Planes, Trains, and ...Germs?
Travel Health Risks You Can -- and Can't - Avoid
By Daniel J. DeNoon
WebMD Feature
Reviewed by Brunilda
Nazario, MD
Wherever you go, however you get there, you always have traveling companions
-- germs.
Will these fellow travelers make you sick? That depends partly on luck,
experts say. But you can do a lot to protect yourself.
The modes of transportation most often blamed for spreading disease are
airplanes, cruise ships, and subway trains. Are they just scapegoats? Or are
these popular conveyances really making us ill? WebMD asked experts who've
studied transportation health.
Up in the Air, Germs Are There
The Ides of March, 2003, was unlucky indeed for the 120 travelers who that
day boarded Air China flight 112. The Boeing 737-300 completed its three-hour
flight from Hong Kong to Beijing without apparent incident. But coughing in seat
14E -- a middle seat near the center of the plane -- was a person carrying the
deadly SARS virus.
Within eight days, 20 passengers and two flight attendants would come down
with SARS. Some of those who became infected were sitting as far as seven rows
away from the man carrying the SARS virus. Five would die.
It's not just SARS - and it's not just China. In 1979 a commercial airliner
sat on the tarmac for three hours with its ventilation system shut down. Someone
on board had the flu -- and, within three days, so did nearly three-fourths of
the plane's passengers.
SARS and influenza, of course, are only two of the multitude of bugs lurking
out there. But the case of Flight 112 suggests that the current understanding of
the spread of airborne disease aboard aircraft, which is based on tuberculosis
investigations, may be outdated. Emergency medicine specialist Mark A. Gendreau,
MD, senior staff physician at Lahey Clinic Medical Center, Burlington, Mass.,
recently reviewed what is and isn't known about infectious disease spread during
air travel.
"The CDC and World Health Organization say you risk getting an infection only
if you are sitting within two rows of someone who has something - and only if
you are sitting there for more than eight hours," Gendreau tells WebMD. "But
Flight 112 was only three hours long, and people sitting as far as seven rows
back were affected. So that says, 'Wait a minute folks.' That old advice may
have worked for tuberculosis, but what about SARS and other infectious diseases?
More study into that is needed."
There's a lot we don't know, agrees Roy L. DeHart, MD, MPH, senior consultant
in occupational and aviation medicine at Vanderbilt University, Nashville, Tenn.
And if anyone understands the various health risks of flying, it's DeHart. He
capped his 23-year Air Force career as commander of the USAF School of Aerospace
Medicine. Former director of occupational and environmental Medicine at the
University of Oklahoma, he's an FAA-certified senior aviation medical examiner.
"We don't know what that passenger next to you is contributing to the air
stream as he is inhaling and exhaling," DeHart tells WebMD. "With flights coming
out of developing countries where prevention programs are not as strong as they
might be, it is not unusual that a person may have a problem like tuberculosis.
It spreads. Usually just to two or three people, but if a patient is found on
board, health authorities have a tough job trying to track those people down. It
can be a horrendous problem. There can be hundreds of patients spreading
whatever, wherever. Major spread is possible. So, yes, there can be problems."
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