about possible medical problems. The mean age of the travelers was 39.9 years, and the mean duration of stay was 2.8 weeks. Health problems were significantly more frequent in young adults, visitors to West Africa, people on adventure tours, and those who lived with natives or worked abroad.

Illness and Accidents in Travelers

Malaria was found to be one of the most frequent health problems among travelers from every region, with 11 of the 12 definite or possible cases originating in Africa. Hepatitis A and non-A, non-B hepatitis affected 291.6 per 100,000 visitors to developing countries in the 2.8-week stay. Chronic diarrhea was found in 73 (0.9%) travelers, with the highest rate (1.8%) noted upon return from West Africa and after journeys through various regions of the Far East. Accidents affected 38 (0.5%) travelers, with the most severe cases resulting from traffic accidents or assaults.

Malaria

Malaria was imported from Africa at a rate of 97.6 per 100,000 travelers, with an attack rate of 108.0 per 100,000 US travelers to Kenya. Increasing distribution of chloroquine-resistant parasites and growing concern about adverse reactions to prophylactic medication could lead to diminished protection and a further increase in malaria incidence.

Hepatitis

The hepatitis incidence rate was significantly higher than in retrospective surveys, and it occurred exclusively in travelers who had not received prophylactic immunoglobulin. Therefore, prophylactic immunoglobulin might be suggested for each traveler to a developing country to prevent hepatitis A.

Typhoid Fever and Cholera

No cases of typhoid fever or cholera were reported in the study, indicating that typhoid vaccination should only be recommended for travelers “off the usual tourist itinerary” and those visiting certain high-risk countries. In addition, cholera vaccination should be restricted to those visiting countries still requiring a certificate despite World Health Assembly recommendations.

Diarrhea

Only 8.5% of all travelers suffered from “severe” diarrhea, focusing on chronic or incapacitating forms. Higher infection rates are possible due to asymptomatic courses and spontaneous eradication of certain parasitic and bacterial intestinal infections. Diarrhea occurring after returning home tended to last longer and become chronic compared to cases occurring abroad.

Accidents

Serious accidents were rare, with only 1% of travelers requiring hospitalization. However, travelers should be reminded to wear shoes while swimming over coral reefs and disinfect any lacerations. These measures would avoid a significant proportion of cases with subsequent inability to work.

Differences between Travelers to Developing Countries and Control Group

In the control group of travelers to the Greek or Canary Islands, far fewer serious health problems were reported. No cases of severe infection were confirmed, and only dermatological problems and accidents occurred slightly more frequently in the control group.

Conclusions

This study provides a comprehensive and updated analysis of the health risks faced by short-term travelers to developing countries. The results highlight the importance of destination-specific and age-related differences in the risk of illness and accidents. High-risk travelers require more detailed medical recommendations, and prophylactic measures should be tailored accordingly.

Background

Approximately 8 percent of travelers to developing countries require medical care during or after travel. However, the current understanding of morbidity profiles among ill-returned travelers is based on limited data from the 1980s. The GeoSentinel sites, specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill-returned travelers. The study aimed to compare the frequency of each diagnosis among travelers returning from six developing regions worldwide.

Methods

Data were collected from June 1996 through August 2004. The characteristics of each patient were documented, and the diagnoses were categorized into 21 major syndrome categories. By analyzing the data, the study aimed to verify the assumption that the travel destination is associated with the probability of each diagnosis among travelers returning from the developing world.

Overall Morbidity

The median travel duration ranged from 14 days for the Caribbean to 35 days for South America. Most patients (64%) were seen within a month after travel, while 10% had indolent diseases or diseases with a long incubation period and were not seen until more than six months after the journey.

Destination Analysis

Significant differences in proportionate morbidity were seen among the travel regions for 16 of the 21 syndrome categories. In particular, systemic febrile illness was found disproportionately among patients presenting to GeoSentinel sites after traveling to sub-Saharan Africa or Southeast Asia, and acute diarrhea among those presenting after traveling to south-central Asia.

Regional Morbidity According to Specific Diagnosis

Malaria was the most frequent cause of systemic febrile illness among travelers from every region. Travelers with dengue presented more frequently than malaria for every area except sub-Saharan Africa and Central America. Rickettsial infections, primarily tick-borne spotted fever, appeared almost exclusively among travelers returning from sub-Saharan Africa, and typhoid fever was a primary contributor to systemic febrile illness among travelers from south-central Asia.

For all regions except Southeast Asia, parasite-induced diarrhea was more common among ill-returned travelers than bacterial diarrhea. Insect bites were the most common cause of dermatologic problems, followed by cutaneous larva migrans, allergic reactions, and skin abscesses. Leishmaniasis was primarily found among patients who had traveled to South America or, to a lesser extent, Central America.

Rare Diagnoses

Rare or exotic diagnoses, such as Ebola virus disease, Japanese encephalitis, and yellow fever, did not occur among the 17,353 travelers whose data were analyzed in this study. However, some rare diagnoses occurred only once among travelers, such as Angiostrongylus cantonensis infestation and hantavirus infection.

Proportionate Morbidity According to Region

Travel destinations are associated with the probability of the diagnosis of certain diseases. These destination-specific differences can guide diagnostic approaches and empiric therapies. This information can be helpful for health providers in assessing the health risks faced by travelers to developing countries and guiding post-travel diagnosis and empiric treatment. It can also aid in prioritizing pretravel intervention strategies.

What Are Travel-Related Diseases?

Travel-related diseases are illnesses that arise as a direct result of traveling to a new location, whether domestically or internationally. These diseases can range from mild to severe, and in some cases, can be fatal if left untreated. Common travel-related diseases include malaria, tuberculosis, typhoid fever, and yellow fever.

Causes of Travel-Related Diseases

There are various causes of travel-related diseases, such as:

• Being bitten by an infected mosquito, tick, or other insect
• Consuming contaminated food and drinks
• Exposure to infected individuals
• Improper use of medications intended to prevent specific diseases
• Lack of proper hygiene
• Not receiving appropriate vaccinations

Common Symptoms

Symptoms of travel-related diseases can range from mild to severe. Some common symptoms associated with specific diseases include:

• Malaria: Flu-like symptoms, such as chills and high fever
• Tuberculosis: Chest pain, weight loss, chills or fever, loss of appetite, night sweats, and a cough lasting three or more weeks with blood
• Typhoid fever: Stomach pain or headaches, prolonged high fever, loss of appetite, rash, constipation, and weakness
• Yellow fever: Body aches, headaches, fever, and chills that may take three to six days to manifest

Treatment Options

Treatment options are specific to the disease and may include:

• Hydration: Maintaining proper hydration is vital, especially for diseases that cause dehydration
• Medication: Antibiotics or other medications may be prescribed to combat the disease
• Rest: Time resting in a hospital may be necessary for certain diseases
• Surgical intervention: In cases where typhoid fever causes intestinal damage, surgery may be required

Prevention and Preparation

To reduce the risk of travel-related illnesses, it is crucial to prepare before traveling and take preventive measures such as:

• Consulting a pediatric travel medicine specialist for children
• Updating routine vaccines
• Receiving specialized travel vaccines
• Using preventive medicines
• Appropriately using insect repellents containing DEET or picaridin

Common Travel-Related Illnesses

Some common travel-related illnesses include:

• Diarrheal disease: Acquired by consuming contaminated water and food
• Hepatitis A: Acquired by consuming contaminated water and food
• Malaria: Caused by a parasite and acquired through the bite of an infected mosquito
• Dengue fever: A viral illness acquired through the bite of a mosquito
• Parasitic infections: Acquired through contaminated food, swimming or wading in infested water, or walking barefoot
• Tuberculosis: A bacterial infection that usually attacks the lungs and is transmitted person-to-person
• Typhoid fever: A bacterial illness that spreads through contaminated food and water or close contact with an infected person
• Yellow fever: A virus that spreads to humans by the bite of an infected mosquito
• Japanese encephalitis: A virus that is the leading cause of vaccine-preventable encephalitis
• Leptospirosis: A bacterial infection acquired by contact with contaminated fresh water
• Chikungunya: A viral illness that spreads to humans through the bite of an infected mosquito
• Rabies: A deadly virus that spreads to people from the saliva of infected animals, usually through animal bites

Travel-Associated Illness (TAI) and Emerging Global Threats

As international travel becomes more common, so does the risk of travel-associated illness (TAI). With globalization, it is essential to raise awareness, improve surveillance, and foster collaboration to address infectious diseases and emerging global threats. Health care professionals should encourage patients to discuss travel plans, obtain a thorough travel and occupational history, and be knowledgeable about travel specialists, as well as common TAI and emerging global threats.