Air Travel - Health Issues
Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. Airlines may require medical clearance from the medical department / adviser if there is an indication that a passenger could be suffering from any disease or physical or mental condition that:
- May be considered a potential hazard to the safety of the aircraft.
- Adversely affects welfare and comfort of the other passengers and/or crew.
Travel by air is not normally advisable in the following cases:
- Infants less than 48 hours old (longer after premature births).
- Women after the 36th week of pregnancy (32nd week for multiple pregnancy).
- Those suffering from:
- angina or chest pain at rest
- any active infectious disease
- decompression sickness after diving
- increased intracranial pressure
- infection of the sinuses
- recent heart attack
- recent stroke
- recent surgery or injury where trapped air or gas may be present (e.g. abdominal trauma, gastrointestinal surgery, craniofacial and ocular injuries, brain surgery or eye operations)
- severe chronic respiratory disease
- breathlessness at rest
- unresolved pneumothorax
- sickle cell anaemia
- psychotic illness, except where fully controlled.
The above list is not exhaustive so any potential traveller with an underlying medical condition who is unsure, should seek advice from their GP in the first instance. Airlines' regulations may vary so if in doubt advice should also be sought from the medical department of the airline concerned. Many airline’s website have very comprehensive information with this regard. Many airline’s website have very comprehensive information with this regard.
Research has shown that there is very little risk of any infectious disease being transmitted on board an aircraft. The quality of the aircraft cabin air is carefully controlled. However, transmission of infection may occur between passengers who are seated in the same area of an aircraft, usually as a result of a cough or sneeze or by touch. This is no different from being close to someone in any other form of transport such as a bus or train.
The airline has the right to refuse travel to any passenger who is unwell and they suspect may be contagious. Anyone who has recovered from an infectious disease, but still shows signs (e.g. spots following chicken pox) would be advised to carry a letter from their GP confirming that they are no longer infectious.
In order to minimise the risk of passing infections in an aircraft, passengers who are actively unwell, especially if they have a fever, should delay travel until they have recovered.
Where an individual has travelled and is subsequently found to have a serious infectious illness with potential risks to other passengers (e.g. measles), contact tracing of passengers will be carried out by public health authorities.
The following table is a guide to communicability periods of some infections. If in doubt about an individual traveller, they should be assessed by a doctor.
|Disease||Period of Communicability|
|Chicken pox||1-2 days before onset or rash and continuing until all lesions have crusted (usually about 5 days after) - longer in the immunocompromised.|
|Influenza||Up to 3-5 days from clinical onset. Up to 7 days in young children.|
|Measles||From 1 day before prodromal period (usually 4 days before rash) to 4 days after rash.|
|Mumps||Up to 7 days before to 9 days after onset of parotitis - maximum infectiousness 2 days before to 4 days after.|
|Pertussis (whooping cough)||Highly contagious in early catarrhal stage and at beginning of paroxysmal cough stage (first 2 weeks). Thereafter decreases until negligible at 3 weeks.|
|Rubella||1 week before and at least 4 days after onset of rash; highly communicable|
|Tuberculosis||Until at least 2 weeks following effective treatment.|
The World Health Organisation (WHO) advises that, with TB increasing worldwide, there is a small but real risk of infection being transmitted during air flights. Transmission has only been recorded in flights lasting over eight hours. The risk is clearly greater when many of those on board are from countries with a high incidence of the disease. Infectious TB patients should be informed by their doctor that they must not travel by air until they have completed at least two weeks of adequate treatment. Patients with multidrug resistant TB should not travel until proven by laboratory confirmation to be non infectious. To date no case of active TB has been identified as a result of exposure on a commercial aircraft.
In Britain an estimated nine million people suffer anxiety about flying and may miss out on professional and personal opportunities. There is no single personality type, prone to fear of flying and there may be a link with problems at work or home.
Fear may develop from a bad experience - a rough flight, or after a news report of a high jacking or crash. Panic attacks are common (sudden, intense anxiety, sweating and trembling). The sensation is often so frightening that the sufferer may refuse to fly in the future. Fear of flying is often underpinned by a fear of losing control but fear of turbulence, terrorism, feeling trapped, claustropbhobia or fear of heights can all be contributing or causative factors.
Advice for the Traveller who is Afraid of Flying
- Fear of flying is common despite flying being safer than road or rail travel in most developed countries.
- Try distraction by talking with other passengers, watching inflight films, eating or reading.
- Tell the cabin crew. Reassurance about strange sounds can help.
- A visit to the doctor prior to travel can provide reassurance about general fitness for air travel.
- Mild sedation before departure is sometimes used but this should be a decision made on medical grounds. Sedative drugs do not mix well with alcohol and should not be taken at the same time.
Cognitive Behaviour Therapy
Recent research has indicated that cognitive behaviour therapy can be helpful for more severe cases. The person identifies what they actually fear and then learns different ways of overcoming it.
Courses and Counselling on Fear of Flying
- Some airlines have their own courses such as Virgin Atlantic Flying Without Fear and British Airways Flying with Confidence.
- 'Freedom to Fly' courses are run independently by Elaine Iljon Foreman, clinical psychologist, website: www.freedomtofly.biz).
World events in recent years have led to a marked increase in airport and aircraft security. Restrictions on equipment and fluids being taken into the aircraft cabin can have implications for travellers who need to carry medication for use during the flight. In addition, travellers are advised not to pack all medications and essential medical equipment into hold luggage for fear of luggage going missing or being delayed.
Customers who require the use of hypodermic needles for medical reasons, for example, e.g. those with diabetics and customers with or allergies, may be asked for proof of medical need, such as a doctor’s letter, before being allowed to take on board.
Preparation is the key, further advice may be available and should be sought from the airlines in advance. Most airlines have a medical advisory service such as British Airways Medical Service who also provide a useful booklet 'Your Patient and Air Travel' giving advice on fitness to travel and specific contraindications.
The circulating air in aircraft cabins is dry since there is very little moisture in the air taken from outside the cabin to replenish supplies when the planes are at high altitude. Skin moisturizers can help alleviate dry skin and lips and if contact lenses irritate they should be removed and spectacles used instead.
There is no evidence that the dry air results in significant internal dehydration in those otherwise fit and well. Alcohol (especially spirits) and caffeine containing drinks can cause dehydration especially when inadequate clear fluids are taken - passengers should try and drink sufficient non-alcoholic beverages to keep the urine a normal pale straw colour.
Deep Vein Thrombosis (DVT)
Prolonged periods of immobility can lead to slow blood flow in the veins which increases the risk of developing deep vein thrombosis (DVT). Blood clots most commonly form in the lower extremities; parts of the clot may break off and travel to the lung where they can cause a pulmonary embolism (PE) which is potentially life threatening.
See the Deep Vein Thrombosis advice page for detailed information.
This term is used to describe psychological or physical violence occurring within aircraft. It is of particular concern because of the cramped conditions inside an aircraft and the inevitable involvement of not only the cabin crew but also other passengers. There have been instances where aircraft have had to land prematurely to offload disruptive passengers and legal action taken against those involved.
What is Air Rage?
There is no one cause of air rage but likely a combinations of stress factors and a developing cycle of events. Contributing factors include:
- Anxiety precipitated by airport security checks and a feeling of loss of control.
- Tiredness due to lack of sleep, extended travel, delays etc.
- Excessive use of alcohol, sometimes used to compensate for fear of flying; in addition the effect of alcohol is enhanced at altitude. It is estimated that alcohol intoxication accounts for 1 in 3 air rage incidents.
- Lack of space, space restrictions and enfringement of personal space can cause discomfort and irritability.
- Nicotine withdrawal in heavy smokers (nicotine gum or patched are useful).
- Minor irritations due to behaviour of fellow passengers which elsewhere would largely go unnoticed can become disproportionate.
Changes to Circadian Rhythms
These regulate our sleep patterns and need time to adjust to changes in local time (usually about one day per time zone crossed). Westward travel may be better tolerated than eastward travel but problems occur when travelling in both directions. The effects of jet lag include - sleep disturbance, loss of appetite, nausea and sometimes vomiting, bowel changes (e.g. constipation), general malaise, tiredness and poor concentration.
- A relaxed flight is important.
- Avoid travelling when you are already tired and take rest before departure.
- Remember the actual home to destination travelling time will usually be at least twice the actual time spent in the air since it will include waiting in airports and often unexpected delays.
- Breaking very long journeys halfway with a stopover can be helpful.
- On the flight get maximum sleep or take frequent naps.
- Stretch and exercise as much as possible to aid circulation and prevent swollen ankles.
- Drink plenty of water or soft drinks and remember alcohol in spirits and wine and also caffeine increase dehydration (caffeine is present in coffee, tea, chocolate and many carbonated soft drinks).
- Jet lag is made worse by a hangover!
- Avoid heavy commitments on the first day. Be prepared for tiredness in the evenings and early waking which can last up to 5 or more days.
- Establish a new routine by eating and sleeping at the correct times at the destination.
- After arrival hypnotics (sleeping tablets) have been shown to help.
Altitude Sickness After Landing at High Altitudes
High altitude is generally considered to be from 2400 metres (8000 feet). Aircraft cabins are maintained at a pressure approximately equivalent to between 1800-2400 metres and so altitude sickness symptoms are not usual during flights.
A few airports are sited above 2400 metres, for example, in the Andes and Himalayas - healthy people can then develop symptoms after arrival (headache, nausea, breathing difficulty, mental confusion). Symptoms usually develop up to 36 hours after arrival at altitude.
Those with pre-existing respiratory or cardiac problems may be more likely to experience symptoms during or after flights. Being aware that they may be due to altitude can be helpful. Dehydration may make symptoms worse as may strenuous exertion.
Those with serious pre-existing hypoxic respiratory disease may need to seek specialist advice before planning air flights and sometimes request, in advance, supplementary oxygen supplies in flight or after arrival. An estimate of the degree of hypoxia occurring on exercise may be able to predict whether they will experience problems.
- See also Altitude and Travel.