Assessment of Public Health Events through International Health Regulations, United States, 2007–2011

Katrin S. Kohl

, Ray R. Arthur, Ralph O’Connor, and Jose Fernandez

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.S. Kohl, R.R. Arthur, R. O’Connor); and Department of Health and Human Services, Washington, DC, USA (J. Fernandez)

Abstract

Under the current International Health Regulations, 194 states parties are obligated to report potential public health emergencies of international concern to the World Health Organization (WHO) within 72 hours of becoming aware of an event. During July 2007–December 2011, WHO assessed and posted on a secure web portal 222 events from 105 states parties, including 24 events from the United States. Twelve US events involved human influenza caused by a new virus subtype, including the first report of influenza A(H1N1)pdm09 virus, which constitutes the only public health emergency of international concern determined by the WHO director-general to date. Additional US events involved 5 Salmonella spp. outbreaks, botulism, Escherichia coli O157:H7 infections, Guillain-Barré syndrome, contaminated heparin, Lassa fever, an oil spill, and typhoid fever. Rapid information exchange among WHO and member states facilitated by the International Health Regulations leads to better situation awareness of emerging threats and enables a more coordinated and transparent global response.

Global air travel makes it possible for most countries to be reached from a country furthest away within a day, and some countries are connected by direct flights to >70 other countries. Just as persons and goods travel rapidly around the world, so too can pathogens. The outbreak of severe acute respiratory syndrome (SARS) in 2003 continues to symbolize the real possibility of rapid international disease spread of an emerging pathogen (1). It also raised awareness that global disease threats can go undetected and unreported to the point that control efforts are extremely difficult because major spread has often already occurred.

The experience with SARS led to the call for more transparent and rapid sharing of information on health risks and public health measures between countries and the World Health Organization (WHO) (2). In 2005, the World Health Assembly adopted revised International Health Regulations (IHR) with the declared purpose 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 unnecessary interference with traffic and trade” (3). The IHR legally bind 194 WHO states parties, including all WHO member states. One of the key principles inspiring the IHR is open, fast, and secure information exchange about disease emergence and response activities. The IHR provide a platform for dialog in form of national focal points (NFPs), which are always-available points of contacts in each IHR state party for all IHR-related information exchange with WHO and other NFPs, and through provision of a secure web portal, the IHR Event Information Site (EIS), which is accessible by all NFPs.

The IHR went into effect in the United States on July 18, 2007, with the explicit reservation that the United States assumes its obligations “in a manner consistent with its fundamental principles of federalism,” an acknowledgment that responsibilities in the United States under these Regulations are shared between the Federal Government and the States. In addition, the United States specifically understands that all countries have an obligation to notify to WHO potential public health emergencies of international concern (PHEICs) “irrespective of origin or source, whether they involve the natural, accidental or deliberate release of biological, chemical or radionuclear materials” (4). In this report, we focus primarily on application of IHR assessment and reporting requirements within the United States for rapid sharing of information on potential PHEICs.

Fungi article
Volume 18, Number 7–July 2012

Assessment of Public Health Events through International Health Regulations, United States, 2007–2011

MEDSCAPE CME

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
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All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid ; (4) view/print certificate.
Release date: June 13, 2012; Expiration date: June 13, 2013

Learning Objectives

Upon completion of this activity, participants will be able to:
• Describe overall potential public health emergencies of international concern (PHEIC) from states parties posted by WHO on a secure Web portal between July 2007 and December 2011
• Describe potential PHEIC from the United States posted by WHO on a secure Web portal between July 2007 and December 2011
• Describe potential benefits of having the IHR framework for notification in place, as well as strategies for reporting and sharing information with the WHO

CME Editor

Thomas J. Gryczan, MS, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Thomas J. Gryczan, MS, has disclosed no relevant financial relationships.

CME AUTHOR

Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

AUTHORS

Disclosures: Katrin S. Kohl, MD, PhD, MPH; Ralph O’Connor, PhD; and Jose Fernandez, PhD, have disclosed no relevant financial relationships. Ray R. Arthur, PhD, has disclosed the following relevant financial relationships: owns stock in Vivus Inc.