Food and Water Precautions for Travelers

Purpose

Publication name: CDC Yellow Book: Health Information for International Travel
Edition: 2026
Chapter authors: Anna N. Chard and Vincent Hill
Top takeaway: Healthcare professionals should recommend safe food and water practices during international travel.
Food frying in a pan.

Introduction

Contaminated food and water pose an infectious disease risk to travelers due to the numerous pathogens and toxins that can be transmitted. Additional information on pathogens and toxins associated with travelers' diarrhea and treatment options can be found in the Travelers' Diarrhea and Post-Travel Diarrhea chapters.

Food

Travelers should select food with care. While abroad, travelers should follow food safety practices recommended in the United States. Raw food, including unpasteurized dairy products, is especially likely to be contaminated. Raw or undercooked meat, fish, shellfish, eggs, and produce can be contaminated with pathogens, and some fish harvested from tropical waters can transmit toxins that survive cooking (see Food Poisoning from Marine Toxins chapter).

In areas where hygiene and sanitation are inadequate or unknown, travelers should take additional food safety precautions, as described in Box 1.7.1.

Box 1.7.1: Safe food practices for travelers in areas with inadequate or unknown hygiene and sanitation

Avoid

Usually safe

Salads, uncooked vegetables, raw and unpeeled fruits, and unpasteurized fruit juices

Fruits that can be peeled, which are safest when rinsed with safe water and peeled by the person who eats them; vegetables should be rinsed with safe water before cooking

Raw or undercooked meat, fish, shellfish, eggs

Fully cooked meat and eggs

Unpasteurized milk and milk products

Pasteurized milk and milk products

In restaurants, inadequate refrigeration and lack of food safety training among staff can result in transmission of pathogens or their toxins. Consumption of food and beverages obtained from street vendors increases the risk of illness. In general, fully cooked foods that are served hot and foods that travelers carefully prepare themselves are safest.

Travelers should exercise the same caution about food and water served on flights as they do for restaurants. Additionally, travelers should not bring perishable food back to their home country without refrigeration. Travelers can use insulated packaging and materials, such as frozen gel packs, to keep perishable food cold in transit. Perishable food should arrive at least as cold as it would be in a refrigerator (4°C [40°F] or below) and should not sit at room temperature for more than 2 hours. Travelers are prohibited from bringing some food items into the United States from abroad; refer to the United States Department of Agriculture's Animal and Plant Health Inspection Service guide for travelers for more information.

Feeding infants

Breastfeeding

For infants ages <6 months, the safest way to feed is to breastfeed exclusively. Practicing careful hygiene when using a breast pump and washing pump parts using a safe source of water can reduce the risk of getting pathogens into the milk (for details, see Travel and Breastfeeding chapter, and How to Keep Your Breast Pump Kit Clean: The Essentials).

Formula

For infants who are formula-fed, parents should consider using liquid, ready-to-feed formula that is sterile. When preparing formula from commercial powder, mixing it with a safe source of water following the manufacturer's instructions usually is sufficient. Although no powdered formula is sterile, travelers should consider packing enough for their trip because manufacturing standards vary widely around the world.

For infants ages <3 months and those with weakened immune systems, formula safety can be increased by reconstituting powder using hot water (≥70°C [≥158°F]). Boil water and wait about 5 minutes before mixing with formula powder; after mixing, wait for the prepared formula to cool before feeding the baby. Prepared formula should be used within 2 hours of preparation or refrigerated for a maximum of 24 hours. After feeding, any remaining liquid or prepared formula should be discarded. Once opened, formula containers should be stored in a cool, dry place with the lid tightly closed and used within 1 month.

For more on infant feeding hygiene, see How to Clean, Sanitize, and Store Infant Feeding Items, Infant Formula Preparation and Storage, and Cronobacter: Prevention and Control.

Water

Swallowing, having contact with, or inhaling aerosols of contaminated water can transmit pathogens that cause diarrhea, vomiting, or ear, eye, skin, respiratory, or nervous system infections. Travelers should follow safe water practices (see Water Disinfection for Travelers chapter) recommended in the United States while abroad.

Drinking water and other beverages

In many parts of the world, particularly where water treatment, sanitation, and hygiene are inadequate, tap water can contain disease-causing agents, including bacteria, viruses, parasites, and chemical contaminants. Consequently, tap water might be unsafe for drinking, preparing food and beverages, making ice, cooking, and brushing teeth. Infants, young children, pregnant women, older people, and immunocompromised people (e.g., persons with HIV, on chemotherapy, or who take certain immune-suppressing medications) might be especially susceptible to illness (see Travelers with HIV and Immunocompromised Travelers chapters).

Travelers should avoid drinking or putting tap water into their mouths unless they are reasonably certain the water is safe. Similarly, travelers should avoid ice unless they are reasonably certain it was made using safe water. Box 1.7.2 provides tips and recommendations of other safe water and beverage practices for travelers.

Box 1.7.2

Safe water and beverage practices: a checklist of recommendations for travelers

  • In areas where tap water could be unsafe, use only commercially bottled water from an unopened, factory-sealed container or water that has been adequately disinfected for drinking, preparing food and beverages, making ice, cooking, and brushing teeth. Avoid getting tap water in your mouth when showering or bathing.
  • Many people choose to disinfect or filter their water when traveling to destinations where safe tap water might not be available (for details and proper techniques, see Water Disinfection for Travelers chapter).
  • Beverages made with water that has just been boiled (e.g., tea, coffee) generally are safe to drink.
  • Unless further disinfected, tap water that is safe for drinking is not sterile and should never be used for sinus or nasal irrigation or rinsing, including use in neti pots and for ritual ablution. Never use tap water to clean or rinse contact lenses.

  • Water that looks cloudy or discolored could be contaminated with chemicals and will not be made safe by boiling or disinfection. In these situations, use bottled water.

  • 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 surfaces on the outside of cans and bottles might be contaminated, these surfaces should be wiped clean and dried before opening or drinking directly from the container.

  • Beverages that might not be safe for consumption include iced drinks and fountain drinks or other drinks made with tap water. Because ice might be made from contaminated water, ask that all beverages be served without ice.

  • The alcohol content of alcoholic beverages will not kill pathogens in ice made from contaminated water.

Recreational water

Pathogens that cause gastrointestinal, respiratory, skin, ear, eye, and neurologic illnesses can be transmitted via contaminated recreational freshwater or marine water. Water from inadequately treated pools, hot tubs, or splash pads can also be contaminated. Recreational water contaminated by human or animal feces, sewage, 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. Infectious pathogens (e.g., Cryptosporidium) can survive for days, even in properly operated pools, splash pads, and hot tubs.

To protect themselves and other people, travelers should take health and safety precautions before, during, and after entering recreational water, as described in Box 1.7.3. Additional guidance can be found on CDC's Healthy Swimming website.

Box 1.7.3: Healthy swimming for travelers

Healthy Swimming for Travelers - Box 1.7.3
Do not Enter recreational water if you have diarrhea.
Enter pools, splash pads, and hot tubs with improper chlorine or bromine levels, with improper pH, with cloudy water, with loose or broken drain covers, or without a lifeguard and safety equipment (e.g., rescue pole or ring).
Swim or wade near storm drains, in lakes or rivers after heavy rainfall, or in water that smells bad, looks discolored, or has algal mats, foam, or scum on the surface.
Enter freshwater streams, canals, or lakes in schistosomiasis-endemic areas of Africa, Asia, the Caribbean, and South America (see Schistosomiasis chapter).
Avoid Entering hot tubs if you are at increased risk for legionellosis (e.g., people ages ≥50 years, those with weakened immune systems).
Entering recreational water if you have open wounds. If an existing wound (e.g., from a recent surgery, piercing, or tattoo) or wound sustained while swimming comes into contact with untreated recreational water, it should be washed thoroughly with soap and water to reduce the chance of infection. Cover wounds completely with a waterproof bandage if there is a chance it could come in contact with recreational water.
Do A self-inspection of the recreational water venue for health and safety information. Consider using test strips to make sure the water has a proper free chlorine or bromine level and pH.
Wear a nose clip, hold your nose shut, and avoid jumping or diving into warm freshwater to help prevent water from going up your nose.

Maintaining proper pH and chlorine or bromine concentration is necessary for preventing transmission of most infectious pathogens in pools, splash pads, and hot tubs. If travelers would like to test recreational water before use, the CDC recommends a free chlorine concentration of 3–10 parts per million (ppm) in hot tubs (or 4–8 ppm total bromine) and 1–10 ppm free chlorine in pools and splash pads (2–10 ppm for those using chlorine stabilizer, such as cyanuric acid). Travelers can purchase test strips at most large retail companies, hardware stores, or pool supply stores. When hot tubs are not properly operated and chlorine or bromine concentrations are not adequately maintained, pathogens such as Pseudomonas, which can cause "hot tub rash" or otitis externa, and Legionella, which can cause life-threatening pneumonia, can multiply.

In freshwater recreational areas, there are many naturally occurring pathogens that can cause disease. Naegleria fowleri is a parasite found around the world in warm freshwater, including lakes, rivers, ponds, hot springs, and locations with water warmed by discharge from power plants and industrial complexes. Naegleria fowleri has also been found in inadequately chlorinated water, including in pools, splash pads, and a surf venue. People become infected when water containing Naegleria fowleri goes up their nose, usually while swimming. Healthcare professionals should also inform travelers that Naegleria fowleri infection has been linked to use of contaminated tap water for sinus or nasal irrigation. Even though Naegleria fowleri infection is rare, it is almost always fatal.

In seawater or brackish water, pathogens such as Leptospira (see Leptospirosis chapter) and Vibrio vulnificus can infect people through open wounds, potentially causing serious and life-threatening disease. People with underlying health conditions, such as liver disease, cancer, diabetes, and immunocompromising conditions, are at higher risk of V. vulnificus wound infection.

Handwashing

Travelers should follow recommended handwashing practices by washing their hands with soap and water before preparing or eating food, after using the bathroom or changing diapers, before and after caring for someone who is ill, and after contact with animals or animal environments. When soap and water are not available, travelers should use an alcohol-based hand sanitizer containing ≥60% alcohol and then wash hands with soap and water when possible. Hand sanitizer is not as effective as handwashing for removing some pathogens, like Cryptosporidium or norovirus (see Norovirus chapter), and does not work well when hands are visibly dirty or greasy.

Acknowledgements

The following authors contributed to the previous version of this chapter: Brigette Gleason and Patricia M. Griffin.

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National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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