Hygiene when travelling: water, food and diarrhoea

It is mainly caused by bacteria, their toxins or viruses, and more rarely by parasites. These germs come from the stools of infected people or animals, get into water or food, and then into your mouth.

Heat kills most of them: a dish that is well cooked and served hot is safe, but a lukewarm dish from a buffet is not.

The risk is higher if you have a bowel disease, a weakened immune system or take a medicine for stomach acid.

• Hepatitis A, a liver infection: for all tropical and subtropical countries.
• Typhoid fever, a serious bacterial infection: depending on the country, the length of your stay and the conditions you will be staying in.
• Cholera: only for humanitarian workers who are clearly exposed, for example in a refugee camp.

Most cases of diarrhoea get better on their own. Antibiotics are rarely needed, and taking them for no reason encourages resistant bacteria. Are you going somewhere far from any doctor, or do you have a chronic illness? A standby treatment can be discussed at a consultation. It is only taken in specific situations.

To pack: hand sanitiser gel (at least 60% alcohol), water purification tablets or a water filter, rehydration sachets, loperamide, a thermometer, wipes.

Safe to drink:

• water from a sealed bottle that you open yourself;
• water boiled for at least 1 minute;
• water treated with tablets (Micropur®, Chlorina®), an ultraviolet lamp, or a filter that works against bacteria, viruses and parasites.

No tap water, not even for brushing your teeth. Tea, hot drinks and sealed cans are generally safe.

Generally safe: hot dishes freshly prepared, fruit that you peel yourself, bread and dry foods.

Avoid:

• raw vegetables and salads;
• raw or undercooked meat, fish, seafood and eggs;
• unpasteurised milk, ice cream and juices sold in the street.

Drink 2 to 3 litres a day: safe water, tea, salty broth. For children, older people and very watery diarrhoea, use a rehydration solution from a sachet. If you have no sachets, here is an emergency recipe: 1 litre of drinking water, 6 level teaspoons of sugar and half a level teaspoon of salt. Fizzy drinks are not suitable: too much sugar, not enough salt.

Eat light meals as the diarrhoea eases: rice, bananas, carrots. For a few days, avoid fatty or spicy food and milk, which is harder to digest after gastroenteritis.

Loperamide: avoid it as much as possible. Never if you have a fever or blood in your stools: it keeps the germs in the bowel and can cause complications. Never in young children.

Antibiotic: only if it has been prescribed for you, in the situations explained at your consultation.

Straight away, even while travelling, if:

1. you have a fever;
2. there is blood or mucus in your stools;
3. you are dehydrated: dry mouth, passing little urine, dizziness, severe tiredness;
4. you are vomiting and cannot drink enough;
5. you are pregnant, elderly, or have a chronic illness such as diabetes.

Diarrhoea that lasts more than 48 hours despite drinking enough: ask for medical advice. Diarrhoea that lasts more than 7 days, or that comes back after you return: see a doctor, and we will test your stools if needed. In a small child, diarrhoea and vomiting can quickly become dangerous: see a doctor early.

In Switzerland, emergencies: 144. Abroad: the local emergency number.

Are your stools still abnormal? See a doctor. A stool test sometimes finds parasites such as Blastocystis, which many people carry and which are usually harmless. Treating them does not usually improve symptoms: the doctor will then look for another cause.