Introduction
As airlines fly to more exotic destinations and aircrews have shorter layovers, it’s important for these frequent travelers to be prepared for the health risks they may face. While aircrews are similar to other travelers in some ways, there are some differences that require special attention. For example, aircrews may be more adventurous and take on more risks than typical tourists. They also tend to travel frequently and may go to new destinations on short notice. Despite their short trips, aircrews may not realize the potential health risks due to their healthy status and short in-country exposure time. That’s why I want to share some guidelines for this special group. While airlines try to educate their crews about health risks, they may not have occupational health providers or travel medicine experts on staff. So, airlines should consider seeking out knowledgeable professionals to help make recommendations for their traveling employees. The following article is a summary of the keypoints of CDC’s health recommendations for aircrews derived from the CDC Yellow Book 2020: Health Information for International Travel. The links to the source material can be found at the bottom of this page.
Medication
Pilots are pretty clued up on the types of meds that can affect their ability to fly, but it’s important that their providers don’t prescribe any medications that affect the central nervous system when they’re on the job. It’s also worth noting that pilots who take sedating antihistamines like Benadryl or chlorpheniramine should wait until at least 5 half-lives have passed since their last dose before flying. That’s around 2 days for diphenhydramine and 9 days for chlorpheniramine. If pilots need to take new medications or anything that could interfere with their abilities or judgement, they should test it out in between trips, not during them.
To ensure pilots are fit to fly, the Federal Aviation Authority (FAA)-certified aeromedical examiners (AMEs) examine them regularly. However, for some common medications, AMEs may not certify pilots taking them without clearance from the FAA. To avoid any confusion, the FAA has provided a list of these medications on their website, and if any questions arise, pilots should consult with an AME.
Plan Accordingly
When it comes to advising flight crews on their travel health, it’s not just a matter of following the standard recommendations. It’s important to understand what the airline itself requires. While any travel health provider can offer advice to flight crews, they should make sure to ask each crew member about their company’s specific requirements. If there’s any uncertainty, the provider should reach out to the airline’s medical director or occupational health department for guidance.
For example, some aircrews only fly domestic or Western European routes, and may not encounter regions with a risk of yellow fever in their normal work. However, their airline may still require them to be vaccinated against yellow fever in case of urgent needs or unforeseen circumstances that require a shift in crew. So, it’s important to be aware of these requirements and plan accordingly.
General Health Measures
If you’re a pilot or flight attendant traveling to international destinations, it’s important to take extra steps to stay healthy. Even if you have regular check-ups to make sure you’re fit to fly, these visits may not cover health issues you may encounter abroad, especially in developing countries. To stay on top of your health, consider talking to your healthcare provider about the following recommendations:
Get a periodic tuberculin skin test if you’re frequently traveling to areas where tuberculosis is more common than in the United States, where there’s a higher incidence of antimicrobial resistance, or where you’ll be in close contact with crowds.
Make sure your routine immunizations are up-to-date, and get vaccinated against seasonal flu each year.
Bring extra quantities of your chronic medication in case they’re not available or are counterfeit at your destination. Counterfeit drugs are a growing problem in many developing countries, and they can contain little or no active ingredient or even toxic contaminants.
Remember, staying healthy while traveling is important not just for your own well-being, but also for the safety of your passengers and crew. If you have any questions or concerns, don’t hesitate to reach out to your healthcare provider or airline medical director for guidance.
Vaccinations
Vaccinations are an essential aspect of international travel, particularly for aircrews, who are frequently exposed to various diseases that may not be common in the United States. For instance, measles can be a life-threatening disease for adults, and it is more common in most parts of the world, including Europe. As a result, aircrews need to be cautious and ensure they are adequately vaccinated before traveling.
International flight crews should consider scheduling a travel health visit to ensure they have complete protection against any potential health risks. However, some may have short notice before traveling to new destinations. Therefore, it is crucial to ask aircrew members about upcoming trips during their visit so that vaccinations may be given for the upcoming trips, or a vaccination series can be started early.
It is important to educate travelers about the health risks associated with various destinations since vaccination administration for certain diseases will depend on the traveler’s tolerance for risk. At the very least, aircrew members should be up-to-date with routine vaccinations, including measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella, polio, and seasonal influenza vaccines.
There are no established guidelines or recommendations for the use of travel vaccinations in pilots and other aircrew members. However, it may be reasonable to offer meningococcal, Japanese encephalitis, yellow fever, and typhoid vaccines because of the frequent, short-stay, and unpredictable assignments. Additionally, because some pilots do relief work or fly to areas of natural disasters, cholera vaccine may also be considered for them. Hepatitis A is advisable for all travelers and may be stressed for aircrews, given that most adults in the United States have not been immunized. Hepatitis B is advisable for frequent travelers due to the unpredictability of exposure.
Vaccinations are critical for aircrews, given their frequent exposure to various diseases in different parts of the world. Therefore, aircrews should consider travel health visits to ensure complete protection against potential health risks. Educating travelers about health risks in different destinations and administering vaccinations based on the traveler’s tolerance for risk is essential. Lastly, it is vital to ensure aircrew members are up-to-date with routine vaccinations and that they consider taking additional vaccines based on their travel itinerary.
Malaria
Malaria can be a serious risk to aircrews who frequently travel to destinations where the disease is endemic. Airlines typically inform crewmembers about which destinations may harbor malaria, but it’s important for aircrews to educate themselves about the risks as well. Some European and Asian airlines have more experience flying to these destinations and have developed policies for preventing malaria, but not all American carriers have the same level of awareness.
In some areas, such as capitals or larger urban areas of China or the Philippines, there may be little risk of malaria transmission. However, in sub-Saharan Africa, even a short 24-hour layover can expose aircrews to substantial risk. Even during layovers in hotels, the risk of malaria transmission can be increased at international airports and during outings. While there is little published data on the risk of malaria for flight crews, some information suggests that the risk is lower than for tourists.
Unfortunately, American and European aircrews traveling to malaria-endemic destinations continue to acquire the disease, often due to lack of awareness or failure to take proper precautions. To prevent malaria, aircrews should have access to educational materials and prophylaxis, and should have an individual risk assessment for preventive measures. For high-risk destinations, such as countries in West Africa, prophylaxis for layovers should be taken. For destinations where the risk is thought to be low, providers may advise the use of insect repellents and other precautions without prophylaxis.
Regardless of the destination, aircrews should educate themselves about malaria, use personal protective measures such as repellents properly, take prophylaxis if recommended, and seek medical assistance immediately if symptoms occur. Country-specific recommendations for prophylaxis can be found in this text or on the CDC Travelers’ Health website. Atovaquone-proguanil is generally the most suitable prophylaxis drug for aircrews due to its adverse effect profile and dosing.
Other Vectorborne Diseases
As air travel has become more frequent and far-reaching, the risk of contracting mosquitoborne diseases like dengue, chikungunya, and Zika has increased. Mosquito bites can transmit these diseases, which can have serious health consequences, including birth defects in the case of Zika virus infection during pregnancy. Therefore, preventing mosquito bites in tropical and subtropical destinations is essential to safeguarding the health of flight crews and passengers alike.
To this end, airlines should develop policies that account for the risks posed by mosquitoborne diseases. For example, flight crews who are pregnant, planning to become pregnant, or have a partner who is or may become pregnant should be advised of the risks associated with travel to areas where Zika virus is prevalent. Additionally, airlines may wish to provide mosquito nets, insect repellent, and other protective measures to help reduce the risk of bites during layovers and other travel-related activities.
While there is no specific vaccine or prophylactic treatment for dengue, chikungunya, or Zika virus, other preventive measures can help reduce the risk of disease transmission. These include wearing long-sleeved shirts and pants, using insect repellent, and staying in air-conditioned or screened-in accommodations where possible.
Flight crews should also be aware of the symptoms of these diseases and seek medical attention if they develop a fever, rash, joint pain, or other flu-like symptoms after returning from a trip. Early diagnosis and treatment can help prevent complications and limit the spread of disease to others.
Ultimately, preventing the spread of mosquitoborne diseases requires a collaborative effort between airlines, public health officials, and individual travelers. By working together to promote awareness, education, and preventive measures, we can help reduce the risk of disease transmission and ensure that air travel remains safe and healthy for everyone.
Food and Water Precautions and Travelers’ Diarrhea
When it comes to food and water safety, pilots and aircrew members should adhere to the same guidelines as other travelers to avoid travelers’ diarrhea and other related illnesses. Additionally, it is important for aircrew members to know how to identify and self-treat moderate to severe cases of travelers’ diarrhea to minimize the duration of illness and prevent it from impacting their job performance. It is also recommended that pilots ensure their preferred self-treatment medication is safe to use while flying.
It’s important to note that drinking water safety varies between countries, and water from unfamiliar sources should be avoided. It is also recommended to avoid ice cubes in drinks made from tap water, as they may be contaminated. Additionally, raw or undercooked meats, seafood, and dairy products should be avoided as they can pose a higher risk for foodborne illnesses. Fresh fruits and vegetables should be washed thoroughly with clean water or peeled before consumption.
Travelers’ diarrhea can occur despite best efforts to avoid it. It is recommended to bring medication for self-treatment, such as antibiotics and antidiarrheal medications, on trips. However, it’s important to ensure that the chosen medication is safe to take while flying. If symptoms persist, it is recommended to seek medical attention.
Following food and water safety precautions and being knowledgeable about travelers’ diarrhea prevention and self-treatment are essential for pilots and aircrew members. This knowledge can help prevent illness and ensure optimal job performance during trips.
Bloodborne and Sexually Transmitted Infections
As aircrews are frequent travelers, they may have an increased risk of contracting bloodborne and sexually transmitted infections (STIs). It is important to note that travelers have higher rates of HIV and other STIs due to the potential for unprotected and casual sex while traveling.
The risk of acquisition is not limited to diseases such as gonorrhea and chlamydia, but also includes chronic illnesses such as hepatitis B and C. Activities like dental procedures, acupuncture, tattooing, and piercing are ill-advised during travel to developing countries. It is important for aircrews to take these risks into consideration and protect themselves against potential exposure.
To prevent bloodborne and STIs, aircrews should practice safe sex and use protection like condoms. They should also avoid sharing needles, razors, and other items that could be contaminated with blood. In addition, they should be aware of the potential risks associated with medical procedures and take necessary precautions, such as ensuring that medical equipment is properly sterilized.
If aircrews do engage in sexual activity while traveling, they should seek medical attention if they experience any symptoms of an STI, such as pain, discharge, or rash. It is also important to note that some STIs may not have noticeable symptoms, so getting tested regularly is crucial.
In conclusion, aircrews should take precautions to protect themselves against bloodborne and sexually transmitted infections while traveling. Safe sex practices, avoiding shared items that could be contaminated with blood, and being aware of potential risks associated with medical procedures are all important measures that should be taken to ensure the health and safety of aircrews.
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