Travel health

Why is it important to be healthy when flying? 

Travelling when you're unwell can be bad for your health and may impact on the health of your fellow passengers and flight crew. Whether it's just a cold or something more serious, flying can make you worse.

Conditions that may affect air travellers include:

• Changes in air pressure. Most people don't have problems, but changes in air pressure during flight can affect both your heart and respiratory systems. If you have a pre-existing heart or lung condition, check with your GP before booking flights.
• Close quarters. When people cough or sneeze, small droplets carry germs that spread in air currents. If you breathe in an airborne virus, bacterium or other germ, you may become infected and get the disease. Your chance of this happening increases when many people are in a confined space such as an aircraft cabin.
• Pregnancy. Most airlines will not permit women to fly internationally after 36 weeks of pregnancy. If you have complications of pregnancy or are expecting twins or other multiples you will require medical clearance for domestic or international flights. In any case, check with your obstetrician, GP or midwife that there are no additional risks to you if you fly.
• Ear and nose blockages. If you have ear or sinus problems, try taking a decongestant or nasal spray before takeoff and landing. Whether or not you have sinus problems, for most people, swallowing, yawning to 'pop' your ears, blowing into a pinched nose, sucking on a sweet, or chewing gum may help. Babies can suck on breast, bottles or dummies during the flight.

What is deep vein thrombosis and what are the risks when flying? 

The risk of deep vein thrombosis (DVT) increases during, and for several weeks after, flights of four or more hours. DVT occurs when blood flow is slow, usually because of inactivity, coupled with the dehydrating conditions of flying. A clot forms in the larger veins initially, usually in the lower leg. Clots may break off and travel to other parts of the body such as the heart and lungs (known as a pulmonary embolism) and this can be fatal.

Each year in Australia there are up to 400 deaths from pulmonary embolism and a small number may be associated with air travel. Increased risk factors include older age, obesity, smoking, pregnancy, the use of oral contraceptives or hormone replacement therapy, cancer, lower limb injury, recent surgery, family history of DVT, prolonged periods of immobility and previous DVT.

Tips to reduce the risks of DVT

Especially during long flights or frequent short ones, wear loose clothing, move your feet and ankles regularly, and get up and walk around every hour or so. Drink plenty of water, avoid alcohol and coffee as they can increase dehydration, and stretch your calf muscles. If you know you have poor circulation, suffer from swollen ankles or may be at risk of these conditions, wearing support stockings or flight socks may help.

While some people are advised to take a low dose of a blood thinner like aspirin, it's important to note that these drugs can have side effects of bleeding so they aren't for everyone. Talk to your doctor or pharmacist so you can weigh up your known risk of side effects against the possible benefits before you consider using the medication.

Avoid sleeping pills which may prevent you from moving sufficiently; this is especially dangerous if you are unable to lie flat, as prolonged sitting compresses blood vessels and may cause restricted blood flow.

How do I stay well and decrease the risk of infection for others? 

Infection control should begin as soon as you feel unwell. If you're coughing or sneezing, you're most likely to spread germs to others around you. This may mean going home from work or staying home if you intend to travel.

If you must travel, consider your fellow passengers by covering your mouth and nose when you cough or sneeze and disposing of dirty tissues immediately in an appropriate manner.

Another important way to reduce infectious disease transmission is to wash your hands carefully and frequently. Good hand-washing means using soap, washing fingertips, palms and backs of hands thoroughly for at least 20 seconds and drying well, preferably with paper towels. Hot water is unnecessary. Hands should be washed before preparing and eating food and after sneezing, coughing, touching the nose or mouth, wounds, rubbish or animals, as well as after using the toilet. Keep a small bottle of alcohol-based hand wash gel with you when you travel, which can be very useful if soap and water aren't available.

Other ways you can decrease your travel health risks 

• Get vaccinated. Immunisation can significantly reduce your chances of contracting many diseases. Make sure to keep your recommended vaccinations up to date, and ensure other members of your household are appropriately vaccinated - especially your children. Depending on the country you're going to visit, ask your GP or a travel doctor for advice on other vaccinations or medications, such as anti-malarials, that may be needed.
• Use antibiotics sensibly. Only take antibiotics when necessary. When they're prescribed, take them as directed, and don't stop taking them early because your symptoms have gone away. Improper use of antibiotics can lead to bacteria becoming more resistant, making future infections more difficult to cure.
• Take out travel insurance. Organise this before you travel, especially if you're going to a country where health care is expensive or possibly not of a high standard. Read the terms carefully to check what's covered, especially if you already have a health condition, and make sure that everyone in your family or travel party is insured. If you're staying away for a long time, confirm that your cover doesn't expire before you return.
• Be informed. Check the travel advisory information for the country you intend to visit for risks to health and personal safety. This information is available on the Australian Government's Smartraveller website (see the Further information section below for more details).

If I have a medical condition, what should I do before I travel? 

• See your GP before you fly for advice on any specific precautions you need to take, including vaccination and medications. Some of your medications may not be readily available in other countries. If you're unwell and you must fly, the airline may require you to obtain medical clearance.
• Carry all of your medications with you in your hand luggage, along with a letter from your doctor about your condition and treatment. Check that the medications are legal in the country you're visiting by contacting the embassy or foreign mission office in Australia. Contact details are available on the Department of Foreign Affairs and Trade website (see the Further information section below for more details).
• If you need to carry needles and syringes on the plane or in the destination country, make sure you have an appropriate letter from your doctor and check with your airlines well before you travel.
• Be aware of any risks of medical conditions or side effects of medicines that may arise through flying - speak with your doctor or pharmacist if you're unsure.
• Remember to order any special meals that may be required if you have allergies or a condition that may be affected by your diet, such as diabetes.
• If you have a disability, ask the airline in advance about wheelchairs, shuttle services, boarding and seating arrangements. Remember to check ahead for any ongoing or return flights we well. Allow extra time for flight connections and transfers. Try to book direct flights whenever possible.
• Safety regulations state that mobility-impaired passengers must not occupy seats next to exits - remember to tell your travel agent and remind check-in staff if this affects you.
• If you have a condition that requires an electrical apparatus as part of your treatment, check the voltage of the country you are visiting and find out about plugs and adaptors. Also, some equipment may be banned during the flight. Check with the airline if this affects you. Pacemakers and hearing aids are generally allowed.

Further information 

Smartraveller

www.smarttraveller.gov.au/index.html

Department of Foreign Affairs and Trade

www.dfat.gov.au/embassies.html

Sources 

Centers for Disease Control and Prevention (CDC). Handwashing. [online] Atlanta, GA: CDC. [Last reviewed May 2011 May 18, accessed 29 Jun 2011] Available from: http://www.cdc.gov/handwashing/

Civil Aviation Safety Authority. Advice for air travellers: health. [online] Canberra, ACT: Commonwealth of Australia. c2008 [Accessed 29 Jun 2011] Available from: http://www.casa.gov.au/scripts/nc.dll?WCMS:STANDARD::pc=PC_91470

Comcare. Deep vein thrombosis (DVT) and long distance air travel. [online] Canberra, ACT: Commonwealth of Australia. c2008 [Accessed 22 Jul 2011] Available from: http://www.comcare.gov.au/forms__and__publications/fact_sheets/deep_vein_thrombosis_dvt_and_long_distance_air_travel

Firkin F Nandurkar H. Flying and thromboembolism. Aust Presc. 2009; 32: 148-150. [online] Available from: http://www.australianprescriber.com/magazine/32/6/148/50/

Pain MCF Campbell DA Cade JF. Venous Thromboembolism and Air Travel: A Position Paper Of The Thoracic Society Of Australia And New Zealand. [online] Sydney, NSW: The Thoracic Society of Australia and New Zealand. c2010 [Accessed 22 Jul 2011] Available from: http://www.thoracic.org.au/documents/papers/vtairtravel.pdf

Smarttraveller. Travelling well. [online] Barton, ACT: Department of Foreign Affairs and Trade. [Accessed 29 Jun 2011] Available from: http://www.smarttraveller.gov.au/tips/travelwell.html

Last published: 30 July 2011

Disclaimer
This information has been developed and reviewed for Bupa by health professionals and to the best of their knowledge is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice. Bupa Australia Pty Ltd makes no warranties or representations regarding the completeness or accuracy of the recommendations or assessments and is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health. For more details on how we produce our health content, visit the About our health information page.