Food and Beverage Precautions Contaminated food and drink are frequently encountered threats during international travel. The more common infections that travelers may acquire include E. Coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, and hepatitis A. Other potential infections include typhoid fever and other salmonelloses, cholera, poliomyelitis, and infections caused by parasites. Water that has been adequately chlorinated will provide significant protection against viral and bacterial waterborne diseases. However, chlorine treatment alone may not kill some viruses and the parasites that cause giardiasis, amebiasis, and cryptosporidiosis. In areas where chlorinated tap water is not available, or where hygiene and sanitation are poor, travelers should be advised that only the following may be safe to drink: Beverages, such as tea and coffee, made with boiled water Canned or bottled carbonated beverages, including carbonated bottled water and soft drinks Beer and wine Where water may be contaminated, ice or containers for drinking also should be considered contaminated. In these areas, ice should not be used in beverages. If ice has been in contact with containers used for drinking, the containers should be thoroughly cleaned, preferably with soap and hot water, after the ice has been discarded. It is safer to drink directly from a can or bottle of a beverage than from a questionable container. However, water on the outside of cans or bottles of beverages might be contaminated. Wet cans or bottles should be dried before opening, and surfaces which are contacted directly by the mouth in drinking should first be wiped clean. Where water may be contaminated, travelers should avoid brushing their teeth with tap water. Boiling is by far the most reliable method to make water of uncertain purity safe for drinking. Water should be brought to a vigorous rolling boil for one minute and allowed to cool to room temperature, without ice. At very high altitudes, generally above two kilometers, boil for three minutes or use chemical disinfection. Adding a pinch of salt to each quart, or pouring the water several times from one container to another will improve the taste. Chemical disinfection with iodine is an alternative method of water treatment when it is not feasible to boil water. Two well-tested methods for disinfection with iodine are the use of tincture of iodine and the use of tetraglycine hydroperiodide tablets. The tablets are available from pharmacies and sporting goods stores, and manufacturers' instructions should be followed. Chlorine is less reliable than iodine for chemical disinfection. Cloudy water should be strained through a clean cloth into a container to remove any sediment or floating matter, and then the water should be boiled or treated with iodine. There are a variety of portable filters currently on the market for providing safe drinking water. Although, in theory, these filters may be useful, the U.S. Centers for Disease Control and Prevention has not established the effectiveness of such filters, and makes no recommendation regarding their use. As a last resort, if no source of safe drinking water is available or can be obtained, tap water that is uncomfortably hot to touch may be safer than cold tap water; however, proper disinfection or boiling is still advised. Food should be selected with care to avoid illness. All raw food is subject to contamination. Particularly in areas where hygiene and sanitation are inadequate, the traveler should be advised to avoid salads, uncooked vegetables, unpasteurized milk and milk products such as cheese; and to eat only food that has been cooked and is still hot, or fruit that has been peeled by the traveler. Cooked food that has been allowed to stand for several hours at ambient temperature may provide a fertile medium for bacterial growth and should be thoroughly reheated before serving. Consumption of food and beverages obtained from street vendors has been associated with increased risk of illness. The easiest way to assure a safe food source for an infant less than six months of age is to have the child breast-feed. If the infant has already been weaned from the breast, formula prepared from commercial powder and boiled water is the safest and most practical food. Some species of fish and shellfish can contain poisonous biotoxins, even when well cooked. The most common type of fish poisoning in travelers is ciguatera fish poisoning. Barracuda is the most toxic fish and should always be avoided. Red snapper, grouper, amberjack, sea bass, and a wide range of tropical reef fish contain toxin at unpredictable times. The potential for ciguatera poisoning exists in all subtropical and tropical insular areas of the West Indies, and Pacific and Indian Oceans where the implicated fish species are consumed. Cholera has also occurred among persons who ate crabs brought back from Latin America by travelers. Travelers should not bring perishable seafoods with them when they return.