Food and water safety precautions play a prominent role in the “CDC Yellow Book 2020.” The Yellow Book, published every other year for half a century is the world travelers’ handbook for staying healthy.

Chapter 2 provides blunt warnings for international travelers about the risk of contaminated food and water. It says: “Swallowing, inhaling aerosols of, or coming in contact with contaminated water — including natural freshwater, marine water, or the water in inadequately treated swimming pools, water playgrounds (splash parks or splash pads), or hot tubs and spas — can transmit pathogens that can cause diarrhea, vomiting, or infection of the ears, eyes, skin, or the respiratory or nervous system”

Yellow Book 2020’s food and water warnings go on to include raw and undercooked meat, fish, and shellfish. The risks of toxins are enough to take the romance out of tropical waters. Travelers are encouraged to wash their hands often with soap and water or use those alcohol-based hand sanitizers. Both require proper techniques to be effective.

“In many parts of the world, ” the book adds, “particularly where water treatment, sanitation, and hygiene are inadequate, tap water may contain disease-causing agents, including viruses, bacteria, and parasites, or chemical contaminants. As a result, tap water in some places may be unsafe for drinking, preparing food and beverages, making ice, cooking, and brushing teeth.”

While disclosing all the dangers, the Yellow Book wants travelers to “stay healthy while enjoying the sights, activities, and cultures of countries around the world. As travelers plan the details of their itinerary, clinicians can use the Yellow Book to help inform their health protection strategy.”

The Yellow Book offers readers current U.S. government travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts.

CDC’s travel health experts wrote the Yellow Book as a reference for health care providers, including doctors, nurses, and pharmacists. Other audiences that find the Yellow Book to be a helpful resource include:

  • Travel industry,
  • Corporations and chief medical officers,
  • Missionary and volunteer organizations,
  • Americans who live abroad and travelers on short trips.

The Yellow Book contains numerous resources to assist health care professionals in making appropriate recommendations to their patients, before, during, and after international travel.

Pre-travel resources include

  • How to conduct a pre-travel consultation
  • Travel-related disease information: Causes, global distribution, prevention measures
  • Vaccines: Updated vaccine requirements and recommendations
  • Clinical guidance: An in-depth look at the specific travel health needs of infants and children, pregnant travelers, and those with chronic medical conditions or weakened immune systems
  • Overviews of popular tourist destinations and itineraries
  • Recommendations for expatriates, travelers visiting friends and relatives overseas or participating in study abroad, travel for work, adventure travel.

During-travel resources

  • Conditions: Including travelers’ diarrhea, altitude illness, jet lag, motion sickness, and respiratory infections.

Post-travel resources

  • How to conduct a post-travel evaluation
  • Post-travel evaluation and management: Fever in the returned traveler, sexually transmitted infections, skin and soft tissue infections, persistent diarrhea, screening newly arrived immigrants and refugees.


CDC first published the Yellow Book in 1967 as a small pamphlet entitled Immunization Information for International Travel. It was about the size of an index card and contained information about a few diseases, like cholera, smallpox, yellow fever, and malaria.

NEW FOR 2020

CDC Yellow Book 2020 adds to this 52-year old franchise with a variety of new sections and information, including.

  • Henipaviruses
  • Recommendations for practicing travel health remotely, via telemedicine
  • Updated vaccine recommendations
  • Updated road and traffic-safety advice
  • Emerging travel-related illnesses, including Zika, Ebola, and sarcocystosis
  • New FDA-approved drugs
  • Rapid diagnostic tests for tropical infectious diseases
  • Recommendations for travelers with severe allergies
  • Use of the One Health approach to managing zoonotic diseases
  • Treating infectious diseases in the face of increasing antimicrobial resistance
  • Legal issues facing clinicians who provide travel health care

Anyone planning international travel may purchase the Yellow Book through Oxford University Pressexternal icon, other major online booksellers, at most major bookstores, or as an eBook. The entire content of the book is also available online at the CDC website.

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