By Sheldon Margen and Dale A. Ogar We can't help you decide where to go on vacation this year, but we can help with some precautions about food, water and sanitation that may help keep you well during your travels. Traveler's diarrhea is one of the most common ailments you are likely to encounter in your travels. Symptoms include diarrhea, nausea, cramps and fever. The nasty little bug is a familiar one: E. coli and is most bothersome in Africa, the Middle East, the Mediterranean countries, Southeast Asia, and Latin and Central America. Unfortunately, if you aren't careful, traveler's diarrhea may be the least of your worries. You could contract cholera, typhoid, hepatitis or worse. If you are traveling to Europe (except for parts of southern Europe), Australia, New Zealand, Canada or Japan, you can probably drink the water and sample all the local cuisines without worry. However, if you are going somewhere else, keep in mind the following precautions: Food Don't eat raw vegetables. Just assume they are contaminated. Lettuce very often contains parasites, so stay away from salads. Make sure that all vegetables have been well cooked. Eat fresh fruit and nuts only if there are no breaks in the peel or shell. Wash all fruits in soap, and rinse in boiled water. Remove the peel before eating. Do not eat any fruit that has been already peeled.
Be sure that all meat and fish is thoroughly cooked, and try to eat it while it is still hot. This will lower your risk of getting tapeworm or trichinosis. Some restaurants leave food sitting around for hours and then reheat it in a microwave before serving. This may or may not protect you against many microorganisms. When in doubt, ask how the food was prepared. Try to make sure that all fish is freshly caught. Do not eat uncooked fish, including sushi, ceviche or fish eggs (caviar). No matter where you are -- even at home -- avoid raw shellfish. Some fish are not thought to be safe even when cooked because they may have toxins in their flesh. This is especially true of fish caught on tropical reefs, rather than in the open ocean. Take extra care with milk and other dairy products, especially if they have not been pasteurized or properly refrigerated. Avoid perishable food sold unrefrigerated (e.g., from street vendors). Pay special attention to cold cuts, pastries, custards, meat salads and fish. Water Many modern hotels, even in the developing countries, purify the water, but if you are at all in doubt, don't drink it. Don't even use the tap water to brush your teeth. Safe beverages include coffee and tea (if the water has been boiled), bottled wine, beer and canned soft drinks. Bottled soft drinks are iffy, so avoid them.
If you have small children with you, it might be useful to carry along a few bottles of pediatric oral rehydration solution. Children are at great risk for complications from severe diarrhea and dehydration. You should be especially mindful of what they eat and drink.
Traveler's diarrhea is rarely serious, but if the diarrhea is severe and appears to be bloody, you may have dysentery and should seek medical attention right away. Frequent hand washing is usually a good idea, but washing your hands in contaminated water may not do much good. When you're in places where the water supply is iffy, take along premoistened wipes. Remember that vacations are supposed to fun, but it wouldn't take much to turn an expensive trip into a miserable experience. For excellent, up-to-date information on health advisories in various parts of the world, check out the U.S. Centers for Disease Control and Prevention (CDC) Web site. Have a good trip, and send us a postcard. Reviewed July 2008 Sheldon Margen, M.D., is a professor of public health at the University of California at Berkeley. Dale A. Ogar is managing editor of the University of California at Berkeley "Wellness Letter." They are the authors of "The Simply Healthy Lowfat Cookbook," "The Wellness Lowfat Cookbook" and "The Wellness Encyclopedia of Food and Nutrition."
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