Disease Surveillance and Epidemiology (DSE) – WHO Indonesia1 |
International Health Regulations (2005) and EWARS
International Health Regulations (2005) and EWARS
Dr Nirmal Kandel, MBBS, MA, MPH
Disease Surveillance and Epidemiology
WHO - Indonesia
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia2 |
ObjectivesObjectives
The IHR history and principles
Define EWAR as a component of IHR and as such the need of EWAR components in the surveillance systems of countries
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia3 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia4 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia5 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia6 |
• 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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia7 |
• 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)
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia8 |
• Intelligence
• Verification
• Risk assessment
• Response (GOARN)
• Logistics
Surveillance and
response at global level
IHR Annex 2 (notification instrument)
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia9 |
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 »
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia10 |
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.
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia11 |
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,
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia12 |
Core Capacities (Annex 1a)Surveillance and ResponseDefinition
History
Functions
Principles
EWAR and IHR
Conclusions
– Detection (EWAR)– Verification – Investigation– Notification – Response
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia13 |
Function of a surveillance system
aiming to detect any abnormal phenomenon
that will trigger prompt public health
interventions
Early WarningEarly Warning
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia14 |
Early warning and response Early warning and response
Report Data
Public health alert
CaptureFilterVerify
CollectAnalyseInterpret
Assess
Surveillance:
Response
Event-based surveillance Case-based surveillance
Post-outbreak strengthening Evaluate
InvestigateControl
Signal
Strengthen
Report Data
Public health alert
CaptureFilterVerify
CollectAnalyseInterpret
Assess
Surveillance:
Response
Event-based surveillance Case-based surveillance
Post-outbreak strengthening Evaluate
InvestigateControl
Signal
Strengthen
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia15 |
Indicator-based surveillance Event-based surveillance
Signal
Initial assessment
Monitor Discard or close
Investigate
DailyRoundTable
ReportDaily
InternalResponse
Team
ExternalResponse
Team
Action plan
Support
Coordinate
Update assessment
Prepare Sit repMonitor
Early Warning and Response Loop
Ear
ly W
arn
ing
Res
po
nse
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia16 |
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 PHEIC
DG of WHO declares PHEIC
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia17 |
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”
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia18 |
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
Yes ALERTPublic 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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia19 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia20 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia21 |
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
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia22 |
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.
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia23 |
Question TimeQuestion 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?
Disease Surveillance and Epidemiology (DSE) – WHO Indonesia24 |
Thank youThank you
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