Avoiding Water Borne Illness While Traveling, Part 1

imageThis is the first in a three part series on water purification options.  I originally wrote this blog article several years ago, but decided to edit it and repost it on my new blog (this one).

On the day I was to board my flight back to the US, I started to get severe heart burn.  I was tired and a little hung over.  I slowly sipped water waiting for it to die down.  It didn’t. 

During my layover, I listlessly shuffled through the Tokyo airport searching for some bottled water, to mix some crushed Alka Seltzer.  During the flight from Tokyo to Dallas, the heartburn would return several times.  I probably ate something spicy, I thought to myself.  The heartburn slowly subsided and I forgot all about.

Several days later, I soon became stricken with gas, bloating, cramps, fatigue, and soon after, severe diarrhea.  For the next four hellish days, I couldn’t eat any solid food.  I survived on water and Gatorade.  I slept continuously, waking up every several hours to spend quality time in the bathroom.  While I had enough energy to listlessly do things around the apartment, I would have to run to the bathroom at random intervals.  After two more days, I entered the local emergency room to seek treatment because I could no longer drink Gatorade without vomiting.

Thankfully, I fully recovered, but for months afterward my digestive system wasn’t back to normal.  It was a major wake up call.  It could have been worse.. a lot worse.

I vowed that I would never get sick again, and started researching how to effectively prevent this in the future.  What could I buy that would render putrid foul smelling water into tasty safe drinkable water?  The gadget-freak in me cried out to go shopping for some insurance that I could drop in my suitcase on those long overseas trips.

Total budget?  The equivalent of my emergency room visit – roughly $400 or less.

Researching on the Internet: Where Every Symptom is Cancer and Where Even Idiots are Experts.

Unfortunately, I quickly found a lot of miss-information about water purification perpetuated by ignorant campers, hikers, and preppers.  Worse yet, I found some advice on traveler forums that was ridiculous, conflicting, or simply harmful. 

Moreover, I found that most advice on water purification on backpacking and survival forums seems to be biased towards the biological threats found in North America.

In North America, contrary to what water filtration companies and environmentalist want you to believe, you will rarely encounter viruses in streams and lakes.  The number one threat is Giardia or bacteria.  In fact, most streams and lakes in the United States are extremely clean, which is why so some idiots will proudly tell you that you only need a bandana or sock to filter water. 

So I started my research.  I needed a portable method of purifying water that would get rid of any of the threats I would face: viruses, bacteria, and protozoa (Cryptosporidium, Giardia, etc.).  For the remainder of this blog series, it is assumed that the water is free of chemical toxins and may have one or more of the following:

  • Viruses.  There are over 140 extremely small (0.004 to 0.1 microns) enteric viruses known to infect humans, including hepatitis A, Norwalk, poliovirus and rotavirus.
  • Protozoa.  There are several very nasty single celled microorganisms (Giardia Lamblia, Cryptosporidium parvum, Entamoeba histolytica (amebic dysentery), and Clyclospora cayetanesis) some of which are associated with death.
  • Bacteria. Bacteria range in size between 0.2 and 10 microns, and are the likely culprit behind your travelers diarrhea and gastroenteritis.  Significant bacteria include: E coli, Brucella melitensis, Leptospira icterohaemorrhagiae (spirochaetales), Pasteurella pseudomallei, Salmonella typhosa (Typhoid Fever), Salmonella paratyphi (Paratyphoid fever), Salmonella schottinulleri, Salmonella hirschfeldi C., Shigella flexneri (Bacillary dysentery), Vibrio comma (Cholera) and Vibrio cholerae. 

But before I get started, here is some generalized (good) advice for travelers.

Prevention (Better Living through Chemistry)

  • Bismuth subsalicylate (2 oz. t.i.d.).  Studies from Mexico have shown when taken on arrival at the destination (three times a day), Bismuth subsalicylate (Pepto Bismol) can reduce the incidence of travelers diarrhea from 40% to 14%.  That’s right, taking Pepto-Bismol — 2 oz. of liquid or 2 chewable tablets can increase your chance of not getting Traveler’s Diarrhea (TD), but you have to take it before you get TD.  Note: this won’t work it you encounter a virus.
  • Probiotics (Lactobacillus GG and Saccharomyces boulardii) don’t work.  All studies to date have been inconclusive.
  • Halogenated hydroxyquinoline derivatives, enterovioform, and other substances are effective, but may cause "neurologic adverse events" and best should be avoided.  I’m not sure what a "neurologic adverse event" is, but I’m betting it might land you in a difficult spot in a country where you don’t speak the language.
  • Antibiotics are effective (attack rate reduced from 40% to 4%), but only on pathogenic bacteria which are sensitive.  However, the medical community in recommends against prophylactic antibiotics except for short-term travelers who are high-risk hosts (immunosuppressed travelers).
  • Antimicrobials have no effect on viral illness.  Hepatitis A and Typhoid vaccinations are a good idea before traveling abroad.

Prevention (Better Living through Common Sense)

This should be common sense for most of us, but for those who have never traveled extensively:

  • First, try to figure out if the water is potable.  In most of the U.S., Canada, and western Europe tap water is generally safe to drink.  In the rest of the world, the reverse is probably true.
    If the water isn’t safe to drink, avoid ice, since it probably is made from tap water.
  • In areas with sketchy water, do not brush your teeth with tap water (no matter what anyone says); use bottled or boiled water.  This is especially true if the hotel has labeled the water "not fit for drinking" above the sink (as I saw this in Macau and in a hotel in the Philippines).  Also, use bottled water or boiled water to wash your contact lenses or dentures (if you have them).
  • Coffee and tea are generally safe, given that most harmful bacteria and viruses will be killed before the water gets to the boiling point, which is lower at higher elevations.  However, cream and milk are not.  If you must have light coffee, bring non diary creamer with you.
  • US and European chains (such as McDonalds) and large hotel restaurants are also usually safe choices.  Avoid street vendors.
  • Don’t drink from or brush your teeth with the water in the aircraft’s rest room.  They are filled with regular tap water in whatever country they happen to be in.  A recent EPA study showed the bacterial contamination of various water samples taken from aircraft were extremely high in bacteria.
  • Check to see if the bottled water you just purchased has an unbroken sealed cap.  In some countries, unscrupulous vendors will refill used bottled water containers with tap water and sell them on the streets.
  • Stick with name brand water.  In some countries, some water companies bottle unfiltered tap water.

In part 2, I will delve into various water disinfection and purification methods and then finally describe my water purification setup in part 3.