IHR News. The WHO quarterly bulletin on IHR implementation. 30 June 2009, No. 7

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1 IHR News The WHO quarterly bulletin on IHR implementation 30 June 2009, No. 7 Issued by the International Health Regulations (IHR) Coordination Department World Health Organization (WHO), Geneva and Lyon ihrinfo@who.int WHO response to pandemic (H1N1) 2009 virus In late April, further to the emergence of human cases of a novel influenza A (H1N1) virus in North America, the virus continued to spread to many countries, with increasing numbers of people affected. To date there have been total of more than 50,000 confirmed cases of pandemic (H1N1) 2009 virus in more than 100 countries. In response to the first reported cases and in accordance with the International Health Regulations (IHR), the WHO Director-General convened, on 25 April, the 1 st meeting of the IHR Emergency Committee, comprised of leading influenza experts, virologists and public health officials, to seek their view on the event. Further to this consultation, the WHO Director-General declared this event a public health emergency of international concern, the first since the revised International Health Regulations came into force on 15 June As part of the response, WHO set up an operations group, including logistics, the Global Outbreak and Response Network (GOARN), and planning. Four task forces were created on science knowledge and standards, vaccine, antiviral and zoonosis. In addition, a WHO Global Response Plan was developed, outlining the specific response activities in place at headquarters and in the six WHO regions. As WHO monitored the global course of the epidemic, the Director-General continued to consult the IHR Emergency Committee and declared the move from phase 4 to phase 5. Then, on 11 June, with sustained community spread in multiple locations around the globe and on the basis of expert assessments, the level of influenza pandemic alert was raised to phase 6 as the scientific criteria for an influenza pandemic had been met. The phase change was not a signal that the virus had become more virulent but rather reflected its extensive geographic spread. WHO, working 24 hours a day, 7 days a week, through its emergency response mechanism at headquarters and in all six regional offices, continues to monitor the evolution of the pandemic and the severity of illness, which could change over time and manifest itself differently in different locations, population groups, and countries. To keep countries informed at any time of new developments, the WHO Event Information System, which links WHO and the National IHR Focal Points in all countries, is continuously updated, while the general public is also kept informed via situation updates. The latest technical guidelines can be found at: The emergence of Pandemic (H1N1) 2009 virus underscores the importance for all countries to strengthen their national disease surveillance and response capacities. This is one important IHR requirement. Towards this goal, the six WHO regional offices provide technical guidance to all countries to help them improve their national surveillance and response systems and meet the IHR core capacity requirements by Much needs to be done and time is running out.

2 In this issue: WHAT S NEW IN IHR COORDINATION AND SUPPORT International partnership for an IHR implementation course 62 nd World Health Assembly, May 2009, Geneva, Switzerland Case management of Influenza A (H1N1) in air transport, 18 May 2009, WHO, Geneva, Switzerland Guide to hygiene and sanitation in aviation, 3 rd Switzerland, 2009 Laboratory Quality Management System: Training toolkit edition, WHO, Geneva, WHAT S NEW IN RISK AND DISEASE CONTROL Pandemic (H1N1) 2009 virus guidance documents, FAQs and situation updates WHO experts consultation on Ebola Reston pathogenicity in humans, 1 April 2009 Polio network helps respond to pandemic (H1N1) 2009 virus Polio vaccination required for the Hajj Yellow fever Release of two new interactive CD ROMS WHAT S NEW IN THE WHO REGIONS 1 AFRO: Strengthening biosafety and biosecurity 8 13 June 2009 and Training for Packaging and Shipping Infectious Substances, June 2009, Johannesburg, South Africa AFRO: Assessment of core capacities, June 2009, Kenya AFRO: Review of preparedness and response capacity during mass gatherings, June, Johannesburg, South Africa EMRO: International consultation on preparedness for mass gatherings (Umrah and Hajj), June, 2009, Kingdom of Saudi Arabia PAHO: Regional response to pandemic (H1N1) 2009 virus PAHO: Launch of Cooperative Arrangement for Preventing the Spread of Communicable Disease through Air Travel (CAPSCA) in the Americas, June 2009, Mexico City, Mexico SEARO and WPRO: Bi-regional Workshop of the Asia Pacific Strategy for Strengthening Health Laboratory Services ( ), Bali, Indonesia, June The six WHO regional offices: AFRO Regional Office for Africa ; EMRO - Regional Office for the Eastern Mediterranean; EURO - Regional Office for Europe; PAHO/AMRO Pan American Sanitary Bureau/Regional Office for the Americas; SEARO - Regional Office for South-East Asia; WPRO - Regional Office for the Western Pacific. 2

3 WHAT S NEW IN IHR COORDINATION AND SUPPORT International partnership for an IHR implementation course Further to the series of face-to-face briefings and online training modules developed by the IHR Coordination Department to support countries to implement the IHR, WHO has also stimulated a more extensive and longer-term training programme, which aims to empower key players engaged in the implementation of the IHR. This programme has been developed in collaboration with the University of Pretoria, South Africa, Georgetown University Law Center, USA, and the Universities of Lausanne and Geneva, Switzerland. The course targets public health professionals, mainly belonging to National IHR Focal Points (NFP), but also professionals from other related sectors from national or international organizations, in the public and private sectors. Two courses will be organized per year. Each course will target 40 trainees and will represent 220 hours of work over a period of four months, combining distance-learning periods with a two week regrouping session. The first course will take place in March July 2010, with the face-to-face session to be held in Lyon, France, from July. The courses will be delivered in English initially, and will be developed subsequently in other WHO official languages. For detailed information on the course curriculum, registration, eligibility, please contact Dr Pierre Nabeth or Ms Anouk Berger: ihrinfo@who.int 62nd World Health Assembly, May 2009, Geneva, Switzerland Member States demonstrated a high level of commitment towards the implementation of the International Health Regulations (IHR), underscoring its importance as the only international legal framework for the management of international health crises such as the current pandemic (H1N1) 2009 virus. Delegates further stressed the need for training on the IHR, particularly in the areas of points of entry and laboratory capacity strengthening, as well as the need for enhanced collaboration in global epidemic surveillance. Case management of Influenza A (H1N1) in air transport, 18 May 2009, WHO, Geneva, Switzerland This document is the result of collaboration between the International Health Regulations Coordination Department and the Task Force for the Influenza A (H1N1) Response at WHO, the International Civil Aviation Organization (ICAO) and the International Air Transport Association (IATA). It compiles recommendations from existing guidelines for air travel and health as well as specific WHO guidelines related to the pandemic (H1N1) 2009 virus where applicable for air transport, and outlines measures to be taken by aircraft operators, airport operators airport personnel, crew members and national authorities. It can be used together with the document Guide to Hygiene and Sanitation in Aviation, 3rd edition (please see below). Useful guidance related to this subject is also available from the web sites of ICAO ( and IATA ( Case management of Influenza A (H1N1) in air transport: : Note: similar guidelines for the management of pandemic (H1N1) 2009 cases on board of ship, particularly cruise ship, will be released soon. Guide to hygiene and sanitation in aviation, 3rd edition, WHO, Geneva, Switzerland, 2009 The third edition of the Guide to Hygiene and Sanitation in Aviation addresses water, food, waste disposal, cleaning and disinfection, vector control and cargo safety. It was developed by the Department of Public Health and Environment in collaboration with IHR Coordination to assist all airport and aircraft operators and other responsible bodies to achieve high standards of hygiene and sanitation to protect travellers and crews engaged in air transport. These guidelines lay out procedures and quality specifications that must be applied in 3

4 domestic and international air travel in all developed and developing countries. Laboratory Quality Management System: Training toolkit This training toolkit, developed in collaboration between WHO, the US Centers for Disease Control and Prevention (CDC), and the Clinical and Laboratory Standards Institute, covers the 12 topics that are essential for quality management in the public health or clinical laboratory. It has been designed for use by trainers in national or international settings, and the materials contained in it can be customized to conduct workshops that meet the local training and target audience needs. For more information: WHAT S NEW IN RISK AND DISEASE CONTROL Pandemic (H1N1) 2009 virus guidance documents, FAQs and situation updates To inform countries and the general public on the evolving pandemic (H1N1) 2009 virus, WHO has set up a web page with complete coverage of this public health event. It provides situation updates and maps, technical guidance documents, information for the general public such as frequently asked questions and basic advice on prevention and hygiene. The page is updated regularly. Please visit: WHO experts consultation on Ebola Reston pathogenicity in humans, 1 April 2009 The discovery of Reston ebolavirus in pigs in the Philippines in November 2008 and subsequent human infections, prompted WHO to organize an informal meeting of international experts to provide guidance to WHO in responding to specific questions related to the pathogenicity of Reston ebolavirus in humans. A panel of 18 experts was convened by teleconference on 1 April 2009 bringing together expertise on Reston ebolavirus and emerging infectious diseases in the fields of virology, pathogenicity, immunology, epidemiology, laboratory techniques and ecology. The meeting focused on the pathogenicity of Reston ebolavirus in humans and addressed a specific set of questions. The report of the meeting is available at: Polio network helps respond to pandemic (H1N1) 2009 virus The technical network of the Global Polio Eradication Initiative (GPEI) is actively helping support the global response to pandemic (H1N1) 2009 virus. With a network of technical staff and associated transportation, communications and data management capacity in more than 70 countries, the GPEI network has in the past helped identify and respond to outbreaks due to avian influenza, SARS, meningitis, Marburg fever, Ebola, cholera and other serious infectious diseases. Polio vaccination required for the Hajj The Ministry of Health of the Kingdom of Saudi Arabia has again highlighted polio in its health regulations for the Hajj, the annual pilgrimage of Muslims in Mecca. Saudi Arabia requires that all pilgrims arriving from countries with on-going polio transmission must vaccinate their children prior to arrival. Pilgrims travelling from polio-endemic countries must be vaccinated, regardless of age, and will then receive another dose of oral polio vaccine on arrival. For further information: Yellow fever: Release of two new interactive CD ROMs Two new interactive CD ROMS for control and prevention of yellow fever are now available in French: Investigation d'une épidémie de fièvre jaune and Campagne de vaccination contre la fièvre jaune. The first provides training based on role-playing and decision-making, and it has been developed for use by health professionals working in Sub-saharan Africa. The second CD ROM, Campagne de vaccination contre la fièvre jaune is a training tool developed within 4

5 the GAVI initiative to combat yellow fever. The objective is to encourage countries to develop quality immunization campaigns. To obtain a copy, please contact: publications@who.int The English versions will be released shortly. WHAT S NEW IN THE WHO REGIONS AFRO: Strengthening biosafety and biosecurity, 8 13 June 2009 and Training for Packaging and Shipping Infectious Substances, June 2009, Johannesburg, South Africa The two training programmes, developed in collaboration between IHR Coordination, the African Center for Integrated Laboratory Training, Johannesburg, the National Institute for Communicable Diseases and National Health Laboratory Service, South Africa, and the US Centers for Disease Control and Prevention, brought together participants from 17 countries in the African Region, Barbados and Viet Nam. Each of the trainings began with a pre-test, followed by modules and a final test per section. All of the participants passed the tests, and received certificates of achievement for biosafety and security and for the transport of infectious substances. For further information: ihrinfo@who.int AFRO: Assessment of core capacities, June 2009, Kenya The mission to assess IHR core capacities in Kenya from 13 to 24 June 2009 was carried out in collaboration with a team from AFRO, the Country Office and the Ministry of Public Health and Sanitation. Assessments were made in all of the provinces in the country, including Nairobi Province. The results were shared with major stakeholders and partners, and a plan of action for strengthening IHR core capacities will be developed shortly based on the findings and recommendations. For further information: ihrinfo@who.int AFRO: Review of preparedness and response capacity during mass gatherings, June 2009, Johannesburg, South Africa Under the scope of the IHR, an assessment mission took place to review public health aspects of preparedness and response regarding public health risks in South Africa for mass gatherings (MG), pandemic (H1N1) 2009 virus and IHR core capacities. The team assessed health measures implemented for mass gatherings using WHO MG tools, observed MG health measures implemented during the current Confederations Cup and made several site visits to airports, hospitals and stadia. It also met with national health authorities and the FIFA/Local Organizing Committees. For further information: ihrinfo@who.int EMRO: International consultation on preparedness for mass gatherings (Umrah and Hajj), June 27 30, 2009, Kingdom of Saudi Arabia The objective of this multidisciplinary consultation on communicable diseases preparedness and planning was to strengthen planning for Umrah and the Hajj pilgrimage in Work during this meeting focussed on the finalization of a comprehensive strategic preparedness plan for this year s Umrah and Hajj season, with emphasis on planning in the context of the current pandemic (H1N1) 2009 virus. For further information: ihrinfo@who.int PAHO: Regional response to pandemic (H1N1) 2009 virus In response to pandemic (H1N1) 2009 virus in the PAHO Region, the majority of the countries followed their pandemic preparedness risk communication strategies, created over the last three years during risk and outbreak communication training throughout the Region and based on the IHR set of reporting as well as the WHO Outbreak Communication Guidelines. A PAHO survey of South and Central America revealed that the ministers of health in most of the countries responded to the outbreak in North America by speaking almost immediately with their populations via the media. The first announcements of cases were handled quickly and transparently and the media reported fairly and accurately. 5

6 PAHO: Launch of Cooperative Arrangement for Preventing the Spread of Communicable Disease through Air Travel (CAPSCA) in the Americas, June, Mexico City, Mexico The first meeting of the International Civil Aviation Organization (ICAO) on the CAPSCA Americas project was held as part of the pandemic preparedness planning in the aviation sector. The goal of this project is to contribute to global efforts for preventing the spread of communicable diseases of international public health concern by reducing the risk of transmission by air travellers. Objectives of this meeting included establishing the Steering Committee and project implementation teams, and reviewing the project workplan. ICAO encourages all states and territories in the Americas region to participate in, and become members of, the project. For further information: SEARO/WPRO: Bi-regional Workshop of the Asia Pacific Strategy for Strengthening Health Laboratory Services ( ), June 2009, Bali, Indonesia The bi-regional workshop to promote health laboratories strengthening, a special focus on improving quality, was held in Bali from 23 to 25 June. This workshop was designed within the framework of the IHR and bi-regional strategy for Asia Pacific, a collaborative project between SEARO, WPRO and WHO headquarters (Lyon). The objectives were to review the status of health laboratories in Asia Pacific; discuss and finalize the draft of Asia-Pacific strategy on strengthening health laboratory services ( ); identify national mechanisms for implementation of quality systems in health laboratories; introduce the WHO- CDC-CLSI Laboratory Quality Management Training Toolkit (see above) and develop a roadmap for its implementation in the Asia Pacific region. For further information: ihrlyon@who.int This newsletter seeks to provide useful information for NFPs, countries and partners in implementing the IHR. We welcome your suggestions and comments and invite you to send these to Ms Sophia Desillas at ihrinfo@who.int World Health Organization 2009 All rights reserved 6