Travelers with Chronic Illnesses

Purpose

Publication name: CDC Yellow Book: Health Information for International Travel
Edition: 2026
Chapter authors: Fátima Coronado and Noreen A. Hynes
Top takeaway: Healthcare professionals should educate international travelers on how to manage chronic conditions and ensure medications are available during travel.
Traveler holding an inhaler.

Introduction

Chronic illnesses, such as heart disease, cancer, and diabetes, are the leading causes of death and disability in the United States. A recent study using nationally representative data showed that 6 in 10 adults in the United States have a chronic illness, and 4 in 10 adults have 2 or more. In this study, the prevalence of chronic conditions was highest among women, non-Hispanic White adults, adults aged 65 or older, adults aged 18–64 on Medicaid, dual-eligible adults (Medicare and Medicaid), and adults living in rural areas. Furthermore, recent data indicate that chronic illnesses affect approximately 40% of children in the United States. Common chronic conditions in children include allergies, asthma, diabetes, seizure disorders, and those affecting behavior and learning.

Having 1 or more chronic health conditions does not usually mean “do not travel.” Rather, it signals that healthcare professionals and travelers should work together to ensure that the travelers’ chronic conditions are controlled and managed optimally. Healthcare professionals should advise patients with chronic conditions to seek pre-travel consultation before paying for non-refundable trips and to do so at least 4–6 weeks before departure. This will ensure adequate time to respond to immunizations, try new medications, acquire any medical devices or supplies that may be needed before travel, or redefine the itinerary based upon pre-travel consultation recommendations.

General approach

Advising travelers

Adequate preparation for patients with chronic conditions for international travel requires the active participation of the traveler, their primary healthcare professional, and their disease-related specialists, in addition to their travel medicine specialist. Together, they should take into consideration the destination, duration, and modes of travel, planned activities, time of year of the planned travel, and airline- and cruise-specific specifications. Box 2.4.1 includes a checklist of pre-travel activities for healthcare professionals to discuss with travelers with chronic conditions.

Healthcare professionals play a critical role in advising persons with chronic underlying conditions how to remain healthy while traveling. As part of the pre-travel risk assessment (see The Pre-Travel Consultation chapter), ask the traveler about health-related issues encountered during previous travel, using this information to personalize recommended prevention strategies for healthy travel. Assist the traveler with chronic conditions to prepare up to 4–6 weeks in advance of travel by sharing the advice found on the checklist in Box 2.4.1. Further, ensure that the traveler has medications for the entire trip plus extra in case of unexpected delays and discuss when to take medications if travel involves changes in time zones. All medications should be carried in hand luggage rather than in checked baggage. Discuss vaccine and medication/prescription side effects and possible interactions with their current daily medication regimens. Recommend medication or dosing schedule modifications as needed (see Medication and Vaccine Interactions in Travel Medicine chapter).

Using the checklist in Box 2.4.1, assist the traveler in creating a personal plan for staying healthy while traveling, including managing minor problems or exacerbations of underlying illnesses, and how to seek care in the country of destination (see What to Do When Sick Abroad chapter). The checklist review can remind the traveler to contact airlines (see Air Travel chapter) or cruise lines (see Cruise Ship Travel chapter) well in advance if they require special assistance. Finally, highlight the checklist recommendation for the traveler to obtain supplemental insurance, including supplemental medical insurance and medical evacuation insurance, because most domestic medical insurance policies do not cover injuries or illnesses acquired and cared for outside the United States (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter).

Box 2.4.1

Preparing for international travel: A checklist for travelers with chronic illnesses

4–6 weeks before travel

Find a clinic and attend an appointment with your healthcare professional and a travel medicine specialist to discuss:

  • Specific health conditions and how travel may affect them based upon travel destination, itinerary, and planned activities.
  • Recommended prevention strategies, including vaccines, malaria prevention, medications, prescriptions, and other ways to prevent illness or injury. If traveling internationally, the list of vaccines required by or recommended for country of destination can be found on CDC's Travelers' Health website.
  • Limiting travel to destinations or on cruise ships that have access to quality care for your condition (see Cruise Ship Travel chapter).

Contact the airline or cruise line to give advanced notice if you need special assistance (e.g., supplemental oxygen, wheelchair, lifting services).

Identify healthcare professionals and pharmacies at your destination available to provide care if you are ill or injured.

3–4 weeks before travel

Obtain a letter about your health, treatments, and fitness to travel with your chronic conditions from your healthcare professional. The letter should be on office letterhead stationery and outline existing medical conditions, medications prescribed (including generic names and doses), allergies, and any equipment required to manage the condition. The healthcare professional's name and contact information should be included.

If possible, download travel health mobile applications to input medical records, medications, and other health information (e.g., electrocardiogram) so these are accessible if needed.

Obtain medical clearance and approval of any carry-on medical devices from the airline or cruise line, if required.

If traveling internationally, check with the U.S.-based foreign embassy or consulate for your destination country to clarify whether any medication restrictions exist. Some countries do not allow visitors to bring certain medications into the country, especially narcotics and psychotropic medications (see Traveling with Prohibited or Restricted Medications chapter).

Purchase a travel insurance plan that includes a 24/7 assistance phone line and emergency medical evacuation insurance for use when traveling. Several organizations provide travel resources and information about purchasing insurance, including the U.S. Department of State; International Association for Medical Assistance to Travelers; U.S. Travel Insurance Association; and the American Association of Retired Persons; see Travel Insurance, Travel Health Insurance and Medical Evacuation Insurance chapter.

Purchase a medical alert bracelet or plan to carry medical information on your person. Various brands of jewelry or tags, even electronic ones, are available.

1–2 days before travel

For your carry-on baggage: Pack enough medicines for your chronic condition for the length of your travel and several days afterward in the event of travel delays; include medical information in your carry-on items.

Pack a travel health kit (see Travel Health Kits chapter). Take health kits on board as carry-on luggage and bring all necessary medications and medical supplies (e.g., pouching for ostomies) in their original containers.

Sign up for the Smart Traveler Enrollment Program, a free service of the U.S. Department of State to U.S. citizens and permanent residents, to receive destination-specific travel and security updates. This service also allows the Department of State to contact international travelers during emergencies.

While traveling

Stay hydrated, wear loose-fitting clothing, and walk and stretch at regular intervals during long-distance air or ground travel (see Deep Vein Thrombosis and Pulmonary Embolism chapter).

Wear a medical alert bracelet or carry medical information on your person.

Seek medical attention if you experience exacerbation of symptoms related to your chronic condition (see What to Do When Sick Abroad chapter).

Specific chronic medical conditions

Some medical conditions may affect the recommendations that healthcare professionals make to a traveler upon completing the risk assessment conducted as part of the pre-travel consultation (see The Pre-Travel Consultation chapter). Some online resources for travelers who have chronic medical conditions can be found in the Travelers with Disabilities chapter, and Table 2.4.1.

Some persons with chronic conditions are also immunocompromised because of the condition itself or medical treatment (see Immunocompromised Travelers chapter). For example, renal conditions such as nephrotic syndrome and chronic renal failure, even without the use of immunosuppressive agents, are considered immunocompromising, along with any renal disease treatment with an immunosuppressive medication. Table 2.4.2 addresses issues and recommendations related to specific non-immunocompromising chronic conditions and should be used in conjunction with the other recommendations given throughout this book. Travelers with cardiac, pulmonary, and some renal conditions who are considered high risk for complications may be advised to not travel until their conditions are stable.

Let your patient know that, in some instances, airlines and cruise lines may refuse service to passengers with chronic illnesses if they are considered unfit to travel. Even if a passenger has been given a medical certificate from their healthcare professional, the medical department of the airline or cruise line considers the submitted letter as advice only. The final medical clearance considers the letter, but it will be completed by the medical department of the airline or cruise line which has the expertise. A person traveling frequently with a stable chronic medical condition may seek a frequent traveler medical clearance (FREMEC), after which the assigned FREMEC number and associated information are provided each time an airline reservation is made. Travelers can request a FREMEC number from airlines (check airlines' website information on medical clearance). Several online sites also facilitate obtaining a FREMEC number.

If a traveler needs special services, such as supplemental oxygen on the aircraft or cruise ship, a wheelchair, special seating, a stretcher or lifting services, they must inform the airline or cruise line far in advance of planned travel.

Travelers who require service animals, including emotional support animals, should check, before each planned travel, with the airline or cruise line and the destination country to ensure that both the carrier and the country will allow the animal. Documentation and permits might also be required (see Traveling with Pets and Service Animals chapter).

Counsel travelers, if necessary, to investigate international healthcare accreditation agencies to identify healthcare facilities at the travel destination that have received recognition or accreditation for high care standards and good patient safety records.

The Transportation Security Administration (TSA) Cares Helpline (toll-free at 855-787-2227) or TSA Cares online assistance can provide information on how to prepare for the airport security screening process for a particular disability or medical condition. Cruise lines also provide similar information for travelers for specific disembarkation ports.

Table 2.4.1: Online resources for travelers with chronic illnesses

Online Resources for Travelers With Chronic Illnesses - Table 2.4.1
Chronic Condition Organization Online Resource
Asthma Asthma and Allergy Foundation of America Traveling with Asthma and Allergies
KidsHealth Traveling and Asthma
Blood clotting disorder/thromboembolic conditions Anticoagulation Forum Resource Center
Bleeding Disorders and Travel (Takeda) What to know when you're on-the-go
Cancer Cancer.Net All About Cancer
BreastCancerNow Travel and breast cancer
American Cancer Society Diet, Physical Activity, and Healthy Living
Celiac disease Celiac Disease Foundation Tips for Traveling Gluten-Free
Chronic pain The American Chronic Pain Association The American Chronic Pain Association
Cognitive impairment Alzheimer’s Association Traveling
Diabetes CDC: 21 Tips for Traveling With Diabetes Tips for Traveling With Diabetes
The American Diabetes Association What Can I Bring With Me on the Plane
Epilepsy/seizure disorders Epilepsy Foundation: Traveling Tips Traveling Tips
Heart conditions American Heart Association: Travel and Heart Disease Travel and Heart Disease
Inflammatory bowel disease (IBD) Crohn’s & Colitis Foundation: Traveling With IBD Traveling with IBD
Irritable bowel syndrome (IBS) The IBS Network: Air Travel and IBS Traveling on an Airplane with IBS
Kidney disease National Kidney Foundation: Travel Tips—A Guide for Kidney Patients Travel Tips: A Guide for Kidney Patients
Lung disorders Cystic Fibrosis Foundation: Before Traveling Before Traveling
American Lung Association: Traveling With Oxygen Oxygen Therapy: Traveling with Oxygen
Multiple sclerosis (MS) Multiple Sclerosis Foundation MS Focus Magazine 5 Tips for Air Travel and MS
National Multiple Sclerosis Society A Doctor's Travel Tips
Sleep apnea The Sleep Foundation Best Travel CPAP Machines
American Sleep Apnea Association Three-quarters of People with Sleep Apnea Travel with their CPAP Machines. Here’s How.

Table 2.4.2: Special considerations for travelers with chronic Illnesses1

Special Considerations for Travelers With Chronic Illnesses - Table 2.4.2 
Condition Considerations Before Travel
Age
>70 years
  • Since 2023, many cruise lines require a Certificate of Medical Fitness to Travel prior to embarkation for persons aged >70 years, regardless of whether chronic medical conditions are present. The traveler should check with their cruise line when planning travel.
Blood Disorders
Anemia
  • Defer travel if hemoglobin <8.5 g/dL (5.3 mmol/L) unless it is chronic and stable; defer travel if acute bleeding is the cause and has not stopped.
  • May need supplemental oxygen to travel; see “Supplemental Oxygen Needed to Fly” section.
Sickle cell disease
  • Defer travel if there has been a sickle crisis in the previous 9 days.
  • Air travel is a risk factor for splenic complications, vaso-occlusive crises, and acute chest syndrome.
  • No consensus recommendations on supplemental oxygen use to prevent complications. Consult a sickle cell disease specialist or hematologist and, if needed, arrange with the airline in advance. See “Supplemental Oxygen Needed to Fly” section.
Cardiovascular and Other Cardiocirculatory Disorders
Recent episodes related to underlying chronic disorder
  • Acute heart failure
  • Angina, unstable
  • Angiography
  • Cardiac ablation
  • Cardiac bypass surgery or other cardiac surgery
  • Coronary stenting
  • Defibrillator or pacemaker implanted
  • Myocardial infarction
  • Defer travel for period recommended by treating cardiologist.
  • Traveler should obtain heart condition-related specific medical clearance to travel from their cardiologist.
  • Medications should remain unchanged for at least 2 weeks before long-distance travel.
  • Pacemakers and implanted defibrillators are usually not affected by air travel. Consult treating cardiologist to determine if settings may need to be checked and possibly reset for a long-haul flight; inform airport security of the device before going through screening.
  • Traveler should carry a current EKG or place it along with medical history in an easy-to-access app, website, or email.
  • If oxygen needed for the flight: See “Supplemental Oxygen Needed to Fly” section.
Venous thromboembolism (VTE): Deep venous thrombosis (DVT), pulmonary embolism (PE), or both
  • Air travel is a risk factor for VTE; the longer the flight, the greater the risk for VTE, beginning at 4 hours duration; graded compression stockings are effective in decreasing risk; past history of VTE increases risk of recurrence associated with air travel of 4 hours or more; traveler should discuss need for anticoagulation with treating specialist when engaging in prolonged air, car, or train travel of 4 hours or more.
  • If recent DVT history, delay travel until asymptomatic and stable on oral anticoagulants; traveler should receive clearance to travel from treating physician.
  • Defer travel if recent PE (<4 days since the event), traveler is not on stable anticoagulation, and traveler has abnormal PaO2 on room air (see Deep Vein Thrombosis and Pulmonary Embolism chapter).
Central Nervous System Disorders and Spinal Issues
Cognitive impairment
  • Defer travel if paranoia, delusions, or aggressive or disinhibited behaviors are present.
  • Defer travel if impairment due to neurodegenerative diseases until stable to travel with clearance of treating physician.
  • Mild to moderate impairment: safe to travel with focused and specific advanced planning; consider if traveler should be accompanied throughout transport and travel activities; environmental changes can trigger wandering or confusion.
Cranial surgery
  • Defer travel if <9 days before departure. If >9 days and no cranium air (may take up to 1 month to clear), request a medical clearance to travel from surgeon.
Seizure disorder with recent seizure, generalized or unknown onset tonic-clonic or new onset seizure
  • Defer travel if event occurred <24 hours before departure, delay travel until stable on medication.
Stroke
  • Supplemental oxygen is needed if the stroke happened <2 weeks before travel (see “Supplemental Oxygen Needed to Fly” section); inform airline in advance; a medical escort may be required by some airlines.
Transient ischemic attack
  • Defer travel if event was <2 days before departure; after 2 days, the traveler needs assessment for risk of recurrence with expert input; delay travel if moderate to high risk of recurrence within 1 month.
Eye/Ears/Nose/Throat Conditions
Wired jaw (fracture treatment)
  • Defer until hardware removed (anticipate hardware for 6–8 weeks) or travel with an escort (by air or sea) who carries wire cutters and has been trained to use them in case of a medical emergency (e.g., severe difficulty with breathing) requiring the wires to be cut.
  • No deferral if self-, quick-release wiring is used and the traveler is trained in how and when to release by their surgical team.
Respiratory/Pulmonary Conditions
Asthma
  • Delay if current infection with symptoms.
  • Delay travel if condition is unstable on current treatment regimen.
  • Ensure patient or caregiver (if applicable) has a treatment plan and understands what actions are needed if an exacerbation occurs during travel.
Bronchiectasis
  • Delay until current infection resolved.
  • Administer walking test before travel even if no supplemental oxygen routinely used to determine if needed.
  • Treating pulmonologist should clear for travel by air or cruising and recommended if supplemental oxygen is needed (see “Supplemental Oxygen Needed to Fly” section); traveler to inform airline/cruise line of need for supplemental oxygen in advance of travel.
Cancer
  • Delay travel if major hemoptysis or other bleeding episode is present.
  • Delay travel if severely immunocompromised, anemic, or thrombocytopenic.
  • Need assessment by treating specialist if any of the above or undergoing active treatment or has a pleural effusion or is dyspneic at ground level; treating specialist should provide letter stating condition, treatment, and clearance to travel by air or sea, as indicated.
Chest surgery
  • Defer travel if chest surgery is <10 days before departure if uncomplicated (e.g., open lung biopsy, lobectomy, pleurectomy). Before travel, patients who have had chest surgery should be medically stable.
Chronic obstructive pulmonary disease, emphysema, pulmonary fibrosis
  • Delay travel if unresolved recent symptom exacerbation until full recovery of the exacerbation and non-infectious to others and has no currently transmissible infection.
  • If oxygen-dependent at ground level, traveler needs to secure supplemental oxygen for the flight and inform the airline or cruise line ahead of travel (see “Supplemental Oxygen Needed to Fly” section).
Cystic fibrosis
  • Delay travel if current active infection or FEV1 <50% at ground level.
Pneumonia
  • Defer travel if pneumonia with symptoms or if traveler is considered contagious.
  • Travel permitted if symptom-free (even if chest x-ray has not yet resolved).
  • Consider oxygen for flight if traveler is older, longer flight, or pneumonia is recent; see “Supplemental Oxygen Needed to Fly” section.
Pneumothorax (PTX)
  • Defer travel if PTX is <6 days after full inflation; consult airline if traveling with a drain in place.
  • Defer travel if PTX is <14 days after inflation for a traumatic PTX.
Pulmonary hypertension
  • Consider testing all patients with a walking test on room air prior to travel.
  • All travelers should have written clearance from their treating physician to fly or go on a cruise including statement of the need for supplemental oxygen for travel; inform airline and cruise line of oxygen needs in advance of travel (see “Supplemental Oxygen Needed to Fly” section).
Tuberculosis
  • Delay travel if untreated or unresponsive to treatment.
  • Delay travel until disease is no longer considered contagious and patient has been cleared to travel by public health authorities.
  • Ensure patient has sufficient medication to continue treatment for the duration of travel.
  • Consider referral to public health authorities at destination, especially for long-term travelers and those relocating or returning to another country.
Ventilator use
  • Before planning travel, discuss with airline or cruise line.
Supplemental Oxygen Needed to Fly
Routine use of supplemental oxygen or trip-specific oxygen recommendation

Notes

1If travel is medically necessary to obtain treatment in another location, transportation should be coordinated with and facilitated by an accredited medical transport service.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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