Food Safety Awareness

Annually, September is recognized as National Food Safety Education Month. Food safety is important while traveling as contaminated food or drinks can lead to illness and disrupt travel. Travelers should take precautions to ensure their food is safe to eat, especially when traveling internationally.

Advise travelers to avoid lukewarm food, raw foods, street food, and local wild game, also called bushmeat. These foods are more likely to cause illness due to factors like inadequate refrigeration and poor sanitation. Raw foods such as cut-up fruits and vegetables, fresh salads, condiments or sauces made from raw fruits and vegetables, and raw meat and seafood should also be avoided. These items may be contaminated during preparation or have bacteria that cannot be washed off. Foods that are dry, packaged, or in factory-sealed containers are usually safe.

Additionally, in places with unknown water quality, travelers should not drink or use tap water to wash fresh fruits or vegetables or prepare baby formula, and should avoid drinking beverages with ice, as it may have been made with water that had not been disinfected.

More food safety tips for traveling can be found on the CDC Travelers’ Health web page.

Medications While Traveling

Many international travelers carry medications or supplements with them to treat a wide range of medical conditions. Travelers should keep in mind that medicines prescribed or available over the counter in the U.S. might be unlicensed or controlled in other countries.

Before departure, travelers should check with the U.S. Embassy at their destination as well as the embassies of countries where they may have layovers for requirements and restrictions. Travelers should bring written copies of medication prescriptions with them when traveling and leave a copy at home with friends or family as well. Travelers who use controlled substances or injectable medications, like insulin, should ask the prescribing health care provider to provide a note for those medications and administration supplies. Additionally, travelers should be sure to pack enough medication for the duration of the trip and extra in case of delays. Travelers planning to be gone for more than 30 days should make a plan with their health care provider and their insurance company to make sure they can get enough medication.

During travel, medications including routine OTC anti-inflammatory, cold and flu, ophthalmic, and topical products and supplements should be kept in their original, labeled containers. This may complicate daily dosing for individuals that take multiple medications and are accustomed to aliquoting their products together by day and a.m./p.m. A medication table or chart for reference can be a helpful reminder while traveling and shuffling through multiple containers. Additionally, if a traveler will be in a different time zone, providers should ensure travelers know about any changes in taking their medication.

Marine animals

Recreational activities in the ocean like scuba diving, snorkeling, and swimming can lead to encounters with marine animals that can sting or bite. Cnidarians include corals, hydroids, jellyfish, and sea anemones. These organisms have highly developed stinging structures called nematocysts on their tentacles that can penetrate the skin and cause pain and irritation. Many cnidarian stings cause painful and itchy rashes but are not typically associated with severe illness. Cone snails which are found throughout tropical waters of the Indo-Pacific region pose a hazard to divers or beachcombers who attempt to handle them, especially because many species have ornate, attractive shells. Cone snails have a long hollow proboscis that can inject venom using a dart-like tooth capable of penetrating a wetsuit. The venom contains proteins called conotoxins that can rapidly cause paralysis, coma, and death. Certain types of fish like lionfish, stingrays, and stonefish possess sharp venomous spines that can injure humans. The defensive spines from these fish can cause painful stings resulting in redness and swelling, nausea, vomiting, headache, and dizziness. Stings can also cause more serious complications such as infections, cardiac arrythmias, muscle weakness or spasms, and life-threatening seizures. The blue-ringed octopus can be found hidden in crevices in waters around Australia and the Indo-Pacific region. Scuba divers and snorkelers may encounter them underwater, although they may also be found by beachgoers in shallow water along the shore. The blue-ringed octopus displays bright blue rings when threatened and may bite humans when handled. Its salivary glands contain tetrodotoxin, a venom that can cause paralysis and death if not treated. Sea urchins can cause severe puncture wounds, especially when stepped on. The venom on their spines can cause intense burning pain, redness, and swelling of the injured areas. Sea urchin spines can be brittle and difficult to remove; retained spines can cause severe inflammation, infection, and scar tissue formation. Although most sea stars are harmless, the crown-of-thorns starfish has long, sharp spines that contain toxins which can cause severe pain, nausea, vomiting, muscle paralysis, hemolysis, and coagulopathies. They are found in tropical coral reefs throughout the Pacific and Indian Oceans, from the Red Sea and East African coast to the Pacific coast of Central America and are especially common near Australia.

Prevention recommendations

Travelers who plan to participate in activities in or near bodies of water should avoid handling marine animals. Travelers should ask about the local sea animals at their destination. Many marine animals have defense mechanisms that can pierce wetsuits. Scuba divers and snorkelers should avoid touching venomous animals they may see while diving such as crown-of-thorns starfish, blue-ringed octopi, stingrays, lionfish, and cone snails. Travelers should also be aware that certain venomous marine animals like stonefish can camouflage and may be hard to see. Travelers who plan to scuba dive or snorkel should listen to local guides and pay attention to their surroundings to avoid potential injury.

Treatment and follow-up

Treatment of injuries from venomous marine animals varies depending on the type of animal involved. Travelers should consult a qualified local health provider for advice.

Vinegar is a common treatment for stings and may be a reasonable first aid treatment depending on the location and species involved. Ice packs can provide some relief of pain for mild stings. Folk remedies such as using urine or alcohol for irrigation of stings are not recommended. Additionally, hot water immersion is a treatment that can potentially halt the effects of some jellyfish and spiny fish venoms, including the Australian box jellyfish toxin that affects the heart. The technique involves soaking the affected body part in 113°F (45°C) water for approximately 20 minutes. Although the efficacy has not been well-proven, this may be a first aid treatment to consider if available.

For specific guidance on pain control, wound care, and the removal of foreign material, providers can consult the CDC Yellow Book. 

Scorpions

Scorpions can be found around the world but are most commonly seen in subtropical and tropical areas. Scorpion stings often cause intense pain and redness, but venom from some species can cause severe illness, affecting the heart, nervous system, and other organs. Manifestations include agitation, arrhythmias, bleeding and other coagulation disorders, pancreatitis, uncontrollable muscle spasms, shock, and even death.

Prevention recommendations

Preventive measures to avoid scorpion stings include shaking out clothing and shoes before putting them on and wearing long-sleeved shirts and long pants when walking in areas known to contain scorpions. Travelers who are camping should shake out bedding and sleeping bags before getting into bed.

Treatment and follow-up

While most scorpion stings are not serious, medical attention may be needed for pain management and wound care, including preventive tetanus vaccine. Young children are more likely to develop neurologic symptoms and need urgent treatment. People with severe symptoms of envenomation often require hospitalization and antivenoms, if available.

Snakes

Many snake species possess venom used to immobilize or kill prey. In humans, snakebites can cause serious injury, disability, or even death. Cobras, mambas, and coral snakes are found in subtropical and tropical areas throughout the world. They possess venom associated with neurotoxic effects, including blurred vision, numbness and tingling, muscle paralysis, difficulty swallowing, and impaired breathing. Vipers are widely found throughout the world except in Australia, Hawaii, Madagascar, and other isolated islands. They have hemotoxic and myotoxic venoms. Hemotoxic venom interferes with blood clotting, which can cause abnormal bleeding. Myotoxic venom effects cause extensive tissue and muscle damage at the site of the bite. Sea snakes are found in tropical and temperate areas of the Indian and Pacific Oceans. All 52 known species of sea snakes are venomous, and human deaths from bites have been reported. Sea snake bites are often painless or cause minimal pain but can be very dangerous. Victims typically experience neurologic symptoms such as difficulty breathing, difficulty swallowing, muscle spasms, and paralysis, which can be life-threatening. Damage to muscle tissue can be painful and extensive. Liver and kidney damage have also been reported.

Prevention recommendations

Although snakes can be found in many settings, simple preventive measures can greatly reduce the risk of snakebites. Counsel travelers to wear long pants, socks, and high boots when hiking in areas inhabited by venomous snakes and to inspect the ground before sitting down, especially at the base of a tree. Snakes are often found in vegetation along the banks of streams, rivers, and lakes. Counsel travelers to use a flashlight when walking outdoors at night and to not reach blindly into brush, tree branches, rocky ledges, holes, or even bags before checking visually for snakes and other venomous animals. Wearing heavy protective gloves when gathering firewood, not sleeping on the ground, and carefully shaking out bedding material, shoes, and clothing before use also may reduce risk. Mosquito nets may prevent snakebites and should be tucked securely under sleeping bags. When appropriate, travelers should work with a knowledgeable local guide familiar with local snake species.

Treatment and follow-up

First aid recommendations vary depending on the type of snake involved; for advice, consult local qualified health care providers with knowledge about the types of snakes that are in the area. Photographs of the snake may aid in identification, although untrained persons should not attempt to capture the snake. Tourniquets that cut off blood flow, cutting the skin surrounding fang marks, attempts to suck out the venom, topical treatments, herbs, and other folk remedies are not recommended. Immobilization of a bitten arm or leg in an elevated and extended position with a splint may be helpful. Pressure immobilization bandages to limit lymphatic drainage may be considered for neurotoxic venom.

Access to prompt medical treatment is the most important measure to limit the extent of injury and illness following a snakebite, and delayed access to care can be life-threatening. Treatment often requires antivenom, which could be difficult to obtain in remote areas. When traveling in areas known to have venomous snakes, it is prudent to obtain information about the location of the closest medical facility, availability of antivenom, and resources for transportation to a larger hospital if needed.

Spiders

Most encounters with spiders are harmless and do not result in injury or illness. Some spiders, however, capture and immobilize prey using venom; these species may potentially bite humans. Spiders are shy and typically do not attack humans without provocation but may bite in self-defense if disturbed. Reports of spider bites are often unreliable because people commonly mistake skin wounds and infections for spider bites, even if no spider was seen. Australian funnel web spiders are considered some of the most poisonous spiders worldwide, implicated in human deaths. They live in underground burrows and crevices in Australia. Funnel web spider bites can cause involuntary muscle twitching and spasms, sweating, rapid and irregular heart rate, tearing, drooling, vomiting, and difficulty breathing. Envenomation from widow spiders has been known to cause severe symptoms. Widow spiders are found in temperate and tropical areas around the world; they hide in crevices, stone walls, wood piles, and tight spaces in buildings. Their venom can cause severe painful muscle cramps and spasms, along with restlessness, sweating, vomiting, and other symptoms. Bites from recluse spiders can cause wounds with local tissue damage. They can be found in hidden crevices of human homes, under stones, in firewood, tree bark, or other tight spaces. The bitten area may become red at first, followed by blistering, bleeding, dark discoloration, and ulcer formation. Armed, banana, or wandering spiders are found in Brazil and other parts of South America. They can be found in human dwellings as well as banana plantations, where farm workers may be at higher risk of being bitten. In addition to pain and redness at the bite site, pain can spread to the entire body. Envenomation can also cause dizziness, nausea, restlessness, tachycardia, vomiting, salivation, sweating, and vision changes due to neurotoxins in the venom. Tarantula bites may be painful, but their venom typically does not cause serious illness. Some tarantulas defend themselves by releasing small urticating hairs that can penetrate the skin and cause itching and inflammation.

Prevention recommendations

Counsel travelers to be careful near spaces spiders like to live—like closets, attics, wood piles, and window areas—particularly if they are traveling to areas with venomous spiders like Australia and South America. Travelers should shake out bedding and clothing for spiders before using. Advise travelers to brush off spiders that land on them rather than crush or swat it. 

Treatment and follow-up

First aid includes use of a pressure immobilization bandage and immediate transport to the nearest hospital. Timely use of antivenom can limit the severity of symptoms after a bite from some species like widow spiders. Although death is rare, symptoms can be temporarily debilitating, and medical treatment for pain control and wound care, including tetanus vaccine, may be needed. People who develop wounds or other symptoms of illness after a spider bite should seek immediate medical attention.