International Health

• The international health regulation (IHR) was first adopted by the WHO in 1969 to replace the international sanitary regulations that was in force since 1951.
• They are a set of legally binding international agreement that govern the roles of the WHO and all (194) of its Member states in identifying, sharing information about, and responding to public health events that may have international consequences.
• The IHRs are intended to ensure maximum security against the international spread of diseases with minimum interference of world traffic.
• There were first introduced to help monitor and control serious diseases (cholera, yellow fever, plague, smallpox, louse-borne relapsing fever and louse-borne typhus) which had serious potential to spread between countries.
• The international health regulations were further amended between 1973 and 1981 and the six diseases were reduced to only four and subsequently to three: yellow fever, plague and cholera (as smallpox had been eradicated in 1980).
• As trade and international travels increased significantly since its first adoption it became rather necessary to broaden the scope of the IHR.
• The IHR was revised recently in 2005. The scope of the revised IHR 2005 has been expanded to include any disease or event that presents, or could present significant harm to humans. The revised IHR 2005 introduced the concept of “public health emergency of international concern” (PHEIC), whereby any event that affects the public health of more than one WHO member state may qualify as a PHEIC.
• This would include, for example, the chemical discharge of a hazardous agent, the contamination of food crossing borders, etc., as well as some infectious diseases. The revised IHR 2005 therefore broadened the scope, and the IHR is no longer limited to the notification of specific diseases, but cover all other hazards or events that constitute public health emergencies of international concern

International Notification of Diseases

For diseases notification, the IHR aimed to reflect more on communicable diseases, including the emerging and re-emerging diseases. Previously, notification was limited only to three main diseases, namely: cholera, yellow fever and plague.

The revised International Health Regulations, 2005 broadened the scope to include three main categories of events that require to be notified under the IHR as follows:

1. Four conditions that must be notified to the WHO, namely:
• Small pox,
• Poliomyelitis due to wild type poliovirus ,
• Human influenza caused by the new subtype, and
• SAARS (severe acute respiratory syndrome)
2. Other diseases or events may require notification if they are considered to be events of potential international public health concern namely cholera, plague, Yellow fever, VHF (Lassa , Ebola, Marburg virus disease) and other diseases that are of special national or regional concern, e.g. dengue fever
3. Any event of potential international public health concern including those of unknown cause or source, and those involving other events or diseases than those listed in a) and b) above.

• Port health services carries out implementation of the relevant provisions of the WHO.
• It enforces the quarantine law and the public health laws
• The services rendered include;
• Environmental sanitation
• Provision of health measures on departure
• Provision of measures applicable btw port of departure and arrival
• Provision of measures on arrival
• Provision of treatment services
• Immunizations services as prescribed by IHR
• Quarantine services
• Improving environmental sanitation in and around ports
• Ensuring port is free of rodents and pests, regular fumigation exercises are to be carried out
• Food hygiene including surveillance of catering services
• Port health services should prevent departure of any infected person or luggage or suspect, and demand valid vaccination certificate from travellers.
• Every aircraft on international voyage is to be disinfected with aerosol in order to kill all insects, especially mosquitoes.
• The ships, aircrafts and land vehicles should be inspected before departure to ensure that a good sanitary condition is maintained on board, and detect and abate any nuisance on board that can promote the spread of disease, and ensure that only wholesome foods and potable water are served to passengers and crew.
• A ship must be declared “Healthy” by the port Health Services before the embarkation or disembarkation of passengers, crew or cargoes.
• On arriving from another country.
• If the ship is healthy the captain hoists a yellow flag signifying that the vessel is healthy and should be given a free pratique to embark or disembark. (in the night, after 18.00 hours, a red light at about 3 feet apart serves as alternative to flying the yellow flag?)
• If the ship is suspected to be infected, it flies a double yellow flag signifying that the ship is a suspect, having had on board a case of cholera within six days prior to arrival, or left an infected area within 10 days on arrival, or had an abnormal, unexplained mortality on board among rodents. Such a ship is diverted to Mooring station or Quarantine Anchorage for appropriate measures to rid the ship and its crew and passengers of the infection.
• If the ship is infected it flies the yellow blue flag on arrival at the port
• A ship is infected if for instance it has on board
• A case of cholera on arrival or within six days before arrival;
• A case of yellow fever;
• A case of human plague on arrival or developed more than five days after embarkation;
• A plague infested rodent found on arrival.
• When a ship is infected with any of the diseases under the IHR, the following measures must be taken:
• Isolation of case or Quarantine of contact/suspect (for the purpose of IHR) 6 days for plague and yellow fever and 5 days for cholera.
• Revaccination of passengers and crew.
• Disinfection/De-ratification of ship.
• International notification (notification to WHO).
• The captain of an aircraft, immediately on landing should submit to the port health officer completed Aircraft General Declaration, including other general information regarding the health condition of all on board.
• If satisfied with the health condition of the aircraft, a free pratique is issued. If the aircraft is suspected or is inspected, it is detained or quarantined at the hanger.
• Other certificates issued by port Health services include:
• Ship sanitation control certificate (IHR, 2005), previously called the De-rating certificate. Issued following a control measure on a ship that was previously found to be infested or contaminated
• Ship sanitation control exemption certificate(IHR, 2005), previously De-ratting certificate Exemption, issued when there is no evidence of public Health risk found, and ship is exempted from control measures. Duration for 1 and 2 above in 6 months
• Ship sanitation extension certificate issued when, at the expiration of either the control or control exemption certificate, a re-inspection for some reason cannot be carried out, and there I not an evidence of contamination. (The extension certificate is for 1 month only)

Immunization services as prescribed by IHR

Immunizations for international travels are given for diseases as follows:

• For yellow fever: immunization should be given 10 days before the travel and is valid for 10yrs.
• For cholera: vaccination is given 8 days before the travel and validity is for a period of 6months starting from 6 days post vaccination
• For covid-19

Vaccination should be properly documented on the international certificate of vaccination also known as YELLOW CARD.

A yellow card must have the following information

• Signature of the vaccine
• Signature and professional status of the vaccinator
• Date of the vaccination
• Official designated stamp
• Dose and batch number of vaccine

Quarantine is enforced or practiced for all communicable diseases covered by IHR

Quarantine can be define as the restriction of activities or limitation of freedom of movement of such well persons or domestic animals that have been exposed to a case of communicable disease during its period of communicability in such a manner to prevent contact with those not affected and to limit transmission of diseases.

The duration of quarantine is for a period of no longer or equal to the longest incubation period of the disease in question.

• These are agencies and organizations that promote international health
• WHO has the responsibility of coordinating international health in collaboration with various multilateral, bilateral and other agencies.
• The organization assist in
• Promoting development of comprehensive health services
• Prevention and control of communicable diseases
• Improving environmental conditions
• Planning and implementing health programs
• Developing health manpower

Types of International Health Agencies

1. Multilateral Agencies
2. Bilateral Agencies
3. Non-governmental Organization

Multilateral Agencies

• Multilateral means that funding comes from multiple government and is distributed to many different countries.
• The major multilateral agencies include:
1. WHO
2. UNICEF
3. UNFPA
4. FAO
5. UNESCO
6. UNDP
7. ILO

Bilateral Agencies

• Bilateral agencies are governmental agencies in a single country which provide aid to developing countries.
• They include:
• The United States agency for international development (USAID)
• Swedish international development agency (SIDA)
• Canadian international development agency (CIDA)
• Department for international development (DFID)
• Japanes e international cooperation agency (JICA)
• Political and historical reasons often determines which countries receives donation from bilateral agencies.
• It assist in combating childhood communicable diseases, malaria control and health information and health planning

Non-Governmental Organizations

• These include:
• Rotary international
• Red Cross
• Lions club
• Bill and Melinda foundation

The WHO is composed of 194 member states joined in association under the terms of the WHO constitution

The WHO consist of:

1. The World Health Assembly
• The World Health Assembly (WHA) is the legislative and supreme body of WHO. Based in Geneva, it typically meets yearly in May.
• It appoints the director-general every five years and votes on matters of policy and finance of WHO, including the proposed budget.
• It also reviews reports of the executive board and decides whether there are areas of work requiring further examination.
2. The Executive Board
• The Assembly elects 34 members, technically qualified in the field of health, to the executive board for three-year terms.
• The main functions of the board are to carry out the decisions and policies of the Assembly, to advise it, and to facilitate its work.
3. The Secretariat

WHO has six regions, each with a regional committee made up of the representatives of countries of the region which meets once in a year.

The regions report to the WHO headquarters located in Geneva, Switzerland. The regional office include:

1. AFRO includes most of Africa, with the exception of Egypt, Sudan, Djibouti, Tunisia, Libya, Somalia and Morocco (all fall under EMRO). The headquarters is in Brazzaville, Republic of the Congo.
2. EURO includes all of Europe (except Liechtenstein), Israel, and all of the former USSR. The headquarters is in Copenhagen, Denmark.
3. SEARO – South East Asia Regional Office. North Korea is served by SEARO. The headquarters is in New Delhi, India.
4. EMRO— The Eastern Mediterranean Regional Office serves the countries of Africa that are not included in AFRO, as well as all countries in the Middle East except for Israel. Pakistan is served by EMRO. The headquarters is in Cairo, Egypt.
5. WPRO covers all the Asian countries not served by SEARO and EMRO, and all the countries in Oceania. South Korea is served by WPRO. The headquarters is in Manila, Philippines.
6. AMRO- the Americas Regional Office. Also known as the Pan American Health Organization (PAHO). The headquarters is in Washington, D.C., United States.

1. Directing and coordinating international health activities
2. Supplying technical assistance to countries
3. Develops norms and standard
4. Promotes research
5. Disseminates health information
6. Provides training in international health
7. Collects and analyzes epidemiologic data
8. Develops systems for monitoring and evaluating health programs.

Some publication of WHO include

1. World health report
2. World health statistics
3. International health regulation
4. Bulletin of WHO
5. Technical Report series
6. International pharmacopeia

1. Arabic
2. Chinese
3. English
4. French
5. Russian
6. Spanish

The WHO has identified some special public health events for observation on certain days of every year and they include:

• World health day: April 7
• World AIDS day: December 1
• World hepatitis Day: July 28
• World Tuberculosis Day: March 28
• World immunization Week: last week of April
• World malaria Day: April 25
• World No Tobacco Day: May 31
• World Blood Donor Day: June 14