Food Safety while travelling
(Reviewed for medical accuracy by Jennifer Reed MD)
Food Poisoning, Montezuma’s Revenge, Delhi Belly, Traveller’s diarrhea: whatever you call it, most of us are afraid of it, especially when traveling.
600 million people fall sick from food Bourne illnesses every year. For 420,000 people, it ends up being fatal.
Many travelers regard it as part of the experience of seeing the world and don’t realize how serious it can be, especially for children. Others are so afraid of getting sick, they do not take their kids abroad, missing out on amazing, educational and emotional growth opportunities. There is a happy medium.
My American-born toddlers have lived in India for a year and a half and have never had food poisoning. I, on the other hand, have had food poisoning half a dozen times with varying severity. I was hospitalized twice with severe dehydration. I’ve been scolded by no less than 2 dozen doctors on how to stop ending up back in their office. I’m combining my personal experience with recommendations from leading health and safety organizations around the world to let you know everything you need to know about food poisoning. How food becomes contaminated, how the bacteria spreads, who’s at greatest risk, safe food options, and if all else fails, what to do if you fall sick. The good news is, for the vast majority of cases, food poisoning is mild, can be treated at home, and the symptoms fully subside after just a few days.
So what exactly is food poisoning?
Thousands of bacteria are naturally present in our environment. Some are beneficial to humans like those found in yogurt or cheese. When certain not so good microorganisms enter our food they can contaminate it, causing foodborne illnesses. Symptoms arise hours to weeks after ingesting contaminated food and include: Nausea, vomiting, diarrhea, cramping, headache, and fever. Sounds like the flu right? Many people actually mistake food poisoning for the flu, especially when they’re not traveling to place that’s particularly known for foodborne illnesses. Most cases of foodborne illness can be prevented by fully cooking foods since the high temps destroy the harmful bacteria.
How does food become contaminated?
Contaminated water
While exploring a country where the tap water is unsuitable for drinking, you need to ensure all fruits and vegetables are washed in clean water before eating them. Be on the lookout for anything that seems like it was prepared with non-filtered/boiled water – for example, dips and sauces.
The Fecal-Oral route
For example, a food service worker uses the restroom. After doing their business, they rinse their hands under running water for 5 seconds and call it good. Except it’s not good, there’s still microscopic fecal matter on their hands that’s invisible to the naked eye. They return to work, cut some fruits, squeeze a few lemons and serve you your food. You enjoy your delicious lemonade and fresh-cut fruit while unknowingly swallowing their crap – literally.
Surfaces Contamination
Bacteria from food handlers, raw eggs, seafood or poultry can stick to knives, cutting boards, and other surfaces, contaminating anything that comes in contact with it. This is why it’s so important to cut your own food.
Bacteria grows on food when it’s left out or not stored at ideal temperatures after cooking.
Insects
Flies can carry more than 200 different types of bacteria. When they land on your food, they can contaminate it. If you have a healthy immune system, there’s probably no need to throw out your food after a fly touches it for a second. If you see a dozen flies hovering around a plate of sliced coconuts, just say no.
You
Think of how many items you’ve touched throughout your day, then think about how many other people have touched those same surfaces since they were last sanitized. Ok, now stop thinking about it before you spiral down a rabbit hole of anxiety.
How to avoid food poisoning while traveling
It may be impossible to fully prevent food poisoning but there are many ways to minimize your risk. Here are a few options.
Avoid any raw or undercooked fruits and vegetables that you have not washed and cut/peeled yourself
The absolute safest (but very limited) option
- Street Food: Avoid all street food and restaurants you haven’t researched online first.
- Beverages: Only drink bottled water or canned soda, that you’ve opened yourself. Say no to ice. Use bottled water to rinse your toothbrush.
- Restaurants: Eat only in well established, well-reviewed restaurants. Ask your hotel concierge for suggestions or research online. Eat only fully cooked foods, including dairy, eggs, etc. Avoid seafood if you’re not close to the source.
- Fruits and Veggies: Avoid all uncooked or undercooked fruits and vegetables that you have not washed and peeled yourself. That includes fruit juices, vegetable pizza toppings which are usually only semi-cooked, etc. Buy whole fruits and veggies from anywhere, but wash and cut them yourself.
The safe enough (happy medium) option (The one my kids follow)
- Street Food: Search out Hygienic food stalls and stick to well-cooked foods – these are rare in some areas.
- Beverages: At reputable restaurants (research ratings online, stick to places rated 4+), try anything, but if you choose water, drink the bottled variety. Reputable restaurants will almost always have a reverse osmosis machine on-site but since there is no guarantee they change the filters when they should, we usually stick to bottled water. Sip fresh-squeezed fruit juices before giving it to your child. (Try fresh watermelon juice or ABC- Apple, Beetroot, Carrot.) If the juice tastes sour, spit it out and send it back – unless it’s a fresh lemonade that is.
- Restaurants: If eating at an unknown spot, stick to only well-cooked foods – no dairy, undercooked eggs, meats, seafood or fruit juices. Eat whatever you want at well-reputed places except for maybe a salad. Ask your hotel concierge for dining suggestions or read reviews online before you go. When selecting a quick, unplanned bite, look for hygiene signs such as hairnets, gloves, etc. Also, look for signs that it’s well known to locals – like a long line or full tables. In India, you can download an app called Zomato – in addition to food ratings they have an independent hygiene rating for most restaurants. Stick to places rated “Very Good” or “Excellent”
- Fruits and Veggies: Avoid all raw, cut fruits and veggies unless the restaurant is well-reputed, generally speaking, 4 and 5-star hotels/resorts should be fine. Buy fruits and vegetables from anywhere, but wash and cut them yourself.
The gambler (for food lovers 5+ with healthy immune systems) option
- Whatever works for you. Avoid undercooked fruits and vegetables when you think it’s been sitting out, at unknown restaurants/street stalls and from visibly unhygienic venders. Pick and choose what “rules” above to follow. Just know that you are taking risks.
For whichever option you choose, Incorporate good bacteria such as probiotics, kefir, yogurts, etc. Avoid unpackaged dairy anytime you think consistent refrigeration may have been an issue.
Breastfeeding can help your baby because of the antibodies contained, so if your thinking of weaning soon, maybe wait until after your trip.
For my kids, we go the safe enough route. They love having fresh watermelon or ABC (Apple Beetroot, Carrot) juice whenever we go out. Fresh cut fruit from hotel buffets is a dietary staple. I used to be more of a calculated gambler but after having such a rough year with food poisoning I now ask myself, “would I feed my kid this?” If the answers no, I pass.
If ever anything tastes or looks “off” in any way stop eating it. Watch your spice level, while pushing past your spice tolerance won’t cause food poisoning, it CAN irritate your intestinal tract enough to give you symptoms of food poisoning.
Personal Hygiene while traveling
Hand Washing
Always wash your hands before eating whenever possible. Washing your hands as soon as you return to your home/hotel is also great practice. You want to avoid spreading the bacteria you’ve picked up from crowded tourist areas all around your living space.
Washing your hands properly is the best way to remove disease causing bacteria from your hands.
How you wash your hands and how long you wash your hand’s matters.
Remove your shoes
When you’re out sightseeing, you’re bound to do a lot of walking. Which means there were plenty of opportunities to step on old food, contaminated water, bird droppings, animal feces, etc. This is especially important if your kids are crawling around touching the floors with their hands…. and then sticking those little hands in their mouths.
Hand Sanitizer
Carry hand sanitizer with you and use it before each meal whenever hand washing isn’t an option (which is often). You want your hand sanitizer to be at least 60% alcohol. Many studies have shown that alcohol-free sanitizers are less effective. Just be sure it drys fully before they bring their hands to their mouths. If your child’s hands are visibly dirty or greasy, try to find a place to wash their hands as hand sanitizer may not be effective.
Washing baby items
For baby bottles, pacifiers and sippy cups, ask your hotel for extra bottled water to wash them in.
Bathing
For older kids, you can just tell them not to drink the water but for younger toddlers and babies, this can sometimes be an issue. Many hotels these days have potable water so if your kids swallow a little (or a lot) in the tub it’s nbd. If your hotel does not, or you’re staying in a vacation rental home, you can purify the water so that it is suitable for drinking. To do this, bring the tap water to a rolling boil for at least 1 minute. Alternately, you can add two drops of household bleach per 1 quart/liter of water. Mix, and let stand for 30 minutes.
You can also buy Potable Aqua Water Purification Treatment (50 Tablets) – Portable Drinking Water Treatment Ideal for Emergencies, Survival, Travel, and Camping
Before your trip
Load up on good bacteria
Start taking probiotics daily for 3 months before your trip, eat yogurts, drink kefir, etc.
Visit your doctor
Make sure your family is up to date on their hepatitis A vaccine (along with any others needed for the region).
Take an antibiotic with you
Have your family physician prescribe an antibiotic to take with you on your trip. This can often save you a Drs visit and can allow you to not miss out on your fun vacation. I usually start feeling better 24 hours after taking the first dose. If you do visit a local pharmacy, be sure to look up the medication they’ve given you online to make sure there was nothing lost in translation.
Travel insurance
Many people choose to buy travel insurance for Dr. visits etc. Others decide that medical treatment in the country they are visiting will be affordable enough to cover the cost if an issue arises. For example, a Dr’s visit here in India is $20 in the (really fancy) hospital and $30 when they come to your home/hotel. Medicine for food poisoning usually varies from $3-$15. That is all without insurance. If something crazy happens and you need an MRI or long hospitalization it is prudent to have. If you forgot to buy it though, don’t let the fear of outrageous costs keep you from seeking medical attention.
Who’s at greatest risk for food poisoning?
Children < 5
The greatest risk is to children under 5 who account for 30% of all fatalities but only make up 10% of the population.
Children who survive a serious food-borne illness may suffer from delayed physical and mental development. Food poisoning can also cause longer-term illnesses, such as cancer, kidney failure, liver failure, brain, and neural disorders. Other people at increased risk include pregnant women, the elderly and individuals with compromised immune systems.
Highest risk regions
Africa has the highest rates of food born illness, followed by South East Asia, so people traveling in those regions are at higher risk and should take extra care.
Don’t Stress
Before you let this scare you from traveling internationally, note that a disproportionate amount of these fatalities occur in very low-income areas with limited access to clean drinking water, functioning sewer systems, etc. Also, note that no country is immune from foodborne illnesses. Countries with more stringent food safety laws do have lower rates of exposure and fatalities. For example, the European region reports the lowest fatality rate with 5000 deaths annually.
What to do if you still get food poisoning
Keep in mind that many people have mild stomach upsets after a sudden and drastic change in their diets, which has nothing to do with contaminated food. Food poisoning causes cramping, nausea, vomiting, and diarrhea. The most important thing is to ensure adequate fluid intake. Oral rehydration packets can be found in nearly every pharmacy in the world. Mix the contents with water to help rebalance your fluids. If symptoms are severe (trust me, you will know) or you start showing the following signs of moderate-severe dehydration see a doctor.
When to get help for food poisoning
Consult a doctor if:
You should consult a Dr. If YOUR CHILD:
- Has had five or more episodes of diarrhea in the past 24 hours
- Is 1 year or younger and has been vomiting for more than 12 hours
- Is under 2 and has been vomiting for more than 24 hours
- Is 2 years or older and has been vomiting for more than 48 hours
- Symptoms are accompanied by a fever
- Has bloody diarrhea- as this may be a sign of specific bacterial infections that may benefit from a course of antibiotics.
- Are showing signs of Jaundice (skin or the whites of the eyes turn yellow)
- Is inconsolable
- Is showing signs of dehydration
- Symptoms are severe (Very frequent episodes of vomiting and/or diarrhea, severe abdominal pain, lethargy, signs of dehydration or significant changes in behavior and activity level)
If you are traveling in the highest risk regions of Africa or South East Asia, seek medical attention promptly if you are on the fence about taking your child in or not.
You should consult a Dr if YOU:
- Have diarrhea lasting more than 10 days
- Are vomiting for more than 2 days
- Symptoms are accompanied by a fever
- Have bloody diarrhea
- Are showing signs of Jaundice (skin or the whites of the eyes turn yellow)
- Are showing signs of dehydration
- Symptoms are Severe (Very frequent episodes of vomiting and/or diarrhea, severe abdominal pain, confusion, signs of dehydration or feel the sickest you’ve ever been)
Going to a doctor in a foreign country can be overwhelming especially when you’re not feeling well. Before heading out, ask the hotel concierge if they can arrange for a Dr to come to your hotel room instead. If this is not possible, hop on Facebook, find an expat community and ask them for hospital and/or physician recommendations. If you are close to an embassy, they often provide recommendations as well. Remember to bring your passport and debit/credit card to the hospital.
Don’t let a fear of food poisoning ruin your vacation
Take it seriously, especially if you’re traveling with children under 5. As parents, we are usually more lax with our own health. So, ask yourself, “would I let my child eat this?” before enjoying outside food. Remember that, in general, if it’s fully cooked – its fine. Enjoy yourself, enjoy the food! Enjoying new foods is a great way to establish a healthy relationship with nutrition early on. So go on, get your happy food dance on.
Update: We have now lived in India for three years. My kids had food poisoning once. I took them to their pediatrician the same day they started showing symptoms since they were severe and they were fine the next day. While it’s not the same as never getting food poisoning, I still feel like food poisoning once in 3 years is pretty good odds. I actually visited the US 6 months ago and had food poisoning there – the day after I at a salad, a contaminated Romain recall was all over the news! Just my luck. Anyhow these guidelines have helped my kids stay free of poisoning for nearly a 1000 days while living here so I’m hoping they’ll keep you safe for your next trip!
Sources:
https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
https://www.nidirect.gov.uk/conditions/dehydration
https://www.nhs.uk/conditions/food-poisoning/causes/
http://www.who.int/mediacentre/news/releases/2015/foodborne-disease-estimates/en/
https://globalnews.ca/news/3883353/houseflies-bacteria-sick-reality-check/
https://phys.org/news/2010-08-uf-house-flies-illness-causing-bacteria.html
https://www.epa.gov/ground-water-and-drinking-water/emergency-disinfection-drinking-water
https://www.ncbi.nlm.nih.gov/pubmed/21219730
https://www.ncbi.nlm.nih.gov/pubmed/15489352
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