Summary
According to the U.S. Department of Commerce’s National Travel and Tourism Office, in 2017, nearly 88 million U.S. citizens traveled outside the United States, a 9.3% increase over 2016 figures. Any mode of travel necessitates being in close proximity to numerous people and physical contact with many surfaces. Long-distance travel involving crossing multiple time zones disrupts normal routines, including sleep patterns, that has the potential to cause elevated stress and increase susceptibility to infections. Further, many people may also neglect self-care, making them more vulnerable to illness due to elevated stress, lack of sleep, dehydration, poor diet, and sedentary life choices. When considered together, the possibility of U.S. citizens traveling internationally falling ill is high.
The following mitigation measures -- before, during, and after travel -- may help avoid getting sick, or reduce the impact, while on lengthy trips. The Appendix provides an informal checklist.
Be Proactive
Learn about the health risks by perusing the U.S. Centers for Disease Control & Prevention (CDC)’s Traveler’s Health Destination pages, including noting which prophylactic vaccines are recommended or required for the country or countries you will be visiting. CDC offers Travel Health Notices to inform travelers about current, elevated health issues related to specific destinations. The three Notice Levels describe the levels of risk for a traveler and recommended preventive measures to take at each level of risk:
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Notice Level
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Traveler Action
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Risk to Traveler
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Level 1: Watch
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Reminder to follow usual precautions for this destination
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Usual baseline risk or slightly above baseline risk for destination and limited impact to the traveler
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Level 2: Alert
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Follow enhanced precautions for this destination
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Increased risk in defined setting or associated with specific risk factors; certain high-risk populations may wish to delay travel to these destinations
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Level 3: Warning
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Avoid all non-essential travel to this destination
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High risk to travelers
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When relevant, a Travel Advisory, issued by the U.S. Department of State, will include a health category should health risks be present, including outbreaks or other crises that might impact the country’s medical infrastructure.
Ensure your insurance covers you outside of the U.S. For more information, visit the State Department’s medical insurance overseas page. Companies offering medical evacuation (“medevac”) charge thousands of dollars for services, which can be very cost prohibitive for private travelers without medevac insurance. Many OSAC constituent organizations provide coverage for their traveling staff; knowing the policy’s terms prior to travel is important, especially for travel to developing countries, since not all policies cover all locations or instances.
It is also wise to understand the climate, as some destinations are prone to recurring inclement weather conditions or natural disasters that may impact health. These can include monsoon season, flooding, drought, earthquakes, or poor air quality.
Consult a primary care physician or get a referral to a travel doctor in advance in order to schedule necessary shots and specific medications. For example, due to vaccine shortages and high demand, travelers may need to contact a yellow fever vaccine provider well in advance of travel.
In the days leading up to the flight, get a little more exercise than usual in anticipation of sitting for a prolonged period. Additionally, try to get as much rest/sleep as possible, and avoid taking on new responsibilities that might cause added stress or anxieties.
Be Prepared
Notably, although illness may occur as a direct result of air travel, it is uncommon. The cabin air environment is not conducive to the spread of most infectious diseases. One of the main concerns is being in close proximity to other passengers with certain communicable diseases. Direct contact occurs through skin-to-skin contact, which is likely to happen in close-proximity spaces like airplane cabins. Droplet spread refers to spray with relatively large, short-range aerosols produced by sneezing, coughing, or even talking; passengers are likely to be in close proximity of people who may be sick throughout a trip. Indirect transmission refers to the transfer of an infectious agent by suspended air particles, inanimate objects (such as food/water, tray tables, seat cushions, waiting areas, handrails), or animate intermediaries (such as mosquitoes). Practicing good handwashing and respiratory hygiene decreases the risk of disease spread by direct or indirect contact.
Once settled, set your watch or phone for the destination time. This way, you can begin to acclimate by sleeping during the destination’s night and being awake – and eating -- during its day. Using a neck pillow for sleep will also help prevent neck pain. Wear layers of clothing, as cabins can be cold, while not all facilities are air conditioned and may be hot. Further, pack healthy fiber-rich snacks, and drink bottled water to stay hydrated throughout the flight. Avoid alcohol and caffeine, as they will disrupt sleep and cause dehydration. Newer aircraft have a cabin air pressure equivalent to an altitude of 2,000 feet, but some are still pressurized at 6,000-8,000 feet, which is similar to high-altitude travel. For more information, please refer to OSAC’s Report “Traveling in High Altitude.” Cabins are also typically drier – often 10-20% humidity – than typically living conditions; this can cause dryness of the mucous membranes of the eyes and airways.
Exercise and stretch as frequently as possible while flying. This includes walking in the aisle; twisting your torso; rolling shoulders and head; straightening your arms and legs; calf muscle exercising; tapping feet; and flexing muscles. Prolonged periods of immobility increase the risk for deep vein thrombosis, which can result in a life-threatening pulmonary embolism.
Consider traveling with health kits. For a flight, this might include eye mask and ear plugs (or noise-cancelling headphones); hand sanitizer and lotion; nasal spray; deodorant and wipes; toothbrush and toothpaste. For general use, this might resemble a first aid kit, including motion-sickness and anti-motility agents. CDC’s Traveler’s Health has interactive packing lists in its TravWell mobile app. This app provides destination-specific vaccine recommendations, a checklist of what you need to do to prepare for travel, and a customizable healthy travel packing list. The app can store travel documents, keep records of medications and immunizations, and set reminders to get vaccine booster doses or take medicines. CDC’s Traveler’s Health also provides “Healthy Travel Packing List” recommendations for each destination page.
Be Protected
Once you have landed, do not become complacent about your health and well-being. For example, be cautious about drinking tap water and eating raw foods. For more information, please refer to OSAC’s Report, “I’m Drinking What in My Water?.” The CDC’s Can I Eat This? app can help prevent food- and water-borne illnesses while abroad. Based on the destination and a few easy questions and graphics, the app will advise whether a food or beverage is likely safe. It includes a short rationale to explain why consumables likely are or are not safe to eat. Be cognizant of alcohol consumption and cultural practices. For more information, please review OSAC’s Report “Shaken: The Don’ts of Alcohol Abroad.” Use sunscreen, protective clothing, and insect repellant as necessary.
Try to acclimate to the time zone and meal cycle as quickly as possible to minimize jet lag. Delay important meetings or decisions until after you have acclimated. Spend time outside during the day. Even if you are not tired, try to rest when locals do, and if possible avoid taking sleeping pills since they do not contribute to REM sleep. In fact, some countries’ over-the-counter medication laws differ from those in the U.S., and sleeping aids could be illegal. For more information, please refer to OSAC’s Report, “Traveling with Medications.” A lack of restorative sleep can impact mood, ability to concentrate, and physical/mental performance. Similarly, try to eat during the local mealtimes, even if you are not hungry.
Monitor your health for weeks to months after returning from a trip and be forthcoming about your international travel history with a health care provider should you develop symptoms including fever, persistent diarrhea, or skin problems. Most after-travel illnesses are mild and not a concern; however, some symptoms may warrant a trip to the doctor. Some diseases, including malaria, can lay dormant for up to a year.
For More Information
For information on global health, please contact OSAC’s Health Team.
OSAC Sources
CDC Sources
Other Sources
See Appendix Check List in attached PDF.
