Germs On Board: How to Stay Safe

By Jennifer Huget
Special to The Washington Post
Sunday, June 17, 2007

It's a different kind of airsickness, that queasy feeling you get when the passenger next to you is hacking, sneezing and blowing his nose. What's he got, you wonder -- and how long before you get it, too?

More upsetting yet: the thought that you might catch something bad -- really bad -- from someone who's just sitting there, looking healthy as can be. When Andrew Speaker flew halfway around the world last month carrying a particularly dangerous and intractable form of tuberculosis, he reportedly showed no discernible symptoms of his potentially lethal disease.

Short of burning your passport and vowing to stay healthy by staying at home, how can you dodge all those invisible infectious germs flying around the airline cabin (or on the train, bus or cruise ship)?

Travel-health experts agree that while the threat of contracting an infectious disease while traveling has increased as the number of people traveling has grown, the actual risk of catching such a disease from a fellow passenger remains very low.

And by taking a few simple precautions, travelers can minimize that risk even further.

Phyllis Kozarsky, a professor of medicine and infectious diseases at Emory University School of Medicine and an expert consultant at the Centers for Disease Control and Prevention in Atlanta, says: "If you're sitting near somebody with a communicable disease that's transmitted via respiratory route, there is a chance you might catch it." But that risk is no higher on an airplane, she says, than in a movie theater or a city bus.

Ziad Akl, who specializes in the prevention and treatment of infectious disease and who also runs the Washington Travel Clinic (, writes in an e-mail: "Of the airborne diseases that are potentially transmissible onboard aircraft, the most important are tuberculosis, influenza, meningococcal disease (which causes meningitis) and measles. Reports of transmission of such diseases are very rare. For instance, there have been only two reports of transmission of tuberculosis onboard a plane. One from a cabin crew member to other crew members, and another from a passenger to other passengers." In both instances, Akl notes, the disease was passed only to those who stayed very close to the sick person for a prolonged period (more than eight hours).

Kozarsky concurs that the risk of catching an infectious disease on an airplane appears to be low. "It's hard to say the extent of the problem, because there are not standardized ways of reporting these things," she says. "But given the number of passengers that fly daily, I would think it would be more obvious if more serious diseases were spread by aircraft." On the other hand, she adds, although catching tuberculosis from a fellow passenger may be "very, very rare," there's no telling how often travelers catch common colds from one another. "It may be more frequent [than in normal, non-traveling life], but there's no way to quantify that."

Neither Kozarsky nor Akl advocates wearing surgical-style face masks to protect against infectious disease while traveling. Face masks are "unnecessary, and surely impractical," Akl says. Kozarsky adds that the person with the disease, not fellow passengers, should wear a mask to avoid spreading germs.

Nor should travelers fear the very air they breathe in the aircraft cabin. "Air handling on airplanes is quite good -- better than in most office buildings," Kozarsky says. "About 50 percent of the air on a commercial jet is fresh air from outside." The rest may be recycled, but it's filtered to remove as much as 99 percent of infectious particles, she says. Akl adds that "no evidence has been found that microbial contamination of cabin air entails a greater risk of disease transmission aboard a commercial aircraft than in any other public setting."

So what should we do?

A bit of planning can help protect you from all those lurking infections, the doctors say. Their tips:

· Start out healthy. Before you even book a flight, Kozarsky advises, "keep yourself in the best health you can. Eat well, rest, consume plenty of fluids." If you're in good health before you board a plane, you'll be less susceptible to whatever germs you may encounter onboard, she says.

· Get your shots. Kozarsky notes that over the past year a number of outbreaks of "vaccine-preventable" diseases such as measles and mumps and mosquito-borne diseases such as malaria have occurred in various parts of the globe. The CDC advises travelers to visit a travel clinic or their own physician four to six weeks before departure to get vaccinated or otherwise armed (with anti-malarial medication, for instance) against any diseases prevalent in the destination locale. These might include vaccination against whatever strain of influenza is circulating in that part of the world, Kozarsky says. For a list of clinics, go to the CDC's travel-health Web site,

· Be careful what you put in your mouth. Akl points out that the greatest health risk on most journeys is traveler's diarrhea, caused by a variety of bacteria and parasites transmitted via contaminated food and water. "Depending on the country of destination," Akl says, "up to 50 percent or more of visitors may contract traveler's diarrhea." The CDC site listed above includes strategies for avoiding this particular plague, including drinking only bottled water, avoiding ice cubes and shunning fresh fruit except pieces whose peels you remove just before eating. (Think bananas.)

· Wash your hands. Both Kozarsky and the CDC recommend frequent and thorough hand-washing, either with soap and water or with liquid sanitizer containing at least 60 percent alcohol to kill infectious bacteria. Many disease-causing bacteria and viruses are transmitted from an infected person's hand to a common surface (such as a handrail), where they're inadvertently picked up by a well person's hand. Stick that infected hand in your nose or mouth or use it to hold your food, and you may be sick soon.

· Pack a travel health kit. A few items, including hand sanitizer, antibiotic cream and insect repellent, can help keep you healthy when you're away from your medicine chest. The CDC travel-health site offers tips on what to pack. Kozarsky suggests going to the pharmacy before leaving town to stock up on your prescription medications and any over-the-counter medicines (those for headaches and diarrhea, for instance) you rely on that might be hard to find abroad.

· Consider purchasing trip cancellation insurance. If you do get sick, at least you won't be out all that money you spent on your trip. Compare policies at companies such as, and read the fine print carefully.

© 2007 The Washington Post Company