FOOD SAFETY

For Older Adults and People with Cancer, 

Diabetes, HIV/AIDS, Organ Transplants, 

and Autoimmune Diseases

July 2020
www.fda.gov i

An Older Adult’s Foodborne Illness Story

Diana was 64 years old and in fairly good health, but her age made her vulnerable to 

foodborne illness. This is her true story.

“My youngest daughter had been ill, and she 

was in the hospital. So, I was in a hurry to 

get something to eat for dinner because it 

was late in the evening. I ran to the grocery 

store and picked up some ground turkey and I 

cooked about half of it as a burger and ate it. I 

put the other half in the freezer.

I woke up with a really, really upset stomach. 

That’s when my problem with diarrhea 

started, and by the next day, it was constant. I 

thought it was just a case of the flu and it had 

gotten severe.

My son came to see me and said, ‘Mom, you 

just sound terrible,’ and he took me to urgent care. The medical staff checked me, and my potassium 

was 0.5. You’re supposed to die when your potassium is as low as 1.5, so the urgent care center 

called an ambulance and immediately transported me to the main hospital.”

Diana was suffering from salmonella poisoning and struggled with constant diarrhea and 

dehydration.

“I was going continually because the diarrhea was nonstop. Nearly every hour, a nurse would 

put another IV bag up because I was losing so much fluid so rapidly. That’s how I got severely 

dehydrated, because fluid was going out faster 

than they could put it in. A couple of times the 

doctor thought I was going to die. I couldn’t lift 

my head off the pillow. I was so sick, and I’m 

just lucky I lived through it. 

I look back at getting food poisoning because 

I had my grandson with me that day. He was 

little then and was a picky eater—that’s the only 

reason he didn’t eat any of the ground turkey. 

Just think how serious it would have been if 

my grandson had eaten the turkey burger and 

gotten sick too!" 
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Keeping patients safe from foodborne illness is fundamental to federal, state, and local 

health agencies. Having a sample of the contaminated food allowed inspectors to trace 

the food back to its source and find out how it had been contaminated.

"Salmonella’s effect on my body was unbelievable. Usually, salmonella poisoning goes away on its 

own without medical treatment. But, since I was older, I ended up with a severe case of foodborne 

illness that I had to be hospitalized for.”

“A woman from the health department called me after I’d gone home from the hospital and told me 

it was salmonella poisoning. I still had the other half of the ground turkey in the freezer. The health 

department asked if they could send a staff member to my house to get the turkey and I said ‘yes.’ 

So, I was able to give the health department 

a sample to analyze and confirm that the 

turkey was contaminated with salmonella.”

The immune system tends to get 

weaker as people age, which increases 

the risk of getting a foodborne infection 

that can result in a serious illness 

requiring hospitalization or even 

causing death.
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Table of Contents

Food Safety for Older Adults and 

People with Cancer, Diabetes, HIV/AIDS, 

Organ Transplants, and Autoimmune Diseases 1

The Immune System: Its Importance 1

Food Safety: Why It’s Critical for 

People with a Weakened Immune System 1

Older Adults 1

People with Cancer 2

People with Diabetes 2

People with HIV/AIDS 2

People with Organ Transplants 2

People with Autoimmune Diseases 2

Eating at Home: Making Wise Food Choices 3

Taking Care: Handling and Preparing Food for 

People with Immune Systems Weakened by Age, 

Illness, or Medication 5

In the Know: Safe Shopping 8

Tips: Transporting Food to a Picnic or a Party 10

Being Smart When Eating Out 10

Stay Safe: Traveling Internationally 11

Foodborne Illness: Know the Symptoms 11

More Information from U.S. Food and Drug Administration 12

Additional Food Safety Information 13

Notes 14

Four Steps to Food Safety 15
www.fda.gov 1

Food Safety for Older Adults and People with Cancer, Diabetes, 

HIV/AIDS, Organ Transplants, and Autoimmune Diseases

Food safety is important for everyone – but 

it’s extremely important for individuals with 

a weakened immune system, which makes 

them especially vulnerable to foodborne 

illness. This guide is intended to help older adults and people with cancer, diabetes, 

HIV/AIDS, organ transplants, or autoimmune 

diseases avoid foodborne infections.

In addition to the information in this booklet, 

talk with your health care provider about any 

foods or other products to avoid because of 

any special health needs you may have.

The Immune System: Its Importance

Your immune system is vital for your health because it defends your body against infectious organisms and other invaders. Spread throughout your body, the immune system is made up of a network 

of cells, tissues, and organs that work together to protect you. When your immune system senses 

disease-causing organisms and other substances that invade the body, it responds to fight them off.

As people get older, their immune systems decline. Diseases such as cancer and diabetes can 

weaken the immune system. Also, medications for HIV/AIDS, organ transplants, and autoimmune 

diseases, like rheumatoid arthritis and lupus, weaken the immune system.

Food Safety: Why It’s Critical for People with a Weakened Immune 

System

When disease-causing bacteria, viruses, or parasites (germs) contaminate food, they can cause 

foodborne illness, often called food poisoning. While the food supply in the United States is among 

the safest in the world, it can still be a source of infection.

According to the Centers for Disease Control and Prevention, 48 million persons — or 1 of every 6 

people get foodborne infections each year. Of those, 128,000 are hospitalized, and 3,000 die from 

their foodborne illness. People who have a weakened immune system have a higher risk for food 

poisoning. People with weakened immune systems are more likely to have a lengthier illness, undergo hospitalization, or even die as a result of foodborne disease.

Older Adults — People 65 and older are at a higher risk for hospitalization and death from 

foodborne illness. This increased risk is because organs and body systems change as the body 

ages.

The digestive system holds food longer, allowing bacteria to grow while the stomach may 

not produce enough acid to limit the number of intestinal bacteria.

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• The liver and kidneys may not properly rid the body of foreign bacteria and toxins.

Between 50 and 60, the immune system in most people begins to decline. After age 75, 

many adults have an immune system so weakened that their risk for contracting a foodborne illness increases while the ability of their bodies to fight the infection is lowered.

People with Cancer — If it spreads into 

the bone marrow, cancer can weaken 

the immune system. Also, most cancer 

patients undergo therapy such as radiation, chemotherapy, and/or medications 

to help fight the disease. A side effect of 

these treatments is that they may weaken the immune system, making patients 

more vulnerable to infections like foodborne illnesses. 

People with Diabetes — The immune 

systems of the millions of people with 

diabetes in the United States may not 

readily recognize the bacteria and viruses that cause food poisoning. This delayed response 

places a person with diabetes at increased risk for infection. Also, diabetes may damage the 

cells that create stomach acid and the nerves that help the stomach and intestines move food 

through the normal digestive process. As result, the digestive tract may hold on to food for a 

longer time, allowing harmful bacteria and viruses to multiply. In addition, diabetes may cause 

the kidneys, which work to cleanse the body, to hold on to harmful bacteria, toxins, and other 

pathogens.

People with HIV/AIDS — When the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) damages or destroys the immune system, individuals become more 

vulnerable to developing an infection, including a foodborne infection.

People with Organ Transplants — A healthy immune system will try to reject or destroy an 

organ or bone marrow transplant – in the same way that the immune system works to clear 

infection from the body. Therefore, transplant recipients commonly take medications to keep 

rejection from happening. These drugs are called immunosuppressants because they suppress 

a person’s immune system to keep it from attacking, or rejecting transplanted organs or bone 

marrow. A side effect of immunosuppressants is that they leave patients more susceptible to 

developing infections – like those that can be brought on by the bacteria and viruses that cause 

foodborne illness.

People with Autoimmune Diseases — Autoimmune diseases, such as multiple sclerosis, 

inflammatory bowel disease, and lupus are conditions in which the immune system mistakenly 

attacks the body. People with autoimmune diseases are often treated with immunosuppressants, and they are more likely to get a foodborne illness because their immune systems can’t 

fight infection effectively. 

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The good news is that taking steps to select and prepare foods safely can often help people 

avoid foodborne infections.

Eating at Home: Making Wise Food Choices

Some foods are riskier than others. The foods most likely to contain harmful bacteria or viruses fall 

into two categories:

Uncooked fresh fruits and vegetables.

Some animal products, such as unpasteurized (raw) milk; soft cheeses made with raw 

milk; raw or undercooked eggs; raw meat, raw poultry, raw fish, raw shellfish and their juices; 

luncheon meats; and deli salads (without added preservatives) prepared on site in a deli-type 

store or restaurant.

The risk these foods pose depends on the origin or source of the food and how the food is 

processed, stored, and prepared.

Follow these guidelines (see chart below) for safe selection and preparation of your favorite foods.

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Common Foods: Select the Lower Risk Options

Type of Food Higher Risk Lower Risk

Meat and Poultry Raw or undercooked meat or poultry Meat or poultry cooked to a safe 

minimum internal temperature 

(Safe Food Handling)

Seafood

Tip: Use a food thermometer to check the internal temperature. See the Safe Minimum Internal 

Temperatures chart on page 7.

• Any raw or undercooked fish, or shellfish, 

or food containing raw or undercooked 

seafood, e.g., sashimi, found in some 

sushi or ceviche

• Refrigerated smoked fish

• Partially cooked seafood, such as shrimp, 

and crab

• Previously cooked seafood 

heated to 165°F

• Canned fish and seafood

• Seafood cooked to 145°F

Milk Unpasteurized (raw) milk Pasteurized milk

Eggs

Tip: Pre-made foods from grocery stores, such 

as Caesar dressing, cookie dough, or eggnog 

that say made with pasteurized eggs/pasteurized egg products are lower risk.

Foods that contain raw/

undercooked eggs, such as: 

• Homemade Caesar salad dressings

• Homemade raw cookie dough

• Homemade eggnog

At home:

• Recipes that call for raw or 

undercooked eggs are made 

with pasteurized eggs.

When eating out:

• Ask if pasteurized eggs were 

used.

Sprouts Raw sprouts (alfalfa, bean, or any other sprout) Cooked sprouts

Vegetables Unwashed fresh vegetables, including lettuce/

salads

• Washed fresh vegetables, 

including salads

• Cooked vegetables

Cheese • Soft cheeses made from unpasteurized 

(raw) milk, such as:

• Feta

• Brie

• Camembert

• Blue-veined

• Queso fresco

• Hard cheeses

• Processed cheeses

• Cream cheese

• Mozzarella

• Soft cheeses that are clearly 

labeled “made from pasteurized milk”
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Common Foods: Select the Lower Risk Options (cont.)

Type of Food Higher Risk Lower Risk

Hot Dogs and Deli

Tip: You need to reheat hot dogs, deli meats, 

and luncheon meats before eating them because Listeria monocytogenes bacteria grow 

at refrigerated temperatures (40oF or below). 

These bacteria may cause severe illness, 

hospitalization, or even death. Reheating these 

foods until they are steaming hot destroys these 

dangerous bacteria and makes these foods 

safe for you to eat.

Hot dogs, deli, and luncheon meats that have 

not been reheated

Hot dogs, luncheon meats, and deli 

meats reheated to steaming hot or 

165oF

Deli Salads Deli salads prepared without preservatives in a 

deli-type store or restaurant

Deli salads freshly prepared at 

home

Pâtés Unpasteurized, refrigerated pâtés or meat 

spreads

Canned or shelf-stable pâtés or 

meat spreads

A Note on Flour and Raw Dough

Flour, regardless of the brand, can contain bacteria that cause disease. An outbreak of illness 

caused by bacteria called E. coli sickened dozens of people across the country. Ten million pounds 

of flour were recalled, including unbleached, all-purpose, and self-rising varieties.

Some of the recalled flours had been used by restaurants that allow children to play with dough 

made from raw flour while waiting for their meals. However, the Federal government advises 

restaurants not to give customers raw dough. 

Flour is ground from raw grain. It may be bleached, but it isn’t usually treated to kill bacteria like 

E. coli. So, follow these tips to keep yourself and your family healthy:

Do not eat or taste any raw cookie dough, cake mix, batter, or any other raw dough or batter 

product that is supposed to be cooked or baked.

Follow package directions for cooking products 

containing flour at proper temperatures and for 

specified times.

Wash hands, work surfaces, and utensils 

thoroughly after contact with flour and raw 

dough products.

Keep raw foods separate from other foods while 

preparing them to prevent any contamination 

that may be present from spreading. Be aware 

that flour may spread easily due to its powdery 

nature.

Follow label directions to chill products containing raw dough promptly after purchase until 

baked.

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Taking Care: Handling and Preparing Food for People with 

Immune Systems Weakened by Age, Illness, or Medication

Foodborne germs are sneaky. Food that looks, smells, or tastes fine can contain pathogens – 

disease-causing bacteria, viruses, or parasites – that can make you sick. Never taste a food to see 

if it is safe to eat.

It’s important for anyone handling and preparing food to always be careful. For people with 

weakened immune systems, and anyone fixing food for them, it’s vital! The proven way to do this is 

to know and follow the four basic steps to food safety – clean, separate, cook, and chill.

Four Basic Steps to Food Safety

1. Clean: Wash hands and surfaces often. 

Bacteria, viruses, and parasites can spread throughout the kitchen and get onto your hands, cutting 

boards, utensils, countertops, and food. 

To ensure that hands and surfaces are clean, be sure to:

Wash hands in warm soapy water for at least 20 seconds before and after handling food, using 

the bathroom, changing diapers, or handling pets.

Wash cutting boards, dishes, utensils, and countertops with hot soapy water between the 

preparation of raw meat, poultry, and seafood products and preparation of any other food that 

will not be cooked. 

An added precaution is to run plastic cutting boards through the wash cycle in your 

dishwasher. Or, sanitize cutting boards and countertops by rinsing them in a solution made 

of one tablespoon of unscented liquid chlorine bleach per gallon of water. 

Use paper towels to clean up kitchen 

surfaces. If using cloth towels, wash 

them often in the hot cycle of the washing 

machine.

Wash produce. Rinse fruits and vegetables 

and use a clean vegetable brush to scrub firmskinned fruits and vegetables under running tap 

water, including those with skins and rinds that 

are not eaten.

Don’t wash meat, poultry, fish, or eggs. If water 

splashes from the sink in the process of washing, it can spread bacteria.

Clean the lids on canned goods before opening.

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2. Separate: Don’t cross-contaminate.

Cross-contamination occurs when germs are spread from one food product to another. This is 

especially common when handling raw meat, poultry, seafood, and eggs. The key is to keep these 

foods – and their juices – away from vegetables and fruit that will be eaten raw and any other readyto-eat foods. 

To prevent cross-contamination, remember to:

Separate raw meat, poultry, seafood, and eggs 

from other foods in shopping carts, grocery 

bags, and in the refrigerator. Place raw meat, 

poultry, and seafood on the lowest shelf in the 

refrigerator so their juices won’t drip on foods 

that will not be cooked.

Never place cooked food on a plate or cutting 

board that previously held raw meat, poultry, 

seafood, or eggs without first washing the plate/cutting board with hot soapy water.

Consider using one cutting board only for raw foods and another only for ready-to-eat foods, 

such as bread, fresh fruits and vegetables, and cooked meat.

Don’t reuse marinades used on raw foods unless they are brought to a boil first.

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3. Cook: Cook to safe temperatures.

Foods are safely cooked when they are heated to the recommended safe minimum internal 

temperatures, as shown on the chart on page 7. 

To ensure that your foods are cooked safely, always:

Use a food thermometer to measure the internal 

temperature of cooked foods. Check the internal 

temperature in several places to make sure that the 

meat, poultry, seafood, or egg product is cooked to 

safe minimum internal temperatures.

Bring sauces, soups, and gravy to a boil when 

reheating. Heat other leftovers to 165oF.

Reheat hot dogs, luncheon meats, bologna, and other 

deli meats until steaming hot or, better, to 165oF.

Allow rest time for fresh beef, veal, lamb, pork, and ham (see the chart on page 7), which 

completes the cooking, before checking the internal temperature with a food thermometer. 

Food is done when it reaches the recommended safe minimum internal temperature.

When cooking in a microwave oven, cover food, stir, and rotate for even cooking. If there is no 

turntable, rotate the dish by hand once or twice during cooking. Do not ignore the after-cooking 

standing time recommended on the packaging to complete the cooking.

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U.S. Department of Agriculture/U.S. Food and Drug Administration 

Recommended Safe Minimum Internal Temperatures

Category Food Temperature (°F) Rest Time

Ground Meat & Meat Mixtures Beef, Pork, Veal, Lamb 160°F None

Turkey, Chicken 165°F None

Fresh Beef, Veal, Lamb Steaks, Roasts, Chops 145°F 3 minutes

Poultry Chicken & Turkey, Whole 165°F None

Poultry Breasts, Roasts 165°F None

Poultry Thighs, Legs, Wings 165°F None

Duck & Goose 165°F None

Stuffing (Cooked Alone or in Bird) 165°F None

Pork & Ham Fresh Pork 145°F 3 minutes

Fresh Ham (Raw) 145°F 3 minutes

Precooked Ham (To reheat) 140°F None

Eggs & Egg Dishes Eggs Cook until yolk and white are firm. None

Egg Dishes 160°F None

Leftovers (of any kind) & 

Casseroles

Leftovers (of any kind) 165°F None

Casseroles 165°F None

Seafood Fin Fish (Cod, Snapper, Tilapia) 145°F or cook until flesh is opaque and 

separates easily with a fork.

None

Shrimp, Lobster, & Crabs Cook until flesh is pearly and opaque. None

Clams, Oysters, & Mussels Cook until shells open during cooking. None

Scallops Cook until flesh is milky white or opaque 

and firm.

None

4. Chill: Refrigerate promptly.

Cold temperatures slow the growth of harmful bacteria. 

Keeping a constant refrigerator temperature of 40°F or 

below is one of the best ways to lower the risk of foodborne 

illness. Use an appliance thermometer to be sure the 

refrigerator temperature is consistently 40°F or below and 

the freezer temperature is 0°F or below. 

To chill foods properly:

Refrigerate or freeze meat, poultry, eggs, seafood, and other perishables within 2 hours of 

cooking or purchasing. Refrigerate within 1 hour if the temperature is above 90°F.

Never thaw food at room temperature, such as on the countertop. It is safe to thaw food in 

the refrigerator, in cold water, or in the microwave. If you thaw food in cold water or in the 

microwave, you should cook it immediately.

Divide large amounts of food into shallow containers for quicker cooling in the refrigerator.

Follow the recommendations in the Cold Storage Chart below.

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U.S. Department of Agriculture/U.S. Food and Drug Administration 

Cold Storage Chart

These time limit guidelines will help keep refrigerated food safe to eat. Because freezing keeps food 

safe indefinitely, recommended storage times for frozen foods are for quality only.

Category Food Refrigerator 

(40°F)

Freezer (0°F)

Eggs Fresh, in shell 3 to 5 weeks Don’t freeze

Hard cooked 1 week Don’t freeze well

Liquid Pasteurized Eggs, Egg Substitutes Opened 3 days Don’t freeze well

Unopened 10 days 1 year

Deli & Vacuum-Packed Products Egg, chicken, ham, tuna, & macaroni salads 3 to 5 days Don’t freeze well

Hot Dogs Opened package 1 week 1 to 2 months

Unopened package 2 weeks 1 to 2 months

Luncheon Meats Opened package 3 to 5 days 1 to 2 months

Unopened package 2 weeks 1 to 2 months

Bacon & Sausage Bacon 7 days 1 month

Sausage, raw – from

chicken, turkey, pork, beef

1 to 2 days 1 to 2 months

Hamburger & Other Ground Meats Hamburger, ground beef, turkey, veal, pork, 

lamb, & mixtures of them

1 to 2 days 3 to 4 months

Fresh Beef, Veal, Lamb, Pork Steaks 3 to 5 days 6 to 12 months

Chops 3 to 5 days 4 to 6 months

Roasts 3 to 5 days 4 to 12 months

Fresh Poultry Chicken or turkey, whole 1 to 2 days 1 year

Chicken or turkey, pieces 1 to 2 days 9 months

Seafood Lean fish (flounder, haddock,

halibut, etc.)

1 to 2 days 6 to 8 months

Fatty fish (salmon, tuna, etc.) 1 to 2 days 2 to 3 months

Leftovers Cooked meat or poultry 3 to 4 days 2 to 6 months

Chicken nuggets, patties 3 to 4 days 1 to 3 months

Pizza 3 to 4 days 1 to 2 months

In the Know: Safe Shopping

Safe Food-handling Practices

Follow these safe food-handling practices when shopping: 

Put raw packaged meat, poultry, or seafood into a plastic bag before placing it in the shopping 

cart so that its juices will not drip on – and contaminate – other foods. If the meat counter does 

not offer plastic bags, pick some up from the produce section before you select your meat, 

poultry, and seafood.

Buy only pasteurized milk, cheese, and other dairy products from the refrigerated section. 

When buying fruit juice from the refrigerated section of the store, be sure that the juice label 

says it is pasteurized.

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• Purchase eggs in the shell from the refrigerated section of the store. (Note: Store the eggs in 

their original carton in the main part of your refrigerator once you are home.) 

For recipes that call for eggs that are raw 

or undercooked, when the dish is served 

– homemade Caesar salad dressing and 

homemade ice cream are two examples – 

use either shell eggs that have been treated 

to destroy Salmonella by pasteurization or 

pasteurized egg products. When consuming raw 

eggs, using pasteurized eggs is the safer choice.

Never buy food that is displayed in unsafe or 

unclean conditions.

When purchasing canned goods, make sure that 

they are free of dents, cracks, or bulging lids. 

(Once you are home, remember to clean each lid before opening the can.)

Buy produce that is not bruised or damaged.

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Food Product Dating

Many consumers misunderstand the purpose and meaning of the date labels that often appear on 

packaged foods. Confusion over date labeling accounts for an estimated 20 percent of consumer 

food waste.

Except for infant formula, manufacturers are not 

required by Federal law or regulation to place date 

labels based on safety or quality on packaged food. 

There are no uniform or universally accepted 

descriptions used on food labels for open dating 

(calendar dates) in the United States. As a result, 

there are a wide variety of phrases used for product 

dating.

The U.S. Food and Drug Administration supports 

efforts by the food industry to make “Best if Used 

By” the standard phrase to indicate the date when 

a product will be at its best flavor and quality. Consumers should examine foods for signs of 

spoilage that are past their “Best if Used by” date. If the products have changed noticeably in color, 

consistency, or texture, consumers may want to avoid eating them. 

If you have questions or concerns about the quality, safety, or labeling of the packaged foods 

you buy, reach out to the company that produced the product. Many packaged foods provide the 

company’s contact information on the package.

Manufacturers apply date labels at their own discretion and for a variety of reasons. The most 

common is to inform consumers and retailers of the date to which they can expect the food to retain 

its desired quality and flavor.
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To learn how best to store foods and how long they will keep safely, access the FoodKeeper at here. 

The FoodKeeper is a complete guide to how long virtually every food available in the United States 

will keep in the pantry, in the refrigerator, and in the freezer.

Bringing Groceries Home

Follow these tips for safe transporting of groceries:

Pick up perishable foods last, and plan to go directly home from 

the grocery store.

Always refrigerate perishable foods within 2 hours of cooking or 

purchasing.

Refrigerate perishable foods within 1 hour if the temperature 

is above 90°F.

In hot weather, take a cooler with ice, insulated bags, or another 

cold source to transport perishable foods safely. 

Tips: Transporting Food to a Picnic or a Party

• Keep cold food cold, at 40°F or below. To be sure, put cold food in 

cooler with plenty of ice or frozen gel packs. Cold food should be 

at 40°F or below the entire time you are transporting it.

Hot food should be kept at 140°F or above. Wrap the food well 

and place in an insulated container.

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Being Smart When Eating Out

Eating out can be enjoyable – to make sure it is, follow some simple 

guidelines to avoid foodborne illness. Don’t hesitate to ask questions before you order and let your 

server know you don’t want any food item containing raw meat, poultry, seafood, sprouts, or eggs. 

Servers can be quite helpful if you ask how a food is prepared.

Basic Rules for Ordering 

Ask whether the food contains uncooked 

ingredients such as eggs, sprouts, meat, poultry, or 

seafood. If in doubt, make another selection!

Don’t order meat cooked “rare.”

Ask how the foods have been cooked. If the server 

does not know the answer, ask to speak to the 

chef to be sure your food has been cooked to a 

safe minimum internal temperature.

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• If you plan to take home leftovers to eat later, refrigerate perishable foods as soon as possible 

and always within 2 hours after purchase or delivery. If the leftover is in temperatures above 

90°F, refrigerate within 1 hour.

Make Safe Menu Choices

Higher Risk: Lower Risk:

Soft cheese made from unpasteurized (raw) milk. Hard or processed cheeses. Soft cheeses only if they are 

made from pasteurized milk.

Refrigerated smoked seafood and raw or undercooked seafood. Fully cooked fish or seafood.

Cold or improperly heated hot dogs. Hot dogs reheated to steaming hot. If the hot dogs are 

served cold or lukewarm, ask to have them reheated until 

steaming, or choose something else.

Sandwiches with cold deli or luncheon meat. Grilled sandwiches in which the meat or poultry is heated until 

steaming.

Raw or undercooked fish, such as sashimi, non-vegetarian 

sushi, or ceviche.

Fully cooked fish that is firm and flaky.

Soft-boiled or “over-easy” eggs, as the yolks are not fully cooked. Fully cooked eggs with firm yolk and whites.

Salads, wraps, or sandwiches containing raw (uncooked) or 

lightly cooked sprouts.

Salads, wraps, or sandwiches containing cooked sprouts.

Stay Safe: Traveling Internationally

Discuss your travel plans with your healthcare provider before traveling 

to other countries. He or she may have specific recommendations for the 

places you are visiting and may suggest extra precautions or medications 

to take on your travels.

For more information about safe food and water while traveling abroad, 

access the Federal Centers for Disease Control and Prevention Traveler’s 

Health page.

Foodborne Illness: Know the Symptoms

Despite your best efforts, you may find yourself in a situation where you suspect you have a 

foodborne illness. Foodborne illness often presents itself with these symptoms:

• Nausea • Diarrhea • Vomiting • Fever • Abdominal Cramps

If you have a weakened immune system, you are at increased risk for a severe case of food 

poisoning. If you suspect that you have a foodborne illness, take these four key steps: 

1. Contact your healthcare provider immediately if you develop symptoms or think you may be at 

risk for food poisoning.

2. Keep the food.

If a portion of the suspect food is available, wrap it securely, label it to say “DANGER,” and 

freeze it.

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• The remaining food may be used in diagnosing your illness and in preventing others from 

becoming ill.

3. Save all the packaging materials, such as cans or cartons.

Write down the food type, the date and time consumed, and when the onset of symptoms 

occurred. Write down as many 

foods and beverages you can recall 

consuming in the past week (or longer), 

since the onset time for various 

foodborne illnesses differ.

Save any identical unopened products 

and the sales receipt, if you have it.

If the suspect food is a United States 

Department of Agriculture (USDA)-

inspected meat, poultry, or egg 

product, call the USDA Meat and 

Poultry Hotline, 1-888-MPHotline 

(1-888-674-6854). 

For all other foods, call the Food and Drug Administration Office of Emergency Operations 

at 1-866-300-4374 or 301-796-8240.

4. Call your local health department if you believe you became ill from food you ate in a restaurant 

or other food establishment.

The health department staff will be able to assist you in determining whether any further 

investigation is warranted.

To locate your local health department, visit Health Guide USA. 

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More Information from U.S. Food and Drug Administration

• U.S. Food and Drug Administration’s Food and Cosmetics Information Center, 

1-888-SAFEFOOD (1-888-723-3366) for information 

on nutrition and food, cosmetic, and dietary supplement 

safety. This hotline is available Monday through Friday 

from 10 a.m. to 4 p.m. ET (except Thursdays from 12:30 

PM to 1:30 PM ET and Federal holidays).

To order or download publications on food safety, 

nutrition, dietary supplements, and cosmetics materials, 

or to find videos on these topics, visit the CFSAN 

Education Resource Library.

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www.fda.gov 13

Additional Food Safety Information

• FoodSafety.gov, The gateway to Federal Government Food Safety Information, including all 

food recalls and FDA alerts. 

Partnership for Food Safety Education

For questions about the safety and safe handling of meat and poultry, call the United States 

Department of Agriculture Meat and Poultry Hotline, 1-888-MPHotline (1-888-674-6854), 

available Monday through Friday from 10 a.m. to 4 p.m. ET.

Centers for Disease Control and Prevention 1-800-232-4636 (24-hour recorded information) 

Travel Health Notices

Food and Water Safety

U.S. Environmental Protection Agency, Office of Water

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www.fda.gov 14

Notes
www.fda.gov 15

Four Steps to Food Safety

CLEAN 

Wash hands and surfaces often

Wash your hands with warm water and soap for at 

least 20 seconds before and after handling food and 

after using the bathroom, changing diapers, and 

handling pets.

Wash your cutting boards, dishes, utensils, and 

counter tops with hot soapy water after preparing 

each food item.

Consider using paper towels to clean up kitchen 

surfaces. If you use cloth towels, launder them often 

in the hot cycle.

Rinse fresh fruits and vegetables under running tap 

water, including those with skins and rinds that are not 

eaten. Scrub firm produce with a clean produce brush.

With canned goods, remember to clean lids before 

opening.

SEPARATE

Separate raw meats from other foods

Separate raw meat, poultry, seafood, and 

eggs from other foods in your grocery 

shopping cart, grocery bags, and 

refrigerator.

Use one cutting board for fresh produce 

and a separate one for raw meat, poultry, 

and seafood.

Never place cooked food on a plate that 

previously held raw meat, poultry, seafood, 

or eggs unless the plate has been washed 

in hot, soapy water.

Don’t reuse marinades used on raw foods 

unless you bring them to a boil first.

COOK

Cook to the right temperature

Color and texture are unreliable indicators of safety. 

Using a food thermometer is the only way to ensure 

the safety of meat, poultry, seafood, and egg 

products for all cooking methods. These foods must 

be cooked to a safe minimum internal temperature to 

destroy any harmful bacteria.

Cook eggs until the yolk and white are firm. Only 

use recipes in which eggs are cooked or heated 

thoroughly.

When cooking in a microwave oven, cover food, stir, 

and rotate for even cooking. If there is no turntable, 

rotate the dish by hand once or twice during cooking.

Always allow standing time, which completes the 

cooking, before checking the internal temperature 

with a food thermometer. 

Bring sauces, soups, and gravy to a boil when 

reheating.

CHILL

Refrigerate foods promptly

Use an appliance thermometer to be sure the 

temperature is consistently 40°F or below and 

the freezer temperature is 0°F or below.

Refrigerate or freeze meat, poultry, eggs, 

seafood, and other perishables within 2 hours of

cooking or purchasing. Refrigerate within 1 hour

if the temperature outside is above 90°F.

Never thaw food at room temperature, such as 

on the counter top. There are three safe ways 

to defrost food: in the refrigerator, in cold water, 

and in the microwave. Food thawed in cold 

water or in the microwave should be cooked 

immediately.

Always marinate food in the refrigerator.

Divide large amounts of leftovers into shallow 

containers for quicker cooling in the refrigerator.
U.S. Food and Drug Administration

Center for Food Safety and Applied Nutrition

5001 Campus Drive

College Park, MD 20740

www.fda.gov

July 2020 AR07