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