Why aircraft disinsection?

Norman G. Gratz,1 Robert Steffen,2 & William Cocksedge3

A serious problem is posed by the inadvertent transport of live mosquitoes aboard aircraft arriving from tropical
countries where vector-borne diseases are endemic. Surveys at international airports have found many instances of
live insects, particularly mosquitoes, aboard aircraft arriving from countries where malaria and arboviruses are
endemic. In some instances mosquito species have been established in countries in which they have not previously
been reported. A serious consequence of the transport of infected mosquitoes aboard aircraft has been the
numerous cases of ‘‘airport malaria’’ reported from Europe, North America and elsewhere. There is an important
on-going need for the disinsection of aircraft coming from airports in tropical disease endemic areas into
nonendemic areas. The methods and materials available for use in aircraft disinsection and the WHO
recommendations for their use are described.

Keywords: mosquito control, methods; malaria, transmission; aircraft; insect vectors; insecticides, administration
and dosage.

Voir page 1001 le résumé en français. En la página 1002 figura un resumen en español.

Introduction application of pyrethroid aerosol sprays for the

disinsection of aircraft. A detailed review conducted
Since the inception of international air traffic there by WHO led to the conclusion that no toxicological
has been concern that mosquito vectors and the hazard was attributable to any of the materials or
diseases they transmit might be introduced by aircraft methods recommended for use in aircraft disinsec-
into countries where they were not previously found tion and that they were safe to use in the presence of
(1, 2). Thus, consideration was already being given in passengers and crew (5).
the early 1930s as to how aircraft might be disinsected There have been reports that the ‘‘blocks away’’
so as to prevent this from happening. method and other types of aerosol disinsection used
In conjunction with its Collaborating Centres, with passengers on board, such as the ‘‘top of
WHO conducted field trials on various materials and descent’’ method (6), are of limited effectiveness and
methods for the disinsection of aircraft and devel- that live mosquitoes have arrived in aircraft following
oped recommendations on this basis. Foremost blocks away disinsection (7). Mosquitoes can con-
among the recommended methods is ‘‘blocks away’’ ceivably survive if treatments are not properly
disinsection, in which an insecticide aerosol spray is effected and if aerosols do not reach all areas where
applied to the interior of aircraft just before they the vectors rest, for instance in overhead baggage
begin taxiing for take off (3, 4). racks. There is a need to improve disinsection
Many countries insist that arriving aircraft be methods (8).
disinsected, especially if they have come from areas
where vector-borne diseases are endemic. It is
common for an arriving aircraft to be sprayed by
the health services of the country of destination if
Vectors introduced by aircraft
there is any doubt as to whether treatment has been There have been frequent instances of insects of
applied earlier in the flight. Moreover, there have public health importance being introduced from one
been instances in which the suspension of landing country to another, with occasional dire conse-
rights has been proposed unless evidence of quences. Until the advent of passenger aircraft in the
disinsection was provided by the crews of arriving 1920s such occurrences were mainly associated with
aircraft. ships. For example, Anopheles gambiae, a major vector
Concern has been expressed about possible of malaria, was probably introduced into Brazil in
adverse effects on passengers and crews of the 1930 from Senegal by a French naval vessel, although
the possibility that an aircraft was responsible cannot
be excluded. This mosquito was first observed in a
1
Medical Entomologist, 4 chemin du Ruisseau, 1291 Commugny, flooded field 2.5 km from the port of Natal and
Switzerland. Correspondence should be addressed to this author. subsequently spread rapidly to other parts of Brazil.
2
University Travel Clinic, Institute for Social and Preventive Medicine, As a result, there was a great increase in the
University of Zurich, Zurich, Switzerland.
3
transmission of malaria and a sharp increase in
Communicable Diseases, World Health Organization, Geneva,
Switzerland.
mortality from the disease in the country. The
importation and subsequent establishment of this
Ref. No. 00-0285

Bulletin of the World Health Organization, 2000, 78 (8) # World Health Organization 2000 995
Policy and Practice

highly efficient vector led to an epidemic of malaria occurred at Roissy (29). During this period, 250–
involving ca. 300 000 cases and 16 000 deaths. A 300 aircraft arrived from areas of Africa where
costly campaign was successfully conducted to malaria is endemic, and it was estimated that 8–20
eradicate the vector from Brazil (9). anopheline mosquitoes were imported on each flight.
The Government of Brazil was concerned This does not take account of the common potential
about the possibility of A. gambiae being re- vector mosquitoes that were probably also on the
introduced into the country. After eradication was aircraft.
achieved, therefore, aircraft arriving in Brazil from Mosquitoes are not always transported in
Africa continued to be inspected. Over a nine-month passenger cabins. For example, A. aegypti eggs were
period in 1941–42 the vector was found on seven found in surveillance ovitraps in Bermuda airport
occasions on such aircraft. During the inspections, during 1982 and were subsequently discovered to be
132 mosquitoes and two live tsetse flies were found. breeding in the freight shed. The species was
This led the government to insist that all aircraft probably reintroduced in infested airfreight contain-
arriving from Africa be disinsected by means of ers (27), which may become a more common vehicle
pyrethrum spray before the passengers disembarked. as volume of traffic increases. At Forbes Air Base in
The first reported occurrence of insects in an Kansas, 16 live larvae of A. aegypti and Culex cinerellus
aircraft was in 1928 when a quarantine inspector were found in May 1968 in water on a tarpaulin that
boarded the dirigible Graf Zeppelin on its arrival in the had been stored in the open in Liberia before being
USA: 10 species of insects were discovered on placed on a US military aircraft. The aircraft had left
plants (10). Charleston, SC, on 28 April and had made stops in
Inspections of 102 aircraft arriving at Miami Suriname, Liberia and the Azores (22).
during 1931 from various airports in the West Indies Cockroaches are frequently found in the galleys
and Central America after flights lasting a day yielded of passenger aircraft, and their introduction into
28 live Culex quinquefasciatus and one live Aedes countries where they have not previously been found
aegypti (1). may be attributable to this source (30).
In the 1930s the Government of India drew up
recommendations for preventing mosquito vectors
of yellow fever from being imported on aircraft Consequences of the importation
arriving in the country. The recommendations
included measures to disinsect aircraft by spraying
of mosquito vectors
them on arrival before the doors were opened. It was The public health consequences of the importation
also recommended that all aircraft flying to India be of mosquito vectors from countries where certain
provided with hand sprayers and pyrethrum so that diseases are endemic into countries where they are
they could be sprayed during long flights (2). not, are as follows:
The results of surveys of insects found in – if the mosquitoes are infected they may transmit
aircraft are summarized in Table 1. There have been disease in the country of arrival, e.g. airport
additional reports of vectors that probably became malaria;
established in countries through being introduced by – the importation of an infected vector may result in
international air or sea transportation (19); however, the establishment of autochthonous transmission
since these do not include reports of finding vectors by a local vector;
on aircraft, they are not included here. – introduced mosquitoes may become established
Among more than 20 000 insects found in in the countries into which they have been
aircraft during a 13-year survey conducted by the US imported, especially in tropical or semitropical
Public Health Service (16) were 92 species of areas;
mosquito, 51 of which were not known to occur in – the introduction and establishment of an imported
mainland USA, Hawaii, or Puerto Rico. vector may necessitate a costly control pro-
In 1960–61, baggage compartments and cabins gramme, as occurred with Anopheles gambiae in
were inspected in 210 aircraft at New Orleans airport, Brazil and Egypt and recently with Aedes albopictus
1183 at Miami international airport, and 89 in in the USA and Italy.
Honolulu. A total of 81 mosquitoes were recovered
in New Orleans, 32 in Honolulu, and 100 in Miami. The Transmission of disease by mosquitoes
species found in Miami and Honolulu were generally imported on aircraft
not native to the USA and the insects appeared to have Airport malaria. The most direct evidence of
been attracted more to the illuminated cabins than to transmission of disease by mosquitos imported on
the baggage compartments (12). aircraft is the occurrence of airport malaria, i.e. cases
The usual rate of malaria infection of anophe- of malaria in and near international airports, among
line vectors in Africa is 2%. Only a minority of persons who have not recently travelled to areas
mosquitoes on aircraft find a host and favourable where the disease is endemic or who have not
conditions for survival on arrival from Africa. It was recently received blood transfusions. Airport malaria
estimated that 2000–5000 anopheline mosquitoes should be distinguished from imported malaria
were imported into France during a three-week
period in 1994 when six cases of airport malaria

996 Bulletin of the World Health Organization, 2000, 78 (8)

 Why aircraft disinsection?

Table 1. Reports of mosquitoes in aircraft

Date Place Origin Species found Reference

1931 Miami Caribbean Culex quinguefasciatus 1
Aedes aegypti
1933 Kisumu, Kenya Juba, Sudan Anopheles gambiae s. l. 11
1936–41 Hawaii California Culex quinquefasciatus 12
Anopheles. pseudopunctipennis
Culiseta incidens
1939 Marseilles West Africa Anopheles gambiae 13
1938–41 Darwin, Aedes 14
Australia Anopheles Culex
Mansonia
1941–42 Brazil West Africa Anopheles gambiae s.l. 11
1942–45 Brazil West Africa Anopheles. gambiae s.l. 15
1946–60 USA Asia Anopheles grabhami 16
Brownsville Americas Anopheles neomaculipennis
Honolulu Anopheles. vestipennis
Houston
New York
Miami
1950 Cyprus Portugal Anopheles superpictus 5
1950 Auckland, Fiji Aedes aegypti 17
New Zealand Sydney Culex annulirostris
1952 Auckland Fiji Culex annulirostris 18
1955–59 Bombay, ? Culex spp. 19
India ?
New Orleans
1960–61 Honolulu 220 mosquitos including 20
Miami 6 species not found in the USA
1964–68 Manila ? 52 live and 482 dead mosquitos 21
1968 Kansas, Liberia Live larvae of Aedes aegypti 22
USA and Culex cinerellus
1968 Nairobi Africa 153 mosquitoes 11
1968–69 Nairobi Europe 356 mosquitoes 11
including 2 species from Europe
1970–74 New Zealand Fiji Aedes vexans 23
Fiji Culex bitaenriorhynchus
Hong Kong
Hawaii Culex quinquefasciatus
Hong Kong Culex sp.
1972–73 Tokyo ? Aedes aegypti 24
Anopheles subpictus
Culex gelidus
Culex sitiens group
1974 Darwin Bali Anopheles sundaicus 25
1975 Australia Indonesia Anopheles subpictus 14
Darwin ? 5517 insects 14
1974–79 Brisbane including 686 mosquitoes
Perth
Sydney
1975–81 Tokyo 3 species of mosquito not 26
found in Japan
1983 Bermuda ? Aedes aegypti 27
1983 Trinidad ? 967 insects 28
including Aedes aegypti and
Anopheles albimanus

among persons who contract the infection during a airport malaria represents an importation of infected
stay in an area of endemicity and subsequently fall ill. Anopheles mosquito aboard an aircraft. Arboviral
The occurrence of airport malaria indicates the diseases, e.g. dengue fever, may be transmitted by
need to disinsect aircraft arriving from areas where imported mosquitoes carrying the infection. Since
vector-borne diseases are endemic. Each case of the symptoms of arboviruses are usually non-

Bulletin of the World Health Organization, 2000, 78 (8) 997

Policy and Practice

specific, however, diagnosis is difficult and single and no evidence of local transmission in any reported
cases may not be detected. Nevertheless, a case of instance of baggage malaria.
airport dengue fever has apparently occurred among Runway malaria. Three documented cases of
German travellers (31). Transmission of leishmania- ‘‘runway malaria’’ have occurred in which the
sis by sandflies in Tajikistan has occurred as a result of infection was transmitted to passengers who had
the importation of these insects from Afghanistan on not the left their aircraft during a transit stop in a
helicopters (32). country where malaria was endemic. Two of the cases
Airport malaria is particularly dangerous in that occurred at Abidjan Airport and one in Banjul,
physicians generally have little reason to suspect it. Gambia. These cases occurred in the course of travel
This is especially true if there has been no recent between countries where the disease was not
travel to areas where malaria is endemic. Diagnosis endemic. In addition, two passengers and a crew
may, therefore, be protracted and death may occur member on a Middle East Airlines flight from
before a correct diagnosis is made and adequate Lebanon to Brazil developed malaria after arrival at
treatment provided, particularly in cases of Plasmo- their destination. P. falciparum was diagnosed about
dium falciparum malaria (33) . two weeks after the flight and the patients were
Several summaries of the known cases of treated in hospitals in São Paulo. No other passengers
airport malaria have been prepared (34–39). Table 2 among the 360 on board the aircraft gave positive
presents an updated version of information (38) on reactions. Investigation showed that they had not
countries in which confirmed or probable cases of been infected in Brazil and it is probable that they
airport malaria have been reported. were infected during a stop in Côte d’Ivoire. During
In 1997 a mother and daughter who had the two-hour stop at Abidjan Airport the doors of the
recently travelled from Luxembourg to Iceland, and aircraft were open and this presumably permitted an
who had never been in an area of endemicity, became infected mosquito to enter (44).
affected with malaria. They lived in a village 1–2 km One of the cases involving Abidjan Airport was
east of Luxembourg’s airport. In 1999 a husband and that of a 37-year-old British woman who lived in Cape
wife travelled by air from Luxembourg to Scotland Town and had travelled to the United Kingdom;
via Brussels on 30 May and returned to Luxembourg 14 days after her arrival she developed fever and
on 18 June. The woman fell ill in late July and malaise; was treated at home with antibiotics. Three
P. falciparum was confirmed by blood smear. A blood days later her fever rose to 40 oC, she became
smear taken from the husband was also positive. A unconscious, and she was taken to hospital with
third patient, who had not travelled by air, lived in a convulsions and thrombocytopenia. P. falciparum was
village 3–4 km east of Luxembourg airport. All five identified, appropriate treatment was given, and she
cases occurred during periods of high summer recovered after a prolonged illness. The patient had
temperatures, which may have allowed imported never been to an area where malaria was endemic.
mosquitoes to survive. Severe thrombocytopenia Her flight from Johannesburg to Europe landed in
was a common feature in these patients (40). Abidjan for about an hour. She did not leave her seat
Baggage malaria. Table 2 includes cases of but noted that the doors of the aircraft remained
‘‘baggage malaria’’ in which infected vectors were open. The aircraft was not sprayed before departure.
evidently brought in baggage to sites, sometimes at a All travellers in transit through an area where malaria
considerable distance from the airport of arrival, and is endemic were advised to obtain prophylaxis, and it
transmitted the disease on escaping (41–43). Ex- was suggested that airlines should spray aircraft in
tensive investigations revealed no indigenous vectors transit with insecticides (45).
In another case associated with Abidjan Air-
Table 2. Countries in which confirmed or probable cases of airport port, a 63-year-old British woman who lived in
malaria have been reported, 1969–August 1999 Johannesburg travelled to the United Kingdom in
July 1989. Nine days after arrival in the United
Period Kingdom she developed fever and malaise and was
Country Total
1969–77 1978–86 1987–95 1996–98 1999 treated on a ambulatory basis for gastroenteritis. Five
days later she developed jaundice and rigors and was
France 9 3 11 3 – 26
admitted to hospital for suspected hepatitis. She was
Belgium 0 9 7 1 – 17
deeply jaundiced, semiconscious, and had a tempera-
Switzerland 3 0 5 1 – 9
United Kingdom 4 3 0 7 – 14
ture of 40 oC. Examination of blood samples
Italy 0 1 3 0 – 4 revealed the presence of P. falciparum. She was treated
USA 0 0 3 1 – 4 with intravenous quinine and made a good recovery.
Luxembourg – – – 2 3 5 Her flight had stopped at Abidjan for an hour. She
Germany 0 0 2 1 1 4 had not left her seat but the doors had remained
Netherlands 0 2 0 0 2 open. The aircraft was sprayed before take off. It was
Spain 0 1 1 0 – 0 surmised that she had acquired malaria on the flight
Israel 0 0 0 1 – 1 between areas where the disease was not endemic
Australia 0 0 0 1 – 1 after being bitten by an infected anopheline mosquito
while the aircraft was standing at Abidjan, perhaps
Total 89
before spraying was carried out (46).

998 Bulletin of the World Health Organization, 2000, 78 (8)

 Why aircraft disinsection?

Two cases of malaria transmission occurred on introduced unless the species is detected in or
an Ethiopian Airlines flight from Heathrow to Rome immediately around an international airport or seaport.
(47, 48); both possibly resulted from the same Several species have been introduced into Pacific
infected mosquito biting twice. islands by aircraft, as evidenced by the finding in
The occurrence of a relatively large number of Guam of Anopheles barbirostris, a malaria vector in Viet
cases of airport malaria in Paris and Brussels reflects Nam and elsewhere in South-East Asia (59). Both
the large number of flights arriving from Central and Anopheles indefinitus and Culex fuscanus were introduced
West Africa. The majority of the cases were caused by into Guam and Saipan after the Second World War,
P. falciparum. At least five deaths have resulted; all probably by aircraft; A. indefinitus, a potent vector of
cases occurred among non-immune individuals, malaria, undoubtedly caused outbreaks of the disease
accounting for a relatively high mortality of 6%. on Guam in 1966 and 1969 (60, 61).
Long delays in achieving correct diagnosis frequently A. aegypti and Aedes albopictus have been
resulted in patients developing severe or complicated disseminated widely by international commerce,
malaria. In the five cases of airport malaria that mainly as eggs laid in used tyres (62), although
occurred in Switzerland in 1990 it was estimated that aircraft were probably responsible for the introduc-
it took as long as 7 days between the occurrence of tion of the species into Bermuda (27), Bolivia (63),
the first symptoms and correct diagnosis of malaria. and Trinidad and Tobago (64). Outbreaks of dengue
In at least one case, 31 days elapsed before a correct fever followed the introduction of A. albopictus into
diagnosis was made (49). the Solomon Islands and of Aedes vigilax into Fiji by
Isaäcson (11) believed that the published aircraft (65). A. albopictus was introduced into Europe
records of airport malaria represented only the more (66–68), Africa (69, 70) Brazil, and the USA (71, 72)
serious cases and that mild cases were either not as eggs in used tyre casings. Aedes atropalpus, an
considered worth publishing or that the patients American species, was introduced into Italy in the
recovered spontaneously and were not diagnosed as same way (73).
having malaria. It is possible that some cases of A. aegypti has spread to most of the countries of
serious malaria were not correctly diagnosed, leading South and Central America in which it previously
to the development of severe symptoms or occurred before attempts to eradicate it. Much of the
death (50). spread is probably attributable to the importation of
tyres or containers containing eggs of the species. In
Autochthonous transmission of malaria 1943, Bolivia was the first country in Latin America to
resulting from importation of infected vectors succeed in eradicating A. aegypti. In 1980 the species
A serious public health problem would arise if the was rediscovered in the city of Santa Cruz, both in the
introduction of infected vectors led to the transmis- vicinity of the airport and near the railway station (74).
sion of malaria by local vectors, particularly if It quickly spread, especially to the old section of the
transmission were renewed in an area where the city were 25% of the houses were infested. A. aegypti
disease had previously been endemic. There are was first found to be breeding in houses near Santa
several known instances in which malaria transmis- Cruz airport and it may have been brought in by
sion, albeit limited, has been reintroduced into aircraft from Cali, Colombia. It is now widely
countries from which it had been eradicated, e.g. distributed throughout Bolivia, as is dengue fever.
Germany (51), Italy (52), and the USA (53–56). In In South or Central America, except in Brazil, there
most instances an infected traveller was responsible, appear to have been virtually no searches for
although some outbreaks may have been caused by mosquito vectors on aircraft.
the importation of infected mosquitoes. The expanding distribution of A. albopictus has
not been associated with increased transmission of
arboviruses. The species was first found in Mexico in
Exotic vectors introduced by aircraft 1988 (75) and has since spread widely in this country;
A serious consequence of the importation of exotic by 1995, wild male and female A. albopictus were
mosquito species on aircraft is that they may establish found to be naturally infected with dengue virus (76).
themselves in the country into which they have been In 1994–95, both Potasi virus and Cache Valley virus
introduced. Although this would not be likely for were isolated from A. albopictus in Illinois, USA (77).
tropical mosquitoes arriving in temperate countries, The filariasis vector, Aedes polynesiensis, is now
introduced species have established themselves in established throughout French Polynesia and it is
several islands of the South Pacific. These established considered that air traffic was more important than
populations are a source of great concern to health maritime traffic in its dispersal (78). Many of the areas
authorities in Australia and New Zealand, and have led in which exotic mosquito species have been
to a requirement for efficient disinsection in aircraft established are islands; communication among the
arriving from areas from which vector mosquito widely separated Pacific islands is principally by air,
species may be introduced and established (57, 58). and their climates and ecologies are similar; a species
There are many instances of exotic vectors established on one island can therefore easily be
having been introduced into and established in spread and establish itself on another.
countries where they had not previously been found. Many species of mosquito have arrived on
It is difficult to verify how a mosquito may have been aircraft in countries where they are not indigenous; in

Bulletin of the World Health Organization, 2000, 78 (8) 999

Policy and Practice

most instances this has not led to their establishment. If an introduced vector mosquito species
It is unlikely that a tropical mosquito such as becomes established the cost of eliminating it may
A. gambiae would be successfully established in be very substantial. Malaria was eradicated from the
temperate parts of Europe or North America other Indian Ocean island of Reunion in 1949; however, in
than for the short period of the year when 1988, 155 cases of imported malaria were detected on
temperatures are suitable. Countries with warmer the island and 3 autochthonous cases occurred. The
climates are at far greater risk of invasion by cost of dealing with these introduced cases and the
A. gambiae, as has happened in Brazil and Egypt. ensuing local transmission was US$ 3 350 000 per
A. albopictus, on the other hand, has spread as far year (0.65% of the total health budget of the country),
north as Minnesota in the USA; the strains equivalent to US$ 6.00 per inhabitant per year; 77%
introduced into both North America and Brazil of the expenditure was on vector control (84).
originated from the northern range of the species and
they are well adapted to surviving both winter and
summer temperatures (79). The strain of A. albopictus Diagnosing imported malaria
established in Italy was probably imported from GA,
USA, in used tyre casings (68). In the event of global Cases of malaria diagnosed in persons who have
warming, vectors and the diseases they transmit neither recently returned from travel to an area of
could extend well beyond their present ranges (80). endemicity nor have a history of blood transfusions
The substantial number of mosquito species or intravenous drug abuse are usually categorized as
introduced into countries in which they were not airport malaria. Such cases have, for the most part,
previously present indicates that such introductions occurred in the vicinity of international airports at
are not unusual. Introductions may occur via all which flights carrying infected vectors have arrived.
means of international transport. Clearly, however, However, infected mosquitoes can be transported by
aircraft can transfer mosquitoes from one place to vehicle or wind for considerable distances from such
another relatively rapidly, thus increasing the chance airports. This undoubtedly happened in two cases of
of their survival in receptive areas. severe P. falciparum malaria at locations 10 km and
15 km from Gatwick Airport in 1983 (85) and in two
cases that occurred 7.5 km from Roissy Airport near
Paris (37). At such distances from an airport there
Economic cost of introduced vectors may be little suspicion that a patient’s illness is caused
and diseases by malaria. Consequent failures or delays in diagnosis
The introduction of malaria by whatever means into may result in inappropriate treatment or death.
an area where the disease is not endemic can be costly
in terms of treatment, hospitalization, epidemiologi-
cal investigations, lost working time, human suffering Discussion and conclusions
and even mortality. A study of 142 patients with There is abundant evidence that disease vectors,
introduced malaria in the USA showed that 110, 21 particularly mosquitoes, are being imported into
and 11, respectively, had mild, moderate and severe countries on aircraft, and there is evidence that this
infections; 2 deaths occurred. The mean cost of can and does lead to the transmission of disease. Many
treating a case was US$ 2743.51. For mild, moderate,
instances of airport malaria, several of them fatal, have
and severe cases, the median costs of treatment per
been recorded. Other cases have probably escaped
case were US$ 467.54, US$ 2701.16 and
diagnosis. Exotic vectors can and do establish
US$ 12 515.52, respectively. For 42 of the patients
themselves in areas where they were not previously
at least one element of therapy was inconsistent with
found and this can have serious consequences for the
recommendations current at the time of the study;
transmission of mosquito-borne disease.
the remainder were treated in what was considered an The costs of periodic treatments of aircraft
appropriate manner (81). with a residual spray and/or the application of a space
An analysis in France of the costs related to spray before take off from an area of high endemicity
33 patients with imported malaria, four of whom had are small in comparison with those associated with
to be hospitalized in an intensive care unit and one of the hospitalization, loss of working time, and
whom died during hospitalization; the cumulative
mortality that may be caused by mosquito vectors.
cost for these cases was at least FF 660 000
It is therefore important to prevent importa-
(ca. US$ 100 000) (82). This did not take into
tions of vectors on aircraft and the risk of introduced
account the costs of lost working time or other
disease transmission. Furthermore, appropriate mea-
expenses to the families of the patients nor the costs
sures would diminish the possibility of vectors
of death. In another study of malaria imported into
becoming established in countries where they have
France the overall cost of an uncomplicated case of been introduced and in which they have not
malaria, involving medical expenses and an average previously been present.
sick leave of two weeks, was estimated at 6400 euros That this can be achieved has been demon-
(ca. US$ 5000) for inpatients and 1400 euros strated in Paris. The largest number of cases of
(ca. US $ 1100) for outpatients (83). airport malaria in Europe has been in France

1000 Bulletin of the World Health Organization, 2000, 78 (8)

 Why aircraft disinsection?

(Table 2), primarily because of the many direct another safe and effective insecticide to passenger
flights arriving from areas of Africa where the cabins, coupled with the use of an aerosol spray
disease is endemic. In order to tackle this problem before boarding takes place, should provide a safe
the health authorities at Charles de Gaulle Airport and effective alternative to the methods now used or
concentrated their efforts on the flights at risk and recommended for aircraft leaving areas where
provided information and sensitization to the airline mosquito-borne diseases are endemic.
companies operating out of airports near which Passenger aircraft are regularly treated with
malaria was common. This resulted in 73% and 87% insecticides for the control of cockroaches and other
of the flights at risk being properly disinsected in insect pests in the galley and toilet areas. Some of the
1995 and 1996, respectively. Despite pyrethroid insecticides applied, both as residuals and ultra-low-
resistance in A. gambiae s.1 in West Africa, the volume aerosols, are the same as those used for
degree of efficacy of aircraft spraying with perme- controlling insects of public health importance. Pest
thrin aerosols is still acceptable (39). control treatments are carried out once a month or
The most recent WHO recommendations for immediately on the return of aircraft to their base if
aircraft disinsection were published in 1995 (5) and cockroaches or biting insects have been seen by crew
1998 (86). The following methods are in use. members. Most treatments are aimed at the control
. The blocks away method, as described above. of cockroach infestations, which are not rare in the
. Pre-flight and top-of-descent spraying are similar galley areas. When galleys and toilets are being treated
to the blocks away method, except that aircraft are with a residual application of permethrin, the
sprayed on the ground before passengers board. passenger cabins could be treated with the same
This allows overhead lockers, wardrobes and product for the control of mosquitoes. The treat-
toilets to be opened and properly sprayed with an ments could be applied by the same operators, and
insecticidal aerosol containing permethrin. the additional cost of treating passenger cabins would
Further in-flight treatment with a quick-acting not be excessive. Highly qualified and licensed pest
knockdown spray is applied. control operators in Europe and the Americas only
. Residual spraying involves the regular application use insecticides that have been approved for
of a residual insecticide to internal surfaces of application on aircraft. No information is available
aircraft except in food preparation areas, at on what pest control operations are carried out or
intervals based on the duration of effectiveness. what pesticides are used other than in Europe and
In addition, spot applications are made to surfaces North America.
that are frequently cleaned. Aircraft occasionally have to be fumigated by
highly trained, licensed operators if rodents are
The aerosol method may not be completely effective present or if there is a very severe cockroach
because it is often not carried out correctly. infestation. This requires the aircraft to be taken
Alternative methods or approaches have been out of service for 7–15 hours. The airport health
proposed that may be more effective than either authorities and aircraft management are informed of
the blocks away or the top-of-descent methods. any fumigations being carried out. n
Periodic residual applications of permethrin or

Résumé
Désinsectisation des aéronefs
On a souvent trouvé des insectes potentiellement alors une menace en raison du risque de transmission de
dangereux pour la santé publique, notamment des maladies.
moustiques, à bord d’aéronefs arrivant dans des pays où Pour éviter que des vecteurs d’espèces exotiques
ces insectes n’existent pas. Les nombreux cas de ne soient fortuitement aéroportés, l’OMS, en concerta-
« paludisme aéroportuaire » signalés dans des pays tion avec ses centres collaborateurs dans plusieurs pays,
non impaludés sont la preuve indirecte de ce type de a mis au point des méthodes et des matériels pour la
transfert. Les cas surviennent lorsque des anophèles désinsectisation des aéronefs en provenance de pays où
parasités s’introduisent à bord des appareils dans les les maladies transmises par les moustiques sont
pays tropicaux d’endémie et s’en échappent au point endémiques. Les essais sur le terrain ont montré que
d’arrivée. Il est probable que des moustiques contaminés ces méthodes étaient efficaces. Les insecticides recom-
par des arbovirus comme celui de la dengue ont été mandés (perméthrine et d-phénothrine) sont sans danger
aéroportés de la même façon. Dans les pays non pour les passagers et pour l’équipage de l’appareil. La
impaludés, le diagnostic est souvent tardif, et le malade désinsectisation des aéronefs en provenance de pays
décède parfois, car les médecins locaux ne soupçonnent d’endémie et l’intensification de la lutte antivectorielle
pas le paludisme chez quelqu’un qui n’a pas séjourné dans les aéroports internationaux et les zones environ-
sous les tropiques. Il arrive aussi que des espèces nantes réduiront le risque d’importation de vecteurs et de
exotiques de moustiques forment des populations dans transmission des maladies dont ils sont porteurs.
des pays où elles ont été importées. Elles constituent

Bulletin of the World Health Organization, 2000, 78 (8) 1001

Policy and Practice

Resumen
Desinsectación de aviones
Son numerosos los casos de insectos, en particular llegado y representan un peligro a causa de su habilidad
mosquitos, que han sido transportados a bordo de para transmitir enfermedades.
aviones hasta paı́ses que no constituyen su hábitat Para prevenir el transporte de especies exóticas de
natural, lo que puede llegar a representar una grave mosquitos vectores a bordo de aviones, la OMS, junto con
amenaza para la salud pública. Los numerosos casos de varios de sus centros colaboradores en diferentes paı́ses,
«paludismo de aeropuerto» registrados en paı́ses sin ha desarrollado métodos y productos para desinsectar los
paludismo endémico evidencian indirectamente ese aparatos procedentes de paı́ses con endemicidad de
fenómeno. Estos casos ocurren cuando mosquitos enfermedades transmitidas por mosquitos. Los ensayos
anofelinos infectados por el paludismo son transporta- sobre el terreno han demostrado la eficacia de esos
dos inadvertidamente en aviones procedentes de paı́ses procedimientos de desinsectación. Los insecticidas
tropicales de endemicidad palúdica y logran huir del recomendados para la desinsectación (permetrina y
aparato. Es probable que también hayan viajado ası́ d-fenotrina) no suponen ningún peligro para los pasajeros
mosquitos infectados por arbovirus, como el virus del ni para la tripulación. La desinsectación de los aviones
dengue. A menudo se tarda en diagnosticar el paludismo procedentes de paı́ses con endemicidad de enfermedades
en los paı́ses no endémicos, a veces con resultados transmitidas por mosquitos y la mejora del control de las
mortales, debido a que en esas circunstancias los poblaciones de vectores tanto en los aeropuertos
médicos no suelen pensar en la enfermedad cuando el internacionales como en sus alrededores disminuirán la
paciente no ha viajado a regiones tropicales. También se amenaza de introducción de vectores y de las enferme-
han dado casos de especies exóticas de mosquitos que dades de que pueden ser portadores.
han fundado poblaciones en los paı́ses a los que han

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