Eating Produce in Istanbul and vaccine for Typhoid

We had to have typhoid vaccines and followed them with boosters when we were heading to a third world country. The doctor said it is good to have, even for Mexico. We ate in restaurants in Istanbul not off street carts except for buying Simi, like a bagel, and pomegranate juice.

Istanbul and Turkey are not a third world country, so I'm not sure about the prior comparison (having said that, some of their hotel pipes are really old and I wouldn't drink tap water there, but then again I don't drink tap water much anyway). You should have no issues with cooked vegetables in any restaurant (I eat mostly vegetables) - veggies are prominent on any mezze selection in just about every restaurant. The only folks on my tour in 2011 that got sick were the ones who seem not to realize they had a fish/shellfish allergy and ate some stuffed muscles (called "midye dolma") one of the street carts. The muscles with lemon juice are very popular. Obviously everyone is different and some people have weak(er) stomachs, but I had no issues in Istanbul at all (I spent more than 2 weeks there). I can't speak for kebabs because I'm a pescatarian, but honestly, I don't think you have that much to worry about going to Istanbul. I readily bought juices off street vendors (fresh pomegranate juice was great) and grilled fish sandwiches by the Galata Bridge (they were called "ekmek balik", and were delicious and grilled on the spot).

I had no additional vaccines prior to going to Turkey (I've been at least 3 times). As a caveat, I'm in my 40s and in very good health. Since only you know how sensitive you are, maybe it's best to not be super adventurous - or just start slowly and see how it goes.

I really regret not doing this, but there are some really interesting food tours and cooking classes in Istanbul that could introduce you to their markets and other street food. I would try to sign up for one if you have extra time. The food markets were sensory overload, and full of really good looking produce, fish, and spices of all kinds.

Salmonella and typhoid are two different things, with similar, uhh, outcomes. The CDC wording is pretty carefully chosen:

You can get typhoid through contaminated food or water in Turkey. CDC recommends this vaccine for most travelers, especially if you are staying with friends or relatives, visiting smaller cities or rural areas, or if you are an adventurous eater. {emphasis added}

CDC makes these recommendations based on their evaluation of public health data from these countries, not just an knee-jerk CYA precaution.

The vaccine does not protect you from salmonella, or other food/water contaminants. Or from the server who doesn't wash their hands. Just one tool.

Actually, salmonella C aka para typhoon, is same Bacteria to typhoid so there may be some help taking typhoid vaccine.having had it and taking three months to heal is no fun.
It is best to avoid soft skin fruits and vegetables from vendors as they might like to get a sale and raw soft skin 'anything' can absorb more than you can wash off. washing cherries with bottled water may not be enough.
If there is a long line up of locals at the vendor booth consider their cooked food but better yet, wat h them cook things from scratch rather than risk reheating of food. Established restaurants and store front shops are less risky.
With the ability to travel now, having a full range of immunizations and meds makes sense. Traveler's gut doesn't have to be serious bacteria, but it can still ruin a few days.

I visited Istanbul in 2012 and it never occurred to me to get any immunizations before I went. We only ate in established restaurants. Our hotel did provide bottled water in our room. The only times I've gotten sick in Europe were in Venice and Moscow in the 1980's. I think I remember getting the oral typhoid vaccine before a trip to Ecuador in the 1990's and the vaccine did make me slightly sick so take that into consideration when planning the timing of the vaccine.

It's been quite a few years but when I was in Istanbul and in Izmir, a few of us enjoyed the street food from vendors and none of us had any issues. The only person on our tour who got sick (stomach and bowel issues) most likely was a victim of the water. They did not eat any street food, or any uncooked fruits or vegetables, but did drink water from the carafes in restaurants which was most likely tap water. I drank only bottled water, but did use tap water to brush my teeth and I'm sure I swallowed some while showering but had no problems. I had no special vaccines before going to Turkey and don't know of anyone else who did. That was in 2001 and I'm sure, if anything, it's better now not worse. I certainly wouldn't consider Turkey a 3rd world country and if you're just going to Istanbul, you're basically in Europe.

I didn't get any immunizations and didn't get sick, so no worries; ranks right up there with, I went to Syria and felt perfectly safe, or I don't get evacuation insurance because I've never needed it.

Suki, Maria, cala, Nancy: Thank you for sharing your first hand experience in Istanbul, this is what I was asking for.

Agnes: I appreciate your knowledge and advice.Edited to say, Suki wasn't calling Turkey a .3rd world country, only that she got a vaccine before traveling to a 3rd world country--that wasn't Turkey.
Thank you for sharing with me the rest of your post.

Stan: dude, Typhoid is caused by a bacterium called Salmonella Typhi, but thanks for the rest of your post.

Kaeleku: I am sure that you don't care, but I find myself trying so hard to appreciate you and your posts on this forum. But do you ever read the stuff you write before you hit the blue button?
1. I did not call Turkey a 3rd world country
2. Just because something never occured to you doesn't mean it shouldn't have occured to you. Traveler's diarrhea is a real problem in Turkey according to reliable sources. It is true that I should decide to follow those recommendations or not. Basically my post is saying "I trust the sources that are telling me not to consume any tap water, but I don't want it to be true and if enough others have been "adventurous eaters" in Istanbul maybe I will take the risk." Really if you want to criticize my thinking it would be more valid to call me out on going by 'strangers' experiences instead of health authorities.
3. I asked you for opinion on questioning the waiter, thanks for your response. But I found the way you responded to me to equally as rude. It is a valid question because eating raw food washed in tap water is a source of traveler's diarrhea.
4. I am absolutely not worried about traveling to Turkey, how dare you imply that I am. I am worried about getting traveler's diarrhea, which is a true risk.
5. If you really want to know my motivation for going to Turkey, I would be happy to share that with you. Again, I agree that my question can be criticized, but my question can not validly compared to "Is it safe to travel to .... because my aunt told me someone was a victim of crime there.

James E: Thank you for your words and an Amen.

James, with respect, never having needed evacuation is a horrible reason for saying you don't need to pay for evacuation insurance. It's like saying you never had measles, so you don't need the vaccine that Intellectual Giant Jenny McCarthy warned against getting.

Insurance is sold to mitigate risks. Do you have a risk? Can you afford the insurance? Can you afford to not have the insurance and have the risk happen to you? That's how adults make decisions.

K....whatever.
Suki didn't call Turkey a third world country either. She said that she received a Typhoid vaccine when she visited a third world country. If you can accuse me of being sensitive, maybe you should look in the mirror.
I responded to you in the exact manner that you responded to me.

Addressing the fact that Istanbul's water can cause illness in American visitors is not calling the country "backwater".
I do agree with you that it isn't the best question to ask, so I will give you that.
Responding to Stan with the name of the bacterium that causes Typhoid is not being sensitive, it is adding facts.

And while I am being oversensitive to unhelpful posts.... Tim buddy, you missed the mark. Read James' post again.

The oral typhoid vaccine is quite easy to take and effective. I don't see any reason for people to be offended that you were asking in advance about possible vaccine needs. I will say that the travel clinic at your local health department is a great place to start with questions about vaccines and health issues around the world.

It may save money to ask the price of the typhoid (or other) vaccine at your local drug store and at your doctor's office. For me the drug store was much less expensive. You'll need a prescription, of course.

I second the suggestion to contact your local Travel Health Clinic to talk with a professional about your travel plans and get their recommendations. If they advise a vaccine(s) for travel to Turkey, or Mexico, or wherever due to the chance of contaminated food or water (especially if you're an adventurous eater), I would heed their advice. The small cost, if any, is worth the peace mind.

I keep my Immunization Record card with my Passport for quick reference. (Just got my third 10-year booster shot for Diptheria/Tetanus/Pertussis for free at the public health clinic this week.)

Fascinating thread.

But I am guessing there are a range of restaurants, some being more of
a niche with sidewalk seating?

Istanbul has every type of restaurant. It is a large cosmopolitan city.

Is it acceptable to ask a waiter if the produce was washed with
filtered water? Would you believe the answer?

No and yes

Has anyone else gotten the vaccine? Your experience?

Yes, when I lived in West Africa for years. Didn’t even consider it for Turkey. Experience - it hurt?

Any recent adventurous eaters in Istanbul? And how adventurous were
you?

Yes. I ate everything as did my husband and kids. Best was the fresh squeezed pomegranate juice from the carts on the side of the road.

IRT Vaccinations. Get every one you can, including Hep A&B. Consider, if possible, Dukoral for travelers diarrhea. While vaccs provide protection for 10 years to lifetime, Dukoral is a short term preventative for about three months.

IRT eating street-food in Istanbul. I was there in 2016 and ate corn on the cob, which came out of boiling water; and fried fish sandwich at the river. The key is risk assessment and reduction accompanied by benefit versus risk assessment. Eating local food is one of the rewards of travel. The corn on the cob was purchased from a small cart in front of Hagia Sophia and I ate it sitting on a bench where by swiveling I could see the Blue Mosque. What a treat, both for taste buds and eyes.
IRT fresh tomatoes, onions etc. I ate them in restaurants without hesitation.
IRT water. I stayed in a small hotel in Sultanamet. They recommended to not drink the tap water. They claimed that no one in Istanbul drank tap water. That was plausible enough that I bought 3 liter jugs of purified water to drink and brush teeth. And I ate all the hotel breakfast items, which included tomatoes, which were probably cleaned in tap water. I showered in tap water. That is part of risk assessment. Reduction of exposure, not elimination. Our immune system is often good at dealing with minor exposures to the agents that cause travelers diarrhea, but can be overwhelmed with major exposures.
If you stay in a large brand name hotel they may have a in-house filtration system.
View some of the YouTube videos covering eating food, including hole-in-wall restaurants and street food, in Istanbul. There are several hours worth. I think they will reassure you and make you impatient for your visit.
Have a wonderful time, and if you learn or experience anything that would benefit us, the RS readers, please post it.

Be aware not all vaccines have the same length of coverage. Typhoid is not as long as 10 years, so any major travel needs regular review with a travel specialist on imunization needs and maintenance.

note Dukoral is not yet available in the US.

I love it when someone says something that makes me do some research and learn a little more.

Is Turkey a 3rd World Country?

The three-world model arose during the Cold War to define countries
aligned with NATO (the First World), the Communist Bloc (the Second
World, although this term was less used), or neither (the Third
World). Strictly speaking, "Third World" was a political, rather than
an economic, grouping.

Turkey has been a member of NATO since 1952.

By the end of the 1960s, the idea of the Third World came to represent
countries in Africa, Asia and Latin America that were considered
underdeveloped by the West based on a variety of characteristics (low
economic development, low life expectancy, high rates of poverty and
disease, etc.)

While not the most economically prosperous country, and given the current discussion on immunizations, I am going to say not the most disease free country; Turkey is no where near the bottom. So the only category identified that it fits in is it being in "Asia".

Quotes from Wikipedia so it must be correct :-)

A little more research shows that Turkey is "Moderately Endemic" with regards to Typhoid. That would be 10 to 100 cases per 100,000 population. Mexico falls into that category too. Too big a spread to be really comfortable with. Is it 11 cases or 99 cases? Most of Europe is non-endemic (less than 10 cases). Most of sub-Saharan Africa and the greater part of Asia outside of Russia and China is Highly Endemic with more than 100 cases.

Just the same, I would get my immunizations.... actually I did.

It might not be worth much - but Canadian here - I have traveled in South America and several visits to Africa including 'living locally' as a volunteer and never used Dukoral. I get an appropriate antibiotic prescription from my travel physician to take when necessary. Of course, that is 'our' joint decision, so we don't see Dukoral as the answer to all traveller's diarrhea problems. If it isn't available, adjust accordingly.

Thank you for the additional replies. I was wondering about the definition of 3rd world country so that info was interesting. I read about Dukoral. Also good to hear more food anecdotes.

For those of you that ate the fish sandwiches-balik ekmek, did you eat the lettuce and onion?

My trip is not until September but I will arrange for the oral Typhoid vaccine.
Thanks for the suggestion to price it at a local pharmacy, that is a great idea.
I will also take a supply of Cipro. Will see how I feel about the risk at the time.

Is it allowed to purchase Dukoral in Canada and bring it back to the US?

You might want to keep this link handy http://www.expatarrivals.com/europe/turkey/istanbul/healthcare-istanbul

For those of you that ate the fish sandwiches-balik ekmek, did you eat
the lettuce and onion?

I ate everything on multiple occasions, it wouldn't have occurred to me to pick some things out (and I doubt the person making the sandwich used gloves, although I can't remember at all). Some vendors just use the grilled fish and bread, but it tastes too dry to me. I like other vegetables in there and I walked around to see which vendor had the most appetizing looking stuff. If you have a reason(s) to be cautious, then stick with it. One person's experience may not be similar to yours - and only you know your risks.

Another popular street food in addition to the sandwiches and the corn are stuffed baked potatoes (kumpir). They stuff them with everything imaginable. I remember passing by such a vendor near the Ortaköy mosque along the Bosphorus.

Vandrabrud,
I went on the RS Turkey tour in October 2018, as you know already. I did not get any vaccines. I followed Rick's advice and drank only bottled water and brushed my teeth with bottled water. I avoided raw fruits and vegetables from street vendors. As the trip progressed, I kept to bottled water but did begin to add fresh fruits and vegetables served at hotels and restaurants. I was very strict in Istanbul especially. I wanted to have the fish sandwich that is so well-known but a friend of a friend who lives in Istanbul said it is a very strong tasting fish. Whatever that might mean to you, to me, it didn't sound appealing.

And, I did not get sick.

I'm going to Israel in 2 weeks and today I got the 1st shot of Hepatitis A vaccine as the doctor advised. Also, he gave me a prescription for Azithromycin for moderate to severe diarrhea just in case. He didn't advise me to get the Typhoid vaccine.
Sept. will be here before you know it!!

Btw, we ate kebabs with cooked tomato and onion in a delightful restaurant called Han. It is near Sultanahmet Square and on the main street that you take to walk to the Archaeology Museum.

cala, I believe Dukoral is by prescription only in Canada, so not an easy endeavour.

hmmm.... I had no issues in Israel and no jabs/shots either. hmmmm.

by the way - up thread about 11 posts - lots of IRT. What's IRT?

Dukoral is available without a prescription in all provinces except Quebec. Maria, haven't you seen the commercial about the 2 families, one which took Ducoral and spent their vacation on the beach and the other didn't and spent their vacation - and here the mom whispers - in the bathroom. It's getting heavy play right now before March Break.....

Khyrista, I gave up TV 6 years ago 😃 and of course this is one time I didn't check Google before posting...

cala re: Dukoral. The thing about Dukoral is, that it is a liquid medication that you take in two steps a week apart. But it has to be kept refrigerated. So you can't just put it in your luggage and bring home to the US.

I wanted to buy some when I was in Canada in 2017, and the pharmacist was happy to sell it to me (100 $CDN), but I didn't need it right away, and had no way of keeping it refrigerated while traveling back to the US, so I passed. I suppose if you went by car, you could bring it home in a cooler, but keep an eye on the expiration date.

I suspect "IRT" = in respect to.

Nigel, IRT = In regard to

It can also mean In Real Time but the way it's used in this thread to me means "In Regard to."

IRT ...... I'm really tired.

I wanted to have the fish sandwich that is so well-known but a friend
of a friend who lives in Istanbul said it is a very strong tasting
fish.

It's grilled mackerel (by the way, I don't remember tomatoes being in the bun - only salad/greens, lemon, and onion). I really liked it, but then again I also like anchovies and sardines.

I will reiterate, Istanbul is one of those food sensory overload places - very worthwhile to do a food tour there and check out all the food and spice markets. I wandered around many markets on my own. Prepare to see cats and kittens everywhere, especially near the fish.

Judy,
I was hoping you would stop by the thread.

I think the bottom line is, that it is good to understand there is some risk, be prepared (vaccine, antibiotics) and be prepared for any consequences should risks be taken.
It is good to know that veggies have been eaten by many with no ill affect.

IRT--in regard to (?)

Agnes,
I LOVE cats and will come home with lots of pictures of cats : )
I love food tours and will be researching that for sure.

They stuff them with everything imaginable.

That is supposed to make me feel better about eating them?

I came home with loads of pictures of cats!

I think it is smart to consult a doctor about vaccines you might need. I didn’t think of that before I went to Turkey. After I came home, a retired doctor friend suggested I look at the CDC website for their recommendations for Israel. I think the main thing is to be careful about the source of the food you are eating and if you have confidence in the hotel or restaurant’s food handling practices. It’s not possible to have a 100% guarantee. Use your innate caution and I think you will be fine.

Maria, thank you for the comment about Typhoid vacc. being shorter than ten years. There is an injectable type and an oral type. One is two years, the other is five years. I may have been thinking of tetanus, which is ten years.

IRT vacc., they are for life threatening illnesses. The infectious agent may not be common, but common is not a suitable measurement for life threatening. Some of my travelling occurred before some vaccs were available. I become ill with what is now a completely avoidable illness; I was incapacitated for three months followed by another three months of recovery. If I can obtain a vacc., I have a high motivation to do so. When I was ill, I was young and healthy; I am now older and not as healthy; I need to give my body every advantage possible. I wish to stay alive as long as possible to enjoy, as much as possible, the wonders of this world.
I was not clear in my posting about the difference between life threatening illness and life inconveniencing illness. Travelers diarrhea [not diarrhea that is a symptom of a major illness, and you need to be able to discern the difference] is an inconvenience. If possible, let our bodies do what they need to do, excrete as quickly as possible the irritant in the bowels. Similarly, if your stomach is irritated, let your body vomit it out. These are beneficial self protective body actions. Of course, be aware of dehydration and similar complications. They are easy to prevent or treat.
However, if your trip is less than three weeks you may not have the option to cocoon yourself for several days while your body eliminates the irritant. In those situations, using OTC or prescription drugs may be necessary. Each person needs to make that decision; and have educated themselves enough in order to make a suitable, informed decision.
It is advisable to download a suitable first aid instruction manual to your electronic device. Some of my travel occurred before electronic devices existed; carrying a two pound first aid book was not feasible; but a 4 ounce emergency first aid summary was possible. Now you can carry the equivalent of a ten pound text book on a notepad, full of illustrations and step by step instructions. It is an amazing resource.
I assume everyone who travels has taken a first aid course and therefore I forget to mention it.
SO, take a first aid course and know what to do to protect yourself and the people around you. They typically emphasis traumatic events such as broken bones, but also includes diarrhea, vomiting, dizziness, loss of consciousness etc. and will cover essentials of infectious diseases.
Harvey