The revised IHR will provide a mechanism for immediate notification of all disease outbreaks of urgent international importance. The disease outbreaks will be characterized initially by clinical syndrome rather than specific diagnosis, in order to expedite notification. An outbreak will be notifiable under the IHR only if both of the following conditions are met: (1) it corresponds to the case definition of one of the specified syndromes, and (2) it represents an event of urgent international importance. Following notification to WHO, a decision to report the outbreak publicly will be taken on the basis of consultation between WHO and the Member State concerned. If further investigation indicates that an outbreak is not after all of international significance, a statement to this effect will also be published.
Routine occurrence of endemic diseases will not be notifiable under the revised IHR. Consequently, cholera would no longer be notifiable unless an outbreak were of urgent international importance, for instance if it occurred in an area where the disease is not endemic, or involved a new strain, unusual severity, or if trade and travel restrictions were applied by other Member States.
The case definitions for the syndromes are intended to ensure that all outbreaks of communicable diseases representing an international threat will be notifiable under the revised IHR. The IHR will refer to the specific syndromes which will be listed in the text, while the full case definitions will be detailed in an annex to the IHR. This will allow for modification of the detailed definitions in the future if necessary. The syndromes proposed for notification are: acute haemorrhagic fever, acute respiratory, acute diarrhoeal, acute jaundice, and acute neurological syndromes, as well as a category covering other notifiable syndromes of presumed infectious origin. Notification of a syndrome will normally be followed by a report on the specific disease once the diagnosis has been established. If the diagnosis is already known, the disease can be notified rather than the corresponding syndrome.
The urgent international importance of an outbreak will determine whether it should be notified. Criteria to assist national health authorities in the assessment of urgent international importance will include the following medical, epidemiological and operational issues: high risk of international spread; unexpectedly high case-fatality rate; unusual occurrence; newly recognized syndrome; high degree of interest by the media; potential for imposition of trade or travel restrictions.
The IHR will address only the issues concerning outbreaks of urgent international importance. Regular disease surveillance and reporting activities will continue, including regular reporting to WHO. The revised IHR will not supersede or interfere with any national or international surveillance efforts.
The last progress report in July 1997 described the proposed changes in notification requirements and the new structure for the IHR. Since then, activities have focused on the following areas:
A pilot study has been organized in selected countries to evaluate the proposed new approach to notification. The objective of the study is to test syndromic notification within existing national disease surveillance systems. At central level, the national health authority will assess incoming reports of disease outbreaks within the country against the IHR case definitions and criteria indicating urgent international importance. The pilot study will demonstrate whether the proposed new approach to notification will facilitate the identification of, and response to, disease outbreaks. It will also test the specificity and sensitivity of the case definitions which will be refined if necessary on the basis of the findings of the study. Draft operational guidelines to accompany the revised IHR will be finalized in the light of experience gained. WHO will work in partnership with the participating countries throughout the pilot study, which will also test WHO's capacity to manage and respond to the incoming information.
A final selection of the 20 countries invited to participate in the study was made in consultation with the WHO Regional Offices. Seminars were organized in each Region for the participating countries during October-November 1997 to provide briefing on the revision of the IHR and the pilot study to evaluate syndromic notification. These briefing seminars will be completed for French- and Spanish-speaking countries in January 1998.
In addition to the prospective pilot study in the selected countries, a retrospective study will also be carried out using outbreak reports received by WHO during the past year. This will provide further information for the evaluation of the proposed case definitions and the assessment of whether syndromic notification would facilitate a more rapid response to outbreaks.
The provisional draft text of the revised IHR has been prepared by a small drafting group convened in September 1997 after wide-ranging international consultations. The drafting group included legal and public health experts.
Preparation of this provisional draft text is now being completed, together with 2 new annexes to the IHR. It is planned to send the text to all Member States early this year as noted in the Weekly Epidemiological Record No. 50 of 12 December 1997. This text will be sent to Members of the Committee on International Surveillance of Communicable Diseases for review. It will also be sent to other intergovernmental and non governmental organizations which have an interest in the IHR.
A progress report on the revision of the IHR was provided to the WHO
Executive Board in January 1998. The next steps in the revision process
will include:
Governments of 86 Member States have now designated focal points for the revision of the IHR. Other governments are still welcome to designate a representative for this purpose. The next progress report will be published in July 1998.
[Table of Contents] [WHO DOCS Index] [Alphabetical Index] [Zamnet] [UNZA] [UNZA Library]
Last updated January 21, 1999