Advice for Aircrews

Advice for Aircrews is a topic covered in the CDC Yellow Book.

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Overview

As airlines expand their reach and aircrews are asked to travel to more exotic destinations, often with short layovers, these frequent travelers need to prepare ahead of time for the exposures they may encounter. To some degree, aircrews are similar to all travelers to such destinations, but the differences require some modifications of travel health guidance for several reasons:

  • Layovers are short, often 24–48 hours.
  • Travel is frequent.
  • Travel to new destinations may be on short notice.
  • Despite short travel times, aircrews may be more adventuresome and thus have more risk than typical tourists.
  • Aircrews may perceive themselves to be low-risk because of their generally healthy status and because their in-country exposure time is short.

Given these factors, it is worth noting some guidelines for this special group. In general, air carriers that fly to the developing world try to inform their crews about health issues they may face. However, airlines do not necessarily employ occupational health providers or experts in travel medicine; they may be unaware of special risks at the destinations they serve. Therefore, airlines may wish to avail themselves of professionals who are knowledgeable in the field and who can help make recommendations for their traveling employees.

Pilots are often aware of some of the medications and classes of medications that may interfere with their flight capacity. Providers should not prescribe for pilots medications that affect the central nervous system when flying. Pilots who take sedating antihistamines (including diphenhydramine [Benadryl] and chlorpheniramine) should not fly until more than 5 half-lives have elapsed since the last dose. For diphenhydramine, this equates to a 2-day “no fly” rule (9 days for chlorpheniramine). Trials of new medications or any drugs with potential side effects that could interfere with a pilot’s abilities or judgment should take place between (not during) trips. Prescriptions or recommendations for nonsedating antihistamines (loratadine, desloratadine, and fexofenadine, for example) can be provided after an initial trial period demonstrates they can be taken without adverse effect.

Federal Aviation Authority (FAA)-certified aeromedical examiners (AMEs) examine pilots regularly and are responsible for certifying that they are fit to fly. For some common medications, AMEs might not certify pilots taking them without clearance from the FAA. For other medications, AMEs will advise pilots not to fly. The FAA provides a list of these medications at www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/dni_dnf. Sometimes medication decisions are made on a case-by-case basis. If questions arise, an AME should be consulted (www.faa.gov/pilots/amelocator).

Although any travel health provider can see and advise flight crews, it is important to ask each crewmember what the company requires, in addition to what is required or recommended to maintain health while traveling. If in doubt, the travel health provider should contact the airline medical director or occupational health department for guidance. For example, some aircrews primarily fly domestic routes or routes to Western Europe or Japan, so would not fly to a region of yellow fever risk in their normal daily work. However, an airline may require that crewmembers without contraindications be vaccinated against yellow fever, so that the airline has flexibility to shift crews and address any urgent needs.

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Overview

As airlines expand their reach and aircrews are asked to travel to more exotic destinations, often with short layovers, these frequent travelers need to prepare ahead of time for the exposures they may encounter. To some degree, aircrews are similar to all travelers to such destinations, but the differences require some modifications of travel health guidance for several reasons:

  • Layovers are short, often 24–48 hours.
  • Travel is frequent.
  • Travel to new destinations may be on short notice.
  • Despite short travel times, aircrews may be more adventuresome and thus have more risk than typical tourists.
  • Aircrews may perceive themselves to be low-risk because of their generally healthy status and because their in-country exposure time is short.

Given these factors, it is worth noting some guidelines for this special group. In general, air carriers that fly to the developing world try to inform their crews about health issues they may face. However, airlines do not necessarily employ occupational health providers or experts in travel medicine; they may be unaware of special risks at the destinations they serve. Therefore, airlines may wish to avail themselves of professionals who are knowledgeable in the field and who can help make recommendations for their traveling employees.

Pilots are often aware of some of the medications and classes of medications that may interfere with their flight capacity. Providers should not prescribe for pilots medications that affect the central nervous system when flying. Pilots who take sedating antihistamines (including diphenhydramine [Benadryl] and chlorpheniramine) should not fly until more than 5 half-lives have elapsed since the last dose. For diphenhydramine, this equates to a 2-day “no fly” rule (9 days for chlorpheniramine). Trials of new medications or any drugs with potential side effects that could interfere with a pilot’s abilities or judgment should take place between (not during) trips. Prescriptions or recommendations for nonsedating antihistamines (loratadine, desloratadine, and fexofenadine, for example) can be provided after an initial trial period demonstrates they can be taken without adverse effect.

Federal Aviation Authority (FAA)-certified aeromedical examiners (AMEs) examine pilots regularly and are responsible for certifying that they are fit to fly. For some common medications, AMEs might not certify pilots taking them without clearance from the FAA. For other medications, AMEs will advise pilots not to fly. The FAA provides a list of these medications at www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/dni_dnf. Sometimes medication decisions are made on a case-by-case basis. If questions arise, an AME should be consulted (www.faa.gov/pilots/amelocator).

Although any travel health provider can see and advise flight crews, it is important to ask each crewmember what the company requires, in addition to what is required or recommended to maintain health while traveling. If in doubt, the travel health provider should contact the airline medical director or occupational health department for guidance. For example, some aircrews primarily fly domestic routes or routes to Western Europe or Japan, so would not fly to a region of yellow fever risk in their normal daily work. However, an airline may require that crewmembers without contraindications be vaccinated against yellow fever, so that the airline has flexibility to shift crews and address any urgent needs.

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