Whether you’re backpacking through France hoping for a glimpse of Lance Armstrong or beaching it at a time-share in Mexico, far-off travel can be challenging to your health.  Fears of new diseases like HINI flu to old standbys such as traveler’s diarrhea concern us more because we simply are more globally mobile.

Below, you’ll find some carry-on knowledge to help you ward off travel- borne illness. (This applies to  the journey as well as the destination!)

Air travel

1. Germs at 50,000 feet
Micro-organisms live on airplane armrests, seat belts and in-flight magazines just as easily as they live at sea level. So, good hand hygiene on the plane is key to staying healthy. Protecting ourselves from in-flight airborne germs is a little more complicated. Short of holding our breaths or wearing masks, what do we do when fellow passengers hack and sneeze?

Travel medicine expert Charles D. Ericsson, MD, says we need only to worry about the people who are sitting within three feet of us because modern jets are equipped with high-efficiency particulate air (HEPA) filters that block almost all harmful bacteria.

“The only person who can pose a threat to you (regarding airborne germ transmission) is somebody sitting right nearby, coughing and sneezing on you,” says Ericsson, professor of internal medicine and head of Clinical Infectious Diseases at The University of Texas Medical School at Houston. “It’s not as if the air on a plane is going to waft something from the first class cabin back to the economy class and get everybody sick. That just doesn’t happen.

“The airflow is around the cigar-shaped body of the plane with a bit of flow from the pilot’s cabin backwards,” Ericsson continues. “There is a slight movement backwards on the plane but not enough to make much difference because in the meantime, it’s being re-circulated in the cabin. The air may get somewhat stale, but it’s supplemented by oxygen and a little bit from outside air. As far as germs go, it’s HEPA-filtered, so very little can get through to be infectious.”

2. Foreign flight food
Ericsson says in-flight meals might be a concern to travelers, and we should be cautious of what we eat and drink on lesser-known airlines in developing countries.

“Personally, I treat those like eating in restaurants in developing countries,” he says. “I prefer not to eat raw things that could have been contaminated. If the food is well cooked and served piping hot, then generally the germs have been killed, and it should be safe to consume. Drink bottled water or carbonated beverages.”

3. Alcohol and sleep aids
If you are among the lucky few who a) are flying first class b) can sleep in the middle seat between a talker and a snorer or c) have the exact spine curvature designed for airplane seats, you can skip this section.

Long-haul travelers often ask their health providers for sleep aids for overseas flights. Though sleep aids (soporifics) such as prescription Ambien or non-prescription Tylenol P.M. have reasonable safety records, Ericsson is reluctant to advise their use. “As a general rule, I discourage them on planes unless the flight is very long, because you should allow at least seven hours sleep to clear the medication before you land.”

Travelers often turn to alcoholic beverages to lull them to sleep, another discouraged endeavor. Though Ericsson does not consider moderate social drinking on board (1-2 drinks) to be a problem, he doesn’t recommend it as a sleep inducer. Alcohol interferes with the REM (rapid eye movement) cycle—that special segment of dreamy, restful sleep. “Avoid drinking if you’re looking for meaningful sleep.”

Alcohol also is a diuretic, so it can have a dehydrating effect. Planes are dehydrating enough, so if you order a cocktail, order water on the side.

For safety’s sake, mixing the two is not advised. At best, you’ll misplace your passport; at worst, you may suffer a drug interaction.

4. Deep vein thrombosis: DVT
With hours of sitting, twisted up like a Rubik’s Cube, some travelers on long-duration flights are at risk for developing deep vein thrombosis (DVT). Often called “economy class syndrome” the label is misleading. DVTs can develop in cars, buses—just about anywhere your legs are immobile and bent for hours.

DVT is a blood clot that forms in a deep vein, usually in the lower leg or calf. If we are idle or unable to lie flat for long periods of time, blood can pool to our lower extremities and stagnate there, Ericsson explains. Serious complications from these clots occur when the clot or a piece of it dislodges and begins to travel up the vein to the lungs.

“Safety permitting, we encourage people to get up and walk around the cabin every couple of hours and move that circulation in your calves,” he says. “Drink plenty of fluids because if you get dehydrated, your blood tends to thicken and clot a bit easier,” Ericsson says.

 If you have a previous history of clots, your doctor may prescribe an anticoagulant (such as low-dose heparin) to take before flight to thwart clot development, Ericsson adds. Though aspirin has been used to ward off arterial clots (those that form in arteries), it has not proven effective (or necessarily safe) against clots that form in veins (venous).

Most importantly, Ericsson recommends that people wear travel stockings on long flights, which are not your average pair of hosiery. “They are considerably tighter and are engineered with a graduating pressure that goes up,” he says, adding that the socks only need to come to the level of your knees and are readily available at your local pharmacy.

Land, ahoy!

Taming germs, casting wary eyes on food and drink translate to terra firma, as well. But once you set foot on land, a whole new set of challenges appear.

5. Jet lag blues
Jet lag is a temporary disturbance of our sleep-wake cycle when we’ve crossed multiple time zones. Symptoms can include insomnia, fatigue, headache and irritability. To help our bodies adjust to jet lag, we need to readjust our internal clocks. The natural way is with sunlight.

“Whenever you get sunlight exposure, just naturally coming into your eyes, it sends a signal to the brain to suppress melatonin production,” Ericsson explains.

Melatonin is a natural hormone that regulates the body’s circadian rhythm or sleep-wake cycle. It rises at night to make us sleepy and ceases during the day when we are awake.

“If you’re traveling 12 time zones away so that where you are at 6 a.m. your body thinks it’s 6 p.m., that’s about the time your body would start making melatonin,” Ericsson says. “So, when you wake up, try to get outdoors. Take a walk. Get sunlight impinging on your eyes to suppress the ‘wrong time’ melatonin production to help your clock readjust.”

Some long-distance travelers also find it useful to take a sleep aid to help curb the symptoms of jet lag. Ericsson does not recommend taking a supplemental form of melatonin because the Food and Drug Administration does not regulate dietary supplements.

6. Mile-high nausea
Sun and altitudes almost always play roles in where we choose to vacation. If hiking and mountain climbing are on your travel itinerary, be wary of acute mountain sickness. The illness occurs from rapidly reaching high altitudes, typically above 8,000 feet. Symptoms range from feeling breathless, dizzy or light-headed to having headaches or nausea and vomiting.

“If you’re flying into Cusco to see Machu Picchu, you’re suddenly at over 11,000 feet,” Ericsson says. “Almost everyone gets a headache and has a little trouble with sudden high-altitude changes if they don’t take a drug called Diamox, a diuretic (water pill) that helps you adapt to high altitude.”

7. Mile-high sunburn
Higher altitudes also bring us closer to the sun’s intense ultraviolet rays. Ultraviolet B (UVB) rays cause sunburn, while ultraviolet A (UVA) rays are what age and tan our skin. Both UVB and UVA contribute to skin cancer.

Sunscreens are rated with an “SPF” or “Sun Protective Factor” to tell us how well the product protects against the sun’s burning or UVB rays, but Ericsson advises choosing a sunscreen that protects against both UVB and UVA light.

“When you get to higher levels of protection against B, you generally pick up A protection,” he says. “The best thing is to pick a sunscreen that also has UVA protection.” Ericsson says that protection from both UVA and UVB rays typically are found in the higher SPF numbers—over 30.

Also, we should wear sunscreen like we wear our swimsuits – by putting it on before we hit the beach or take a dip in the pool. “Apply it about a half hour before you anticipate sun exposure for it to react chemically with your skin to protect you,” Ericsson says, “and put enough on. An average-sized woman in a bikini, for instance, needs an entire ounce of sunscreen to cover her body adequately to protect herself.”

Travel-borne illnesses

8. Treat yourself to DEET
As director of one of two UT Houston travel medicine clinics, and clinical chief of infectious diseases at Memorial Hermann Hospital - Texas Medical Center,  one of Ericsson’s missions is to educate travelers about common diseases or possible disease outbreaks related to their itinerary and advise them on necessary vaccines or preventative prescription drugs. Take malaria for instance.

“We teach our travelers all about medicine, but the nature of the beast is that the medicine simply cannot protect you 100 percent against malaria,” Ericsson says. “You prevent malaria by not being bitten by a mosquito, and that translates to using a proper insect repellent.”

Ericsson stresses that the insect repellent must contain the active ingredient DEET, but that the concentration of DEET need only be in the 20-30 percent range to be effective.

“That’s enough to last for five to six hours at a time if you’re out and about in a developing country with a mosquito concern,” he says. “Higher concentrations of DEET don’t work better to prevent mosquito bites; they just last longer.”  They also carry risks: either of irritating your skin or, at really high concentrations of acting like a solvent. “Some synthetic fibers can literally dissolve, and that can get a little disturbing!”

DEET prevents any mosquito from biting, and Ericsson again advocates using a DEET-containing insect repellent to reduce the risk of the tropical Dengue fever, also known as break bone fever. “There is no vaccine or no treatment for Dengue. The only approach is prevention.”

With yellow fever alerts in Paraguay and Brazil, it’s good to know there is a vaccine for it. It’s the only vaccine, Ericsson says, that is required in many countries. Still, he advises, prevention via a DEET-containing mosquito repellent is best.

9. Travelers’ diarrhea
One of the most common ailments experienced by millions of international travelers every year is travelers’ diarrhea. The risk is highest in developing countries in Latin America, Africa, the Middle East and Asia.

“We typically arm people to self medicate when they are distressed by the illness,” Ericsson says. “Imodium affords temporary relief, and they can take an antibiotic along with the Imodium to cure the illness.”

Another option that’s available and approved for treatment of travelers’ diarrhea is an antibiotic called rifaximin. For prevention, the dosage is one pill a day.  It has a high safety record because this antibiotic stays in the digestive tract instead of being absorbed into the blood system. Very few side effects have been reported, Ericsson says. “But don’t be complacent about safe choices of food and beverages -- the drug is only about 70 percent protective.”

10. Vaccines
The mix and match of appropriate (and useless) vaccines is best left in the hands of a travel medicine specialist. If you pull up the Centers for Disease Control and Prevention (CDC) website, you’ll find a dizzying array of colorful maps that indicate where certain diseases are most prevalent.

Some vaccines cannot be taken in combination with others. Others must be administered several weeks before your travel date. Some are not required for the first leg of your journey, but are required for travel within that region. Only a travel medicine specialist is up to date on the ever-shifting disease state of specific regions.

We’ve covered a lot of ground. Be thoughtful in your travel preparations abroad so that you can check your anxieties at the gate.

 

Last Updated: 7-15-2009

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