Air quality

One’s first notion is to blame the air quality, because it is a cramped space.  The cabin air is without a doubt a significant cause of spreading germs on aircraft.  However, the aircraft manufacturers are aware of this risk and they have done three crafty things to reduce this source of germs and viruses:

1. They replace the air 20 times an hour, in comparison with an average office, where fresh air from outside replaces internal air just twelve times per hour.
2. The air is filtered with “high-efficiency” filters.
3. The air flow is not, as you might expect, from the front of the aircraft to the back, but it flows from ceiling to floor.

The result of the last factor means that if someone is diseased and sitting many rows from you, you are unlikely to breathe the air that contains their germs.  Unfortunately, it also means that if there is anyone within two rows of you with an illness, you are going to breathe the air that they have contaminated.  Again, and again, and again, and again.

The cabin air is typically as dry as a dessert, which also robs your body of some of its protective measures, and the stress of modern air travel also undermines your immune system.

You could ensure that you are getting all the vitamins your body needs, which many people find a help.  To hydrate your sinuses you could use a spray, but that smacks of eccentricity.  One might think that wear wearing a face-mask would protect you.  Not so, according to the British Health Protection Agency.  There is no objective evidence to suggest that they are a useful preventive measure.

If there is someone coughing or sneezing near you and there are empty seats on the plane, you could request that the cabin crew move you.

Lavatories

The aircraft lavatories may start out clean at the beginning of the flight, but by the time that dozens of people have used them, some with suspect personal hygiene, they become Contamination City.  Funny enough, unless someone has had an accident, the seat probably has fewer germs than your phone or your keyboard.  The danger areas are, perversely, the areas that you are most likely to touch: the door handle, lock, tap (faucet), washbasin, walls and the counter.

Never use water from the aircraft’s plumbing system for brushing your teeth.  As recently as 2004 the EPA found that, owing to faecal contamination, no aircraft water systems complied with the national drinking water regulations.  Owing to more stringent regulations this has improved, but on any day, a significant number of planes are carrying water that is unfit for human consumption.  Aircraft water systems need only be disinfected a minimum of four times a year.  Worse yet, if they find E. coli in the water, they can continue to operate the plane for up to 72 hours before restricting public access to the water.

Our suggestions:

• Use bottled water for brushing your teeth.
• Carry alcohol-based handwash and disinfect your hands after having used the lavatory facilities.
• Do not touch your face until after you have disinfected your hands.  Use moist towelettes to wash your face (either provided by the airline, or ones that you carry on board with you).

Your seat and space

According to the US government’s guidelines for cleaning and disinfecting aircraft possibly contaminated with influenza (http://www.flu.gov) the places that can carry infection and can infect subsequent travellers using the same seat are the following:

• Armrests
• The plastic/metal part of the seat back
• Tray tables
• Seat belt buckles
• Light and air controls, cabin crew call button and overhead compartment handles
• The adjacent walls, windows and window shades, and
• The individual video monitor.

With the quick turn-around of planes, particularly short-haul, it is unlikely that these surfaces have all been sterilised.  You can use antiseptic wipes to clean the surfaces yourself, but then you risk looking a bit over-the-top.  Perhaps a more discreet way to handle this would be to wipe just those surfaces that you will likely be in contact with whilst seated, and then use hand-disinfectant when you have had to touch the ventilation, lighting and other controls.

If you sit on an aisle then there is an additional risk you face – people with contaminated hands are likely to steady themselves on the corner of your headrest as they pass by.  If you are phobic about germs then you may do better to sit at the window.

If you need help with finding suitable disinfectants, the EPA maintains a list of approved sterilisers here: http://www.epa.gov/oppad001/chemregindex.htm  List G is probably a good place to start.

However scary this list may be, the simple fact is that few travellers contract any life-threatening ailment on board, and a few simple precautions can substantially reduce your risk of colds or flu.

This food advice is useful even if you are not travelling – even in the USA 250,000 people are hospitalised each year for diarrhoea, and the food safety in the United States is a great deal better than it is in many countries.  There are other examples too: thousands of people got sick and dozens died in mid-2011 from eating raw vegetables originating in Germany, which were contaminated by a strain of E. Coli bacteria.

The cause

Traveller’s diarrhoea (unkindly called various local names including Delhi Belly and Montezuma’s Revenge) and related problems are caused by contaminated food.

Avoiding illness while travelling – What you touch

Good personal hygiene, particularly about one’s hands is critically important in preventing infection whilst travelling.  Wash your hands before and after using the toilet, after handling money, and before meals.  Also wash your hands before touching your face or putting your fingers in your mouth.

Only use potable water to rinse your mouth and toothbrush when you brush your teeth.  Also, do not use water you would not drink to clean items in close contact with eyes and mouth, such as contact lenses.

Be careful about swimming in fresh water.  Aside from the risk of pollutants, you may also unwittingly be exposing yourself to parasites including river blindness and bilharzia, caused by parasitic worms.

First aid

Stay hydrated.  The volume of liquid you take in must approximate the amount of liquid you lose.

The water that you drink must be clean and uncontaminated.  If it is at all suspect you can boil it for twenty minutes to kill off the bacteria.

Research has established that pure water is not absorbed by the body as fast as a mild solution of electrolytes.  You can buy “Oral Rehydration” sachets to add to water, or you can make up your own in an emergency.  The basic recipe is:

1/2 to 1 level teaspoon of salt

6 to 8 level teaspoons of sugar

1 litre of clean, drinkable water

Antimotility drugs are useful as they slow down the rate at which food passes through your body.  This will at least give you the time to get back to your hotel, call a doctor, etc.  Your doctor or pharmacist can advise you which ones to take with you.

See a doctor

Several food poisoning causes are potentially life-threatening and you should always 1) stay hydrated with clean water and 2) exercise caution and see a competent doctor, particularly if the symptoms are severe or protracted.  Diarrhoea can even be a symptom of a serious tropical disease that needs additional specialist medical treatment.

Avoiding illness while travelling – What you eat

The most frequent cause of  illness while travelling is food contamination, caused by:

• Improper food storage and handling leading to bacterial contamination
• Infection by micro-organisms: bacteria and amoebas, protozoa
• Chemical residues and contamination
• Toxins produced by fungi

You should avoid:

• Hot food that has been allowed to cool down
• Cold food that has warmed up
• Reheated food
• Food that has been uncovered or exposed to flies or other creatures

Chicken is particularly treacherous if undercooked.  Even if grilled, it can have uncooked portions if it was put on the griller directly from the freezer.  Boiled or baked is probably the safest.  Microwaved chicken is probably the least safe because you do not know if it has been heated sufficiently right through.  If there are raw or undercooked parts of the chicken, don’t eat it.

Beef should be well done unless you have sound reason to trust the kitchen (for instance if it is a Michelin-Star kitchen then the chances are that even Steak Tartare is safe to eat).

Avoid food prepared in the street, particularly if there is a possibility for cross-contamination between raw meat and cooked meat.

Buffets can be suspect.  The food is exposed for extended periods to contamination, including people coughing and sneezing near them.  You do not know how good the hygiene is of people that have used the serving utensils, so you could be getting germs on your hands while serving.  It is also possible for tongs or spoons to fall into the dish, thus contaminating the food.

Buffets are also bad because it is rare that the temperature control is adequate.  Hot foods need to be kept hot in order to destroy bacteria.  Once they cool down to merely warm they actually promote bacterial growth.  Hot food kept hot (over 40° C) will be over-cooked in a relatively short period of time.

Cold foods also need to be kept cold.  The rate of bacterial growth doubles with every 10° C increase in temperature.  (Around 20° F temperature change.)  A salad may be at freezing point at the bottom but near room temperature at the top surface.

It there is any slight symptom at all of fungus infection of food, do not eat it.  Visible fungus is often very small in relation to the mycelium penetrating the food, so by the time it shows the whole mass of food may be infected.  Fungi produce poisons called mycotoxins that are not destroyed by cooking.  One group of such poisons called aflatoxins are among the most carcinogenic substances known, but you first have to survive the initial poisoning for that to be a worry.  Many do not survive aflatoxin poisoning.

Fresh fruit and vegetables

Fresh fruit and vegetables are potentially dangerous because you have no idea if they are contaminated or if they have been properly cleaned.  In the tropics it is necessary to do more than merely washing fruit and veg. : they need to be soaked and scrubbed in a dilute chlorine bleach to kill off the amoebas and avoid things like amoebic dysentery.

Avoid salads for this reason.  Not only are salads rarely washed thoroughly enough, in addition to bacteria and amoebas they can also harbour parasitic organisms like flukes and snails, particularly in tropical regions.

Eat only vegetables that have been boiled for an extended period, or baked.

Avoiding illness while travelling – What you drink

Bottle of water

Avoid anything containing ice as it is only as good as the water it was made from, as clean as the kitchen it came from, and as pure as the containers and plumbing it has been handled with.

Some countries have entirely safe tap water supplies, which you can determine when researching your destination.  Others, even first-world countries, may have dubious water quality and you should drink only bottled water.  Some countries (for instance Turkey) have water certification procedures and your hotel will display a certificate that indicates their care in relation to water supply.  That does not mean that you can drink their tap water, but merely means that they may, for instance, have safe drinking water available to guests.

It can be difficult or impossible for you to purify contaminated water by yourself as a traveller.  Treatment with iodine or chlorine tablets will help to kill off bacteria if done correctly.  However, this is not magic, and cannot remove metal contamination, or chemical and pesticide residues, etc.  There are other possibilities that first filter the water, then sterilise it usually with activated charcoal, or ultraviolet light.

If the local water is unsafe then use only reputable bottled water (or water stated as potable that is provided by a certified hotel).  If you cannot get bottled water then drink brand-name bottled soda drinks: Coke, Pepsi, etc.  Staying hydrated is more important in the short term than a few extra calories or the state of your teeth