Health and sanitation aspects of international traffic have been of concern to the World Health Organization (WHO) since 1951, when the Fourth World Health Assembly recommended that all governments should “improve sanitary and environmental conditions, especially in and around ports and airports” (resolution WHA4.80); at the same time, the need for “the sanitary protection of populations in mass movement” was also expressed (resolution WHA4.8l). Subsequent resolutions of both the World Health Assembly and the Executive Board emphasized the importance of maintaining high standards of hygiene and sanitation in international traffic (particularly in relation to the provision of safe water and food and the correct procedures for the collection and disposal of wastes).
The annex to the first report of the WHO Expert Committee on Hygiene and Sanitation in Aviation (WHO, 1960a) was published in 1960 as a Guide to Hygiene and Sanitation in Aviation (WHO, 1960b). Its use was recommended by the Twelfth World Health Assembly to guide health administrations in “fulfilling their obligations under the existing International Sanitary Regulations, especially the provisions of Article 14, in providing safe food for international air traffic, and in maintaining satisfactory control of, and protection from, malaria vectors at airports” (resolution WHA12.18).
The reports of the Committee on International Surveillance of Communicable Diseases, as adopted by the World Health Assembly, also emphasized the importance of preventing disease through the improvement of sanitary conditions. The relevant articles of the International Health Regulations (1969) (WHO, 1969) laid down sanitation requirements at airports. The provision of criteria and guidelines for the use of administrations in fulfilling their obligations under the International Health Regulations forms an essential part of WHO's functions.
In 1974, the Twenty-seventh World Health Assembly, “believing that, in view of the growth of international traffic, continuous attention should be given to the safety of food and water and the handling of wastes in such traffic”, stressed “the need for each Member State to clarify the ultimate responsibility for the safety of food and water and the proper handling of wastes in international traffic” and, furthermore, recommended that “Member States coordinate and ensure the close and active participation in such a responsibility of health authorities, port and airport management, aircraft operators, shipping companies, tourist associations, and any other service or agency concerned with international traffic” (resolution WHA27.46). At the same time, the Director-General of WHO was requested to maintain close contact with representatives of international organizations concerned with international traffic with a view to promoting the implementation and coordination of activities aimed at improving the safety of food and water and the handling of wastes and to prepare appropriate guidance for the use of health professionals. The outcome of these activities was the publication of a second edition of the Guide to Hygiene and Sanitation in Aviation, in 1977 (WHO, 1977).
The basic principles of hygiene have not changed significantly since 1977; however, the magnitude of air transport operations has grown tremendously. The number of passengers flying on scheduled airlines rose from 438 million in 1975 to over 2 billion in 2006 (ICAO, 2006), figures that do not take into account charter flight passengers and global corporation business jet passengers, whose numbers are in the millions and increasing every year. Furthermore, the current trend in international civil aviation is towards aircraft of larger passenger-carrying capacity and greater range. The introduction of air services into areas with inadequate public health infrastructure, such as food handling and storage, water supply and waste disposal, creates a challenge for aircraft operators. To protect public health, the application of high standards of hygiene should form an integral part of airport and aircraft operations.
Although hygiene standards have improved during the last few decades, there remains a need to safeguard the health of crew and passengers against waterborne and foodborne illnesses. Incidents of foodborne illness associated with international air travel that are reported from time to time (Turner, 1971; Peffers et al., 1973; McMullan et al., 2007) serve as a reminder of the need to ensure the quality of food and drinking-water on board aircraft. More recently, worldwide attention has turned to the potential for transmission of communicable diseases, such as severe acute respiratory syndrome (SARS) and extremely drug-resistant tuberculosis,1 on board aircraft, which has renewed interest in cleaning and disinfecting aircraft.
The International Health Regulations (2005), hereafter referred to as IHR (2005), are an international WHO legal framework addressing risks of international disease spread and legally binding on 194 States Parties throughout the world, including all 193 WHO Member States. The IHR (2005) are very broad, focusing upon almost all serious public health risks that might spread internationally, whether biological, chemical or radionuclear in origin, and whether transmissible in goods (including food), by persons, on conveyances (aircraft, ships, vehicles), through vectors or through the environment. The IHR (2005) contain rights and obligations for States Parties (and functions for WHO) concerning prevention, surveillance and response; health measures applied by States to international travellers, aircraft, ships, ground vehicles and goods; and public health at international ports, airports and ground crossings. For more information, see http://www.who.int/csr/ihr/en/.
Based on the above considerations and the introduction of the extensively revised and updated International Health Regulations (2005) (WHO, 2005),2 hereafter referred to as IHR (2005), WHO found it appropriate to revise the second edition of the Guide to Hygiene and Sanitation in Aviation.
Go to:
1.2. Scope, purpose and objective
The third edition of the Guide to Hygiene and Sanitation in Aviation (hereafter referred to as “the Guide”) addresses water, food, waste disposal, cleaning and disinfection of facilities, vector control and cargo safety, with the ultimate goal of assisting all types of airport and aircraft operators and all other responsible bodies in achieving high standards of hygiene and sanitation, to protect travellers and crews engaged in air transport. Each topic is addressed individually, with guidelines that provide procedures and quality specifications that are to be achieved.
The guidelines in this document apply to domestic and international air travel for all developed and developing countries.
Although aircraft and airport operators should have a plan to respond to deliberate acts that may threaten public health, this issue is not within the purview of the Guide. The Guide does not address cabin air quality at this time, as this issue is covered extensively elsewhere (WHO, 2008a, 2008b). Finally, the Guide will not address the epidemiological aspects of illnesses related to the topics covered.