Table 1.
The rationale for declaring a PHEIC, and the IHR emergency Committee’s recommendations (1) (Source: World Health Organization)
| PHEIC | Date of declaration | Date of undeclaration | Countries affected at the time of the PHEIC declaration | Number of cases at the time of the declaration | Rationale | Recommendations |
|---|---|---|---|---|---|---|
| H1N1 | 25 April 2009 | 10 August 2010 | Mexico and the USA | Forty-two confirmed cases (20 in USA and 22 in Mexico), 3 death confirmed in Mexico. None in USA | 1. The widespread presence of the virus. 2. Virus containment unfeasibility at that stage. |
1. All countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia 2. Personal protection recommendations 3. In healthcare settings PAHO/WHO recommends enhanced infection control and surveillance and personal protection. 4. It is not recommended to close to border nor restrict international travels. However, it is recommended that travel is postponed if the person is sick, and medical advice should be sought if the person becomes sick after travel. |
| Poliovirus | 5 May 2014 | Remains to be a PHEIC (as decided on the 23rd IHR Emergency Committee meeting held in January 2020) (2) | Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Israel, Nigeria, Pakistan, Somalia, and the Syrian Arab Republic. | Seventy-four cases (59 of those cases have been reported from Pakistan and within Pakistan). | 1. The risk of international spread of wild virus and the increasing evidence that adult travellers were contributing to the spread. 2. During the low season in 2014, there were 10 countries that are considered to have active transmission of wild poliovirus and in contrast with previous years, there has already been a spread from three of these countries internationally. 3. Considering the large number of polio free but conflict torn and fragile states which have severely compromised routine immunization services and are particularly at high risk of infection. |
Temporary recommendations for States currently exporting wild poliovirus (Pakistan, Cameroon and the Syrian Arab Republic): 1. Officially declare, that the interruption of poliovirus transmission is a national public health emergency. 2. Ensure that all residents and long-term receive a dose of OPV or inactivated poliovirus vaccine prior to international travel. 3. Ensure that such travellers are provided with an International Certificate of Vaccination or to record their polio vaccination and serve as proof of vaccination. 4. Maintain these measures until meeting the criteria made by the IHR. Temporary recommendations for States infected with wild poliovirus but not currently exporting (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and particularly Nigeria): 1. Officially declare, that the interruption of poliovirus transmission is a national public health emergency. 2. Encourage residents and long-term visitors to receive a dose of OPV or IPV 4 weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within 4 weeks) should be encouraged to receive a dose at least by the time of departure. 3. Ensure that travellers who receive such vaccination have access to an appropriate document to record their polio vaccination status. 4. Maintain these measures until meeting the criteria made by the IHR. Any polio-free State which becomes infected with wild poliovirus should immediately implement the advice for ‘States infected with wild poliovirus but not currently exporting’. |
| Ebola (West Africa) | 8 August 2014 | 29 March 2016 | Guinea, Liberia, Nigeria and Sierra Leone. | 1711 cases (1070 confirmed, 436 probables, 205 suspect), including 932 deaths. | 1. The Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States. 2. The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns and the weak health systems in the currently affected and most at-risk countries. 3. A coordinated international response is deemed essential to stop and reverse the international spread of Ebola. |
To the States with Ebola transmission: 1. The Head of State should declare a national emergency. 2. Health Ministers and other health leaders should assume a prominent leadership role in coordinating and implementing emergency Ebola response measures. 3. States should activate their national disaster/emergency management mechanisms and establish an emergency operation center. 4. States should ensure that there is a large-scale and sustained effort to fully engage the community. 5. It is essential that a strong supply pipeline be established to ensure that sufficient medical commodities. 6. In areas of intense transmission, the provision of quality clinical care, and material and psychosocial support for the affected populations should be used as the primary basis for reducing the movement of people. 7. States should ensure health care workers receive adequate security measures for their safety and protection. 8. States should ensure that: treatment centers and reliable diagnostic laboratories are situated as closely as possible to areas of transmission. 9. States should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. 10. There should be no international travel of Ebola contacts or cases unless the travel is part of an appropriate medical evacuation. To minimize the risk of international spread of EVD: 11. States should ensure funerals and burials are conducted by well-trained personnel, with provision made for the presence of the family and cultural practices, and in accordance with national health regulations 12. States should ensure that appropriate medical care is available for the crews and staff of airlines operating in the country 13. States with EVD transmission should consider postponing mass gatherings until EVD transmission is interrupted. To the States with a potential or confirmed Ebola Case, and unaffected States with land borders with affected States: 1. Unaffected States with land borders adjoining States with Ebola transmission should urgently establish surveillance for clusters of unexplained fever or deaths due to febrile illness. 2. Any State newly detecting a suspect or confirmed Ebola case or contact, or clusters of unexplained deaths due to febrile illness, should treat this as a health emergency. 3. If Ebola transmission is confirmed to be occurring in the State, the full recommendations for States with Ebola Transmission should be implemented. To all states: 1. There should be no general ban on international travel or trade; restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented. 2. States should provide travellers to Ebola affected and at-risk areas with relevant information on risks. 3. States should be prepared to detect, investigate, and manage Ebola cases. 4. The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure. 5. States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola. |
| Zika | 1 February 2016 | 18 November 2016 | Brazil, France, United States of America, and El Salvador | 594 reported microcephaly cases potentially related to a Zika virus infection, 39 cases were confirmed (30 from Brazil, nine from French Polynesia) | 1. The rising international concerns about Zika infections in South America, especially in Brazil. 2. The postulated link to rising numbers of babies born with the congenital abnormality known as microcephaly. |
Regarding Zika virus transmission: 1. Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas. 2. The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures. 3. Risk communications should be enhanced in countries with Zika virus transmission. 4. Vector control measures and appropriate personal protective measures should be aggressively promoted. 5. Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure. 6. Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes. Regarding longer term measures: 1. Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics, and diagnostics. 2. In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations. Regarding travel measures: 1. There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission. 2. Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites. 3. Standard WHO recommendations regarding disinfection of aircraft and airports should be implemented. Regarding data sharing: 1. National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC. 2. Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of these events. |
| Ebola (DRC) | 17 July 2019 | 26 June 2020 (3) | DRC (in the northeast, specifically in North Kivu and Ituri, Goma), Uganda (Kasese) | 2522 confirmed cases, 1698 deaths were reported (overall case-fatality ratio 67%) | 1. The concern about potential spread from Goma (as the city is a provincial capital with an airport with international flights.) 2. The concern of the reinfection and ongoing transmission in Beni, which has been previously associated with seeding of virus into multiple other locations. 3. The murder of two HCWs demonstrates continued risk for responders owing to the security situation. 4. The lack of the global community contribution to sustainable and adequate technical assistance, human or financial resources for outbreak response, despite the previous recommendations for increased resources. |
For affected countries: 1. Sustain the political commitment and multisectoral coordination approach to the response and expand this commitment to local areas and hot spots of the outbreak. 2. Further enhance the acceptance, access and security situation to provide an enabling environment for all response partners to support public health operations as an essential platform for accelerating disease-control efforts. 3. Continue to strengthen strategy, capacity, implementation, and coordination for community awareness and engagement. 4. Continue cross-border screening and screening at main internal roads, with a particular focus on routes connected to areas with current transmission. 5. Accelerate comprehensive action for active surveillance for cases and unexplained deaths in all areas. 6. Continue to implement optimal vaccine strategies that have proven maximum impact on curtailing the outbreak. 7. Strengthen measures to prevent nosocomial infections, including systematic mapping of health facilities. 8. Strengthen preparedness in non-affected provinces of DRC, and more generally strengthen health system across the country to respond to concurrent health emergencies. For countries at-risk: 1. At-risk countries should work urgently with partners to improve their preparedness for detecting and managing imported or locally acquired cases. 2. Countries should continue to map population movements and sociological patterns that can predict risk of disease spread. 3. Risk communications and community engagement, especially at points of entry, should be increased. 4. At-risk countries should continue to put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness. For all States: 1. No country should close its borders or place any restrictions on travel and trade. 2. National authorities should work with airlines and other transport and tourism industries to ensure that they do not exceed WHO’s advice on international traffic. 3. The Committee does not consider entry screening at airports or other ports of entry outside the region to be necessary. |
| COVID-19 | 30 January 2020 | - | China, Japan, Korea, Viet Nam, Singapore, Australia, Malaysia, Cambodia, Philippines, Thailand, Nepal, Sri Lanka, India, USA, Canada, France, Finland, Germany and United Arab Emirates. | Total of 7794 confirmed cases. 7711 confirmed cases in China (170 deaths of them died), 83 confirmed cases in 18 countries (Of these, only seven had no history of travel in China) | The Committee acknowledged the significant increases in numbers of cases and additional countries reporting confirmed cases and that there are still many unknowns, and human-to-human transmission has occurred outside Wuhan and outside China. The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. |
To WHO: 1. Coordination, planning, and monitoring 2. One health (collaboration) 3. Preparedness to support countries to access and manage all essential health services 4. Risk communication and community engagement 5. Travel and trade (development of a strategic guidance and update recommendations on appropriate travel measures) 6. Surveillance To all states parties: 1. Coordination and Collaboration 2. Preparedness 3. Surveillance 4. Health workers protection prioritization 5. Food security 6. Risk communications and community engagement 7. Research and development 8. Maintenance essential health services. |
1. Organization WH. IHR Emergency Committees Reports 2020 [Available from: http://www.euro.who.int/en/health-topics/emergencies/international-health-regulations/reporting-events/ihr-committees/ihr-emergency-committee.
2. Organization WH. Statement of the 23rd IHR Emergency Committee Regarding the International Spread of Poliovirus. 2020.
3. Final statement on the eighth meeting of the International Health Regulations (2005) [press release]. 2020.