Is Travel Safe After the Hantavirus and Ebola Outbreaks?

Summertime is in full swing, and you finally have enough PTO to take that two-week international trip you’ve had on your mood board all year.  

But you might be feeling a bit stressed seeing scary headlines about Ebola outbreaks or hantavirus spreading on cruise ships. Here’s what to know about what precautions to take before stepping on a plane (or train or automobile) to avoid getting an infectious disease, and to stay healthy while you travel.

Where (and where not) to travel

Even if a country has been on your dream travel destination list for years, you should take time to double-check whether it’s safe to travel there this summer.

Chris Sanford, MD, is the director of the Travel Clinic at UW Medicine Primary Care at Northgate and co-host of the travel health podcast Germ & Worm with fellow physician Paul Pottinger, MD. Sanford says that most of the countries you should avoid traveling to right now are unsafe because of security issues, not the risk of contracting an infectious disease.  

“These include countries currently experiencing war or political instability — places that are tumultuous and dangerous,” says Sanford.

Travel advisories for every country in the world are available on the U.S. Department of State website, which include rankings from “level one” through “level four,” with one being the safest and four being the least safe.

“You should not travel to level four countries,” says Sanford. “If a country is a level three, the buzz phrase is to ‘reconsider travel.’ These countries can also put you at a higher risk of danger.”  

Health risks of traveling internationally  

If the country you’re traveling to isn’t a level three or four, that doesn’t mean it’s risk-free.

“Before traveling to a low-income nation or to a tropical country, we recommend travelers see a travel medicine doctor,” says Sanford. “There are several clinics, including within UW Medicine, that offer pre-travel care.”

They can make sure you have the vaccines and preventive medications you need for the parts of the world you’ll be traveling in.

Here are some of the health risks to prepare for on your trip.

Water and food risks

A common way to contract a disease while traveling is through the food you eat and the water you drink. A good indicator of the risk level is the income level of the country you’re visiting.  

In high-income nations like the U.S., Canada, Western Europe, Australia, New Zealand and Japan, it’s generally safe to drink the tap water and eat whatever food you’re served.

“The risk of diarrhea is not any higher in those places than it is here in the United States,” says Sanford. “But in middle- and low-income nations, there’s a higher risk of traveler’s diarrhea and other food- or waterborne illnesses.”  

In these middle- and low-income countries, it’s safest not to eat from roadside food stands or to consume raw vegetables and salads. Also avoid tap water and drink bottled water when possible. If there’s no bottled water, you can boil the water, add iodine or chlorine, filter it, or shine an ultraviolet light on it, says Sanford. You can buy pumps, pens and straws that will treat your water either online or at travel or outdoor retailers.  

Airborne virus risks  

Whether on the plane to your destination or on a public bus while sightseeing, there are ways to reduce your risk of catching an airborne virus. N95 or KN95 masks are still a great way to protect yourself, but there is some nuance.

“When you’re on a plane, the air is filtered very well, so the risk of airborne viruses is low,” says Sanford. “You can certainly wear a mask through the airport and boarding, where the air isn’t filtered, which will bring down your risk of influenza and COVID-19.”

The same goes for buses and trains, where the air isn’t well filtered.

“I wouldn’t say it’s mandatory, but it’s a reasonable thing to do,” says Sanford. “I think every traveler has to make their own call if wearing the mask is worth the benefit.”

Of course, making sure you’re up to date on your vaccines will also help reduce the risk of the flu or COVID ruining your trip.

Insect- or animal-borne illness risks

Hantavirus was on the front pages of every major news outlet when a cruise ship in the Atlantic Ocean experienced an outbreak this spring. Rodent droppings and urine can spread hantavirus, which is found around the world, including in the United States. But it’s extremely unlikely that you’ll contract it while traveling.  

“I wouldn’t change my itinerary based on hantavirus risk,” says Sanford.

Mosquito-borne diseases such as dengue and malaria are a much bigger risk when traveling to tropical countries.    

The best way to protect yourself is to avoid getting bitten in the first place. Sanford says repellents like DEET and picaridin are effective at keeping mosquitoes away when applied to your skin. You should also stock up on permethrin, a repellent you apply to your clothing.

If you’re in an area with malaria, you should take a preventive medication on top of applying these repellents to your skin and clothes. This combination will reduce your risk of insect-borne diseases.  

Ebola risk

Ebola outbreaks have also been in the headlines recently, with the Congo and Uganda experiencing the largest outbreaks. But Sanford emphasizes that it’s also unlikely that you will contract a disease like Ebola when you’re traveling abroad. 

“I taught in Uganda for a decade,” says Sanford. “I would still go there, even though there are some cases there. Ebola has a different spread — it’s through direct contact.”

Basically, you’d have to touch someone who is sick, or otherwise be exposed to their bodily fluids, including blood, saliva, sweat, semen or feces.

“Because of that, the risk to the general public, or to a tourist, is extremely low,” says Sanford.

What to do if you feel sick while traveling

If you feel like you’re coming down with something while you’re abroad, pay attention to the severity of the illness.  

“If it feels like a head cold, it’s probably a head cold,” says Sanford.  

For traveler’s diarrhea, you can get a prescription for an antibiotic called azithromycin before you go on your trip or buy over-the-counter medications like loperamide.  

For more serious illnesses, with symptoms like a high fever, blood in your stool or significant abdominal pain, you should seek professional help.

“If I’m in a high-income country, I’d feel pretty good about going into a hospital,” says Sanford. “But in many of the low-income countries, care can be substandard. For that reason, we usually recommend people consider medical and evacuation insurance in case they need emergency care and transfer to a facility that can provide a higher level of care.”

If you think you might need to see a doctor while you’re traveling, you can visit websites like the International Society of Travel Medicine or the American Society of Tropical Medicine and Hygiene, which both have lists of pre-vetted doctors and medical clinics from around the world.

Should you stay or should you go?

Unless you’re traveling to an exceptionally risky place, or are immunocompromised or pregnant, infectious disease risk is unlikely to be a good reason to cancel a trip.

“I think 90 percent of the countries in the world are reasonable to go to,” says Sanford. “People tend to worry about things in the news, but there’s almost an inverse relationship between headlines and risk. You never read a headline about an older man having a heart attack or a younger man having a motorcycle accident in Thailand, because those are so common. You read about things like hantavirus or Ebola, because they’re rare.”

So, before you book your trip, make sure you’re up to date on your vaccines, check the country’s risk category and keep a good supply of items that could protect you when you’re out exploring.

But also, remember to practice safe habits.  

“Sometimes safety is in the simplest things,” says Sanford. “Wearing a seat belt, a helmet or even a condom can reduce your risk of injury or disease.”