Escherichia coli (ETEC) - the bacteria that most commonly attacks travelers

A recent post on the Uncornered Market blog addresses the not-so-delicate topic of “how to travel without hugging the bowl.”   Though this is sometimes unavoidable, there are some steps you can take to protect yourself and your vacation from a gastrointestinal attack.

More than 200 foodborne diseases have been identified worldwide and include traveler’s diarrhea, Hepatitis A, typhoid fever, cholera, salmonella, and E. coli. For travelers, the most common foodborne disease is — you guessed it — traveler’s diarrhea.  What causes it? Generally it’s caused by bacteria, often Escherichia coli (ETEC). According to the CDC,  between 20% and 50% of travelers develop diarrhea.

Where should I be extra careful? The World Health Organization (WHO) says, “It most commonly affects persons traveling from an area of more highly developed standards of hygiene and sanitation to a less developed one” and reminds us that “While the risks are greater in poor countries, locations with poor hygiene may be present in any country.”  The CDC says that high-risk destinations are developing countries in Latin America, Africa, the Middle East, and Asia.

What’s wrong in these countries? Developing countries often lack either food regulations or the resources to enforce them. The Codex Alimentarius Commission is a joint organization of the WHO and the FAO (the Food and Agriculture Organization of the United Nations) that suggests voluntary food standards, but countries aren’t required to follow them. You can see the member countries of Codex here.

What can I do to stay healthy? The key is getting rid of the bacteria and viruses that cause disease.  Minimally, use the same judgment abroad that you would use when eating in your own neighborhood: Don’t dine in establishments that don’t appear clean or that have a bad reputation.  Make sure your food is cooked properly — whereas you might like your food a little rare, you may not want to leave that judgment up to the cook in a foreign country.  And when it comes to water, always choose bottled over tap, but know that sometimes bottled water isn’t what it appears to be. A colleague was in a resort recently where we saw employees filling up the bottles from a tap.  Perhaps the source was filtered and fine (many hotels have their own special systems to purify their drinking water), but who knows.  Ice is also a no-no.

The WHO has five basic guidelines that they cover in their traveler’s brochure Prevention of foodborne disease: Five keys to safer food.   You should also check out the CDC destination pages — each page has country specific tips about food and water. For instance, the guide for France recommends avoiding unpasteurized dairy and washing hands, while the guide for Kenya adds comments about water, street vendors, and cooked food.

Do you have any destination-specific advice to share or, worse, horror stories from the proverbial trenches?