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International Health Regulations (IHR)
The international health regulations, which are administered by WHO, are the only legally binding international instruments covering measures for preventing the trans-boundary spread of infectious diseases. They provide a single code of procedures and practices, including routine measures at air ports and sea ports, for preventing the importation of pathogens and vector. They also set out roles and responsibilities for WHO as well as for individual countries for responding to limited range of disease outbreaks. They contribute greatly to the use of uniform and effective protective measures both on routine basis and in certain crisis situations.
Evolution of Health Regulations (IHR)
International health regulations were formulated at the Twenty-second World Health Assembly in July 1969 with the main aim to ensure “maximum security against the spread of a disease from one country to another but with minimum interference with global traffic and trade”.
Subsequently, World Health Assembly amended the International Health Regulations in 1973 to accommodate the view that Cholera vaccine is not mandatory for international travelers. Vaccination against Cholera provides limited protection to travelers and does not protect the community from importation of Vibrio Cholera. It also accepted the view that any restrictive measures would not prevent the International Spread of Cholera. However, there are some obligations by the country where a case of Cholera has been imported and also by the country of origin of infection; therefore, Cholera continues to be included under international health regulations.
The present version of International Health Regulation was finalized in 1981 and updated in 1992. Under the IHR practiced before 1981, four diseases were to be notified, namely, Yellow Fever, Small Pox, Cholera and Plaque. Notification of Small Pox was removed from the International Health Regulations in 1981. It also advised to discontinue Small Pox vaccination not only to international travelers but to stop the practice of Small Pox vaccination to any person whatsoever.
Notification
Each health administration is obliged to notify WHO by telegram of telex within 24 hours the first case of a notifiable disease under IHR (i.e., Yellow Fever, Cholera, Plaque), that is neither an imported case nor a transferred case, but has occurred within the territory of the health administration. The health administration is obliged to notify, in the next 24 hours, the infected area in the territory. Within 24 hours of being informed, the health administration has to notify WHO of an imported case or a case spread to non infected area within the territory. It has also to inform WHO within 24 hours on the arrival of ship or air craft with one or more cases of infected persons of a notifiable disease.
The first notification from the health administration is published in the weekly epidemiological record of WHO, which is widely circulated.
Criterion for Declaring an Area Free of Infection
The health administration, which notifies WHO a disease under IHR, is also obliged to notify WHO when the area becomes free from infection. While deciding that an area is free from the notified disease, certain criteria have to be considered. These are as follow
v Plague and Cholera. Twice the incubation period has elapsed since the last cae was identified, which has recovered and isolated or died and there are no epidemiological evidences of spread
v Yellow Fever not Transmitted by Aedes Aegypti (Imported). Three months has elapsed without any evidence of Yellow Fever Virus activities. In case of Yellow Fver Transmitted by Aedes Aegypti, three months have elapsed since the last occurrence of human case or one month since that occurrence, the Aedes Aegyti index has remained below one percent.
v Plague in Domestic Rodents. One month has elapsed since the last infected rodent was found or trapped.
v Plague in Wild Rodents. Three months should have elapsed without any evidence of the disease in sufficient proximity to sea ports and air ports that could be threat to international traffic.
v Poliomyelitis. The global commission for Certification of Eradication of Poliomyelitis has specified three criteria to be fulfilled by countries in order that they may be certified polio free. (1) Absence of Polio Virus for three years in the presence of adequate acute flaccid Paralysis (AFP), surveillance in children under the age of 15 years.(2) A National Certification Committee in each country to validate and submit the Certification Documentation; and (3) The establishment of mechanisms to detect and respond to the importation of wild Polio Virus
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