How great is the risk of contracting a food-related illness these days, especially For those of us who travel to far-flung regions?
According to most medical authorities, the risk can be surprisingly high. For instance, of those traveling to a developing, tropical, or semi-tropical region (Africa, Latin America, southern Asia), nearly half will suffer from some kind of Traveler’s Diarrhea (TD). But that’s only part of the story.
Although the likelihood of food/water problems is higher in less developed areas, the potential for foodborne illness is truly a worldwide concern. According to the Centers for Disease Control, there are 76 million cases of food-caused illness each year in the United States alone. These result in 325,000 hospitalizations and more than 5,000 deaths per year. A pretty grim statistic, considering that the USA is one of the leading countries in the world in matters of food and water safety.
How Common Foodborne Illness is
If comparatively few people realize how common foodborne illness is, even here in America, fewer still understand how serious and even grave food illnesses can be. Although most cases of food poisoning and infection are either transitory or curable with proper medical treatment, a small percentage involve long-term consequences that are startlingly severe. E. coil bacterial infections can develop into a life-threatening condition called hemolytic uremic syndrome, leading to kidney failure. Campylobacter can lead to a form of acute paralysis known as Guillain-Barre syndrome; Salmonella sometimes triggers severe reactive arthritis, and so on. The point to remember is that food-caused illness can involve much more than an unpleasant bout of the runs.
Its also important to realize that foodborne sickness can occur just about anywhere–in wilderness camps and in high-end resorts and lodges; in international airports and in regional markets; in a hotel restaurant or beachside cafe. Even in your own home, for that matter.
Most food-related illness is caused by the “bug” triumvirate: bacteria, viruses, and parasites. Of these, the most commonly encountered are bacteria, which release toxins either on food or inside the human digestive tract. The result can be true “food poisoning.” Some types of bacteria pass through the gut quickly (if unpleasantly), while other, more dangerous kinds can penetrate through the intestines and invade other parts of the body. Typhoid (caused by Salmonella typhi), cholera (Vibrio cholera), and E. coli or “hamburger disease” (Escherichia coli) are fairly well-known examples of potentially lethal invasive bacteria.
Viruses use food and contaminated water as vehicles to enter a human host. Once inside, they use live cells to reproduce and trigger a variety of nasty symptoms, such as fever, headache, vomiting, and diarrhea. A particularly serious food-related virus is hepatitis A, which attacks liver cells, causing jaundice and organ impairment. Norwalk and rotavirus are the other two food- and water-related viruses known to upset the human digestive tract. Since viruses are destroyed by cooking-level heat, infections are usually caused by eating raw foods (soft fruit and shellfish especially) or food that has been contaminated after cooking.
Food-infecting parasites such as Giardia, Cryptosporidium, and Entamoebahistolytica are single-celled organisms–protozoa–usually associated with feces-contaminated water and/or poor hygiene habits.
These, then, are the main culprits Although there is no surefire way to stop them from messing with your insides, there are a number of things you can do (and not do) to minimize the risk of getting sick.
First, if you’re heading to a developing region like rural Africa or Latin America, it’s always wise to visit a travel medicine specialist a month or so prior to departure. At the very least you’ll want to be immunized for typhoid and hepatitis A.
In any area where water purity or human sanitation and hygiene are suspect, it’s best to avoid eating raw foods of any kind. This includes fruits that are peeled or opened by someone other than yourself, vegetables, salads, unpasteurized milk and cheese, and shellfish. Raw or undercooked shellfish have become a high-risk food everywhere these days About a third of U.S. shellfish beds have bans or limitations on harvesting because of unsafe levels of fecal bacteria. Worldwide, shellfish are linked with a variety of potential ills.
Another good rule when traveling is to avoid foods sold by street vendors, who often operate with minimal concern for sanitation and safety. If you shop in local markets, beware of any fruit that is sliced open for display and any that is sold by weight. The opened fruit is often sprinkled with untreated water to improve its appearance, and whole fruit is sometimes injected with unsafe water to increase its weight and price.
With all foods, no matter where or by whom they are prepared, be aware of a possible “cross-contamination” effect. For instance, if a knife is used to slice through the rind of a fruit, and that kind harbors any pathogens, the knife will probably carry the pathogens into the fruit–and into any other food items, the knife is used on later. Dr. William Forgey, a leading travel-medicine authority, points out that sometimes safe food is served on unsafe dishes–plates and bowls that have been inadequately washed or washed in contaminated water. (Forgey recommends carrying your own plastic bowl and cup, plus your own knife, fork, and spoon in places where sanitation is suspect.)
As a general rule, food is likely to be safe if it is placed before you hot and steaming. However, even food that’s hot on the outside could be unsafe inside if not cooked all the way through. Experts warn against ordering rare or medium-rare beef, especially with ground meat such as hamburger. Undercooked poultry that’s pink or leaking pink juices in the middle, should be returned for full cooking. Eggs are another higher-risk food when undercooked. Sunny-side up or over-easy might not be a good idea in places where freshness, sanitation, hygiene, and/or overall health awareness is in doubt. Whether at home or when traveling, do not use eggs with cracked shells. Bacteria such as salmonella (which are common on poultry products) can easily invade even a hairline shell crack and proliferate inside the egg.
Even safely cooked foods can become unsafe if left standing too long in a room-temperature environment. A strict but good guideline here is the Two-Hour Rule. This means that cooked foods should be consumed or covered and refrigerated within two hours of serving. Beyond that point bacteria such as Staphylococcus (which about half of us carry on our hands) can multiply on the food, producing toxins–classic “food poisoning.” Custards, cream pies, meats, milk, and salads made with mayonnaise are most susceptible to this kind of bacterial poisoning, but other foods are vulnerable as well if left unheated or unrefrigerated for too long. Please note: Once this kind of toxification occurs, reheating, even boiling, will not make the food safe for consumption.
An important way to prevent many types of food-related illness is by keeping consciously high standards of personal hygiene. This is especially important in a hunting camp, for instance, or in any primitive-facility group situation, particularly those involving an outhouse, latrine, or shared bathroom. Lax hand-cleaning can–and often does–cause a group outbreak of food- or water-borne disease. Using a pocket-sized bottle of disinfectants like Purell or Germ-X or an equivalent moist wipe after bathroom visits and before meals is just good common sense. The digestive tract you save could be your own.
Another caution related to foodborne illness and TD-avoidance: Don’t take any antibiotic medication as a “preventative” against possible trouble, unless the drug has been prescribed by a doctor. I mention this to warn against a common practice in developing countries, where antibiotics can often be purchased locally without a prescription. The idea–sometimes promoted by locals and guides–is that you can use such drugs to prevent or quickly stop bowel troubles. Any doctor will tell you this is a bad idea on several counts. For one thing, the antibiotic you use might not be the right one for the job. Also, improper dosing can actually nurture a drug-resistant bacterial strain that’s much harder to cure. Finally, antibiotics can destroy the “good” bacteria in your gut, the flora necessary for proper intestinal function.
On the safer side, there is sound medical evidence that you can prevent some TD by taking two tablets of a Pepto-Bismol type product (bismuth sub-salicylate) before meals and at bedtime. Be aware, however, that Pepto contains aspirin and can inhibit the absorption of some drugs, such as antibiotics. Ask a doctor if Pepto-prophylaxis is a safe option for you.
A final note on medicines: People who use copious antacids and/or acid-inhibiting medications may be increasing their vulnerability to foodborne illness. Many ingested pathogens are destroyed by strong stomach acid. In areas where food safety is questionable, it can be a good idea to cut down on acid-reducing drugs if possible. Better to suffer a bit of heartburn than a full-blown case of food poisoning.