Air travel isn't sure to make you sick, but you can take some precautions

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By Carolyn Butler
Monday, January 3, 2011; 11:11 PM

On the first leg of this season's holiday travel tour, I had the delightful experience of watching my 20-month-old touch nearly every surface on our airplane, from myriad armrests and people we passed in the aisle to our fingerprint-stained window.

As a somewhat compulsive germaphobe, it took everything I had not to douse my son in hand sanitizer and then physically restrain him. But I was flying alone with two children and he was happy eating those Cheerios off the floor, and so, for the sake of my fellow passengers, I let him handle pretty much anything he wanted. Hence, I wasn't surprised when his nose started running shortly after we arrived at our destination, followed by the inevitable hacking cough, which his older brother also picked up. Our "vacation" ended at a CVS Minute Clinic, with ear infections for both kids.

Coming down with a cold, cough or other ailment after air travel is a common refrain, even from adults who don't try to lick the seatback tray table. But is the plane really to blame?

Not particularly, says aviation medicine specialist Mark Gendreau, vice chair of emergency medicine at the Lahey Clinic in Burlington, Mass. "You do have a higher risk of contracting [a viral infection] while traveling, but you have to remember that it's really the door-to-door experience that's exposing you to germs: the crowds on the subway to the airport, the escalator, the security line, getting on and off the aircraft," he explains. "It's almost impossible to say where, exactly, you get sick."

In fact, experts point out that the environment of a plane is probably less risky, health-wise, than many other crowded, confined spaces. Given airliners' improved ventilation systems, germs aren't being constantly circulated through the plane, stresses Cendreau. Instead, he says, you are most likely to pick up a bug from close contact with a sick person or by touching a surface that's been coughed or sneezed on or otherwise contaminated, such as an armrest or an overhead bin latch.

Studies have shown that the highest risk of germ transmission on a plane, by far, comes from those around you, particularly those seated within two rows, says internist Michael Zimring, director of the Center for Healthy Travel at the Mercy Medical Center in Baltimore. "The closer the proximity and the longer the time you're confined with someone in a closed compartment - and usually it's at least a couple of hours - the better the chance of catching a cold," he says.

Research published last May in the journal BMJ studied a packed, long-haul 747 flight from Los Angeles to New Zealand that had at least nine passengers who were later confirmed to have swine flu. Researchers found that the three additional travelers who appeared to have contracted the virus on the flight were all sitting within two rows of an infected person; that put the chance of transmission at 3.5 percent within two rows and roughly 1.9 percent for anyone in the same section of the plane.

"There's no doubt that planes are pretty germy," says Charles Gerba, a professor of microbiology at the University of Arizona who studies how diseases are transmitted in indoor environments and who has found fecal bacteria, norovirus and other pathogens on those dreaded tray tables. "There is no requirement or regulation for the cleaning and disinfection of airplanes - it's up to individual airlines - and it just doesn't get done regularly," he said.

The dirtiest spot on board? By far, the restrooms, according to Gerba, who says that in the course of his research, he has identified E. coli bacteria on almost every toilet surface, with the worst offenders being sink handles and faucets, soap dispensers and doorknobs.

Of course, just because such germs are there doesn't mean they're a problem. "There is definitely an ick factor, but it's one thing to say there's a virus or bacteria on a surface, and another thing for that to make you sick," says Katherine Andrus, assistant general counsel for the Air Transport Association, a trade group representing major U.S. airlines. "Most of us, if we're relatively healthy and have good immune systems, don't have to worry that much about all of the surfaces in the world that may be contaminated." She adds that frequent, proper hand washing goes a long way toward preventing illness in any crowded environment.

There are several other steps you can take. Zimring, author of "Healthy Travel: Don't Travel Without It," says it's important get enough sleep, eat healthfully, exercise and get a flu shot to build up immunity before traveling. Gendreau suggests the following to stay healthy while flying:

Drink up. Proper hydration is critical to optimal immune function. Given that the relative humidity in a passenger cabin can be as low as 10 percent on long flights, it's essential to drink as much water while in the air as possible; avoiding alcohol will help, too. Staying well hydrated can also help prevent mild altitude sickness, with symptoms such as headache, lightheadedness and nausea, which people often mistake for a post-flight cold or flu.

Pack a hand sanitizer. Soap and water do a great job, but the restroom's sink handle, soap dispenser and doorknobs may be contaminated with germs. So use alcohol-based sanitizer after leaving the restroom and throughout the rest of your flight. And think twice before you rub, scratch or otherwise pat your face (or a child's) during a flight; those simple acts can provide ample opportunity for the transmission of bacteria and viruses.

Be wary about that tray. Air carriers with flight turnover times of less than an hour do not routinely disinfect the trays or other surfaces such as the armrests and windows. So wipe them down with an alcohol-based sanitizer when you first take your seat.

Keep the air turned on at your seat. When people cough, sneeze or speak, they eject up to 30,000 droplets, which can travel several feet. To minimize the chance of infected droplets landing on you, turn your air vent to medium flow and position it so that the air current is directed just slightly in front of your face. That will help direct germs away from your eyes, nose and mouth.

As for me, I think I will run with my germaphobic tendencies from now on, forbidding floor snacks, slathering sanitizer on both my children and wiping down our immediate surroundings as soon as we board. The travel might not be happier - for me or for my fellow passengers - but if it's even slightly more healthful, I think it's worth it.


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