Are people from the USA at risk of foodborne illnesses when traveling abroad?

Risk of Foodborne Illness for US Travelers Abroad

Yes, people from the USA are at significantly increased risk of foodborne illnesses when traveling to developing countries, with the risk magnified for immunocompromised individuals who face even higher rates of severe disease and complications compared to their baseline risk in the United States. 1

Risk Magnitude and Destinations

• Travel to developing countries substantially increases exposure risk to foodborne and waterborne pathogens, particularly in regions of Africa, Asia, and Latin America 1
• Among US travelers with Salmonella infections, the most common destinations are Mexico (38%), India (9%), Jamaica (7%), Dominican Republic (4%), China (3%), and the Bahamas (2%) 2
• The proportion of travelers requiring hospitalization and developing invasive disease is inversely related to the income level of the destination country, meaning poorer countries pose higher risks 2
• Travelers to these regions should have high clinical suspicion for Salmonella infection, especially those visiting Africa, Asia, or Latin America 2

High-Risk Foods and Beverages to Avoid

Contaminated items include:

• Raw fruits and vegetables 1
• Raw or undercooked seafood or meat 1
• Tap water and ice made with tap water 1
• Unpasteurized milk and dairy products 1
• Items purchased from street vendors 1
• Fountain beverages in restaurants, bars, and theaters (made from tap water) 1

Safe Food and Beverage Options

Generally safe items include:

• Steaming-hot foods 1
• Fruits peeled by the traveler themselves 1
• Bottled beverages, especially carbonated 1
• Hot coffee or tea 1
• Beer and wine 1
• Water brought to a rolling boil for 1-2 minutes 1

Special Considerations for High-Risk Travelers

Immunocompromised individuals (including HIV-infected persons with CD4+ counts <200) face additional risks:

• Should consult with travel medicine specialists before departure 1
• Have even higher risk for foodborne and waterborne infections than immunocompetent travelers 1
• May develop more severe disease requiring hospitalization 2
• Should avoid raw fish/seafood entirely, as infections like Vibrio vulnificus can cause fulminant septicemia with extremely high mortality in patients with chronic liver disease, cirrhosis, or immunosuppression 3

Antibiotic Prophylaxis Considerations

Routine antibiotic prophylaxis is NOT recommended for most travelers due to adverse effects and promotion of drug-resistant organisms 1

However, prophylaxis may be considered in selected circumstances:

• When risk of infection is very high and travel period is brief 1
• For severely immunosuppressed individuals 1
• Ciprofloxacin 500 mg daily can be considered (avoid in children and pregnant women) 1
• TMP-SMZ (one double-strength tablet daily) is an alternative, but resistance is common in tropical areas 1

Empiric Treatment Recommendations

All travelers to developing countries should carry antibiotics for empiric treatment if diarrhea develops:

• Ciprofloxacin 500 mg twice daily for 3-7 days is the recommended regimen 1
• Alternative antibiotics (e.g., TMP-SMZ) should be used for children and pregnant women 1
• Seek medical attention if diarrhea is severe, stools contain blood, fever with shaking chills occurs, or dehydration develops 1

Antiperistaltic Agent Precautions

Loperamide and similar agents can be used for mild diarrhea, but:

• Should NOT be used if high fever is present 1
• Should NOT be used if blood is in the stool 1
• Should be discontinued if symptoms persist beyond 48 hours 1
• Are NOT recommended for children 1

Additional Waterborne Risks

• Avoid swallowing water during swimming 1
• Do not swim in water potentially contaminated with sewage or animal waste 1
• Water treatment with iodine or chlorine is less effective than boiling but can be used when boiling is impractical 1