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Tish asked...

Tags: travel

Hello, I will be traveling to Thailand for a few months. I understand that the water is not safe to drink there and that bottled water should be used for drinking and brushing teeth. However, what about the shower? Is it safe to use their water to wash body parts and hair etc? Is it also paramount that my mouth is kept closed when in the shower so not to take in water orally that way? What happens if the water gets in your eyes when you shower?

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The Answer

Here are some things you may want to consider about drinking water and bathing in Thailand.

Traveller’s diarrhoea

Thailand is considered to be a high risk destination for acquiring travellers’ diarrhoea.  Travellers’ diarrhoea is caused by a number of organisms and  is a result of a multiple  factors  including the status of the host as well as the management and treatment of the water resource in a given travel destination.  For example, the use food, alcohol, age and stress of travelling to a holiday destination can be risk factors for acquiring traveller’s diarrhoea. The symptoms of travellers’ diarrhoea include the main following symptoms:  diarrhoea, fever, nausea.  Vomiting and bloody stools can also occur but are rare.  The symptoms described are self-limiting and usually last for 3-4 days.

Avoidance of traveller’s diarrhoea

It can be difficult to avoid traveller’s diarrhoea in high risk areas of the world when we visit these countries for a holiday.   It is estimated that between 20 – 60%  of travellers may experience traveller’s diarrhoea.  In countries where sanitation is poor it is advisable not to drink tap water or to use tap water for cleaning teeth.   It is essential that hand washing is undertaken to reduce the risk of traveller’s diarrhoea as this simple activity  alone can reduce the number of traveller’s diarrhoea cases by  up to 35%. 

It is important to follow strict food hygiene so eat only foods that are peeled and or are freshly prepared and cooked thoroughly. Avoid eating reheated buffet foods.  Avoid high-risk foods such as shellfish. Avoid ice in drinks.

Water can also be boiled for extra water safety. It is a good idea to boil the water for full five minutes. Hot drinks made with boiled water are considered to be safe in metropolitan areas of Thailand. In rural areas of Thailand for back packing, it is advisable to look into drinking water purification systems.  Chemicals are useful for preparing safe drinking water but they have their limitations. Chlorine-based tablets are widely available and may be useful.

In Thailand it is common to see people drinking bottled water and this may add to the fear that drinking tap water in metropolitan areas such as Bangkok is unsafe.  The Metropolitan Waterworks Authority in Bangkok follows the World Health Organisation standards for providing safe drinking water for its population in Bangkok.  You can find information about water quality in Bangkok on their organisation’s website.  The Metropolitan Waterworks Authority is committed to providing safe, reliable tap water to the population of Bangkok.  

Swimming pools can be another source of contamination so avoid swimming if you have travellers’ diarrhoea. Only swim in well maintained chlorinated swimming pools.

Cholera

Cholera is transmitted through contaminated food and water. It can occur in Thailand although most travellers are at low risk of catching cholera.  If your planned travel includes travelling to remote areas where you  have limited access to safe water and medical care then you may wish to consider having a cholera vaccine.  This is in the form of a liquid medicine.

Schistosomiasis

We assume that your concern about bathing and getting water in your eyes is related to the infection known as schistosomiasis. Although this infection has been reported previously in Thailand, the World Health Organisation considers the risk of travellers acquiring this infection to be very low.   Larvae (a parasite) are released from freshwater snails (from rivers and lakes) and this larva penetrates intact, healthy skin and results in schistosomiasis. 

You may be exposed to schistosomiasis if your activities include wading, bathing or washing clothes in freshwater streams, rivers or lakes. It is best to avoid these activities.

Using  insect repellent before exposure to water, or towel drying after accidental exposure to schistosomiasis are not reliable methods for avoiding or preventing infection.

Chlorination kills schistosomiasis so there should be no risk in in well maintained swimming pools.

Schistosomiasis cannot be contracted through sea water. Cercariae die when water is heated to 50 degree centigrade or after  48 hours in standing water  heated to 50 degrees centigrade.

Currently there are no vaccines or tablets  available to prevent schistosomiasis

The symptoms of schistosomiasis include: a temperature, headache, joint pain, bloody stools, a rash and  pain in the abdomen.  This infection can present itself in an acute and chronic format so treatment of this parasite is essential, as the chronic presentation of schistosomiasis can lead to damage to many of the body’s major organs such as the central nervous system, heart and liver.

As we said, the World Health Organisation has confirmed that the risk of acquiring schistosomiasis to be of low risk in Thailand since 2012

We would suggest that for further information and guidance on your travel destination of Thailand that you contact your GP or practice nurse to discuss further.

We would  suggest that you review the following recommended  travel sites for up-to-date travel information about your travel destination.

http://www.nathnac.org/travel/

http://www.fitfortravel.nhs.uk/home.aspx

https://www.gov.uk/foreign-travel-advice/thailand

Answered by the Health at Hand nurses  

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