Si está buscando comprar medicamentos en línea en España, es importante elegir una farmacia en línea de confianza y segura para garantizar que los medicamentos que reciba sean auténticos y de alta calidad. En comprar-farmacia.es, ofrecemos una amplia selección de medicamentos, incluido Cialis para la disfunción eréctil (DE), y trabajamos con farmacias acreditadas para garantizar la calidad y la autenticidad de nuestros productos.
Visite nuestro sitio web en comprar-farmacia.es para obtener más información sobre nuestros productos y servicios. Nuestro equipo de atención al cliente está disponible para ayudarlo en todo momento y garantizar una experiencia de compra en línea segura y satisfactoria.
Malariaaricraftdisinfection.pdf
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 tropicalcountries where vector-borne diseases are endemic. Surveys at international airports have found many instances oflive insects, particularly mosquitoes, aboard aircraft arriving from countries where malaria and arboviruses areendemic. In some instances mosquito species have been established in countries in which they have not previouslybeen reported. A serious consequence of the transport of infected mosquitoes aboard aircraft has been thenumerous cases of ‘‘airport malaria’’ reported from Europe, North America and elsewhere. There is an importanton-going need for the disinsection of aircraft coming from airports in tropical disease endemic areas intononendemic areas. The methods and materials available for use in aircraft disinsection and the WHOrecommendations for their use are described.
Keywords: mosquito control, methods; malaria, transmission; aircraft; insect vectors; insecticides, administrationand dosage.
Voir page 1001 le re´sume´ en franc¸ais. En la pa´gina 1002 figura un resumen en espan˜ol.
application of pyrethroid aerosol sprays for thedisinsection 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
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
racks. There is a need to improve disinsection
Many countries insist that arriving aircraft be
disinsected, especially if they have come from areaswhere vector-borne diseases are endemic. It iscommon for an arriving aircraft to be sprayed by
the health services of the country of destination ifthere 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
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
1930from Senegal by a French naval vessel, althoughthe possibility that an aircraft was responsible cannotbe 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.
transmission of malaria and a sharp increase in
3 Communicable Diseases, World Health Organization, Geneva,
mortality from the disease in the country. The
importation and subsequent establishment of this
Bulletin of the World Health Organization, 2000, 78 (8)
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.
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
achieved, therefore, aircraft arriving in Brazil from
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: 10species of insects were discovered on
placed on a US military aircraft. The aircraft had left
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
may be attributable to this source (30).
In the 1930s the Government of India drew up
recommendations for preventing mosquito vectorsof yellow fever from being imported on aircraft
arriving in the country. The recommendations
included measures to disinsect aircraft by sprayingthem 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).
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
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
on aircraft, they are not included here.
– introduced mosquitoes may become established
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
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 210aircraft at New Orleans airport,
Brazil and Egypt and recently with Aedes albopictus
1183 at Miami international airport, and 89 in
Honolulu. A total of 81 mosquitoes were recoveredin New Orleans, 32 in Honolulu, and 100 in Miami. The
species found in Miami and Honolulu were generally
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
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-weekperiod in 1994 when six cases of airport malaria
Bulletin of the World Health Organization, 2000, 78 (8)
Table 1. Reports of mosquitoes in aircraft
Anopheles. pseudopunctipennisCuliseta incidens
Anopheles subpictusCulex gelidusCulex sitiens group
including Aedes aegypti andAnopheles 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)
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
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
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
two weeks after the flight and the patients were
treated in hospitals in Sa˜o Paulo. No other passengers
airport malaria have been prepared (34–39). Table 2
among the 360on 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
were infected during a stop in Coˆte d’Ivoire. During
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
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 30May 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
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 inJuly 1989. Nine days after arrival in the United
Kingdom she developed fever and malaise and was
treated on a ambulatory basis for gastroenteritis. Fivedays later she developed jaundice and rigors and was
admitted to hospital for suspected hepatitis. She was
deeply jaundiced, semiconscious, and had a tempera-
ture of 40 oC. Examination of blood samples
revealed the presence of P. falciparum. She was treated
with intravenous quinine and made a good recovery.
Her flight had stopped at Abidjan for an hour. She
had not left her seat but the doors had remained
open. The aircraft was sprayed before take off. It was
surmised that she had acquired malaria on the flight
between areas where the disease was not endemic
after being bitten by an infected anopheline mosquitowhile the aircraft was standing at Abidjan, perhaps
before spraying was carried out (46).
Bulletin of the World Health Organization, 2000, 78 (8)
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
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%.
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 1990it 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
the Solomon Islands and of Aedes vigilax into Fiji by
Isaa¨cson (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
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
occurred before attempts to eradicate it. Much of the
spread is probably attributable to the importation oftyres or containers containing eggs of the species. In
1943, Bolivia was the first country in Latin America to
resulting from importation of infected vectors
succeed in eradicating A. aegypti. In 1980the 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
the importation of infected mosquitoes.
The expanding distribution of A. albopictus has
not been associated with increased transmission ofarboviruses. The species was first found in Mexico in
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.
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)
most instances this has not led to their establishment.
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 350000 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 andthey are well adapted to surviving both winter andsummer temperatures (79). The strain of A. albopictus
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 10km and15 km from Gatwick Airport in 1983 (85) and in twocases that occurred 7.5 km from Roissy Airport near
Paris (37). At such distances from an airport theremay be little suspicion that a patient’s illness is caused
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 costlyin terms of treatment, hospitalization, epidemiologi-cal investigations, lost working time, human suffering
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
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
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
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
Bulletin of the World Health Organization, 2000, 78 (8)
(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
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
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
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.
Periodic residual applications of permethrin or
De´sinsectisation des ae´ronefsOn a souvent trouve´ des insectes potentiellement
alors une menace en raison du risque de transmission de
dangereux pour la sante´ publique, notamment des
moustiques, a` bord d’ae´ronefs arrivant dans des pays ou`
Pour e´viter que des vecteurs d’espe`ces exotiques
ces insectes n’existent pas. Les nombreux cas de
ne soient fortuitement ae´roporte´s, l’OMS, en concerta-
« paludisme ae´roportuaire » signale´s dans des pays
tion avec ses centres collaborateurs dans plusieurs pays,
non impalude´s sont la preuve indirecte de ce type de
a mis au point des me´thodes et des mate´riels pour la
transfert. Les cas surviennent lorsque des anophe`les
de´sinsectisation des ae´ronefs en provenance de pays ou`
parasite´s s’introduisent a` bord des appareils dans les
les maladies transmises par les moustiques sont
pays tropicaux d’ende´mie et s’en e´chappent au point
ende´miques. Les essais sur le terrain ont montre´ que
d’arrive´e. Il est probable que des moustiques contamine´s
ces me´thodes e´taient efficaces. Les insecticides recom-
par des arbovirus comme celui de la dengue ont e´te´
mande´s (perme´thrine et d-phe´nothrine) sont sans danger
ae´roporte´s de la meˆme fac¸on. Dans les pays non
pour les passagers et pour l’e´quipage de l’appareil. La
impalude´s, le diagnostic est souvent tardif, et le malade
de´sinsectisation des ae´ronefs en provenance de pays
de´ce`de parfois, car les me´decins locaux ne soupc¸onnent
d’ende´mie et l’intensification de la lutte antivectorielle
pas le paludisme chez quelqu’un qui n’a pas se´journe´
dans les ae´roports internationaux et les zones environ-
sous les tropiques. Il arrive aussi que des espe`ces
nantes re´duiront le risque d’importation de vecteurs et de
exotiques de moustiques forment des populations dans
transmission des maladies dont ils sont porteurs.
des pays ou` elles ont e´te´ importe´es. Elles constituent
Bulletin of the World Health Organization, 2000, 78 (8)
Desinsectacio´n de avionesSon 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
aviones hasta paı´ses que no constituyen su ha´bitat
Para prevenir el transporte de especies exo´ticas de
natural, lo que puede llegar a representar una grave
mosquitos vectores a bordo de aviones, la OMS, junto con
amenaza para la salud pu´blica. Los numerosos casos de
varios de sus centros colaboradores en diferentes paı´ses,
«paludismo de aeropuerto» registrados en paı´ses sin
ha desarrollado me´todos y productos para desinsectar los
paludismo ende´mico evidencian indirectamente ese
aparatos procedentes de paı´ses con endemicidad de
feno´meno. 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 paı´ses
procedimientos de desinsectacio´n. Los insecticidas
tropicales de endemicidad palu´dica y logran huir del
recomendados para la desinsectacio´n (permetrina y
aparato. Es probable que tambie´n hayan viajado ası´
d-fenotrina) no suponen ningu´n peligro para los pasajeros
mosquitos infectados por arbovirus, como el virus del
ni para la tripulacio´n. La desinsectacio´n de los aviones
dengue. A menudo se tarda en diagnosticar el paludismo
procedentes de paı´ses con endemicidad de enfermedades
en los paı´ses no ende´micos, 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
me´dicos no suelen pensar en la enfermedad cuando el
internacionales como en sus alrededores disminuira´n la
paciente no ha viajado a regiones tropicales. Tambie´n se
amenaza de introduccio´n de vectores y de las enferme-
han dado casos de especies exo´ticas de mosquitos que
han fundado poblaciones en los paı´ses a los que han
1. Griffitts THD, Griffitts JJ. Mosquitoes transported by airplanes.
13. Sice A, Sautet J, Ethes Y. [One of the most significant vectors
Staining methods used in determining their importation.
of malaria in Africa, Anopheles gambiae Giles, 1903. Can it
United States Public Health Service Public Health Report, 1931,
be transported into France on aircraft?] Revue Me´decine Hygie`ne
Tropicale, 1939, 31: 137 (in French).
2. Sinton JA. Suggestions with regard to the prevention
14. Russell RC et al. Mosquito and other insect introductions to
of the spread of yellow fever to India by air traffic with special
Australia aboard international aircraft, and the monitoring of
reference to insect transmission. Delhi, Government of India,
disinsection procedures. In: Laird M, ed. Commerce and the spread
1938. (Health Bulletin No. 20, 2nd edit.).
of pests and disease vectors. New York, Praeger, 1984: 109–141.
3. Sullivan WN et al. Studies on aircraft disinsection at ‘‘blocks
15. de Mendonc¸a FC, Cerqueira N. Insects and other arthropods
away’’ in tropical areas. Bulletin of the World Health Organization,
captured by the Brazilian Sanitary Service on landplanes
or seaplanes arriving in Brazil between January 1942 and
4. Sullivan WN et al. Worldwide studies on aircraft disinsection
December 1945. Boletı´n de la Oficina Sanitaria Panamericana,
at ‘‘blocks away’’. Bulletin of the World Health Organization,
16. Hughes JH. Mosquito interceptions and related problems in
5. Report on the WHO Informal Consultation on Aircraft Disinsection,
aerial traffic arriving in the United States. Mosquito News, 1961,
Geneva, 6–10 November 1995. Geneva, World Health
Organization, 1995 (unpublished document WHO/PCS/ 95.51).
17. Laird M. Insects collected from aircraft arriving in New Zealand
6. Russell RC, Paton R. In-flight disinsection as an efficacious
from abroad. Wellington; Zoology Publications,Victoria University
procedure for preventing international transport of insects
of public health importance. Bulletin of the World Health
18. Laird M. Insects collected from aircraft arriving in New Zealand
during 1951. Journal of Aviation Medicine, 1952, 23: 280–285.
7. Goh KT, Ng SK, Kumarapathy S. Disease-bearing insects
19. Smith A, Carter I.D, Laird M. International transportation
brought in by international aircraft into Singapore. Southeast
of mosquitoes of public health importance. In: Laird M, ed.
Asian Journal of Tropical Medicine and Public Health, 1985,
Commerce and the spread of pests and disease vectors. New York,
8. WHO Recommendations on the disinsecting of aircraft. Weekly
20. Evans BR, Joyce CR, Porter JE. Mosquitoes and other
Epidemiological Record 1985, 60 (7): 45–47.
arthropods found in baggage compartments of international
9. Soper FL, Wilson DB. Anopheles gambiae in Brazil 1930
aircraft. Mosquito News, 1963, 23 (1): 9–12.
to 1940. New York, The Rockefeller Foundation, 1943.
21. Basio RG, Prudencio M, Chanco IE. Notes on the aerial
10. Kisaluik M. Plant quarantine inspection of the dirigible
transportation of mosquitoes and other insects at the Manila
‘‘Graf Zeppelin’’. Journal of Economic Entomology, 1929,
International Airport. Philippine Entomologist, 1970, 1: 407–408.
22. Pippin WF, Thompson S, Wilson R. The interception of living
11. Highton RB, Van Someren ECC. The transportation
larvae of Aedes aegypti and Culex cinerellus in aircraft. Mosquito
of mosquitoes between international airports. Bulletin of the
World Health Organization, 1970, 42: 334–335.
23. Pillai JS, Ramalingan S. Recent introduction of some medically
12. Pemberton CE. Insects carried in transpacific airplanes.
important Diptera in the Northwest, Central and South Pacific
Hawaii Plant Record, 1944, 48: 183–186.
(including New Zealand). In: Laird M, ed. Commerce and thespread of pests and disease vectors. New York, Praeger,1984: 81–101.
Bulletin of the World Health Organization, 2000, 78 (8)
24. Ogata K et al. Survey of the medically important insects carried
50. Giacomini T et al. Pitfalls in the diagnosis of airport malaria,
by international aircraft to Tokyo International Airport. Japanese
seven cases observed in the Paris area in 1994. Scandinavian
Journal of Sanitary Zoology, 1974, 25: 177–84.
Journal of Infectious Diseases, 1997, 29: 433–435.
25. Russell, R.C. et al. Mosquitoes and other insect introductions
51. Mantel CF et al. Plasmodium falciparum malaria acquired
to Australia aboard international aircraft and the monitoring
in Berlin, Germany. Lancet, 1995, 346: 320–321.
of disinsection measures. In: Laird M. ed. Commerce and the
52. Baldari M et al. Malaria in Maremma, Italy. Lancet, 1998,
spread of pests and disease vectors. New York, Prager, 1984:
53. Mosquito transmitted malaria — Michigan, 1995. Morbidity
26. Takahashi S. Survey on accidental introductions of insects
and Mortality Weekly Report, 1996, 45 (19): 398–400.
entering Japan via aircraft. In: Laird M, ed. Commerce and the
54. Probable locally acquired mosquito-transmitted Plasmodium vivax
spread of pests and disease vectors. New York, Praeger,
infection – Georgia, 1996. Morbidity and Mortality Weekly
27. Mayers P. Recent introduction of Aedes aegypti in Bermuda.
55. Iftikhar SA, Roistacher K. Indigenous Plasmodium falciparum
Mosquito News, 1983, 43 (3): 361–362.
malaria in Queens. New York Archives of Internal Medicine, 1995,
28. LeMaitre A, Chadee DD. Arthropods collected from aircraft
at Piarco International airport, Trinidad, West Indies. Mosquito
56. Maldonaldo Y A et al. Transmission of Plasmodium vivax
malaria in San Diego County, California, 1986. American
29. Giacomini T et al. [Study on six cases of malaria contracted near
Journal of Tropical Medicine and Hygiene, 1990, 42 (1): 3–9.
Roissy-Charles de Gaulle in 1994. Preventive measures necessary
57. Hyde NH. Aircraft disinsection in New Zealand. Surveillance
in airports.] Bulletin de l’Acade´mie Nationale de Me´decine
{Wellington}, 1989, 16 (4): 10–11.
(France), 1995, 179 (2): 335–353 (in French).
58. Laird M. Aircraft disinsection review in New Zealand. Travel
30. Meyers R, Smith EC. Aircraft pest control: the plane truth.
Medicine International, 1989, 2: 73–75.
Pest Management, March 1992: 6–15.
59. Ward RA, Jordan B. Anopheles barbirostris — confirmation
31. Jelinek T, Dobler G, Nothdurft HD. Evidence of dengue
of introduction on the Island of Guam. Mosquito News, 1979,
virus infection in a German couple returning from Hawaii.
Journal of Travel Medicine, 1998, 5 (1): 44–45.
60. Pratt HD, Siren N. Anopheles indefinitus and Culex fuscanus
32. Kiyamov FA et al. [Cases of cutaneous leishmaniasis occurring
in Saipan. Mosquito News, 1971, 31 (1): 114–115.
as a result of importation of sandflies by various means
61. Nowell WR. Vector introduction and malaria infection on Guam.
of transport.] Medicinskaja Parasitologija, 1990, 6: 40–41
Journal of the American Mosquito Control Association, 1987,
33. Giacomini T. [Malaria in airports and their neighborhoods.]
62. Reiter P. Aedes albopictus and the world trade in used tires,
Revue du Praticien, 1998, 48 (3): 264–267 (in French).
1988–1995: the shape of things to come? Journal of the American
34. Isaacson M. Airport malaria: a review. Bulletin of the World
Mosquito Control Association, 1998, 14 (1): 83–94.
Health Organization, 1989, 67: 737–743.
63. Aedes aegypti situation in Bolivia, 1980. Pan American Health
35. Giacomini T, Brumpt LC. [Passive dissemination of Anopheles
Organization Epidemiological Bulletin, 1980, 1 (3): 9–10.
by means of transport; its role in the transmission of malaria
64. Chadee DD et al. Surveillance for Aedes aegypti in Tobago,
(historical review).] Revue Histoire Pharmacie, 1989, 36 (281/
West Indies (1980–1982). Mosquito News, 1984, 44 (4):
36. Signorelli C, Messineo A. Airport malaria. Lancet, 1990,
65. Self LS. Vector introductions associated with disease outbreaks
in the Western Pacific Region. Dengue Newsletter, 1984,
37. Giacomini T, Mathieu F. [Airport malaria: a public health
problem]. Bulletin E´pide´miologigue Hebdomaire, 1996,
66. Adhami J, Murati N. [Presence of the mosquito Aedes albopictus
in Albania]. Revista Mjekesore, 1987, 1: 13–16 (in French).
38. Danis M et al. [Autochthonous and introduced malaria in
67. Sabatini A et al. [Aedes albopictus in Italy and possible spread
Europe]. Me´decine et Maladies Infectieuses, 1996, 26: 393–396
of the species in the Mediterranean area]. Parassitologia, 1990,
39. Guillet P et al. Origin and prevention of airport malaria
68. Pozza GD, Majori G. First record of Aedes albopictus
in France. Tropical Medicine and International Health, 1998,
establishment in Italy. Journal of the American Mosquito
Control Association, 1992, 8 (3): 1–3.
40. Hemmer R. Airport malaria in Luxembourg. Eurosurveillance,
69. Cornel A, Hunt RH. Aedes albopictus in Africa? First records
of live specimens in imported tires in Cape Town. Journal of the
41. Majori G et al. Two imported malaria cases from Switzerland.
American Mosquito Control Association, 1991, 7 (1): 107–108.
Tropical Medicine and Parasitology, 1990, 41 (4): 439–440.
70. Savage M et al. First record of breeding populations of
42. Castelli F et al. Baggage malaria in Italy: cryptic malaria
Aedes albopictus in continental Africa: implications for arboviral
explained? Transactions of the Royal Society of Tropical
transmission. Journal of the American Mosquito Control
Medicine and Hygiene, 1993, 87: 394.
Association, 1992, 8 (1): 101–103.
43. Van den Ende J et al. A cluster of airport malaria in Belgium
71. Aedes albopictus introduction — Texas. Morbidity and Mortality
in 1995. Acta Clinica Belge, 1998, 53 (4): 259–263.
Weekly Report, 1986, 35 (9): 141–142.
44. Csillag C. Mosquitoes stow away on aircraft. Lancet, 1996,
72. Sprenger D, Wuithiranyagool T. The discovery and
distribution of Aedes albopictus in Harris County Texas. Journal
45. Oswald G, Lawrence EP. Runway malaria. Lancet, 1990,
of the American Mosquito Control Association, 1986,
46. Conlun CP et al. Runway malaria. Lancet, 1990, 335: 472–473.
73. Romi R, Sabatinelli G, Pontuale G. [Aedes atropalpus, a new
47. Smeaton M, Slater PJ, Robson P. Malaria from a ‘‘commuter
mosquito imported into Italy with consignments of used tyres.]
mosquito’’. Lancet, 1984, 1: 845–846.
Parasite, 1997, 4: 343–349 (in French).
48. Warhurst D, Curtis CF, White GB. A commuter mosquito’s
74. Surveillance and control of Aedes aegypti in Bolivia. Pan American
Health Organization Epidemiological Bulletin, 1982, 3 (2): 7.
49. Bouvier M et al. [Airport-malaria: mini-epidemic in Switzerland.]
Schweizerische Medizinsche Wochenshrift, 1990, 120 (34):1217–1222 (in German).
Bulletin of the World Health Organization, 2000, 78 (8)
75. Martı´nez-Mun˜oz JP, Ferna´sez-Salas I. Larval ecology of
80. Shope R. Global climate change and infectious diseases.
the exotic dengue vector Aedes albopictus in two states of
Environmental Health Perspectives, 1991, 96: 171–174.
northeastern Mexico. Journal of the American Mosquito Control
81. Bloland P et al. Cost and appropriateness of treating
Association, 1995, 11 (3): 343–344.
Plasmodium falciparum infections in the United States. Journal
76. Iban˜ez-Bernal S et al. First record in America of Aedes
of Travel Medicine, 1995, 2 (1): 16–21.
albopictus naturally infected with dengue virus during the 1995
82. Pugliese P et al. [Malaria attacks after returning from endemic
outbreak at Reynosa, Mexico. Medical and Veterinary
areas. Failure or inadequate chemoprophylaxis?] Presse Me´dicale,
Entomology, 1997, 11 (4): 305–309.
1997, 26 (29): 1379–1380 (in French).
77. Mitchell CJ et al. Isolation of La Crosse, Cache Valley, and
83. Legros F et al. Imported malaria in continental France in 1996.
Potosi viruses from Aedes mosquitoes (Diptera: Culicidae)
Eurosurveillance, 1998, 3 (4): 37–38.
collected at used-tire sites in Illinois during 1994–1995. Journal
84. Denys JC, Isautier H. [Maintaining the eradication of malaria
of Medical Entomology, 1998, 35 (4): 573–577.
in the island of Reunion (1979–1990)]. Annales de la Socie´te´
78. Failloux AB et al. Genetic differentiation associated with
Belge de Me´decine Tropicale, 1991, 71: 209–219.
commercial traffic in the Polynesian mosquito Aedes polynesiensis
85. Whitfield D et al. Two cases of falciparum malaria acquired
Marks 1951. Biological Journal of the Linnean Society, 1997,
in Britain. British Medical Journal, 1984, 289: 1607–1609.
86. WHO recommendations on the disinsecting of aircraft. Weekly
79. Kambhampati S, Black WC, Rai KS. Geographic origin of
Epidemiological Record, 1998, 73 (15): 109–111.
the US and Brazilian Aedes albopictus inferred from allozymeanalysis. Heredity, 1991, 67 (1): 85–93.
Bulletin of the World Health Organization, 2000, 78 (8)
Labour Broker, Payroll Administrator & Nursing Agency P O Box 74028, Lynnwood Ridge, 0040 Tel (012) 804 8039 Fax (012) 804 4862 POLICY: PROCEDURES TO FOLLOW IN EVENT OF HEALTH CARE WORKERS EXPOSED TO BLOOD & BLOOD STAINED BODY FLUIDS Background: The Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) are serious public health threats and Skills Hire is c