Friday, July 26, 2013

Pandemic: what are the criteria for a disease to be considered a PHEIC?

PHEIC = Public Health Emergency of International Concern.  Nowhere in this article does it mention the word "Pandemic".  This article speaks of a PHEIC.  Who will make the call of a Pandemic?

WHO Assistant Director-General for Health Security and the Environment Dr. Keiji Fukuda explained that there is no specific menu or checklist. Instead, health experts find an answer to the question if the situation or event really poses a danger for the global community.
Important questions also need to be answered like: How serious or severe is the infection? How fatal is it? Is the event or situation spreading and growing? Will the declaration of a PHEIC help address the situation?
In answering these questions, the Emergency Committee also ensures that any of their recommendations would be balanced, appropriate and proportional to the situation or event. As mentioned, a declaration of PHEIC would signal the global community to give MERS-CoV its highest level of priority.
Speaking of the WHO, from the article:
Apart from guidelines for health workers, the WHO is expected to release travel recommendations in relation to MERS-CoV in the coming days given the large number of people that are on pilgrimage due to the Hajj and Umrah.
The future of MERS-CoV remains uncertain.
Yesterday, the WHO posted travel advice for pilgrimages to Saudi Arabia on MERS-CoV.  
From the document (excerpts):

2.1. Actions to take before Umra or Hajj

  • Countries should advise pilgrims that pre-existing major medical conditions...

  • Countries should make information known to departing pilgrims and travel organizations on general travel health precautions,1 which will lower the risk of infection in general...
  • Health advisories should be made available to all departing travellers to Umra or Hajj ... 
Additional information on Actions to take during after Umra or Hajj are also posted.  This WHO document will be located on the right side-bar of the blog under "Coronavirus MCoV" for future reference.
The lead in article of this post also states:

Health experts recommend close monitoring of the virus. Countries are likewise being encouraged to strengthen surveillance and laboratory capacity to detect infection. The people, on the other hand, are urged to stay informed and take necessary precautions to prevent the spread of MERS-CoV and other infections.
Indonesia has posted their Guidelines/Awareness for the approaching pilgrimage.  Some excerpts:

JULY 25, 2013 
Approaching the peak pilgrimage and pilgrimage, make the world health authorities (WHO) and Saudi Arabia feel the need to raise awareness, including Indonesia. DG P2PL convey some awareness of the Middle East activities Respiratory Syndrome Corona Virus (Mers-CoV) that have been carried out by the Directorate General of P2PL, among others, as follows:

First, the readiness of facilities and health workers, DG P2PL already made a circular letter to the Provincial Health Office... 

Second, DG P2PL has held a coordination meeting on July 11, 2013 by DG P2PL ranks followed by The Center for Health Haji, representatives of the Directorate General of Health Services and Development Agency and the WHO. Surveillance and activities at the port of entry will be strengthened,...

In addition, the CTF also prepared Thermal Scanner tool, but at this time according to the agreement and the WHO South-East Asia Region Countries not need to activate the device and will be evaluated from time to time.
Up to the month of June 2013, 28 Ports, Airports, and Transboundary Inland Post (PLBD) in 22 CTF has made pandemic preparedness and anticipation, to do drafting contingency plans and response simulation as required in the International Health Regulations (IHR) 2005. The activity is the anticipation of pandemic preparedness and influenza, which in principle can also be used as a preparedness and anticipation of Mers-CoV.
In the event that the virus spreads rapidly out of control, who then will call a Pandemic?  From the WHO "Pandemic Influenza Risk Management Interim Guidance, 2013"
The global phases – interpandemic, alert, pandemic and transition – describe the spread of the new influenza subtype, taking account of the disease it causes, around the world. As pandemic viruses emerge, countries and regions face different risks at different times. For that reason, countries are strongly advised to develop their own national risk assessments based on local circumstances, taking into consideration the information provided by the global assessments
produced by WHO. Risk management decisions by countries are therefore expected to be informed by global risk assessments, but based on local risk assessments.
The risk-based approach to pandemic influenza phases is represented in Figure 1 as a continuum, which also shows the phases in the context of preparedness, response and recovery, as part of an all-hazards approach to emergency risk management. Both WHO guidance and international standards exist that describe formats and conduct of such risk assessment (see Section 4.2). One of the underlying principles of this guidance is to acknowledge that emergency risk management at country level needs to be sufficiently flexible to accommodate different consequences within individual countries, for example, different severities and different numbers of waves of illness.
The global phases will be used by WHO to communicate the global situation. They will be incorporated into IHR (2005) related communications to National IHR Focal Points, in Disease Outbreak News releases and various other public and media interactions, including through social media channels.

Deadly Middle East coronavirus:  Not yet a PHEIC -
WHO Travel Advice:

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