Avoid food poisoning

The best way to avoid food poisoning when traveling is to eat food that is fully cooked and served steaming hot, drink only sealed, boiled, or treated water where tap water may be unsafe, and wash your hands before you eat. In places where hygiene is uncertain, also skip raw salads, ice, unpasteurized dairy, and raw or undercooked meat and seafood.

These habits lower your risk, but they cannot remove it. The CDC estimates that 30% to 70% of travelers get travelers’ diarrhea during a two-week trip, depending on the destination and the season. So it also makes sense to pack oral rehydration salts and to know what to do if you get sick.

Why travelers get food poisoning

Unsafe food is a global problem. The World Health Organization (WHO) estimates that about 866 million people fall ill after eating contaminated food every year, which is almost 1 in 9 people in the world.

For travelers, most cases are caused by bacteria, such as certain types of E. coli, Campylobacter, Salmonella, and Shigella. Viruses such as norovirus and parasites such as Giardia cause the rest. The CDC lists the usual risk factors: poor sanitation and plumbing, unreliable refrigeration, unsafe water, and poor hand hygiene and food handling.

TravelHealthPro, the UK’s national travel health service, says the two most important risk factors are your destination and where you choose to eat. The risk is not limited to faraway places, either. The CDC notes that restaurant food handling has been linked to diarrhea even in high-income countries.

The core rules: hot, cooked, peeled, clean

Most advice from health agencies comes down to a few habits:

• Eat food that is cooked and served steaming hot. Germs that cause food poisoning grow quickly between 40°F and 140°F (about 4°C to 60°C). Avoid food that is lukewarm or has been sitting out.
• Be careful with raw food. Where hygiene is unknown, the CDC advises avoiding salads, raw vegetables, unpeeled raw fruit, and raw or undercooked meat, fish, shellfish, and eggs.
• Peel it yourself. Fruit you peel yourself, such as bananas or oranges, is usually safer. So is produce you wash in bottled or disinfected water.
• Skip fresh sauces made from raw produce. The CDC specifically mentions fresh salsas and other sauces made from raw fruits or vegetables.
• Choose pasteurized dairy. Avoid unpasteurized milk, cheese, yogurt, and ice cream when you are not sure how they were made.
• Wash your hands with soap before eating. If there is no soap and water, use a hand sanitizer with at least 60% alcohol. Sanitizer works less well against norovirus and on greasy or dirty hands, so wash properly when you can.

You may know the old rule “boil it, cook it, peel it, or forget it.” It helps, but the CDC notes that people who follow it can still get sick. Think of these habits as ways to lower your risk, not as a guarantee.

What to drink (and what to skip)

Water and ice cause many problems for travelers. Where tap water may not be safe:

• Drink commercially bottled water from a factory-sealed container, or water you have boiled or treated yourself.
• Carbonated drinks in sealed cans or bottles are usually safe. Hot coffee and tea are generally safe if they are served steaming hot.
• Avoid ice, fountain drinks, and fresh juice made by someone else. These are often made with tap water.
• Do not count on alcohol to make a drink safe. The CDC says alcohol does not kill germs in ice made from contaminated water.
• Brush your teeth with bottled or treated water.

Our guide to tap water and ice explains how to check a destination and how to treat water.

Choosing where to eat

Where you eat matters as much as what you order. Good signs include:

• Food that is cooked to order and served hot, rather than kept warm for a long time.
• Food that is covered and protected from flies. TravelHealthPro warns about food left uncovered in warm places, such as some buffets.
• Raw meat kept apart from cooked and ready-to-eat food. “Separate raw and cooked” is one of WHO’s Five Keys to Safer Food.
• An official hygiene rating, where one exists, and recent reviews that do not mention illness.

Our guides on choosing a safe restaurant and street food go into more detail.

In the cities it covers (see destinations), safeat shows restaurants where our review found no food-safety concern in the last 12 months. It is a starting point, not an inspection or a guarantee, so the habits above still apply.

Foods that need extra care

Some foods carry special risks:

• Reef fish and shellfish. Some tropical fish contain natural toxins that cooking does not destroy. TravelHealthPro advises avoiding pufferfish and other high-risk reef fish such as barracuda and moray eel, and following local warnings about shellfish during or after algal blooms (“red tides”). More in our guide to seafood and shellfish when traveling.
• Unpasteurized dairy. The CDC says raw foods, including unpasteurized dairy products, are especially likely to be contaminated.
• Raw or undercooked meat, seafood, and eggs. Choose dishes that are fully cooked all the way through.

Some travelers need to be more careful than others. TravelHealthPro lists older people, young children, people with a weak immune system, and people taking medicine to reduce stomach acid. If you are pregnant, the CDC advises avoiding unpasteurized cheeses and raw or undercooked meat, because infections such as listeriosis and toxoplasmosis can harm the baby.

How to prepare before you go

A little preparation helps:

• See a health professional. TravelHealthPro suggests seeing your healthcare provider at least four to six weeks before travel. Depending on your destination, vaccines can prevent a few food- and waterborne diseases, such as hepatitis A, typhoid, and cholera.
• Ask about medicines. The CDC does not generally recommend antibiotics to prevent travelers’ diarrhea. A doctor can tell you whether you need a treatment plan, especially if you have a health condition.
• Pack a small kit: oral rehydration salts (ORS), hand sanitizer, and a way to treat water if you are going somewhere remote.
• Get travel insurance that covers medical care abroad.

If you get sick anyway

Most travelers’ diarrhea is mild and gets better within a few days. The most important thing is to drink enough fluids, and the CDC prefers oral rehydration solution when you are losing a lot of fluid.

TravelHealthPro advises getting medical care if your symptoms do not improve within three days. Get care right away for a fever of 38°C (100.4°F) or higher, blood or mucus in your stool, severe stomach pain, yellow skin or eyes, a rash, or confusion. Our guide to food poisoning while traveling, linked at the top of this page, covers rehydration, red-flag symptoms, and how to find a doctor abroad.