Pests on a plane: airports and the fight against infectious disease

Regular flyers are all too aware that air travel can, on occasion, be bad for your health. Jetlag, deep vein thrombosis (DVT), airsickness, dehydration, ear pain, and respiratory infections are just some of the conditions that are reported. Yet while seatbased exercises, air conditioning filters, flight socks, earplugs, boiled sweets, inflatable pillows, and eyeshades may lessen some of the risks and discomfort associated with flying, the warm, pressurised, sealed cabins of passenger aircraft continue to offer the perfect environment in which certain pests and diseases may thrive and spread. Medical journals are replete with stories of airline passengers contracting a range of infectious diseases, including tuberculosis, meningitis, measles, and influenza, from fellow (infected) travellers, while the rapid spread of the SARS virus to over 25 countries around the world in 2003 was attributed, in part, to the long-haul airline network. Since the birth of commercial aviation at the beginning of the twentieth century, airports have found themselves at the forefront of a worldwide battle against the spread of tropical and infectious diseases, and a range of public health interventions have been deployed to try and prevent pests and diseases being transported around the world aboard aircraft. This article reviews some of the public health directives that were devised to prevent the spread of disease by air and explains their implications for the design and operation of airports.