Transplant Recipients

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Food Safety for Transplant Recipients (PDF - 2.92MB) - En español (Spanish) (PDF - 2.90MB)

A need-to-know guide for bone marrow and solid organ transplant recipients

U.S. Department of Agriculture
Food Safety and Inspection Service

U.S. Department of Health and Human Services
Food and Drug Administration  

September 2006; Slightly revised September 2011

Food safety is important for everyone – but it’s especially important for you. That’s why the U.S. Department of Agriculture’s Food Safety and Inspection Service and the U.S. Department of Health and Human Services’ Food and Drug Administration have prepared this booklet. It is designed to provide practical guidance on how to reduce your risk of foodborne illness. In addition to this guide, we encourage you to check with your physician or health care provider to indentify foods and other products that you should avoid. You have a special need for this important information . . . so read on!

What’s Inside:

Food Safety: It’s Especially Important for You

Major Pathogens That Cause Foodborne Illness

Eating at Home: Making Wise Food Choices

Common Foods: Select the Lower Risk Options

Taking Care: Handling and Preparing Food Safely

Cold Storage Chart

In the Know: Becoming a Better Shopper

Food Product Dating

Transporting Your Groceries

Being Smart When Eating Out

Tips for Transporting Food

Foodborne Illness: Know the Symptoms

Foodborne Illness Action Plan

For More Information on Food Safety

Additional Food Safety Resources

Foodborne Illness in the United States

When certain disease-causing bacteria, viruses or parasites contaminate food, they can cause foodborne illness.  Another word for such a bacteria, virus, or parasite is “pathogen.” Foodborne illness, often called food poisoning, is an illness that comes from a food you eat.

  • The food supply in the United States is among the safest in the world – but it can still be a source of infection for all persons.
  • According to the Centers for Disease Control and Prevention, 48 million persons get sick, 128,000 are hospitalized, and 3,000 die from foodborne infection and illness in the United States each year. Many of these people are children, older adults, or have weakened immune systems and may not be able to fight infection normally.

Since foodborne illness can be serious – or even fatal – it is important for you to know and practice safe food-handling behaviors to help reduce your risk of getting sick from contaminated food.

Food Safety: It’s Especially Important for You 

As a transplant recipient, you are probably familiar with the topic of transplant rejection. It’s the body’s natural reaction or immune system’s response to “foreign invasion.”

  • FamilyA properly functioning immune system will try to reject or destroy your new solid organ and/or bone marrow transplant – in the same way that your immune system works to clear infection from your body.
  • Because of this natural rejection possibility, it’s common for transplant recipients to take medications to keep rejection from happening. These drugs are called immunosuppressive medications because they suppress your immune system to keep it from attacking, or rejecting, your transplanted organ or bone marrow. Over the past few decades, substantial progress has been made in the development of these drugs that help prevent you from experiencing a transplant rejection.
  • Immunosuppressive medications are important, as they can protect your transplanted solid organ and/or bone marrow. But a side effect of these immunosuppressants is that they leave you more susceptible to developing infections – like those that can be brought on by disease-causing bacteria and other pathogens that cause foodborne illness.
  • Because you are a transplant recipient, you are more likely to have a lengthier illness, undergo hospitalization, or even die, should you contract a foodborne illness.
  • To avoid contracting a foodborne illness, you must be vigilant when handling, preparing, and consuming foods.

Make safe handling a lifelong commitment to minimize your risk of foodborne illness. Be aware that as you age, your immunity to infection naturally is weakened.

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Major Pathogens That Cause Foodborne Illness

Associated Foods
  • Untreated or contaminated water
  • Unpasteurized (“raw”) milk
  • Raw or undercooked meat, poultry, or shellfish
Symptoms and Potential Impact
  • Fever, headache, and muscle pain followed by diarrhea (sometimes bloody), abdominal pain, and nausea. Symptoms appear 2 to 5 days after eating and may last 2 to 10 days. May spread to bloodstream and cause life-threatening infection.
Associated Foods/Sources
  • Swallowing contaminated water, including that from recreational sources (e.g., swimming pool or lake)
  • Eating uncooked or contaminated food
  • Placing a contaminated object in the mouth
  • Soil, food, water, contaminated surfaces
Symptoms and Potential Impact
  • Watery diarrhea, dehydration, weight loss, stomach cramps or pain, fever, nausea, and vomiting; respiratory symptoms may also be present.
  • Symptoms begin 7 to 10 days after becoming infected and may last 2 to 14 days. In those with a weakened immune system, including bone marrow and solid organ transplant recipients, symptoms may subside and return over weeks to months.
Clostridium perfringens
Associated Foods/ Sources
  • Many outbreaks result from food left for long periods in steam tables or at room temperature and time and/or temperature abused foods.
  • Meats, meat products, poultry, poultry products , and gravy
Symptoms and Potential Impact
  • Onset of watery diarrhea and abdominal cramps within about 16 hours. The illness usually begins suddenly and lasts for 12 to 24 hours. In elderly, symptoms may last 1 to 2 weeks.
  • Complications and/or death occur only very rarely.
Listeria monocytogenes
Can grow slowly at refrigerator temperatures
Associated Foods
  • Improperly reheated  hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry
  • Unpasteurized (raw) milk and soft cheeses made with unpasteurized (raw) milk
  • Smoked seafood and salads made in the store such as ham salad, chicken salad, or seafood salads
  • Raw vegetables
Symptoms and Potential Impact
  • Fever, chills, headache, backache, sometimes upset stomach, abdominal pain, and diarrhea. May take up to 2 months to become ill.
  • Gastrointestinal symptoms may appear within a few hours to 2 to 3 days, and disease may appear 2 to 6 weeks after ingestion. The duration is variable.
  • Those at-risk (including bone marrow and solid organ transplant recipients and others with weakened immune systems) may later develop more serious illness; death can result from this bacteria.
  • Can cause problems with pregnancy, including miscarriage, fetal death, or severe illness or death in newborns.
Escherichia coli O157:H7
One of several strains of E. coli that can cause human illness
Associated Foods
  • Undercooked beef, especially ground beef
  • Unpasteurized milk and juices, like “fresh” apple cider
  • Contaminated raw fruits and vegetables, and water
  • Person-to-person contact
Symptoms and Potential Impact
  • Severe diarrhea that is often bloody, abdominal cramps, and vomiting. Usually little or no fever.
  • Can begin 1 to 9 days after contaminated food is eaten and lasts about 2 to 9 days.
  • Some, especially the very young, may develop hemolytic-uremic syndrome (HUS), which cause acute kidney failure, and can lead to permanent kidney damage or even death.
Norovisuses (and other caliciviruses)
Associated Foods
  • Shellfish and fecally-contaminated foods or water
  • Ready-to-eat foods touched by infected food workers; for example, salads, sandwiches, ice, cookies, fruit
Symptoms and Potential Impact
  • Nausea, vomiting, stomach pain usually start between 24 and 48 hours, but cases can occur within 12 hours of exposure. Symptoms usually last 12 to 60 hours.
  • Diarrhea is more prevalent in adults and vomiting is more prevalent in children.
Salmonella (over 2,300 types)
Associated Foods
  • Raw or undercooked eggs, poultry, and meat
  • Unpasteurized (raw) milk or juice
  • Cheese and seafood
  • Fresh fruits and vegetables
Symptoms and Potential Impact
  • Stomach pain, diarrhea (can be bloody), nausea, chills, fever, and/or headache usually appear 6 to 72 hours after eating; may last 4 to 7 days.
  • In people with a weakened immune system, such as bone marrow and solid organ transplant recipients the infection may be more severe and lead to serious complications including death.
Toxoplasma gondii
Associated Foods/Sources
  • Accidental contact of cat feces through  touching hands to mouth after gardening, handling cats, cleaning cat’s litter box, or touching anything that has come in contact with cat feces.
  • Raw or undercooked meat.
Symptoms and Potential Impact
  • Flu-like illness that usually appears 10 to 13 days after eating, may last months. Those with a weakened immune system, including bone marrow and solid organ transplant recipients, may develop more serious illness.
  • Can cause problems with pregnancy, including miscarriage and birth defects.
Vibrio vulnificus
Associated Foods
  • Undercooked or raw seafood (fish or shellfish)
Symptoms and Potential Impact
  • Diarrhea, stomach pain, and vomiting may appear within 4 hours to several days and last 2 to 8 days. May result in a blood infection.  May result in death for those with a weakened immune system, including people with bone marrow and solid organ transplants, cancer or liver disease.

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Eating at Home: Making Wise Food Choices

lady is Checking the right temperature for cooked foodSome foods are more risky for you than others.  In general, the foods that are most likely to contain harmful bacteria or viruses fall in two categories:

  • Uncooked fresh fruits and vegetables
  • Some animal products, such as unpasteurized (raw) milk; soft cheeses made with raw milk; and raw or undercooked eggs, raw meat, raw poultry, raw fish, raw shellfish and their juices; luncheon meats and deli-type salads (without added preservatives) prepared on site in a deli-type establishment.

Interestingly, the risk these foods may actually 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.

If You Have Questions ….… about Wise Food Choices:
Be sure to consult with your doctor or healthcare provider.  He or she can answer any specific questions or help you in your choices.

…about Particular Foods:
If you are not sure about the safety of a food in your refrigerator, don’t take the risk.

When in doubt, throw it out!

Wise choices in your food selections are important.

All consumers need to follow the Four Basic Steps to Food Safety:  Clean, Separate, Cook and Chill.

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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
Tip:  Use a food thermometer to check the internal temperature on the “Is It Done Yet?” chart for specific safe minimum internal temperature.
  • 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
  • Unpasteurized (raw) milk
  • Pasteurized milk
EggsFoods that contain raw/undercooked eggs, such as:
  • Homemade Caesar salad dressings*
  • Homemade raw cookie dough*
  • Homemade eggnog*
At home:
  • Use pasteurized eggs/egg products when preparing recipes that call for raw or undercooked eggs
When eating out:
  • Ask if pasteurized eggs were used
*Tip: Most pre-made foods from grocery stores, such as Caesar dressing, pre-made cookie dough, or packaged eggnog are made with pasteurized eggs.
  • Raw sprouts (alfalfa, bean, or any other sprout)
  • Cooked sprouts
  • Unwashed fresh vegetables, including lettuce/    salads
  • Washed fresh vegetables, including salads
  • Cooked vegetables
  • Soft cheeses made from unpasteurized (raw) milk, such as: -Feta

-Queso fresco

  • Hard cheeses
  • Processed cheeses
  • Cream cheese
  • Mozzarella
  • Soft cheeses that are clearly labeled “made from pasteurized milk”
Hot Dogs and Deli Meats
  • Hot dogs, deli and luncheon meats that have not been reheated
  • Hot dogs, luncheon meats, and deli meats reheated to steaming hot or 165 ºF
Tip:  You need to reheat hot dogs, deli meats and luncheon meats before eating them because the bacteria, Listeria monocytogenes grows at refrigerated temperatures (40 ºF or below). This 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.
  • Unpasteurized, refrigerated pâtés or meat spreads
  • Canned or shelf-stable pâtés or meat spreads

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Taking Care: Handling and Preparing Food Safely

Foodborne pathogens are sneaky.   Food that appears completely fine can contain pathogens --disease-causing bacteria, viruses, or parasites -- that can make you sick. You should never taste a food to determine if it is safe to eat.

As a transplant recipient, it is especially important that you – or those preparing your food – are always careful with food handling and preparation. The easiest way to do this is to Check Your Steps -- clean, separate, cook, and chill – from the Food Safe Families Campaign.  

Four Basic Steps to Food Safety

Washing cutting board

1. Clean:  Wash hands and surfaces often

Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, counter tops, and food. 

To ensure that your hands and surfaces are clean, be sure to:
Wash hands in warm soapy water for at least 20 seconds before and after handling food and using the bathroom, changing diapers, or handling pets.

  • Wash cutting boards, dishes, utensils, and counter tops 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. As an added precaution, sanitize cutting boards and counter tops by rinsing them in a solution made of one tablespoon of unscented liquid chlorine bleach per gallon of water, or, as an alternative, you may run the plastic board through the wash cycle in your automatic dishwasher.
  • Use paper towels to clean up kitchen surfaces.  If using cloth towels, you should wash them often in the hot cycle of the washing machine.
  • Wash produce.  Rinse fruits and vegetables, and rub firm-skin fruits and vegetables under running tap water, including those with skins and rinds that are not eaten.
  • With canned goods: remember to clean lids before opening.

An image of lady hand holding a knife to cut a row meet

2. Separate:  Don’t cross-contaminate

Cross-contamination occurs when bacteria 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 ready-to-eat foods.

To prevent cross-contamination, remember to:

  • Separate raw meat, poultry, seafood, and eggs from other foods in your grocery shopping cart, grocery bags, and in your refrigerator. 
  • Never place cooked food on a plate that previously held raw meat, poultry, seafood, or eggs without first washing the plate with hot soapy water.
  • Don’t reuse marinades used on raw foods unless you bring them to a boil first.
  • 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.

Checking cooked food temperature with food thermometer

3. Cook: Cook to safe temperatures

Foods are safely cooked when they are heated to the USDA-FDA recommended safe minimum internal temperatures, as shown on the “Is it Done Yet” chart.

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.
  • Cook ground beef to at least 160 ºF and ground poultry to a safe minimum internal temperature of 165 ºF.  Color of food is not a reliable indicator of safety or doneness.
  • Reheat fully cooked hams packaged at a USDA-inspected plant to 140 ºF. For fully cooked ham that has been repackaged in any other location or for leftover fully cooked ham, heat to 165 ºF. 
  • Cook seafood to 145 F.  Cook shrimp, lobster, and crab until they turn red and the flesh is pearly opaque.  Cook clams, mussels, and oysters until the shells open.  If the shells do not open, do not eat the seafood inside.
  • Cook eggs until the yolks and whites are firm.  Use only recipes in which the eggs are cooked or heated to 160 ºF.
  • Cook all raw beef, lamb, pork, and veal steaks, roasts, and chops to 145 ºF with a 3-minute rest time after removal from the heat source.
  • Bring sauces, soups, and gravy to a boil when reheating. Heat other leftovers to 165 ºF.
  • Reheat hot dogs, luncheon meats, bologna, and other deli meats until steaming hot or 165 ºF.
  • 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.  Food is done when it reaches the USDA- FDA recommended safe minimum internal temperature.

Is It Done Yet?
Use a food thermometer to be most accurate. You can’t always tell by looking.

USDA-FDA Recommended Safe Minimum Internal Temperatures

  • Beef, Pork, Veal, Lamb, Steaks, Roasts & Chops
    145 ºF with 3-minute rest time
  • Fish
    145 ºF
  • Beef, Pork, Veal, Lamb Ground
    160 ºF
  • Egg Dishes
    160 ºF
  • Turkey, Chicken & Duck Whole, Pieces & Ground
    165 ºF

An image of foods in the refrigerator

4. Chill: Refrigerate promptly

Cold temperatures slow the growth of harmful bacteria. Keep-ing a constant refrigerator temperature of 40 °F or below is one of the most effective ways to reduce risk of foodborne illness. Use an appliance thermometer to be sure the refrigera-tor temperature is consistently 40 °F or below and the freezertemperature 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 outside is above 90 °F.
  • Never thaw food at room temperature, such as on the counter top. 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 abridged USDA-FDA Cold Storage Chart (below). The USDA-FDA Cold Storage Chart in its entirety may be found at Refrigeration and Food Safety

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USDA-FDA 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.

ProductRefrigerator (40 ºF)Freezer (0 ºF)
Fresh, in shell3 to 5 weeksDon’t freeze
Hard cooked1 weekDon’t freeze well
Liquid Pasteurized Eggs, Egg Substitutes
Opened3 daysDon’t freeze well
Unopened10 days1 year
Deli and Vacuum-Packed Products
Egg, chicken, ham, tuna,
& macaroni salads
3 to 5 daysDon’t freeze well
Hot Dogs
Opened package1 week1 to 2 months
Unopened package2 weeks1 to 2 months
Luncheon Meat
Opened package3 to 5 days1 to 2 months
Unopened package2 weeks1 to 2 months
Bacon & Sausage
Bacon7 days1 month
Sausage, raw – from
chicken, turkey, pork, beef
1 to 2 days1 to 2 months
Hamburger and Other Ground Meats
Hamburger, ground beef,
turkey, veal, pork, lamb,
& mixtures of them
1 to 2 days3 to 4 months
Fresh Beef, Veal, Lamb, Pork
Steaks3 to 5 days6 to 12 months
Chops3 to 5 days4 to 6 months
Roast3 to 5 days4 to 12 months
Fresh Poultry
Chicken or turkey, whole1 to 2 days1 year
Chicken or turkey, pieces1 to 2 days9 months
Lean fish (flounder, haddock,
halibut, etc.)
1 to 2 days6 to 8 months
Fatty fish (salmon, tuna, etc.)1 to 2 days2 to 3 months
Cooked meat or poultry3 to 4 days2 to 6 months
Chicken nuggets, patties3 to 4 days1 to 3 months
Pizza3 to 4 days1 to 2 months

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In the Know: Becoming a Better Shopper

Follow these safe food-handling practices while you shop.

  • Two ladies read food labels on the packageCarefully read food labels while in the store to make sure food is not past its “sell by” date.
  • 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.
  • 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.)
  • Purchase produce that is not bruised or damaged.
  • Check Your Steps:
    • Check “Sell-By” date. 
    • Put raw meat, poultry, or seafood in plastic bags
    • Buy only pasteurized milk, soft cheeses made with pasteurized milk, and pasteurized or juices that have been otherwise treated to control harmful bacteria.
    • When buying eggs, purchase refrigerated shell eggs. If your recipe calls for raw eggs, purchase pasteurized, refrigerated liquid eggs.
    • Don’t buy food displayed in unsafe or unclean conditions

Food Product Dating

Types of Open Dates:An image of food product - sell by date, net pounds, bar code and total price of the product

Open dating is found primarily on perishable foods such as meat, poultry, eggs, and dairy products.

  • A“Sell-By” date tells the store how long to display the product for sale. You should buy the product before the date expires.
  • A “Best if Used By (or Before)” date is recommended for best flavor or quality.  It is not a purchase or safety date.An image of lable - used by November 10, 2006
  • A “Use-By” date is the last date recommended for the use of the product while at peak quality.  The date has been determined by the manufacturer of the product.

“Closed or coded dates” are packing numbers for use by the manufacturer. “Closed” or “coded” dating might appear on shelf-stable products such as cans and boxes of food.

Transporting Your Groceries

Follow these tips for safe transporting of your 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 within 1 hour if the temperature outside is above 90 °F.
  • In hot weather, take a cooler with ice or another cold source to transport foods safely.

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Being Smart When Eating Out

An image of family - eating foods on dinner tableEating out can be lots of fun – so make it an enjoyable experience by following some simple guidelines to avoid foodborne illness.  Remember to observe your food when it is served, and don’t ever hesitate to ask questions before you order.  Waiters and waitresses can be quite helpful if you ask how a food is prepared.  Also, let them know you don’t want any food item containing raw meat, poultry, seafood, sprouts, or eggs.

Basic Rules for Ordering

  • Ask whether the food contains uncooked ingredients such as eggs, sprouts, meat, poultry, or seafood.  If so, choose something else.
  • Ask how these 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.
  • If you plan to get a “doggy bag” or save leftovers to eat at a later time, refrigerate perishable foods as soon as possible – and always within 2 hours after purchase or delivery. If the leftover is in air temperatures above 90 °F, refrigerate within 1 hour.

If in doubt, make another selection!

Smart 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 cerviche.
  • 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.

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An image of insulated container

Tips for Transporting Food

  • Keep cold food cold, at 40 °F or below. To be safest, place cold food in cooler with ice or frozen gel packs. Use 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.

Stay “Food Safe” When Traveling Internationally
Discuss your travel plans with your physician before traveling to other countries. Your physician 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 Centers for Disease Control and Prevention.

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Foodborne Illness: Know the Symptoms

Doctor examining patient with StethoscopeDespite your best efforts, you may find yourself in a situation where you suspect you have a foodborne illness.  Foodborne illness often presents itself with flu-like symptoms.

These symptoms include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fever

If you suspect that you could have a foodborne illness, there are four key steps that you should take. Follow the guidelines in the Foodborne Illness Action Plan (below), which begins with contacting your physician or healthcare provider right away.

When in doubt – contact your physician or healthcare provider! 

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Foodborne Illness Action Plan

If you suspect you have a foodborne illness, follow these general guidelines:

1. Consult your physician or healthcare provider, or seek medical treatment as appropriate.
As a transplant recipient on immunosuppressive medications, you are at increased risk for severe infection.

  • Contact your physician immediately if you develop symptoms or think you may be at risk.
  • If you develop signs of infection as discussed with your physician, seek out medical advice and/or treatment immediately.An image of food wrapped with plastic and lable says "DANGER"

2. Preserve the food.

  • If a portion of the suspect food is available, wrap it securely, label it to say “DANGER,” and freeze it.
  • 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.
  • If the suspect food is a USDA-inspected meat, poultry, or egg product, call the USDA Meat and Poultry Hotline, 1-888-MPHotline (188-674-6854). For all other foods, call the FDA 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 on Food Safety

You may contact the USDA Food Safety and Inspection Service and HHS Food and Drug Administration to obtain additional food safety information in both English and Spanish.

  • Information can be accessed on the FSIS website or the FDA website.
  • “Ask Karen” - The FSIS Virtual Representative
    An automated response system is available 24/7 at disclaimer icon and disclaimer icon .
  • Send e-mail inquiries to or by completing the online form.
  • Call the USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) or call the FDA Food Information Line 1-888-SAFE-FOOD (1-888-723-3366). These year-round, toll-free Hotlines are available Monday through Friday from 10 a.m. to 4 p.m. Eastern Time. An extensive selection of timely food safety messages is also available at these same numbers, 24 hours a day.

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Additional Food Safety Resources

To order this and/or other At-risk booklets, go to:

Apply the filters for Food Safety, Consumers/General Public, PDF Downloads and Orderable Hardcopies and scroll to the title of the booklet you want, then follow the prompts to order and/or download the PDF.

  • Food Safety for Older Adults
  • Food Safety for Pregnant Women
  • Food Safety for People with Cancer
  • Food Safety for People with Diabetes
  • Food Safety for People with HIV/AIDS
  • Food Safety for Transplant Recipients

For information about food safety, nutrition, dietary supplements, and cosmetic safety, contact:

U.S. Food and Drug Administration,
Center for Food Safety and Applied Nutrition’s
Food and Cosmetic Information Center at 1-888-SAFEFOOD
Monday through Friday 10 a.m. to 4 p.m. ET
(Except Thursdays from 12:30 p.m. to 1:30 p.m. ET and
Federal holidays.)

Or, visit the FDA website at

Thank you to Lydia Medeiros, Ph.D., R.D., Patricia A. Kendall, Ph.D., R.D., and Val Hillers, Ph.D., R.D., for their assistance and groundbreaking research and outreach to the at-risk community.

USDA logo

U.S. Department of Agriculture
Food Safety and Inspection Service

HHS Logo

U.S. Department of Health and Human Services
Food and Drug Administration 

The U.S. Department of Agriculture and Health and Human Services are equal opportunity providers and employers.

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