A Systematic Review of Aircraft Disinsection Safety, Toxicity, and Tolerability

Treatment of aircraft with insecticide in a procedure referred to as 'disinsection' is recommended to prevent the conveyance of arthropod vectors internationally and to mitigate the globalization of vector-borne infectious diseases. However, the full spectrum of human-based outcomes related to disinsection of conveyances has not been recently synthesized. A systematic review was conducted to evaluate the human safety and toxicity of insecticides used during the process of disinsecting international aircraft, marine vessels, rail, and ground transportation of mosquitoes. The systematic review was conducted according to the PRISMA guidelines and was registered in PROSPERO (CRD42024543998). The certainty of the evidence was rated, and key primary outcomes, including human health effects of conveyance disinsection, were synthesized. A total of 21 studies that described human health effects of conveyance disinsection and reported outcomes of safety, toxicity, and tolerability were included, and were of generally limited quality and high risk of bias, with low to very low certainty of estimates of effect. No high-quality studies investigating the safety, toxicity, or tolerability of disinsection were identified. Human health effects, including morbidity, including work days lost, adverse events including hospitalization, objective measures of insecticide toxicity, detectable and elevated urinary metabolites, and subjective reporting of symptoms consistent with acute insecticide poisoning, were reported by the small number of uncontrolled observational studies and public health surveillance reports included. Given the reports of significant morbidity, adverse events, and toxicity putatively attributable to aircraft disinsection, well-designed studies in exposed populations investigating the full range of human health impacts of disinsection on passengers and crew are urgently needed.