Download Illustrations of the use of the decision instrument in selected

Illustrations of the use of the
decision instrument in
selected case scenarios
Alert and Response Operation Team
International Health Regulation, Alert and Response
Project
Which event should be notified to WHO?
• The following four diseases which are deemed
always to be unusual or unexpected and may have
serious public health impact, and hence must be
notified to WHO in all circumstances:
–
–
–
–
Smallpox
Poliomyelitis due to wild type poliovirus
Human Influenza caused by a new sub type; and
SARS
• The IHR (2005) also require notification of all (public
health) events which may constitute a public health
emergency of international concern, in accordance
with the Decision Instrument in Annex 2.
Assessment and notification of events
according to decision instrument criteria
•
At the national level, States Parties are required to assess
all urgent events within 48 hours by applying a specific
algorithm contained in Annex II.
• The algoritm provides the parameters to decide whether or
not a specific event needs to be notified to WHO under
the IHR.
• When a State Party identifies an event as notifiable, it must
be notified to WHO immediately, i.e., within 24 hours after
having carried out the assessment.
• The four decision criteria are: (1) the seriousness of the
event's public health impact; (2) the unusual or unexpected
nature of the event; (3) the risk of international disease
spread; and (4) or the risk that travel or trade restrictions
will be imposed by other countries.
Accordingly notification may be required for:
• Events, irrespective of their origin or source, including those
caused by biological (of infectious or non-infectious nature)
chemical agents or radio nuclear materials;
• Events where the underlying agent, disease or mode of
transmission is new, newly discovered or as yet unknown at the
time of notification;
• Events involving transmission or potential transmission through
persons, vectors, cargo or goods (including food products) and
environmental dispersion;
•
Events that carry potential future impact on public health and
require immediate action to reduce the consequences;
•
Events arising outside of their known usual occurrence patterns.
Annex 2 Concordance Study
Introduction
• Mandate WHO to conduct studies to review and
evaluate the functioning of Annex 2 of the IHR:
Article 54.3 of the IHR, as well as World Health
Assembly resolutions 58.37 and 61.2.
• 2008: WHO technical consultation recommended
that an assessment be carried out to evaluate
agreement among NFPs when judging certain
described events using Annex 2.
• The University of Geneva Hospitals’ Infection
Control Programme in Switzerland was
commissioned to carry out this assessment.
Methods
• The survey exploring NFPs’ use of Annex 2 of the IHR
was based on several fictitious scenarios that
described events devised to represent a wide range of
public health risks with a varying likelihood of being
considered notifiable.
• The survey was made available in the six WHO
languages via a secure web site.
• Each State Party could submit only one completed
survey. Participation was voluntary and anonymous.
• Gold standard responses
Analysis
• The degree of consensus among NFPs on a particular
survey item was expressed as the proportion of
participants who chose the most commonly selected
response for that item.
• The degree of concordance between NFPs and the
expert panel was expressed as the proportion of
participating NFPs who selected the panel’s standard
response for that item, where applicable.
Results
• 142 (74%) States parties participating.
• The very high response rate in this survey
suggests a considerable interest among NFPs in
the IHR and the notification assessment using
Annex 2.
Results
Results
Results
Scenario 1 – Pneumonia of unknown etiology
Scenario 2 – Arsenic contamination of ground water
Scenario 3 – International distribution of ineffective HIV drug
Scenario 4 – Multidrug-resistant Klebsiella pneumoniae
Scenario 5 – Dengue fever
Scenario 6 – Outbreak of salmonellosis linked with
chicken
Scenario 7 – Imported case of wild type polio
Scenario 8 – Fuel explosion with important number of casualties
Scenario 9 – Ochratoxin A detected in imported
wheat
Scenario 10 – Outbreak of foot and mouth disease among
livestock