Food & Water Precautions - Chapter 2 - 2020 Yellow Book | Travelers' Health (2023)

Table of Contents

Patricia M. Griffin, Vincent Hill

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Contaminated food and water often pose a risk for travelers. Many of the infectious diseases associated with contaminated food and water are caused by pathogens transmitted via the fecal–oral route. Swallowing, inhaling aerosols of, or coming in contact with contaminated water—including natural freshwater, marine water, or the water in inadequately treated swimming pools, water playgrounds (splash parks or splash pads), or hot tubs and spas—can transmit pathogens that can cause diarrhea, vomiting, or infection of the ears, eyes, skin, or the respiratory or nervous system.


Advise travelers to select food with care. Raw food is especially likely to be contaminated. Raw or undercooked meat, fish, and shellfish can carry various intestinal and systemic pathogens. (Some fish harvested from tropical waters can transmit toxins that survive cooking; see Food Poisoning from Marine Toxins in this chapter.) In areas where hygiene and sanitation are inadequate or unknown, travelers should avoid consuming salads; uncooked vegetables; raw, unpeeled fruits; and unpasteurized fruit juices. Fruits that can be peeled are safest when peeled by the person who eats them. Produce should be rinsed with safe water (see Water Disinfection in this chapter). Foods of animal origin, including meat and eggs, should be thoroughly cooked; milk and milk products, including milk used in soft cheese, should be pasteurized. In restaurants, inadequate refrigeration and lack of food safety training among staff can result in transmission of pathogens. Consumption of food and beverages obtained from street vendors has been associated with an increased risk of illness. In general, foods that are fully cooked and served hot are safest, as are foods people carefully prepare themselves.

Travelers should wash their hands with soap and water before preparing food, before eating, after using the bathroom or changing diapers, before and after caring for someone who is ill, and after contact with animals or their environments. If soap and water are not available, use an alcohol-based hand sanitizer (with ≥60% alcohol) and wash hands with soap and water as soon as they become available. Hand sanitizer is not very effective against Cryptosporidium or norovirus and does not work well when hands are visibly dirty or greasy.

The safest way to feed an infant aged <6 months is to breastfeed exclusively. If the infant is fed formula prepared from commercial powder, the powder should be reconstituted with hot water at a temperature of ≥158°F (≥70°C). This precaution will kill most pathogens with which the infant formula may have been contaminated during manufacturing or through handling after opening. To ensure that the water is hot enough, travelers should prepare formula within 30 minutes after boiling the water (see Water Disinfection in this chapter). The prepared formula should be cooled to a safe temperature for feeding (for example, by placing the bottle upright in a bath of safe water and safe ice [see below], keeping the bath water below the nipple ring) and used within 2 hours of preparation. Bottles and nipples should be washed and then sterilized (in boiling water or in an electric sterilizer). Travelers may wish to pack enough formula for their trip, because manufacturing standards vary widely around the world.

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Tell travelers not to bring perishable food from high-risk areas back to their home country without refrigeration. Moreover, travelers should exercise the same cautions about food and water served on flights that they do for restaurants.


Drinking Water and Other Beverages

In many parts of the world, particularly where water treatment, sanitation, and hygiene are inadequate, tap water may contain disease-causing agents, including viruses, bacteria, and parasites, or chemical contaminants. As a result, tap water in some places may be unsafe for drinking, preparing food and beverages, making ice, cooking, and brushing teeth. Infants, young children, pregnant women, the elderly, and people whose immune systems are compromised (for example, because of HIV, chemotherapy, or transplant medications) may be especially susceptible to illness.

Travelers should avoid drinking or putting into their mouths tap water unless they are reasonably certain it is safe. Many people choose to disinfect or filter their water when traveling to destinations where safe tap water may not be available. Tap water that is safe for drinking is still not sterile and should not be used for sinus or nasal irrigation or rinsing, including use in neti pots and for ritual ablution unless it is further disinfected by the traveler. Tap water should never be used to clean or rinse contact lenses. Water that looks cloudy or colored may be contaminated with chemicals and will not be made safe by boiling or disinfection. In these situations, travelers should use bottled water if it is available.

In areas where tap water may be unsafe, only commercially bottled water from an unopened, factory-sealed container or water that has been adequately disinfected should be used for drinking, preparing food and beverages, making ice, cooking, and brushing teeth. (See Water Disinfection in this chapter for proper disinfection techniques.)


Beverages made with water that has just been boiled, such as tea and coffee, are generally safe to drink. When served in unopened, factory-sealed cans or bottles, carbonated beverages, commercially prepared fruit drinks, water, alcoholic beverages, and pasteurized drinks generally can be considered safe. Because water on the outside of cans and bottles may be contaminated, they should be wiped clean and dried before opening or drinking directly from the container.

Beverages that may not be safe for consumption include fountain drinks or other drinks made with tap water and iced drinks. Because ice might be made from contaminated water, travelers in areas with unsafe tap water should request that beverages be served without ice.

Recreational Water

Pathogens that cause gastrointestinal, respiratory, skin, ear, eye, and neurologic illnesses can be transmitted by contaminated recreational water in inadequately treated pools, water playgrounds (splash pads or spray parks) or hot tubs/spas, or in freshwater or marine water. Recreational water contaminated by human feces from swimmers, sewage, animal waste, or wastewater runoff can appear clear but still contain disease-causing infectious or chemical agents. Ingesting even small amounts of such water can cause illness. To protect other people, children and adults with diarrhea should not enter recreational water. Infectious pathogens, such as Cryptosporidium, can survive for days even in well-maintained pools, water playgrounds, and hot tubs/spas.

Maintaining proper pH and free chlorine or bromine concentration is necessary to prevent transmission of most infectious pathogens in water in pools, water playgrounds, and hot tubs/spas. If travelers would like to test recreational water before use, CDC recommends pH 7.2–7.8 and a free available chlorine concentration of 2–4 ppm in hot tubs/spas (4–6 ppm if bromine is used) and 1–3 ppm in pools and water playgrounds. Test strips may be purchased at most superstores, hardware stores, and pool supply stores. Pseudomonas, which can cause “hot tub rash” or “swimmer’s ear,” and Legionella (see Chapter 4, Legionellosis) can multiply in hot tubs and spas in which chlorine or bromine concentrations are not adequately maintained. Travelers at increased risk for legionellosis, such as the elderly and those with immunocompromising conditions, may choose to avoid entering or walking near higher-risk areas such as hot tubs/spas. Travelers should avoid pools, water playgrounds, and hot tubs/spas where bather limits are not enforced or where the water is cloudy. Additional guidance can be found at

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Travelers should not swim or wade 1) near storm drains; 2) in water that may be contaminated with sewage, human or animal feces, or wastewater runoff; 3) in lakes or rivers after heavy rainfall; 4) in freshwater streams, canals, and lakes in schistosomiasis-endemic areas of the Caribbean, South America, Africa, and Asia (see Chapter 4, Schistosomiasis); 5) in water that might be contaminated with urine from animals infected with Leptospira (see Chapter 4, Leptospirosis); or 6) in warm seawater or brackish water (mixture of fresh and sea water) when they have wounds.

A traveler with an open wound should consider staying out of the water or covering the wound with a water-repellent bandage (often labeled “waterproof”), as seawater and brackish water can contain germs, such as Vibrio spp., that can cause wound infections. If a sore or open wound comes into contact with untreated recreational water, it should be washed thoroughly with soap and water to reduce the chance of infection.

Naegleria fowleri ( is a parasite found in warm freshwater around the world. To help prevent a rare but fatal infection caused by this parasite, travelers should hold their nose shut or wear a nose clip when swimming, diving, or participating in similar activities in warm freshwater (including lakes, rivers, ponds, hot springs, or locations with water warmed by discharge from power plants and industrial complexes). They should also avoid digging in or stirring up sediment, especially in warm water. This infection has also been linked to use of contaminated tap water for sinus and nasal irrigation.


  1. CDC. Notes from the field: primary amebic meningoencephalitis associated with ritual nasal rinsing—St. Thomas, US Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013 Nov 15;62(45):903.
  2. Drinking Water: Camping, Hiking, Travel. CDC; 2016. [cited 2016 Apr 15]. Available from:
  3. Eberhart-Phillips J, Besser RE, Tormey MP, Koo D, Feikin D, Araneta MR, et al. An outbreak of cholera from food served on an international aircraft. Epidemiol Infect. 1996 Feb;116(1):9–13.
  4. Food Safety. CDC; 2018. [cited 2018 Mar 4]. Available from:
  5. Healthy Swimming: Ear Infections. CDC; 2016. [cited 2016 Apr 15]. Available from:
  6. Healthy Swimming: Rashes. CDC; 2016. [cited 2016 Apr 15]. Available from:
  7. Legionella (Legionnaires’ Disease and Pontiac Fever). CDC; 2017. [cited 2018 Mar 4]. Available from:
  8. Parasites—Naegleria fowleri—Primary amebic meningoencephalitis (PAM) - Amebic Encephalitis. CDC; 2017. [cited 2016 Apr 15]. Available from:
  9. Traveler’s Health: Food and Water Safety. CDC; 2018. [cited 2018 Mar 4]. Available from: /travel/page/food-water-safety.
  10. Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, et al. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012 Nov;55(9):e79–85.


What precautions will you take to prevent contamination of drinking water? ›

Keep the area around your well clean and free of debris. Do not pour harmful chemicals on the ground and don't overuse fertilizers and pesticides. Have your septic system checked each year, and pumped every 3-5 years. Dispose of household chemicals properly.

How are food and water related to health? ›

Food, water and environment are personal and immediate matters. Nutritious food maintains health, promotes growth in children, and prevents blindness. Safe drinking water nurtures and restores; unsafe water, even when it looks clean, is harmful.

What diseases are spread by contaminated food and water? ›

Food and Water Borne Diseases
  • Campylobacter.
  • Cryptosporidium.
  • E. coli infection.
  • Giardiasis (Giardia)
  • Hepatitis A.
  • Listeriosis.
  • Norovirus.
  • Salmonellosis (Salmonella)

How can you prevent the transmission of food and waterborne parasites? ›

Wash hands thoroughly with soap and water for at least 20 seconds, rubbing hands together vigorously and scrubbing all surfaces. Wash hands thoroughly after using the toilet, changing a diaper or cleaning up a child who has used the toilet, and before and after tending to someone who is ill with diarrhea.

Why is it important to protect water and keep it clean? ›

Unsafe water causes water-borne illnesses such as Escherichia coli-induced diarrhea, cholera, typhoid fever, giardia, Hepatitis A, and dysentery. Communities need clean water to stay physically healthy and prevent diseases caused by a lack of adequate water, sanitation, and hygiene (WASH).

What are 10 ways to reduce water pollution? ›

15 Proven Ways We Can Reduce Water Pollution
  1. Dispose of Toxic Chemicals Properly: ...
  2. Shop with Water Pollution in Mind: ...
  3. Do Not Pour Fat and Grease Down the Drain: ...
  4. Use Phosphate-Free Detergent and Dish Cleaner: ...
  5. Check Your Sump Pump or Cellar Drain: ...
  6. Dispose of Medical Waste Properly: ...
  7. Eat More Organic Food:
20 Jul 2017

What are the 5 importance of water? ›

Here are just a few examples of the ways water works in your body:
  • Regulates body temperature.
  • Moistens tissues in the eyes, nose and mouth.
  • Protects body organs and tissues.
  • Carries nutrients and oxygen to cells.
  • Lubricates joints.
  • Lessens burden on the kidneys and liver by flushing out waste products.
29 Sept 2022

What are the 10 importance of water? ›

Enough water intake prevents constipation, indigestion and other problems of gastrointestinal tract. Lack of fluids in the body makes stool tight and it tends to pull water from the colon resulting in constipation. Proper hydration improves digestion and allows maximum nutrient absorption in the blood.

What are the 4 main functions of water? ›

Water's importance in the human body can be loosely categorized into four basic functions: transportation vehicle, medium for chemical reactions, lubricant/shock absorber, and temperature regulator.

What are 4 water borne diseases? ›

Commonly recognized waterborne infections are:
  • Cryptosporidiosis (Cryptosporidium)
  • Cyclosporiasis (Cyclospora spp.)
  • Escherichia coli O157:H7 Infection (E. ...
  • Giardiasis (Giardia)
  • Harmful Algal Blooms (HABs)
  • Hot Tub Rash (Pseudomonas Dermatitis/Folliculitis)
  • Legionellosis (Legionella)

What are the four major types of water related diseases? ›

Common waterborne illnesses include typhoid, cholera, dysentery, gastroenteritis, and hepatitis.

What are 3 ways food can be contaminated? ›

There are three ways that food can be contaminated:
  • biological hazards (microorganisms) including bacteria, fungi, yeasts, mould and viruses.
  • chemical hazards. including cleaning chemicals or foods with naturally occurring toxins, such as green potatoes.
  • physical hazards.

What are 10 ways to prevent food contamination? ›

Here are some tips to help you reduce your risk of food poisoning at home.
  1. Wash your hands. ...
  2. Wash worktops. ...
  3. Wash dishcloths. ...
  4. Use separate chopping boards. ...
  5. Keep raw meat separate. ...
  6. Store raw meat on the bottom shelf. ...
  7. Cook food thoroughly. ...
  8. Keep your fridge below 5C.

Which disease is caused by water contamination? ›

Contaminated water and poor sanitation are linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio.

How does clean water affect health? ›

When people without access to purified water resort to drinking from contaminated water sources, someone could easily contract diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid, and polio. However, a major effect of clean water is that it helps prevent water-borne illness.

Which is the best method of purification of water? ›

Reverse Osmosis

An RO Purifier proves to be one of the best methods of purifying water. Reverse Osmosis forces water through a semipermeable membrane and removes contaminants.

What is the cleanest water? ›

Spring water is widely accepted to be the cleanest water on earth; provided that it has been sourced naturally and not subjected to transportation factors such as pumps, pipes, faucets or BPA-laden bottles.

What are the main causes of air pollution? ›

Vehicle emissions, fuel oils and natural gas to heat homes, by-products of manufacturing and power generation, particularly coal-fueled power plants, and fumes from chemical production are the primary sources of human-made air pollution.

What are 20 benefits of drinking water? ›

20 Amazing Health Benefits of Drinking Water
  • Prevents constipation.
  • Aids digestion.
  • Supports kidneys health.
  • Boosts skin health.
  • Makes you work out better.
  • Improves mood.
  • Keeps you energized.
  • Helps you lose weight.

What is a deficiency of water? ›

Dehydration is a deficiency of water in the body. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration. People feel thirsty, and as dehydration worsens, they may sweat less and excrete less urine. If dehydration is severe, people may be confused or feel light-headed.

Should you drink water after eating? ›

In fact, drinking water during or after a meal helps how your body breaks down and processes food (digestion). Water is vital for good health. Water and other drinks help break down food so that your body can take in (absorb) the nutrients. Water also makes stool softer, which helps prevent constipation.

What are 100 uses of water? ›

"Using water mostly in our daily life for drinking"
  • Brushing Teeth.
  • Bathing.
  • Washing Clothes.
  • Cleaning Floor.
  • Flushing Toilets.
  • Cleaning Fruits.
  • Cleaning Vegetables.
  • Cleaning Dishes.
8 May 2020

Is drinking hot water healthy? ›

Drinking water, hot or cold, keeps your body healthy and hydrated. Some people claim that hot water specifically can help improve digestion, relieve congestion, and even promote relaxation, compared with drinking cold water.

What are 3 reasons why water is important? ›

Five reasons water is so important to your health
  • Water boots energy. Water delivers important nutrients to all of our cells, especially muscle cells, postponing muscle fatigue.
  • Water helps weight loss. ...
  • Water aids in digestion. ...
  • Water detoxifies. ...
  • Water hydrates skin.
22 Jun 2016

When is the best time to drink water? ›

The Best Times to Drink Water in a Day to Maintain Optimal Hydration
  1. Right When You Wake Up. Start your day off right with a big glass of H2O. ...
  2. Before and During a Meal. ...
  3. Midafternoon to Avoid the Slump. ...
  4. Before, During, and After Exercise. ...
  5. When You Have a Headache or Migraine.
2 Aug 2021

What organ regulates water in the body? ›

While almost a liter of water per day is lost through the skin, lungs, and feces, the kidneys are the major site of regulated excretion of water. One way the the kidneys can directly control the volume of bodily fluids is by the amount of water excreted in the urine.

What happens if I drink too much water? ›

When you drink too much water, your kidneys can't get rid of the excess water. The sodium content of your blood becomes diluted. This is called hyponatremia and it can be life-threatening.

What are water borne diseases PDF? ›

Water borne diseases including cholera, Dracunculiasis, Typhoid fever, Diarrhea, Ulcers, Hepatitis, Arsenicosis, Respiratory Tract Infection, Kidney Damage, and Endocrine Damages are very risky for lives of individuals and especially for humans ultimately leading to death.

How is contaminated water treated? ›

Disinfection. After the water has been filtered, water treatment plants may add one or more chemical disinfectants (such as chlorine, chloramine, or chlorine dioxide) to kill any remaining parasites, bacteria, or viruses.

What are the 3 major waterborne diseases? ›

Typhoons and heavy rains may cause flooding which, in turn, can potentially increase the transmission of water-borne diseases, or diseases transmitted through water contaminated with human or animal waste. These include typhoid fever, cholera, leptospirosis, and hepatitis A.

What are the three categories of water diseases? ›

Water-borne diseases: infections spread through contaminated drinking water (Diarrhoeal Diseases, Typhoid Fever) Water-washed diseases: diseases due to the lack of proper sanitation and hygiene (Ascariasis =roundworm infection, Ancylostomiasis (=hookworm infection)

Is typhoid a water washed disease? ›

Typhoid fever is a bacterial disease spread by drinking or eating contaminated water or food.

Which hepatitis is waterborne? ›

Hepatitis A is an inflammation of the liver that can cause mild to severe illness. The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.

How can you prevent or control coliform contamination in drinking water of your respective community? ›

Prevent Contamination

Protect Your Well by constructing it in a safe spot. Regularly inspect your well for damage. Contact a Licensed Well Contractor if you find any damage. Test your well water every year for coliform bacteria.

What precautions should one take to store water? ›

Precautions for water storage during vacations
  1. Put all faucet points closed. ...
  2. Do not keep any stored water uncovered. ...
  3. Drain off reserved water from water purifier. ...
  4. Keep cover on your storage tank in the bathroom. ...
  5. Do not keep any water in refrigerator. ...
  6. Clean the swimming pool before you use.
22 Oct 2013

What are the precautionary measures to maintain a clean and safe water for human consumption? ›

Here are the top ten actions you can take to help keep drinking water sources clean in your community:
  1. Handle and dispose of waste properly: ...
  2. Maintain heating oil tanks and fill lines: ...
  3. Maintain and use septic systems properly: ...
  4. Maintain wells:

What are the ways of contaminating water? ›

Trash, bacteria from pet waste and aging septic tanks, fecal bacteria, litter, pesticides and herbicides, dust from brake pads on cars, and many other pollutants impact our local streams, rivers, beaches, and groundwater aquifers.

What are the 4 types of food contaminant? ›

There are four main types of contamination: chemical, microbial, physical, and allergenic.

What are the four types of water related diseases? ›

Common waterborne illnesses include typhoid, cholera, dysentery, gastroenteritis, and hepatitis.

What is the most common disease caused by contaminated water? ›

Diarrhea. The most common of all water-borne diseases, diarrhea, mainly affects children below five years of age. The symptoms include dizziness, dehydration, pale skin, and loss of consciousness in severe cases.

How long can you store water in 5 gallon jugs? ›

As stated, the shelf life of 5-gallon bottles is up to two years. The water will not go bad at that point. Yet, it may develop a stale taste. The jug itself lasts indefinitely as it is made from food-grade plastic or glass.

How long can you store water in plastic bottles? ›

Storing Water in Plastic Containers

When you're using plastic containers, never store water in them for longer than 3 to 6 months, and keep a close eye for when it starts to become discoloured, cloudy or for any signs of contamination that will make it harmful for consumption.

What are three water types? ›

Water exists in many forms, such as a liquid, a solid, as in snow and ice, underneath the land surface as groundwater, and in the atmosphere, as in clouds and invisible water vapor.

What are 10 ways to conserve water? ›

25 ways to save water
  1. Check your toilet for leaks. ...
  2. Stop using your toilet as an ashtray or wastebasket. ...
  3. Put a plastic bottle in your toilet tank. ...
  4. Take shorter showers. ...
  5. Install water-saving shower heads or flow restrictors. ...
  6. Take baths. ...
  7. Turn off the water while brushing your teeth. ...
  8. Turn off the water while shaving.

What are 10 sources of water? ›

No matter how much water is present on earth, a little amount is only suitable for consumption.
  • Ocean Water. We know that oceans are a great source of water. ...
  • Surface Water. Surface water is quite a broad term when we look at it. ...
  • Ground Water. ...
  • IceCaps and Glacial Melting. ...
  • Solved Question for You.

What is the full form of wash? ›

Water, sanitation and hygiene (WASH)

What are the 5 contaminants of water? ›

The Five Most Common Contaminants Found in Drinking Water
  • Nitrates. ...
  • Arsenic. ...
  • Microorganisms, Bacteria, and Viruses. ...
  • Aluminum. ...
  • Fluoride. ...
  • What Can Be Done About Contaminants in Tap Water? ...
  • Frequently Asked Questions.
19 Apr 2019

What are the 3 main types of water pollution? ›

Water pollutants can be divided into three major categories: (1) substances that harm humans or animals by causing disease or physical damage; (2) substances or situations that decrease the oxygen content of water, leading to anaerobic decay and the death of aquatic life; and (3) substances that are indirectly harmful, ...

What are unsafe sources of water? ›

Rivers, streams, and lakes might be contaminated with livestock waste, human sewage, chemicals, and other contaminants which can lead to illness when used for drinking, bathing, and other hygiene activities. During flood events, well water might be contaminated as well.


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