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Volume 12, Number 7—July 2006
Perspective

Global Public Health Surveillance under New International Health Regulations

Michael G. Baker*Comments to Author  and David P. Fidler†
Author affiliations: *Wellington School of Medicine and Health Sciences, Wellington, New Zealand; †Indiana University School of Law, Bloomington, Indiana, USA

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Table 1

International Health Regulations (IHR 2005) assessed according to attributes of public health surveillance systems (adapted from [8])

Attribute Attribute details Relevance to IHR 2005
Usefulness Contribution to prevention and control of adverse health-related events Design and scope imply improved usefulness compared with IHR 1969 but attribute must be evaluated after IHR 2005 has operated for a period
Sensitivity Proportion of true events detected by system and ability to detect outbreaks Specifies notification of all potential public health emergencies of international concern (PHEIC) and provides multiple pathways to increase sensitivity
Timeliness Speed between steps particularly from event onset to response Specifies assessment within 48 h and reporting within 24 h by state parties and prescribes immediate reporting of events at local and intermediate levels within state parties
Stability Reliability and availability of surveillance system All state parties must notify all potential PHEIC from June 2007 and establish capacity to detect, assess, and report events by 2012, with potential extensions to 2016
Simplicity Simplicity of structure and ease of operation Architecture of surveillance system is streamlined and transparent, especially at international level
Flexibility Ability to adapt to changing information needs and operating conditions Use of risk assessment criteria means that surveillance applies to new as well as established disease threats
Acceptability Willingness of persons and organizations to participate Establishment of surveillance in international law represents commitment by state parties to participate
Data quality Completeness and validity of recorded data Specifies information to be reported and includes provisions for validation and assessment of all reports to separate rumors from real events
Positive predictive value Proportion of reported events that are true events Oriented toward high sensitivity with correspondingly low specificity and positive predictive value, so WHO will not declare most notified events to be PHEIC
Representativeness Ability to describe events over time and their distribution by place and person Likely to be increased after validation and assessment, as for data quality

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References
  1. World Health Assembly. Revision of the International Health Regulations, WHA58.3. 2005 [cited 2006 May 2]. Available from http://www.who.int/gb/ebwha/pdf_files/WHA58-REC1/english/Resolutions.pdf
  2. United Nations. International Sanitary Regulations, 175 UN Treaty Series 214. 1951.
  3. World Health Organization. International Health Regulations (1969). 3rd ed. Geneva: The Organization; 1983.
  4. Fidler  D. International law and infectious diseases. Oxford: Clarendon Press; 1999.
  5. World Health Organization. Global crises—global solutions: managing public health emergencies through the revised International Health Regulations. Geneva: The Organization; 2002.
  6. Fidler  D. From international sanitary conventions to global health security: the new International Health Regulations. Chin J Int Law. 2005;4:325–92. DOIGoogle Scholar
  7. Thacker  SB. Historical development. In: Teutsch ST, Churchill RE, editors. Principles and practice of public health surveillance. New York: Oxford University Press; 2000. p. 1–16.
  8. Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group. MMWR Morb Mortal Wkly Rep. 2001;50:1–36 Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5030a5.htm.PubMedGoogle Scholar
  9. Morse  SS. Factors in the emergence of infectious diseases. Emerg Infect Dis. 1995;1:7–15. DOIPubMedGoogle Scholar
  10. Heymann  DL, Rodier  G. Global surveillance, national surveillance, and SARS. Emerg Infect Dis. 2004;10:173–5.PubMedGoogle Scholar
  11. Morris  J, Ward  JD, Nicoll  A. Proposed new International Health Regulations 2005—validation of a decision instrument (algorithm). Euro Surveill. 2004;9:66–7 Available from http://www.eurosurveillance.org/eq/2004/04-04/pdf/eq_12_2004_66-67.pdf.
  12. Jajosky  RA, Groseclose  SL. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health. 2004;4:29. DOIPubMedGoogle Scholar
  13. Grein  TW, Kamara  KB, Rodier  G, Plant  AJ, Bovier  P, Ryan  MJ, Rumors of disease in the global village: outbreak verification. Emerg Infect Dis. 2000;6:97–102. DOIPubMedGoogle Scholar
  14. Reflections on SARS. Lancet Infect Dis. 2004;4:651. DOIPubMedGoogle Scholar
  15. Ferguson  NM, Cummings  DA, Cauchemez  S, Fraser  C, Riley  S, Meeyai  A, Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature. 2005;437:209–14. DOIPubMedGoogle Scholar
  16. Longini  IM Jr, Nizam  A, Xu  S, Ungchusak  K, Hanshaoworakul  W, Cummings  DA, Containing pandemic influenza at the source. Science. 2005;309:1083–7. DOIPubMedGoogle Scholar
  17. Samaan  G, Patel  M, Olowokure  B, Roces  MC, Oshitani  H; World Health Organization Outbreak Response Team. Rumor surveillance and avian influenza H5N1. Emerg Infect Dis. 2005;11:463–6.PubMedGoogle Scholar
  18. Butler  D. Disease surveillance needs a revolution. Nature. 2006;440:6–7. DOIPubMedGoogle Scholar
  19. Fraser  C, Riley  S, Anderson  RM, Ferguson  NM. Factors that make an infectious disease outbreak controllable. Proc Natl Acad Sci U S A. 2004;101:6146–51. DOIPubMedGoogle Scholar
  20. Mandl  KD, Overhage  JM, Wagner  MM, Lober  WB, Sebastiani  P, Mostashari  F. Implementing syndromic surveillance: a practical guide informed by the early experience. J Am Med Inform Assoc. 2004;11:141–50. DOIPubMedGoogle Scholar
  21. Weber  SG, Pitrak  D. Accuracy of a local surveillance system for early detection of emerging infectious disease. JAMA. 2003;290:596–8. DOIPubMedGoogle Scholar
  22. Revision of the International Health Regulations. Progress report. Wkly Epidemiol Rec. 2001;76:61–3.PubMedGoogle Scholar
  23. Cockerill  FR, Smith  T. Response of the clinical microbiology laboratory to emerging (new) and reemerging infectious diseases. J Clin Microbiol. 2004;42:2359–65. DOIPubMedGoogle Scholar
  24. Silk  BJ, Berkelman  R. A review of strategies for enhancing the completeness of notifiable disease reporting. J Public Health Manag Pract. 2005;11:191–200.PubMedGoogle Scholar
  25. Secretary-General of the United Nations. In larger freedom: towards development, security and human rights for all: report of the secretary-general, A/59/2005. New York: United Nations; 2005.
  26. McNabb  SJ, Chungong  S, Ryan  M, Wuhib  T, Nsubuga  P, Alemu  W, Conceptual framework of public health surveillance and action and its application in health sector reform. BMC Public Health. 2002;2:2. DOIPubMedGoogle Scholar
  27. Bravata  DM, McDonald  KM, Smith  WM, Rydzak  C, Szeto  H, Buckeridge  DL, Systematic review: surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med. 2004;140:910–22.PubMedGoogle Scholar
  28. Statement for the record by the Government of the United States of America concerning the World Health Organization's revised International Health Regulations. 2005 May 23 [cited 2006 May 2]. Available from http://usinfo.state.gov/usinfo/Archive/2005/May/23-321998.html
  29. Wilson  K, McDougall  C, Upshur  R. The new International Health Regulations and the federalism dilemma. PLoS Med. 2006;3:e1. DOIPubMedGoogle Scholar
  30. Hesketh  T. China in the grip of SARS. BMJ. 2003;326:1095. DOIGoogle Scholar
  31. Liu  Y. China's public health-care system: facing the challenges. Bull World Health Organ. 2004;82:532–8.PubMedGoogle Scholar
  32. Fidler  D. SARS, governance, and the globalization of disease. Basingstoke (UK): Palgrave Macmillan; 2004.
  33. World Health Assembly. Application of the International Health Regulations (2005). WHA59.3. 26 May 2006 [cited 2006 June 1]. Available from http://www.who.int/gb/ebwha/pdf_files/WHA59/WHA59_2-en.pdf

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Page updated: December 16, 2011
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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