Implementation of IHR Roles

1
Implementation of IHRRoles Responsibilities of
State

• Dr. Sujeet Singh

2
Broad Areas

• IHR requirements
• Key areas
• Activities for effective implementation
• Core capacities
• Roles responsibilities

3
What are IHRs?
An international legal instrument, legally
binding on all WHO Member States who have not
rejected them

• IHR (1969)
• Objective Maximum security against international
  spread of diseases with minimum interference to
  world traffic
• Scope Only 3 diseases (Cholera, plague, yellow
  fever)
• Limitations
• Dependence on affected country to notify
• Lack of mechanisms for collaboration between WHO
  and affected country

4
Emerging Pathogens and IHR

• Smallpox, cholera, plague subject to regulations
  till 1970s- Now eradicated/ controlled.
• IHR were not fulfilling purpose as evident from
  plague outbreak (1994), SARS outbreak ( 2003)
  and Influenza A H1N1 (2009)
• Emergence and re- emergence of diseases of
  International concern in last decade

5
(No Transcript)
6
Recent Outbreaks

• In other countries
• SARS
• Avian Influenza
• Influenza A H1N1
• In India
• Plague
• DHF
• PHEIC related to disasters, Chemical accident,
  radiological

7
SARS Outbreak (2003)

• IHR 1969 with provision for reporting for 3
  diseases only
• No IHR provisions for SARS China
• Delay in cause detection, mode of spread etc.
• Surveillance response in each country were
  different ( Mostly Reactive response)
• Entry screening (1.20 lac pax. screened per
  week)
• Isolation and quarantine
• Lab. Testing prophylaxis/treatment for cases
  and contacts
• Reporting documentation
• Highlighted the importance and need for
  revision of IHR 1969

8
Influenza A H1N1

• IHR (2005) in place (better planned)
• Guidelines on surveillance response
• Uniform procedures - entry screening, contact
  tracing, chemoprophylaxis, PPEs etc.
• Isolation and sample for Laboratory tests
• Guidelines for management of case suspects,
  disinsection use of PPEs
• Periodic review of strategy by daily reporting

9
IHR (2005) Document

• 66 Articles organized in X Parts
• 9 Annexes
• Annex 1 Core Capacity Requirements for
  Surveillance Response, and for Designated
  Airports, Ports and Ground Crossings
• Annex 2 Decision Instrument for Assessment
  Notification of Events that may constitute a
  Public Health Emergency of International Concern
• Available on Website http//www.who.int/csr/ihr/e
  n/

10
What is New in IHR (2005)

• Concept of National focal point
• Covers all dangerous diseases both new and
• existing PHEIC
• WHO has the mandate to verify rumors, news
• from print/electronic media of disease /
  outbreaks
• Obligation to develop core capacity both at
• country level as well as ports/ airports
• Provision for WHO assistance for early diagnosis
• Provision of dispute solving through court of
• arbitration
• Covers notification for chemical radio-nuclear
  
• events as well

10
11
Major Obligations for Member States
Designation of National IHR Focal Point
Response
Legal administrative framework
Major Obligations
Assess events notify potential PHEIC
Core capacities to detect, report and respond

12
Responsibility of National Focal Point (NCDC)

• To notify PHEIC to WHO
• To respond to requests for verification of
  information of such events.
• Support field investigations, provide early
  diagnosis and provide technical guidance to
  states for timely and effective response to PHEIC
• Co-ordination with state units and WHO

12
13
Public Health Emergency of International Concern
(PHEIC)

• An extraordinary public health event which
• constitutes a public health risk to other
  countries through international spread of disease
• potentially requires a coordinated international
  response

Disease means an illness or medical condition,
irrespective of origin or source that presents or
could present significant harm to humans
14
Determination of PHEIC 4 criteria

• Unusual or Unexpected Event
• Event resulting in Serious Public Health Impact
• Event with significant risk of international
  spread
• Event with significant risk of international
  travel or trade restriction

Any event irrespective of origin source meeting
any 2/more criteria shall be considered as PHEIC
notified to WHO under IHR (2005)
15
Notification

• The IHR(2005) requires notification of all events
  which may constitute PHEIC within 24 - 48 hours
• To respond to requests for verification of rumors
  / news received from print media or other sources
  
• No specified list of diseases (algorithm
  provided)

15
16
(No Transcript)
17
Key Areas for effective implementation

• Legal provision IHR (legal technical)
• National - Epidemic Disease Act -1987
• Disaster Management Act 2005
• Draft Public Health (prevention, control and
  management of epidemics, bioterrorism and
  disasters) Bill provides for prevention, control
  management of epidemics and public health
  consequenses of disasters
• Indian Aircraft (public Health) Rules, 1954
  Indian Port Health rules, 1955

18
Key Areas (contd.)

• Assessment strengthening of core capacities at
  national/state/districts nodal officers/RRTs
  (multidisciplinary)
• Trained manpower development contingency plan
• SOPs for procedures case management,
  screening, contact tracing, chemoprophylaxis,
  PPEs etc.
• Facilities for isolation, quarantine and case
  management laboratory/hospital back-up support
• Risk assessment and Communication network
• Periodic review, data processing and reporting

19
Activities undertaken for Effective
Implementation of IHR (2005)

• Activities at National level
• Activities by State Governments/ UTs and District
  Authorities
• Activities related to the Airports/ Ports/ Ground
  Crossings

20
Activities at National Level

• National IHR focal point designated - NCDC
• Coordination with WHO states/districts
• Designation of Nodal officers
• Core capacity building
• Increased awareness about IHR among health
  administrators and professionals
• Surveillance response capacity (RRT)
• Enhanced Satellite based disease surveillance
• Strengthening laboratory network

21
National Level Activities

• Develop RRT guidelines, laboratory computer
  manuals, and training materials
• Train State Rapid Response Teams
• Strengthen network National Regional
  laboratories
• Establish rapid communication network
• Technical review, co-ordination, monitoring
  evaluation

22
Activities State/UT Govts District
Authorities

• State District IHR focal points designated
• Reporting by State/District to National Focal
  Point as per IHR
• IHR in IDSP trainings
• Surveillance response capacity enhanced
  Influenza A H1N1

23
IDSP Objectives

• Establish early warning mechanism
• Laboratory strengthening networking for
  surveillance rapid confirmation of diagnosis
• Effective use of surveillance data using rapid
  means for communication
• Institute appropriate timely response for
  prevention control of outbreaks

24
Alert Response Operations
Events that may constitute PHEIC
Detection Verification Risk assessment
Response
25
Surveillance response capacities required at
each level

• Event alert
• verification
• Assessment
• Intl. response

Regional International level

• Assessment
• Notification
• P.H. response

National level

• Confirmation
• Response
• Assessment

Intermediate level
Local level

• - Detection of event
• Reporting
• Controlling

26
At the National Level

• Assessment and notification. The capacities
• To assess all reports of urgent events within 48
  hours and
• To notify WHO immediately
• To confirm the status of reported events and to
  support or implement additional control measures
  and
• To assess reported events immediately and, if
  found urgent, to report all essential information
  to the national level. For the purposes of this
  Annex, the criteria for urgent events include
  serious public health impact and/or unusual or
  unexpected nature with high potential for spread.

27
Activities on the part of State Governments/UTs
and District Authorities

• Designation of IHR focal points 24x7
  accessibility
• Assessment and strengthening of disease
  surveillance response capacity as per IHR
• Evaluation strengthening of laboratory
  capacities (inventory of regional /national labs)
• Evaluation strengthening of isolation
  facilities infection control practices
• Mechanism for rumour verification
• Awareness reg. information to be reported to NFP

28
Activities on the part of State Governments/ UTs
and District Authorities contd...

• Preparation and periodical updating of public
  health contingency plans
• Involvement of private sector and professional
  organizations (e.g. IMA) for disease surveillance
  activities
• APHOs/ PHOs/ Ground crossings be included in
  state surveillance committees
• Identification of high-risk areas near
  international borders and programme for
  cross-border control of diseases

29
Activities (contd.) State Governments/ District

• Linkages of IDSP/NFP with all state/ district HQs
  
• Nodal officers to be identified in
• Designated hospitals, laboratories and various
  pest/ vector control agencies
• State Health Directorates, District Health
  Authorities
• Local municipality, cantonment board, other
  relevant agencies
• Ministries of Civil Aviation, Shipping, Surface
  transport, Agriculture (veterinary dept.), Home
  Affairs, Tourism, Railways
• Customs, Immigration, AAI
• AOC, Association of shipping agents
• CISF

30
Activities related to the Airports/ Ports/ Ground
Crossings

• Designation of Airports/ Ports/ Ground Crossings
  IHR Focal Points
• Training of technical staff on IHR
• Assessment strengthening of capacities at
  designated entry/ exit points
• Awareness about information to be reported to NFP
  
• Referral system for medical care services
• Creation of new public health units
• Improve infrastructure of quarantine centers
• District IDSP lab be designated for each APHO/
  PHO
• Provision of entomologist for vector surveillance
  control activities

31
District Responsibilities

• Identify district RRT members multidisciplinary
  
• Train Medical Officers PMWs event reporting
• numbers of human cases and deaths, conditions
  affecting the spread of the disease and the
  health measures employed and Clinical
  descriptions
• Modernize computerize District Epid. Cell
• Identify strengthen District Labs
• SOPs for sample collection/transportation, media
• Reporting of events / PHEIC from district/state
• Response plan

32
National level response

• To determine rapidly the control measures
  required to prevent domestic and international
  spread
• To provide support through specialized staff,
  laboratory analysis of samples (domestically
  /regional collaborating centres) and logistical
  assistance (e.g. equipment, supplies and
  transport)
• To provide on-site assistance to supplement local
  investigations
• Coordination / liaison with other relevant
  ministries/departments/NGOs
• Coordination with senior health officials to
  approve rapidly and implement containment and
  control measures
• To establish links with hospitals, clinics,
  airports, ports, ground crossings, laboratories
  etc.for the dissemination of information and
  recommendations received from WHO regarding
  events
• To establish, operate and maintain a national
  public health emergency response plan, including
  the creation of multidisciplinary/ multisectoral
  teams to respond to PHEIC

33
State Level Capacities

• To detect events involving disease or death above
  expected levels for the particular time and place
  in all areas within the territory of the State
  Party and
• To report all available essential information
  immediately to the appropriate level of
  healthcare response.
• At the community level, reporting shall be to
  PHC/CHCor the appropriate health personnel. At
  the primary public health response level,
  reporting shall be to the district/State or
  national response level,
• Essential information includes
• Clinical descriptions, laboratory results,
  sources and type of risk, numbers of human cases
  and deaths, conditions affecting the spread of
  the disease and the health measures employed and
• To implement preliminary control measures
  immediately.

34
Laboratory strengthening

• Identify and strengthen labs at National,
  Regional,State and district
• Intrasectoral, intersectoral and international
  networking
• SOPS facilities for sample collection/storage/tr
  ansportation
• Outbreak Investigation Kits
• Inventory of Biosafety levels labsBSL-2/BSL-3/
  BSL-4
• Focus on Epidemic-prone and EIDs
• Arrangements for diagnostic kits and reagents
• Mechanism of release of reports documentation
• Define role of private labs

35
Laboratory Roles

• Focus labs for neglected areas TSS,Food
  Posionings
• Labs - Diseases in Animals
• Environmental sampling Air,food, water
• Water quality monitoring
• Mobile labs/ Portable labs / Temporary labs
• Lab-based surveillance before, during and after
  the disasters
• Plan for processing of non-conclusive
  samples-newer pathogens? Where to send?
• Ensure availability PPEs, disinfectants,
  chemo/immunoprophylaxis

36
Networking Web-based surveillance

• Interactive website www.nicd.org, is operational
  for online data entry
• Directory of NSPCD official at centre, state and
  districts is available

37
Web-based Surveillance
38

• SUMMARY
• Action plan for (Proactive Response)
• Core capacity development - IHR module for PHEIC
• Training of manpower including field staff on
  Surveillance, response case reporting
• Resource planning drugs, reagents, PPEs
• Intersectoral coordination
• Laboratory support
• Real time exercises
• Retrospective Epidemiological study of disasters
  in the area
• Collaboration of plan with allied agencies, areas
  and states

39

• THANKS