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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 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 areaswhere vector-borne diseases are endemic. It iscommon for an arriving aircraft to be sprayed by Vectors introduced by aircraft 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) # World Health Organization 2000 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 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: 10species 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 vectorsof yellow fever from being imported on aircraft Consequences of the importation arriving in the country. The recommendations of mosquito vectors 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).
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 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 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 in the USA and Italy.
Honolulu. A total of 81 mosquitoes were recoveredin 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-weekperiod in 1994 when six cases of airport malaria Bulletin of the World Health Organization, 2000, 78 (8) Why aircraft disinsection? Table 1. Reports of mosquitoes in aircraft Culex quinguefasciatus Anopheles gambiae s. l.
Culex quinquefasciatus Anopheles. pseudopunctipennisCuliseta incidens Anopheles gambiae Anopheles gambiae s.l.
Anopheles. gambiae s.l.
Anopheles grabhami Anopheles. vestipennis HoustonNew YorkMiami Anopheles superpictus Culex annulirostris Culex annulirostris 220 mosquitos including 6 species not found in the USA 52 live and 482 dead mosquitos Live larvae of Aedes aegypti and Culex cinerellus including 2 species from Europe Culex bitaenriorhynchus Culex quinquefasciatus Anopheles subpictusCulex gelidusCulex sitiens group Anopheles sundaicus Anopheles subpictus including 686 mosquitoes 3 species of mosquito not 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) 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 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 airport malaria have been reported.
were infected during a stop in Coˆte 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 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 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 inJuly 1989. Nine days after arrival in the United Kingdom she developed fever and malaise and was 1969–77 1978–86 1987–95 1996–98 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) 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 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 diagnosis was made (49).
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 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 spread is probably attributable to the importation oftyres 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 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 mosquito vectors on aircraft.
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 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) 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 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 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 10km and15 km from Gatwick Airport in 1983 (85) and in twocases that occurred 7.5 km from Roissy Airport near Economic cost of introduced vectors 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 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$ 4 67.54 , U S$ 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 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 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) Policy and Practice 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 para transmitir enfermedades.
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 dades de que pueden ser portadores.
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.
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Microsoft word - treatment of patients who decline transfusion of blood components and or blood products.doc

Treatment of Patients who decline transfusion of Blood Components and/or Blood Products November 2008 Page 1 of 23Page 1 of 23 Title: Treatment of Patients who decline transfusion of Blood Components and/or Blood Products Reference Number: Corp09/003 Implementation Date: This policy will be implemented after being signed off by the Chief Executive Review date: This policy will be reviewed one year after the effective date and thereafter every two years Responsible Officer: The officer responsible for reviewing this policy is the Haemovigilance Practitioner on behalf of the Hospital Transfusion Committee This policy has been developed within the context of Equality and Human Rights statutory obligations and requirements.


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