The International Health Regulations (IHR) are a legally binding agreement between WHO member states aimed at preventing, protecting against, and controlling the spread of disease internationally. The IHR require countries to report certain public health events and diseases to the WHO and develop minimum core public health capacities for surveillance, risk assessment, and response. Major revisions in 2005 expanded the scope of the IHR beyond specific diseases to all public health emergencies of international concern. The IHR establish procedures for WHO to verify country reports and determine whether events constitute a public health emergency of international concern.
2. What are International Health Regulations(IHR)?
What are the purpose of IHR?
What are the functions of IHR?
What are Public Health Emergencies of
International Concern?
What are the notifiable diseases?
What are the core capacities in each level?
What are the important vaccinations to be given
for travelers?
Learning Objectives
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3. INTRODUCTION:
➢ The IHR are legally binding set of regulations adopted by WHO
which helps countries to save lives caused by diseases spread
internationally and other health risks.
4. THE INTERNATIONAL HEALTH REGULATIONS
EVOLUTION
• 1948: WHO Constitution
• 1951: Adopted ISR
• 1969: Revised to IHR
1969 IHR( Cholera, plague, YF, small pox, relapsing fever and typhus)
In early 1990s, emergence of Ebola hemorrhagic fever
• 1995: 48th World Health Assembly ; Call for revision
•2001: Links to Global health Security strategy
• 2005: Adopted IHR 2005
•2007: IHR(2005) comes into effect
5. Why were the IHR revised?
1. Increase in cross-border travel, trade and communication
technology
2. Focus on just three diseases (cholera, plague and yellow fever) -
not equipped to address the growing and varied public health
risks
3. Reluctance to promptly report outbreaks of these diseases for fear
of unwarranted and damaging travel and trade restrictions
6. IHR (2005)
61. From control of borders to containment at source
2. From diseases list to all threats
3. From pre-set measures to adapted and real time response
7. PURPOSE AND SCOPE OF IHR:
“To prevent, protect against, control and provide a public
health response to the international spread of disease in
ways that are commensurate with and restricted to public
health risks,
and which avoid unnecessary interference with
international traffic and trade.”
8. May 2005: World Health Assembly approved revised IHR and
June 15, 2007: Initial start date for revised IHR
June 2009:Member Countries complete assessment of the
ability of their national structures and resources to meet
minimum core capacities
2012: Member Countries should achieve the required
minimum level of core capacities, unless WHO grants an
extension
8THE ORIGINAL TIMELINE FOR IHR
IMPLEMENTATION
9. 2014: End of 2-year extensions on achieving core capacity,
unless an exceptional circumstance exists and a further
extension is granted by WHO
After a 2 year extension, in 2014, 64 countries reported
fully achieving the IHR core capacities.
Only about 1/3 of the countries in the world currently
have the ability to assess, detect and respond to public
health emergencies
10. The Stakeholders for IHR Implementation
Airports,
Ports &
Ground
Crossings
States, UTs
&
District
Authorities
National Focal Point
NICD, Delhi
Other
Ministries
, Dtes., &
Deptts.
MOHFW
DGHS
Other ministries
and deppts.
states, UTs and
District
authorities
11. INNOVATIONS:
(a) Not limited to any specific disease
(b) State Party obligations to develop certain minimum core public health
capacities;
(c) obligations on States Parties to notify WHO of events that may
constitute a public health emergency
(d) provisions authorizing WHO to obtain verification from States Parties
concerning such events;
(e )Determination and recommendation by the Director-General of PHEIC
(f) protection of the human rights of persons and travellers
(g) National IHR Focal Points and WHO IHR Contact Points for urgent
communications between States Parties and WHO.
12. MAJOR OBLIGATIONS FOR
MEMBER STATES: 196 WHO members
.
Major
Obligations
Designation
of a National
Focal PointCore
capacities to
detect, report
and respond
Comply with
routine
provisions
Legal &
administrative
framework
Assess events
& notify
Potential
PHEIC
13.
14. 14
The IHR require that all countries have the ability to do the
following:
Detect: Make sure surveillance systems and laboratories can
detect potential threats
Assess: Work together with other countries to make decisions
in public health emergencies
Report: Report specific diseases, plus any potential
international public health emergencies, through participation
in a network of National Focal Points
Respond: Respond to public health events
15. PUBLIC HEALTH EMERGENCY OF
INTERNATIONAL CONCERN: (PHEIC)
Defined as “ An extraordinary event which is determined to
constitute a public health risk to other states through the international
spread of disease and to potentially require a coordinated international
response”.
These events of potential international concern, which require States
Parties to notify WHO, can extend beyond communicable diseases and
arise from any origin or source.
17. Under IHR, a PHEIC is declared by the World Health
Organization if the situation meets 2 of 4 criteria:
❑Is the public health impact of the event serious?
❑Is the event unusual or unexpected?
❑Is there a significant risk of international spread?
❑Is there a significant risk of international travel or trade
restrictions?
18. Is the public health impact of the
event serious?
1. Is the number of cases and/or number of deaths for this type of event large for
the given place, time or population?
2. Has the event the potential to have a high public health impact?
Concomitant factors that may hinder or delay the public health response (natural
catastrophes)
Spread of toxic, infectious or hazardous materials that has the potential to
contaminate a large geographical area.
3. Is external assistance needed to detect, investigate, respond and control the
current event, or prevent new cases?
Inadequate human, financial or technical material
19. Is the event unusual or unexpected?
Is the event unusual?
Occurrence of the event itself unusual for the area, season or
population.
5. Is the event unexpected from a public health perspective?
Event caused by a disease/agent that had already been eliminated
or eradicated from the State Party or not previously reported.
20. Is there a significant risk of
international spread?
6. Is there evidence of an epidemiological link to similar events
in other States?
7. Is there any factor that should alert us to the potential for
cross border movement of the agent, vehicle or host?
Where there is evidence of local spread, an index case (or other
linked cases) with a history within the previous month of travel
Event caused by an environmental contamination that has the
potential to spread across international borders.
21. Is there a significant risk of international
travel or trade restrictions?
8. Have similar events in the past resulted in international
restriction on trade and/or travel?
9. Is the source suspected or known to be a food product or any
other goods that might be contaminated that has been
exported/imported to/from other States?
10. Has the event occurred in association with an international
gathering or in an area of intense international tourism?
11. Has the event caused requests for more information by
foreign officials or international media?
22. Main Challenges
Building core capacities for surveillance and
response at all levels – national, intermediary,
local (technical challenge)
Mobilization of resources to meet core
capacities requirements (financial challenge)
National Commitment to rapid sharing of
information, materials and inter-country
collaboration (political challenge)
23. Once a WHO member country identifies an event of
concern, the country must assess the public health risks of
the event within 48 hours.
If the event is determined to be notifiable under the IHR,
the country must report the information to WHO within 24
hours.
Some diseases always require reporting under the IHR, no
matter when or where they occur, while others become
notifiable when they represent an unusual risk or situation.
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STEPS
24. Notifiable:
Smallpox
Poliomyelitis due to wild-type poliovirus
Human influenza caused by a new subtype
Severe acute respiratory syndrome (SARS)
Since the revised IHR were put into place, three PHEICs
have been declared by WHO
HINI (2009)
Polio (2014)
Ebola (2014)
25. ❑Epidemic prone diseases
Cholera, yellow fever, meningococcal disease, SARS, avian
influenza, Ebola, Marburg haemorrhagic fever, drug resistant
diarrhoeal diseases, West Nile Fever hospital acquired infections,
malaria, meningitis, respiratory tract infections and sexually
transmitted infections and HIV infections.
❑ Food borne diseases
Microbial contamination chemicals and toxins. The emergence of
new food borne diseases i.e. new variant of Creutzfeldt Jakob disease
associated with bovine spongiform encephalopathy (BSE).
❑ Accidental and deliberate outbreaks
Breaches in bio-safety measures are often responsible for
outbreaks associated with the accidental release of infectious agents
for example anthrax in USA in 2001.
26. ❑Toxic chemical accidents
Dumping of 500 tons of petrochemical waste in at least 15
sites led to the deaths of 8 people, and 90000 were seeking
medical help in West Africa in the year 2006.
❑Radio nuclear Accidents
Chernobyl disaster in 1986 resulted in the evacuation and
resettlement of over 3,36,000 people.
❑ Environmental disasters
❑Heat wave in Europe 2003, the lives of 35,000 persons
were linked to extremes in weather.
❑Bhopal gas tragedy in December 1984
27. IHR: capacities required at each
level
Local level
National level
Intermediate level
Regional & International
level
- Detection of event
- Reporting
- Controlling
-Confirmation
Response
Assessment
--Assessment
-Notification
-P.H. response
- Event alert
- Verification
- Assessment
- Intl. response
28. • At all times
• Access to medical services
• Transport of ill travellers
• Inspection of conveyances
• Control of vectors
• For responding to events
• Emergency contingency
• Arrangement for isolation
of ill patients
• Apply specific
control/quarantine measures
Minimum Core Capacities at
Designated Points of Entry
29. Core Capacity
requirements for
Designated
Airports, Ports and
Ground Crossings
Contingency
plan Care or affected
travellers
Space: interview
suspect
Assessment,
quarantine of suspect
travellers
Deratting,
disinfection ,
disinsection
Entry/exit
controls for
travellers
Transfer of
travellers carrying
infection
30. All travelers
Routine Vaccination:
These vaccines include measles-mumps-rubella
(MMR) vaccine, diphtheria-tetanus-pertussis
vaccine, varicella (chickenpox) vaccine, polio
vaccine, and yearly Rotavirus shot.
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Vaccination
34. Article 1
“Isolation”- separation of ill persons from healthy people
“quarantine”- the restriction of activities and/or separation
from others of suspect persons who are not ill or of suspect
baggage, containers, conveyances or goods in such a manner
as to prevent the possible spread of infection or contamination
“temporary recommendation” means non-binding advice
issued by WHO for application on a time-limited, risk-specific
basis, in response to a public health emergency of international
concern, so as to prevent or reduce the international spread of
disease and minimize interference with international traffic
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Articles Under IHR 2005
35. 35
ARTICLE 4
Relates to responsible authorities
PUBLIC HEALTH RESPONSE (ARTICLE 5-14)
ARTICLE 5
surveillance
ARTICLE 6
notification
ARTICLE 7
Information-sharing during unexpected or unusual public health
events
ARTICLE 8
consultation
36. ARTICLE 9
Other reports
ARTICLE 10
Verification
ARTICLE 11
Provision of information by WHO
ARTICLE 12
Determination of a public health emergency of
international concern
ARTICLE 13
Public health response
ARTICLE 14
Cooperation of WHO with intergovernmental
organizations and international bodies
37. Coordinating implementation of the IHR.
They are working to:
Foster global partnerships
Strengthen national disease prevention, surveillance, control
and response systems
Strengthen public health security in travel and transport
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WHO Responsibilities
38. Strengthen WHO global alert and response
systems
Strengthen the management of specific risks
Sustain rights, obligations and procedures
Conduct studies and monitor progress
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39.
40. Focus is on detection, prevention, and control.
One major role for CDC is to support existing health
monitoring systems that identify and report diseases.
Collaborate with local, state, and federal public health
authorities to improve the ability of national health
monitoring systems to report possible PHEICs under
IHR provisions.
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CDC Responsibilities
41. In 2014, the United States and its partner countries
came together to commit to the Agenda
The GHS Agenda provides a road map to help reach
the initial goals set out by the IHR in 2005
The GHS Agenda lays out a framework to:
Prevent avoidable epidemics
Detect threats early
Respond rapidly and effectively
Creates clear goals and activities that support the
regulations
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Global Health Security Agenda (GHS)
