Tips for staying flu-free during holiday travel

Nov 25, 2009 11:23 AM

You may have heard that the swine (H1N1) flu outbreak has potentially peaked in the U.S. It’s possible—the CDC noted recently that flu-like activity has declined in every region of the country, though some areas are still seeing increases. But even at a declining rate, this year’s flu activity already outpaces a typical flu year, which generally doesn’t get going until December. “Even when a peak has occurred,” says Anne Schuchat, M.D., director of the National Center for Immunization and Respiratory Diseases, “half of the people who are going to become ill haven't gotten ill yet.” And there’s always the possibility of a second wave during a flu pandemic.

Officials also warn that holiday travel could lead to a bump in flu activity. So don’t let your guard down just yet. If you’re traveling during this Thanksgiving holiday, make sure you take some precautions. “The first step is to travel well," said Schuchat. “That means travel only when you are well.” Other precautionary measures that the CDC recommends, which should be familiar to readers of this blog, are:

Washing hands frequently with soap and water or an alcohol-based hand sanitizer containing at least 60 percent alcohol
Covering your coughs and sneezes with tissues or your sleeve
And vaccination, especially if you’re in a priority group

The risk from flight
If you are flying this holiday season, crowded planes aren’t just a nuisance; they can actually increase your chances of infection. A review of studies published in 2005 in the British medical journal The Lancet called commercial airlines “a suitable environment for the spread of pathogens carried by passengers or crew.” However, they also concluded that the “perceived risk is greater than the actual risk.”

According to the researchers, the data suggest that risk of transmission from one contagious person to other healthy passengers within an aircraft cabin is generally associated with sitting within two rows from the sick person during a flight lasting more than eight hours. But there is variation. One study of SARS transmission on an aircraft found that one person was affected who was seated seven rows from the contagious passenger.

Ventilation is the key. That’s supported by a study that found influenza transmission was widespread throughout a cabin when passengers were grounded on the runway in an aircraft with an inoperable ventilation system. The good news is that, contrary to many reports, there is very little airflow from the front to the back of a plane. If the ventilation system is working properly, the airflow is divided into sections limiting the spread of airborne pathogens.

And the conventional wisdom that all of the air in an airplane is recycled is false. Typically, about half of the air is fresh, brought in by the engines when the plane is in flight, or auxiliary power units when it is grounded. And the air that is recirculated passes through high efficiency particulate (HEPA) air filters, which should catch most virus-containing particles.

Nonetheless, the tight confine of a plane is an ideal setting to pick up a bug, and more study is needed to fully understand the risk. But there are some extra precautions you can take this flu season:

Carry antibacterial wipes. Use the wipes to clean the plastic armrests and tray-table where viruses can cling.
Consider carrying a facemask. You can wear it to protect others if you feel a fever or begin coughing or sneezing. Or you could politely offer it to another passenger who appears to be ill. If you have underlying conditions that put you at greater risk of complications of flu, you may consider wearing one if somebody very close to you has flu symptoms. And if you don't have a mask, you can ask your flight attendant if they can supply one.
Pack a medical travel kit. Be sure to bring a full supply of your prescription medicines when you travel. For flu, also include some medications for fever and pain, such as acetaminophen or NSAIDs (ibuprofen, naproxen). If you’re at high risk of complications for flu, you may consider talking to your doctor to see if an advance prescription for anti-viral drugs is warranted, should you experience flu symptoms during travel. Pack your medications in their original bottles in your carry-on bag.
Consider travel insurance in case you do become ill and need to cancel your plans. Some airlines are also reportedly relaxing their ticket cancellation or change fees for people who can't travel due to H1N1 flu. Call your airline and ask about its policy.

Finally, do cancel your travel plans if you get sick. The rigors of travel won’t do much to get you felling well, and you could be putting others at risk. It’s not easy skipping Thanksgiving dinner, but instead of bringing a virus to the party just have someone bring you some leftovers. Isn’t that turkey sandwich on Friday the best part anyway?

For more travel health tips, see 6 Ways to Stay Healthy and Safe.

—Kevin McCarthy, associate editor

Keep up with all our swine flu coverage and recommendations.