E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

International Health Regulations and

EWAR

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Objectives of this lecture

• To summarize the IHR history and principles• To define EWAR as a component of IHR and as

such the need of EWAR components in the surveillance systems of countries

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

What is IHR?Definition

History

Functions

Principles

EWAR and IHR

Conclusions

A binding legal document between

WHO and Member States with:

rights

obligations

standardized procedures

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

IHR 2005Definition

History

Functions

Principles

EWAR and IHR

Conclusions

•Established by negotiation between States

•Adopted at the World Health Assembly (2005)

& legally binding on WHO’s Member States

•Entry into force on 15 June 2007

•Five years to develop country core capacities

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Definition

History

Functions

Principles

EWAR and IHR

Conclusions

International Health Security

IHR(2005), a paradigm shift

•From control of borders to containment at source

•From diseases list to all threats

•From preset measures to adapted response

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

• Health system

• Epidemiology• Laboratory• Preparedness• Case management• Infection control• Social mobilisation• Communication• …

• Health system

• Epidemiology• Laboratory• Preparedness• Case management• Infection control• Social mobilisation• Communication• …

National disease surveillance and response

system

IHR Annex 1A

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

• Ports

• Airports

• Ground crossings Intersectoral collaboration

• Aviation sector (ICAO, ACI, IATA)

• Shipping (IMO, ISF, CLIA)

• Railways (UIC)

IHR Annex 1B, (also 3, 4, 5, 8, and 9)

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

• Intelligence

• Verification

• Risk assessment

• Response (GOARN)

• Logistics

• …

Surveillance and

response at global

level

IHR Annex 2 (notification instrument)

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Aim of IHRDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

«  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 unecessary interference with international traffic and trade »

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

IHR 2005 innovationsDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

• WHO authorized to:

– consider unofficial reports or disease events and obtain verification,

– declare a PHEIC and issue temporary recommendations ,

• Establishment of IHR National Focal Points and WHO Contact Points for urgent communications (24/7 availability),

• Update and revise many technical and regulatory functions, including points of entry.

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

IHR 2005 innovationsDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

• Not limited to specific diseases, but to any

threat,• Country obligations to:

– develop minimum core public health capacities,

– Notify WHO of any potential PHEIC according to defined criteria,

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Core Capacities (Annex 1a)Surveillance and ResponseDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

– Detection (EWAR)– Verification – Investigation– Notification – Response

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

PHEICDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

“an extraordinary event which constitutes a public health risk to other States through the international spread of disease and potentially require a coordinated international response”

Member States need to report any potential PHEICDG of WHO declares PHEIC

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

NotificationDefinition

History

Functions

Principles

EWAR and IHR

Conclusions

Countries have the obligation to:

• Notify WHO of any potential PHEIC

• Within 24 hours of assessment, using a

specifically designed decision instrument

• Continue to provide WHO with detailed

information

• “Notification” process itself does not

mean a real “PHEIC”

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

IHR - Event notification and determination IHR - Event notification and determination

Community concern

MediaPrivate/public clinicians concern

Public services, agencies

Health care system

Lab

Pharmacies

HOT LINEInformal system

Event-based

Surveillance Health system based

Signal

YesALERT

Public health risk identifiedUnusual disease pattern ?

Event verified ?

Public health Significance?

InternationalConcern?

PHEICInvestigation

& control

Notificationto WHO

Yes

Yes

Early Warning Response

Source

Status

Decision

Action

IHR National Focal Point

IHR WHO Focal Point

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Decision instrument to identify a potential PHEIC

Definition

History

Functions

Principles

EWAR and IHR

Conclusions

– All cases of:new subtype human influenza, wild-type polio, SARS, smallpox

– Events involving certain other diseases (cholera, pneumonic plague, yellow fever, viral haemorragic fevers, West Nile Fever, meningococcal disease)

– All events involving at least 2 of 4 criteria: 1. Potentially severe public health impact 2. Unusual or unexpected nature3. Significant risk of international spread 4. Significant risk of restrictions on

international travel or trade

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Risk of spread internationally?

Reassess when more information available

No

Yes

No

Is the event unexpected?

Notify the event under the International Health Regulations

Yes

Yes

Is the event unexpected?

No

Risk of spread internationally?

No

Yes

Yes

Risk for international sanctions?

No

Is the event serious?

Yes

No

IHR Decision intrument

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Conclusions (1)Definition

History

Functions

Principles

EWAR and IHR

Conclusions

IHR is a legally binding international instrument

developed through negotiation between States

Purpose of IHR is to prevent and respond to the

international spread of disease while avoiding

unnecessary interference with international traffic

and trade

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Conclusions (2)Definition

History

Functions

Principles

EWAR and IHR

Conclusions

IHR represents a huge opportunity to develop

needed core capacities in every country

To establish and maintain an effective national

early warning system (EWAR) is an obligation for

all member States.

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Question Time

1. Do you think IHR is a useful instrument at national and international level?

2. If you were nominated National IHR Focal Point tomorrow how would you proceed to ensure that the obligations of your country in terms of surveillance and response were met?

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

For more information you may consultThe WHO/SEARO checklist to assess core

capacities

For more information you may consultThe WHO/SEARO checklist to assess core

capacities Topics:1. Legislation and national policy

2. Collaboration and partnerships

3. Surveillance – epidemiology

4. Response

5. Case management, including infection control and disease control

6. Laboratory issues

7. Port health

8. Communication

9. Resources