2. • History
• What is IHR?
• Principles, objectives & purpose of IHR
• Comparison of 1969 & 2005 IHR
• Implementation of IHR
• Indian scenario
• Summary
• References
3.
4. • 1948- WHO constitution
• 1951: Adopted ISR (4th WHA)
• 1969: Revised to IHR (22nd)
• 1995: Call for revision (48th )
• 2003 : Intergovernmental Working
Group
• 23rd May 2005: adopted IHR (58th )
• 2007: IHR (2005) came into effect
5. An international legal instrument, legally binding on
all WHO Member States who have not rejected
them.
196 countries have agreed to work together to
prevent and respond to public health crises.
IHR includes specific measures at ports, airports and
ground crossings
o to limit the spread of health risks to neighboring
countries
o to prevent unwarranted travel and trade restrictions
6.
7. International
spread of
disease
To prevent
To protect
against
To control
To provide
public
health
response to
In ways that are commensurate with & restricted to
public health risks,
Without unnecessary interference with
international traffic & trade.
8. Not limited to any specific disease or manner of
transmission
Minimum core public health capacities
Obligations on State Party to notify PHEIC
Authority to WHO, to consider unofficial reports of
public health event & to verify
DG- decision about PHEIC & issuing temporary
recommendation
Protection of human rights
National Focal IHR & WHO IHR
Relevance & applicability
9. Principles
of IHR
Implementation
of IHR
with full
respect,dignity
for the human
rights
guided by the
Charter of the
UN &
Constitution of
WHO
for the
protection of all
people of the
world from the
international
spread of
disease.
States have right
to legislate and
to implement
legislation in
pursuance of
their health
policies
10. Objective: Maximum security
against international spread of
diseases with minimum
interference with world traffic
Scope: Cholera, Plague,
Yellow Fever, Smallpox,
relapsing fever & plague
Limitations
11. Area of focus IHR(1969) IHR(2005)
Type of threat Specific infectious disease Any PHEIC (biological, chemical,
radiological, etc)
Focus of
activities
Control disease at port &
border without hampering
trade & travel
Detect, report & contain any public
health threat at port, borders &
anywhere within national borders while
minimizing impact on trade & travel
Risk
assessment
Only 6 diseases Decision instrument to evaluate risk of
public health event , prompting
notification to WHO where emergency
committee of experts evaluates risk
Response Pre-determined health
controls at points of entry
Flexible, evidence based responses
adapted to nature of threat
Communication Nations identify
appropriate authorities
Notification to and from WHO via
designated IHR National Focal Points
Actively & collectively
National
capacity
requirements
Public health & infection
control measures at port
of entry
Capability to detect, assess, report &
respond to public health threats in
near-real time at national & community
level
12. From six diseases to all public health threats
From preset measures to adapted response
From control of borders to, also containment at source
From reactive to proactive
Major Paradigm
Shift
13. “Public Health Emergency Of International Concern”
An extraordinary event which is determined, as
provided in these Regulations:
(i) to constitute a public health risk to other States
through the international spread of disease
(ii) to potentially require a coordinated international
response;
14. Decision Instrument For The Assessment & Notification
Of Events Constituting PHEICs
UNUSUAL
DISEASES
-Smallpox
-Human
Influenza
-Wild Polio
-SARS
Any event of
potential
international
public health
concern
KNOWN EPIDEMIC
PRONE DISEASES
-Cholera
-Pneumonic Plague
-Viral Hemorrhagic fever
-Yellow Fever
-West Nile Fever
-Other Locally Important
Diseases
Is the public health impact of the event serious?
Is the event unusual or unexpected?
Is there significant risk of international spread?
Is there significant risk of travel or trade
restrictions?
If YES to any 2 of these questions
National IHR Focal Point to notify WHO
15. Epidemic Prone Diseases
Food Borne Diseases
Accidental and Deliberate Outbreaks
Toxic Chemical Accidents
Radio Nuclear Accidents
Environmental Disasters
16. I. Definitions, purpose and scope, principles and
responsible authorities
II. Information and public health response
III. Recommandations
IV. Points of entry
V. Public health measures
VI. Health documents
VII. Charges
VIII. General provisions
IX. The IHR Roster of Experts, the Emergency
Committee & the Review Committee
X. Final provisions
17. WHO Director-
General
WHO IHR
Contact Point
National IHR
Focal Points
(NFP)
• Accessibility at all times
• Primary channel for
communications
• Disseminate information within
WHO
• ACTIVATE the WHO
assessment & response system
• Determine PHEIC
• Make temporary &
standing recommendations
• Accessibility at all times
• Communications with WHO
• Dissemination of information
nationally
• Consolidating input nationally
Unusual
health
events
National
Surveillance &
response systems
Detect
Assess
Report
Respond
Emergency
Committee Expert
Roster
Review
Committee
Other
competent
organizations
(IAEA etc)
Ministries &
Sectors
concerned
Notification
Consultation
Report
Verification
Community
18. Designation of IHR Contact Point
shall assist States Parties, upon
request, to develop, strengthen and
maintain the capacities
collect information regarding events
through its surveillance & assess risk
Rapid outbreak response & technical
guidance
19. • Decision about public health emergency of
international concern
• Issuance temporary recommendations in
accordance with the procedure
• Make standing recommendations of
appropriate health measures
20. 1. Foster global partnerships
2. Strengthen national disease prevention,
surveillance, control and response systems
3. Strengthen public health security in travel and
transport
4. Strengthen WHO global alert and response
systems
5. Strengthen the management of specific risks
6. Sustain rights, obligations and procedures
7. Conduct studies and monitor progress
24. Core capacities will be strengthened to report and
respond to public health risks and a PHEIC in the
country.
Clear guidelines on outbreak verification process,
technical and logistical support will be provided by
WHO upon request in the case of a PHEIC.
Eligibility for support from Global Outbreak Alert and
Response Network (GOARN).
Disputes may also be settled by referral to the WHO
Director General.
25.
26. • List of certified airports & ports.
• Responsibility of Pilot in command of
aircraft & officer in command of the ship
• Emergency landing
• Free pratique by States Parties
27. HEALTH PART OF THE AIRCRAFT
GENERAL DECLARATION
• Declaration of Health
• Name and seat number or function of persons on board with
illnesses other than airsickness or the effects of accidents,
who may be suffering from a communicable disease (a fever
- temperature100 °F or greater - associated symptoms or
signs)
• Details of each disinfecting or sanitary treatment (place,
date, time, method) during the flight. If no disinfecting has
been carried out during the flight, give details of most recent
disinfecting.
• Signature of Crew member concerned.
• This version of the Aircraft General Declaration entered into
force on 15 July 2007.
http://www.icao.int
28. 1. On ground before passengers
come on board using residual
insecticide aerosol
2. Plus in additional flight
treatment with quick acting
spray shortly before take-off &
landing
3. Regular application of a
residual insecticide to all
internal surfaces of aircraft
except food preparation area
29. • Certificates
(a)Ship Sanitation Control
Certificates and the provision of
the services
(b) Issuance of Ship Sanitation
Control Exemption Certificates
(c) Extension of the Ship Sanitation
Control Exemption Certificate for
a period of one month until the
arrival of the ship in the port at
which the Certificate may be
received.
30. 1. Quarters
2. Galley, pantry and service areas
3. Stores
4. Child-care facilities
5. Medical facilities
6. Swimming pools and spas
7. Solid and medical waste
8. Engine room
9. Potable water
10. Sewage
11. Ballast water
12. Cargo holds
13. Other systems and areas
31. • No health measure shall be applied to a
civilian lorry, train or coach not coming
from an affected area which passes
through a territory without embarking,
disembarking, loading or discharging.
32. • States Parties sharing common borders
should consider:
(a)entering into bilateral or multilateral
agreements or arrangements concerning
prevention or control of international
transmission of disease at ground crossings
in accordance with IHR
(b) joint designation of adjacent ground
crossings for the capacities
33. 1.State Party may require for public health
purposes-
(a) with regard to travellers:
(i) information about traveller’s destination
(ii) traveller’s itinerary
(iii)review of the traveller’s health documents
(iv) medical examination
(b) inspection of baggage, cargo, containers,
conveyances, goods, postal parcels
2.States Parties may apply additional health
measures
34. • No measures without their prior express informed
consent.
• Travellers shall be informed of any risk associated
with vaccination or with non-vaccination and with
the use or non-use of prophylaxis in accordance
with IHR.
• Measures in accordance with established national
or international safety guidelines and standards to
minimize such a risk.
35. • Treating with courtesy and respect
• Consideration about the gender, sociocultural,
ethnic or religious concerns
• Provision of adequate food and water,
accommodation and clothing, protection for
baggage, appropriate medical treatment, means of
communication, assistance for travellers who are
quarantined, isolated for public health purposes.
36. No charge for-
(a)Any medical examination or supplementary
examination
(b)Vaccination not published requirement or is a
requirement published in less than 10 days
prior to provision
(c) Isolation or quarantine requirements
(d)Certificate issued
(e)Health measures applied to baggage
37. • Individualized immunization schedule
• Consultation by travel medicine practitioner 4-8 wks prior
Routine
Vaccines
These vaccines are not
specific
to travellers, but the pre-travel
consultation is a good
opportunity for health care
providers to review the
immunization status of infants,
children, adolescents and
adults
DPT,
Hepatitis B
Hib,
HPV
MMR
Pneumococcal
Polio
Rotavirus
Tuberculosis
Varicella
38. Travel-
related
vaccines
These vaccines are
recommended to provide
protection against
diseases endemic to the
country of origin or of
destination.
They are intended to
protect travellers and to
prevent disease spread
within and between
countries.
Cholera
Hepatitis A & E
JE
Meningococcal
Polio (adult
booster dose)
Typhoid fever
Yellow fever
Rabies
Tick-borne
encephalitis
39. Required
vaccines
Some countries
require proof of
vaccination for
travellers to
enter the country.
Polio vaccine-
There is a list of countries
currently requiring proof of
polio vaccination for incoming
travellers.
Yellow fever vaccine-
For travellers going to &
coming from countries or
areas at risk of yellow fever.
Meningococcal vaccine-
(required by
Saudi Arabia for pilgrims)
40. Polio- Travellers from infected areas should have
completed a full course of vaccination against polio,
preferably with OPV & should receive an additional
dose of OPV at least 6 weeks before each
international journey.
41. Vaccination for travellers
Yellow fever-
o17D vaccine, live-attenuated, single, subcutaneous
Injection for aged 9 months or older
oThe international certificate of vaccination for yellow
fever vaccine becomes valid 10 days after primary
vaccination and remains valid for a period of 10 years.
42. Detained in isolation for up to 6 days if traveller-
(i) Has arrived within 6 days of departure from an
area with risk
(ii) Has been in risk area in transit (exception)
(iii) Arrives on a ship that started from or touched
at any port in risk area up to 30 days before its
arrival in India, unless disinfected
(iv) Arrives on an aircraft that has been in an
risk area and has not been disinfected
43. • Cholera: No country reports a
requirement for a certificate of vaccination
against cholera as a condition for entry.
• Smallpox: Since the global eradication of
smallpox was certified in 1980, WHO does
not recommend smallpox vaccination for
travellers.
44. Malaria risk exists throughout the year in India at altitudes below 2000
m, with overall 40–50% of cases due to P. falciparum and the remainder
due to P. vivax.
Recommended prevention in risk area
in the
listed higher risk areas: IV
•Use of antimalarial drugs for prophylaxis in travellers
Start 1 day before departure & continue till 7 days after return- Atovaquone
proguanil combination-
Start 1 day before departure & continue till 4 wks after return-
1. chloroquine- proguanil combination 2.Doxycyclin 3.Proguanil
Start 1 week before departure & continue till 4 wks after return-
1. Mefloquine 2.Chloroquine
45.
46. Since the Revised IHR
were put into place, four
PHEICs have been
declared by WHO:
1. H1N1 influenza (2009)
2. Polio (2014)
3. Ebola (2014)
4. Zika virus (2016)
48. Cooperative Arrangement for the Prevention of Spread of Communicable Disease Through Air Travel (CAPSCA)
AIRSAN: Coordinated action in the aviation sector to control public health threats
49. Global Outbreak Alert & Response Network
(GOARN) provides a framework for technical
coordination of international alert & response.
New obligations devised to collectively respond
to international public health challenges, taking
advantage of new developments.
Supported by the WHO Secretariat & guided by
a Steering Committee of technical partners.
50.
51. Several password protected systems have been
developed to assist IHR National Focal Points, IHR
Regional Contact Points, and other Subject Matter
Experts.
54. INDIA : Prof. (Dr.) Atul Goel
Director
National Centre for Disease Control (NCDC),
22-Shamnath Marg, Delhi 110054
Telephone: 011-23913148, 23971272
Email: dirnicd@bol.net.in ; dirnicd@gmail.com
India : 8 August 2007
National Focal Point: NCDC, Delhi
Surveillance : IDSP (Rs. 408 Crores)
55. PoE: 44 (Airports- 25, Ports- 12, Ground crossings-7)
YF vaccination Centers (27) (Designated by GoI)
Biosafety laboratories – National Institute of
Virology, Pune. & NICD, Delhi
Connectivity: In collaboration with the ISRO, the
National Informatics Centre & BSNL, districts are being
connected electronically through satellite & the
terrestrial network for transmission of surveillance data,
videoconferencing & distance
56. Legal
National Health Policy 2015 has been drafted
Indian Port Health Rules & Indian Aircraft (Public
Health )
Rules are currently being examined for their
compliance with IHR (2005)
National Epidemic Disease Act- 1987
Disaster Management Act- 2005
57. • 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)
• Legal Issues
A challenge that requires time, commitment and the
willingness to change & mutual coordination
58. IHR AFTER COVID-19 PANDEMIC
• The COVID-19 pandemic has changed many aspects of our
lives, but it has not yet compelled substantial changes to the
legal landscape of global health.
• The most ambitious revisions, proposed by the USA, included
rapid sharing of pathogen genetic sequence data and
introducing shorter deadlines for reporting and responding to
emerging threats.
• However, many have found the performance of the IHR in the
current pandemic disappointing. It was unable to compel a
robust, coordinated response against the PHEIC and few states
showed adequate preparedness and timeliness as the IHR
requires.
• What has prevented agreement on IHR reform so far? One of
the root causes is the inequality in resource, capacity, and
power between high-income countries and low-income and
middle-income countries
59. http://www.who.int/ihr
http://www.ncdc.gov.in/
WHO, International Travel and Health. World Health
Organization; January 2007
International travel and health,2012,
http://who.int/ith/ITH_EN_2012_WEB_1.2.pdf?ua=1
Vaccine‐preventable diseases and vaccines
http://www.who.int/ith/ITH_chapter_6.pdf?ua=1
