PHEIC & Decision Instrument Dr Reuben Samuel WHO Country Office - India

What is a PHEIC?  PHIEC – Public Health Emergency of International Concern  An extraordinary event which is determined, as provided in these Regulations: i.to constitute a public health risk to other Member States through international spread of disease and ii.to potentially require a coordinated international response.

Alert and Response Operations DetectionVerification Risk assessment Response Response Events that may constitute a Public Health Emergency of International Concern need:

Verification of events  Value of unofficial sources of information for early alert  WHO requests for verification of potential public health events of international importance  Member States provide initial reply within 24 hours and provision of information  On-site assessment, when necessary

Event notification  Any event that may constitute a Public Health Emergency of International Concern (PHEIC)  Within 24 hours of assessment  By the most efficient means of communication  Continue to provide WHO with detailed information  Does NOT mean a real “PHEIC ”

Disease List  Four diseases (a single case is notifiable): Smallpox, Poliomyelitis, human influenza (caused by a new subtype), SARS  Utilization of the decision instrument: Cholera, plague, viral haemorrhagic fevers, yellow fever, … Diseases of regional concern: dengue fever, meningococcal diseases …

Decision Instrument 1.Is the public health impact of the event serious? 2.Is the event unusual or unexpected? 3.Is there a significant risk of international spread? 4.Is there a significant risk of international travel or trade restrictions? two Answering "yes" to any two of the criteria requires a member state to notify WHO Criteria for assessment

Is the event serious? Is the event unexpected? Could it (or has it) spread internationally? Risk for international sanctions? Not notified at this stage. No Notify the event under the International Health Regulations Yes No Is the event unexpected? Yes No Could it (or has it) spread internationally? Yes No

Is the event serious?  Morbidity and mortality  Does the event have potential for high impact? Population at risk Cases in health staff; highly infectious Factors affecting response e.g. war, natural catastrophe High population density  Immediate or potential need for external assistance

Is the event unexpected?  Is the cause of the event unknown?  Are the circumstances unusual? Cases worse than usual Treatment failures Event unusual for place/season Caused by eliminated/eradicated agent  Suspected or known intentional or accidental release of chemical, biological or radiological agent

Is the event likely to spread internationally?  Similar cases in other countries where it was unexpected?  Factors alerting to cross-border implications? Caused by epidemic-prone organism Source suspected/ known to be related to food import/export Index case with international travel history In area with international tourism/ traffic, person or goods In border areas with limited capacity for control

Is event likely to result in international travel and trade restrictions?  Similar events previously led to restriction on travel/ trade?  Source known or suspected food product/ goods known to be imported or exported?  In area with international tourism?  Attracted media attention ?

Combinations of answers requiring notification  Serious and unexpected  Serious and risk for international spread  Serious and risk for international restrictions  Unexpected and risk for international spread  Unexpected and risk for international restrictions

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