International air travel is increasingly affecting the epidemiology of infectious diseases. A particular public health, economic, and political concern is the role of air travel in bringing infectious passengers or vectors to previously non-endemic areas. Yet, little research has been done to investigate either the infection risks associated with air travel or the empirical evidence for the effectiveness of infection control measures on aircraft and at borders. We briefly review the interface between international and national legislation, policy, and guidelines in the context of existing infection risks and possible scenarios. We have found that public health guidance and legislation, which airlines are required to follow, are often contradictory and confusing. Infection control measures for air travel need to be underpinned by coherent and enforceable national and international legislation that is based on solid epidemiological evidence. We recommend further research investment into more effective on-board vector control, health screening, and risk communications strategies, and the development of enforceable and harmonised international legislation.

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Food contamination during air travel presents unique risks to those affected. Foodborne pathogens can cause serious illness among all on board, and potentially jeopardize flight safety. These risks are likely to increase with current trends of "densification" and a predicted massive expansion of air travel. While aircraft are being equipped with ever newer designs with a focus on efficiency and comfort, regulations remained largely unmodified in terms of basic hygiene requirements. Strict guidelines for food hygiene exist for on-ground food settings and catering kitchens. There is uncertainty about hygiene standards on board commercial aircraft, and little regulatory oversight of what happens to food in-flight. In two hypothetical scenarios we indicate the potential risks associated with poor food handling practice onboard aircraft, with the ultimate aim of bringing aviation food safety in line with on-ground regulations. Changes in cabin design alongside adequate training in safe food handling have the potential to increase public health protection. We urge a review of existing in-flight hygiene protocols to better direct the development of regulation, prevention, and intervention measures for aviation food safety.

Increases in international air transport are playing a major role in the global dispersion of mosquito- borne diseases, notably malaria and dengue fever. Disinsection of aircraft is the formal name of the process undertaken to control disease vectors that may be inadvertently imported from endemic regions. The goals of not exposing passengers and crews to insecticides, while also eliminating mosquitoes on flights, are potentially incompatible concerns. Understanding this problematic tourism-health link is important as organisations and individuals strive to make global tourism more sustainable. Aircraft disinsection as a means of disease vector control offers multiple opportunities for tourism research. This review offers a broad study agenda involving tourism and social science work which reaches beyond the medical research paradigm that dominates disinsection studies. It can be suggested that the key question is not whether to side with disinsection or not, but under what conditions is it most effective? Such decisions can be assisted through more integrated aviation and tourism policy analysis, crew and passenger health studies, analysis of crew behaviours and interpretation research.