In-flight spraying in aircrafts: determination of the exposure scenario

Aircraft disinsection: what is the usefulness as a public health measure?

RATIONALE FOR REVIEW

Insecticide treatments in aircraft (termed 'aircraft disinsection') aim to support the containment of potentially disease-carrying vector insects. The introduction of non-endemic mosquito species is of concern as some mosquitoes can act as vectors of many serious human diseases. Expansion of vectors to previously non-endemic regions, extended flight networks and mosquito resistance to insecticides pose challenges to contemporary vector-control approaches. Despite established efficacy of aircraft disinsection in trials, there is increasing concern over its effectiveness and feasibility in flight operations, and its usefulness as a public health measure.

KEY FINDINGS

We explored the literature on disinsection through a narrative approach to obtain a pragmatic assessment of existing and future implementation challenges. We describe the shortcomings that hinder evaluation of the success of aircraft disinsection. These shortcomings include operational constraints that may impact effective treatment outcomes, lack of longitudinal data on pesticide exposure scenarios, lack of compliance mechanisms, pesticide resistance in mosquitoes, and limited evidence of the extent and type of mosquito species potentially transported via aircraft.

CONCLUSIONS AND RECOMMENDATIONS

Concerns about the introduction of non-endemic mosquito vectors reinforce the need for effective preventive measures. Import of disease vectors is likely to occur in the future under changing environmental and operational conditions. Optimal impact from disinsection requires appropriate deployment, commitment and use. The current system of evaluation is inadequate for producing the evidence needed for informed policy decisions. While utilizing the results of research into environmentally sustainable vector-control methods for use in aircraft, future approaches to aircraft disinsection require improved evidence of anticipated benefits and harms, reliable monitoring data on insecticide resistance, and must be supported by strong vector control at airports.

The safety and applicability of synthetic pyrethroid insecticides for aircraft disinsection: A systematic review

BACKGROUND

Air travel contributes to the global spread of vectors and vector-borne infections. Although WHO provides guidance on methods for disinsection of aircraft, there is currently no harmonized or standardized decision-making process to decide when disinsection of an aircraft should be conducted. It is however compulsory for flights arriving in certain countries. Concerns have been expressed about the usefulness of disinsection for preventing the international spread of vectors and vector-borne diseases via air travel and possible toxicity for passengers and flight crew.

METHODS

We performed a systematic literature review using the databases PubMed, Embase, Medline, Scopus and CINAHL to evaluate all research findings about the applicability and safety of chemical-based, aircraft disinsection. Official reports from the WHO were also screened. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and meta-analysis (PRISMA) statement. The literature search strategy included "disinsection, airplane/plane/aviation/aircraft" and several other search items including d-phenothrin, permethrin, insecticide. Papers in English, French and German were reviewed. Reports of adverse events attributed to the disinsection of aircraft were also searched. AMP and PS screened all papers of relevance and agreed on a final selection.

RESULTS

Our search resulted in 440 papers of possible relevance. After screening, we included a total of 25 papers in this systematic review. Ten papers reported possible human toxicity and 17 papers addressed the applicability of disinsection and 2 papers addressed both topics. Chemical disinsection at recommended insecticide concentrations was found to be highly effective against a broad range of arthropods. Three papers reported passenger or crew illness possibly associated with insecticide spraying in passenger cabins - one describing a single passenger, the other two papers describing occupational illness of 12 and 33 aircrew members respectively, possibly due to aircraft disinsection. Another paper evaluating exposure of flight attendants to permethrin found higher levels of urinary metabolites in those working in planes that had recently been sprayed but this could not be linked to adverse health outcomes.

CONCLUSION

Our analysis confirmed that disease vectors are carried on international flights and can pose a threat particularly to island populations and certain airport hub areas. Disinsection with permethrin or d-phenothrin was shown to be highly effective against vectors. Despite several hundred million passenger and crew exposures to chemical disinsection, very few proven cases of toxicity have been reported. There is limited evidence linking exposure to insecticide spraying with negative health impact.

Human exposure to conventional and nanoparticle--containing sprays-a critical review

The release of pesticides from conventional spray products has been investigated in depth, and suitable analytical techniques detecting the mass of the released substances are available. In contrast, nanoparticle-containing sprays are less studied, although they are perceived as critical for consumers because inhalation exposure can occur to potentially toxic nanoparticles. A few recent studies presented analytical concepts for exposure experiments and generated data for exposure assessment. This study attempts to review and compare the current approaches to characterize nanosprays and to identify challenges for future research. Furthermore, experimental setups used for exposure assessment from conventional sprays are reviewed and compared to setups used for nanoparticle-containing sprays. National and international norms dealing with nanoparticle characterization, spray characterization and exposure are inspected with regard to their usefulness for standardizing exposure assessment. Different approaches in the field of exposure modeling are reviewed and compared. The conclusion is that due to largely varying experimental setups to date exposure values for nanosprays are difficult to compare. All studies are only conducted with a limited set of sprays, and no systematic evaluation of the study conditions is available. A suitable set of experimental setups as well as minimum reporting requirements should be agreed upon to enable the systematic evaluation of consumer sprays in the future. Indispensable features of such experimental setups are developed in this review.

Modeling flight attendants' exposures to pesticide in disinsected aircraft cabins

Aircraft cabin disinsection is required by some countries to kill insects that may pose risks to public health and native ecological systems. A probabilistic model has been developed by considering the microenvironmental dynamics of the pesticide in conjunction with the activity patterns of flight attendants, to assess their exposures and risks to pesticide in disinsected aircraft cabins under three scenarios of pesticide application. Main processes considered in the model are microenvironmental transport and deposition, volatilization, and transfer of pesticide when passengers and flight attendants come in contact with the cabin surfaces. The simulated pesticide airborne mass concentration and surface mass loadings captured measured ranges reported in the literature. The medians (means ± standard devitions) of daily total exposure intakes were 0.24 (3.8 ± 10.0), 1.4 (4.2 ± 5.7), and 0.15 (2.1 ± 3.2) μg day(-1) kg(-1) of body weight for scenarios of residual application, preflight, and top-of-descent spraying, respectively. Exposure estimates were sensitive to parameters corresponding to pesticide deposition, body surface area and weight, surface-to-body transfer efficiencies, and efficiency of adherence to skin. Preflight spray posed 2.0 and 3.1 times higher pesticide exposure risk levels for flight attendants in disinsected aircraft cabins than top-of-descent spray and residual application, respectively.

Studying permethrin exposure in flight attendants using a physiologically based pharmacokinetic model

Assessment of potential health risks to flight attendants from exposure to pyrethroid insecticides, used for aircraft disinsection, is limited because of (a) lack of information on exposures to these insecticides, and (b) lack of tools for linking these exposures to biomarker data. We developed and evaluated a physiologically based pharmacokinetic (PBPK) model to assess the exposure of flight attendants to the pyrethroid insecticide permethrin attributable to aircraft disinsection. The permethrin PBPK model was developed by adapting previous models for pyrethroids, and was parameterized using currently available metabolic parameters for permethrin. The human permethrin model was first evaluated with data from published human studies. Then, it was used to estimate urinary metabolite concentrations of permethrin in flight attendants who worked in aircrafts, which underwent residual and pre-flight spray treatments. The human model was also applied to analyze the toxicokinetics following permethrin exposures attributable to other aircraft disinsection scenarios. Predicted levels of urinary 3-phenoxybenzoic acid (3-PBA), a metabolite of permethrin, following residual disinsection treatment were comparable to the measurements made for flight attendants. Simulations showed that the median contributions of the dermal, oral and inhalation routes to permethrin exposure in flight attendants were 83.5%, 16.1% and 0.4% under residual treatment scenario, respectively, and were 5.3%, 5.0% and 89.7% under pre-flight spray scenario, respectively. The PBPK model provides the capability to simulate the toxicokinetic profiles of permethrin, and can be used in the studies on human exposure to permethrin.

Computational fluid dynamics modeling of transport and deposition of pesticides in an aircraft cabin

Spraying of pesticides in aircraft cabins is required by some countries as part of a disinsection process to kill insects that pose a public health threat. However, public health concerns remain regarding exposures of cabin crew and passengers to pesticides in aircraft cabins. While large scale field measurements of pesticide residues and air concentrations in aircraft cabins scenarios are expensive and time consuming, Computational Fluid Dynamics (CFD) models provide an effective alternative for characterizing concentration distributions and exposures. This study involved CFD modeling of a twin-aisle 11 row cabin mockup with heated manikins, mimicking a part of a fully occupied Boeing 767 cabin. The model was applied to study the flow and deposition of pesticides under representative scenarios with different spraying patterns (sideways and overhead) and cabin air exchange rates (low and high). Corresponding spraying experiments were conducted in the cabin mockup, and pesticide deposition samples were collected at the manikin's lap and seat top for a limited set of five seats. The CFD model performed well for scenarios corresponding to high air exchange rates, captured the concentration profiles for middle seats under low air exchange rates, and underestimated the concentrations at window seats under low air exchange rates. Additionally, both the CFD and experimental measurements showed no major variation in deposition characteristics between sideways and overhead spraying. The CFD model can estimate concentration fields and deposition profiles at very high resolutions, which can be used for characterizing the overall variability in air concentrations and surface loadings. Additionally, these model results can also provide a realistic range of surface and air concentrations of pesticides in the cabin that can be used to estimate potential exposures of cabin crew and passengers to these pesticides.

Anaphylaxis in an airplane after insecticide spraying

Flights departing from malarious areas are sprayed with pyrethroids. They are presumed to be safe since reports of adverse responses among passengers or crew were only anecdotal. However, asthmatic reactions after domestic and occupational exposure have been published. We present the first case description of pyrethroid allergy in an airplane.

Sampling scheme for pyrethroids on multiple surfaces on commercial aircrafts

A wipe sampler for the collection of permethrin from soft and hard surfaces has been developed for use in aircraft. "Disinsection" or application of pesticides, predominantly pyrethrods, inside commercial aircraft is routinely required by some countries and is done on an as-needed basis by airlines resulting in potential pesticide dermal and inhalation exposures to the crew and passengers. A wipe method using filter paper and water was evaluated for both soft and hard aircraft surfaces. Permethrin was analyzed by GC/MS after its ultrasonication extraction from the sampling medium into hexane and volume reduction. Recoveries, based on spraying known levels of permethrin, were 80-100% from table trays, seat handles and rugs; and 40-50% from seat cushions. The wipe sampler is easy to use, requires minimum training, is compatible with the regulations on what can be brought through security for use on commercial aircraft, and readily adaptable for use in residential and other settings.

Investigating ozone-induced decomposition of surface-bound permethrin for conditions in aircraft cabins

The reaction of ozone with permethrin can potentially form phosgene. Published evidence on ozone levels and permethrin surface concentrations in aircraft cabins indicated that significant phosgene formation might occur in this setting. A derivatization technique was developed to detect phosgene with a lower limit of detection of 2 ppb. Chamber experiments were conducted with permethrin-coated materials (glass, carpet, seat fabric, and plastic) exposed to ozone under cabin-relevant conditions (150 ppb O(3), 4.5/h air exchange rate, <1% relative humidity, 1700 ng/cm(2) of permethrin). Phosgene was not detected in these experiments. Reaction of ozone with permethrin appears to be hindered by the electron-withdrawing chlorine atoms adjacent to the double bond in permethrin. Experimental results indicate that the upper limit on the reaction probability of ozone with surface-bound permethrin is approximately 10(-7). Extrapolation by means of material-balance modeling indicates that the upper limit on the phosgene level in aircraft cabins resulting from this chemistry is approximately 1 microg/m(3) or approximately 0.3 ppb. It was thus determined that phosgene formation, if it occurs in aircraft cabins, is not likely to exceed relevant, health-based phosgene exposure guidelines.

PRACTICAL IMPLICATIONS

Phosgene formation from ozone-initiated oxidation of permethrin in the aircraft cabin environment, if it occurs, is estimated to generate levels below the California Office of Environmental Health Hazard Assessment acute reference exposure level of 4 microg/m(3) or approximately 1 ppb.

Calculating human exposure to endocrine disrupting pesticides via agricultural and non-agricultural exposure routes

Endocrine Disrupting Chemicals (EDCs) are of increasing concern because of their potential impacts on the environment, wildlife and human health. Pesticides and some pesticide metabolites are an important group of EDC, and exposure to them is a poorly quantified source of human and environmental exposure to such chemicals generally. Models for estimating human exposure to Endocrine Disrupting (ED) pesticides are an important risk management tool. Probabilistic models are now being used in addition to deterministic ones in all areas of risk assessment. These can provide more realistic exposure estimates, because they are better able to deal with variation and uncertainty more effectively and better inform risk management decisions. Deterministic models are still used and are of great value where exposure data are scarce. Models or groups of models that provide holistic human ED pesticide exposure estimates are required if the risk posed to humans by ED pesticides is to be better assessed. Much more research is needed to quantify different exposure routes such as exposure from agricultural spray drift and the medical use of pesticides to develop such models. Most available probabilistic models of human exposure were developed in the USA and require modification for use elsewhere. In particular, datasets equivalent to those used to create and apply the American models are required. This paper examines the known routes of human pesticide exposure with particular reference to ED pesticides and their quantification as unlike pesticides generally, many ED pesticides are harmful at very low doses, especially if exposure occurs during sensitive stages of development, producing effects that may not manifest for many years or that affect descendants via epigenetic changes. It also summarises available deterministic and probabilistic models commonly used to calculate human exposure. The main requirement if such models are to be used in the UK is more quantitative data on the sources and pathways of human ED pesticide exposure.

Aircraft disinsection: Exposure assessment and evaluation of a new pre-embarkation method

A new "pre-embarkation" method for aircraft disinsection was investigated using two different 2% d-phenothrin containing aerosols. Five experiments in aircrafts of the type Airbus 310 (4x) and Boeing 747-400 (1x) were performed. In the absence of passengers and crew the d-phenothrin aerosol was sprayed under the seat rows and in a second step at the height of approximately 1.60 m by moving from one end of the cabin to the other. Concentration levels of d-phenothrin were determined at different time periods after application of the aerosol spray. In a B 747-400 with the air conditioning system operating the concentrations ranged between 853 and 1753 microg/m3 during and till 5 min after the beginning of spraying at different locations in the cabin. Within 5-20min after the end of the spraying concentrations of 36-205 microg/m3 and 20-40 min thereafter only ca. 1 microg d-phenothrin/m3 were detectable (average values in relation to each period of measurement). On cabin interior surfaces the median values for mainly horizontal areas ranged from 100 to 1160 ng d-phenothrin/cm2. d-Phenothrin concentrations in the air were sufficient to kill flying insects like house flies and mosquitoes within 20 min. Horizontal surfaces were 100% effective against insects up to 24 h after spraying. Doses inhaled by sprayers determined by personal measurements were calculated to be 30-235 microg d-phenothrin per 100 g spray applied (30% in the respirable fraction for Arrow Aircraft Disinsectant; 10% for Aircraft Disinsectant Denka). If passengers will board, e.g., 20 min after the end of the disinsection operation, inhalation exposure is estimated to be practically negligible. Also possible dermal exposure from residues in seats and headrests is very low for passengers during the flight. Therefore any health effects for passengers and crew members are very unlikely.