prop · GT03215 · 2006-09-15 00:00:00 — (b)to provide assessment of and care for affected travellers or animals by establishing arrangements with local and veterinary facilities for their isolation, treatment and other support services that may be required; (c)to provide appropriate space, separate from other travellers, to interview suspect or affected persons; (d)to provide for the assessment and, if required, quarantine of suspect travellers, preferably in facilities away from the point of entry; (e)to apply recommended measures to disinsect, derat, disinfect, decontaminate or otherwise treat baggage, cargo, containers, conveyances, goods or postal parcels including, when appropriate, at locations specially designated and equipped for this purpose; (f)to apply entry or exit controls for arriving and departing travellers; and (g)to provide access to specially designated equipment, and to trained personnel with appropriate personal protection, for the transfer of travellers who may carry infection or contamination. DECISION INSTRUMENT FOR THE ASSESSMENT AND NOTIFICATION OF EVENTS THAT PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN Events detected by national surveillance system (see 1) A case of the following diseases is unusual or health impact, and thus shall be notifieda, b: or diseases than those listed in the box on the left and the box on the right shall lead to caused by a new syndrome (SARS). Is the public health impact of the event serious? An event involving the following diseases shall always lead to utilization of the algorithm, because they have demonstrated the ability to cause serious public health impact and to spread rapidly internationallyb: -Viral haemorrhagic fevers (Ebola, , Marburg) -Other diseases that are of special national or regional concern, e.g. dengue fever, Rift Valley fever, and meningococcal disease. Is the event unusual or unexpected? Is the event unusual or unexpected? Is there a significant risk of international spread? Is there a significant risk of international spread? Is there a significant risk of inter- national or trade restrictions? Not notified at this Yes No stage. more information becomes available. EVENT SHALL BE NOTIFIED TO WHO UNDER THE INTERNATIONAL HEALTH aAs per WHO case definitions. bThe disease list shall be used only for the purposes of these Regulations. EXAMPLES FOR THE APPLICATION OF THE DECISION INSTRUMENT FOR THE ASSESSMENT AND NOTIFICATION OF EVENTS THAT PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN The examples appearing in this are not binding and are for indicative guidance purposes to assist in the interpretation of the decision instrument criteria. DOES THE EVENT MEET AT LEAST TWO OF THE FOLLOWING CRITERIA? I.Is the public health impact of the event serious? 1.Is the number of cases and/or number of deaths for this type of event large for the given place, time or population? 2.Has the event the potential to have a high public health impact? THE FOLLOWING ARE EXAMPLES OF CIRCUMSTANCES THAT CONTRIBUTE TO HIGH PUBLIC HEALTH IMPACT: Event caused by a pathogen with high potential to cause epidemic (infectiousness of the agent, high case fatality, multiple transmission routes or healthy ). Indication of treatment failure (new or emerging antibiotic resistance, vaccine failure, antidote resistance or failure). Event represents a significant public health risk even if no or very few human cases have yet been identified. Cases reported among health staff. The population at risk is especially vulnerable (refugees, low level of immunization, children, elderly, low immunity, undernourished, etc.). Concomitant factors that may hinder or delay the public health response (natural catastrophes, armed conflicts, unfavourable weather conditions, multiple foci in the State Event in an area with high population density. Spread of toxic, infectious or otherwise hazardous materials that may be occurring naturally or otherwise that has contaminated or has the potential to contaminate a population and/or a large geographical area. Is external assistance needed to detect, investigate, respond and control the current event, or prevent new cases? THE FOLLOWING ARE EXAMPLES OF WHEN ASSISTANCE : Inadequate human, financial, material or technical resources in particular: Insufficient laboratory or epidemiological capacity to investigate the event (equipment, personnel, financial resources) Insufficient antidotes, drugs and/or vaccine and/or protective equipment, decontamination equipment, or supportive equipment to cover estimated needs Existing surveillance system is inadequate to detect new cases in a timely . Answer yes if you have answered yes to questions 1, 2 or 3 above. Is the event unusual or unexpected? II.Is the event unusual or unexpected? 4.Is the event unusual? THE FOLLOWING ARE EXAMPLES OF UNUSUAL EVENTS: 9The event is caused by an unknown agent or the source, vehicle, route of transmission is unusual or unknown. 9Evolution of cases more severe than expected (including morbidity or case-fatality) or with unusual symptoms. 9Occurrence of the event itself unusual for the area, season or population. Is the event unexpected from a public health perspective? THE FOLLOWING ARE EXAMPLES OF UNEXPECTED EVENTS: 9Event caused by a disease/agent that had already been eliminated or eradicated from the State Party or not previously reported. Answer yes if you have answered yes to questions 4 or 5 above. Is there a significant risk of international spread? Is there a significant risk of international spread? Is there evidence of an epidemiological link to similar events in other States? Is there any factor that should alert us to the potential for cross border movement of the agent, vehicle or host? THE FOLLOWING ARE EXAMPLES OF CIRCUMSTANCES THAT INTERNATIONAL SPREAD: 9Where there is evidence of local spread, an index case (or other linked cases) with a history within the previous month of: international (or time equivalent to the incubation period if the pathogen is known) participation in an international gathering (pilgrimage, sports event, conference, etc.) close contact with an international traveller or a highly mobile population. 9Event caused by an environmental contamination that has the potential to spread across international borders. 9Event in an area of intense international traffic with limited capacity for sanitary control or environmental detection or decontamination. SIGNIFICANT RISK OF INTERNATIONAL SPREAD? Answer yes if you have answered yes to questions 6 or 7 above. Risk of international restrictions ? Is there a significant risk of international or trade restrictions? similar events in the past resulted in international restriction on trade and/or ? 9.Is the source suspected or known to be a food product, water or any other goods that might be contaminated that has been exported/imported to/from other States? 10.Has the event occurred in association with an international gathering or in an area of intense international tourism? 11.Has the event caused requests for more information by foreign officials or international media? SIGNIFICANT RISK OF INTERNATIONAL TRADE OR RESTRICTIONS? Answer yes if you have answered yes to questions 8, 9, 10 or 11 above. States Parties that answer yes to the question whether the event meets any two of the four criteria (I-IV) above, shall notify WHO under Article 6 of the International Health Regulations. MODEL SHIP SANITATION CONTROL EXEMPTION CERTIFICATE/SHIP SANITATION CONTROL CERTIFICATE This Certificate records the inspection and 1) exemption from control or 2) control measures applied Name of ship or inland navigation ......................Flag....................... Registration/IMO No. At the time of inspection the holds were unladen/laden with ...... of .......................... cargo Name and address of inspecting officer.. Ship Sanitation Control Exemption Certificate Ship Sanitation Control Certificate Areas , [systems, and Hold(s)/cargo Other areas specified - applicable, by marking N/A. No evidence found. Ship/is exempted from control measures. Control measures indicated were applied on the date below. Name and designation of issuing officer ............ 1 (a) Evidence of infection or contamination, including: vectors in all stages of growth; animal reservoirs for vectors; rodents or other species that could carry human disease, microbiological, chemical and other risks to human health; signs of inadequate sanitary measures. (b) Information concerning any human cases (to be included in the Declaration of 2 Results from samples taken on board. Analysis to be provided to ships by most expedient means and, if re-inspection is required, to the next appropriate port of call coinciding with the re-inspection date specified in this certificate. Sanitation Control Exemption Certificates and Sanitation Control Certificates are valid for a maximum of six months, but the validity period may be extended by one month if inspection cannot be carried out at the port and there is no evidence of infection or contamination. ATTACHMENT TO MODEL SHIP SANITATION CONTROL EXEMPTION CERTIFICATE/SHIP SANITATION CONTROL CERTIFICATE Areas/facilities/systems Swimming pools/spas Indicate when the areas listed are not applicable by marking N/A. TECHNICAL REQUIREMENTS PERTAINING TO CONVEYANCES AND Section A Conveyance operators 1.Conveyance operators shall facilitate: (a)inspections of the cargo, containers and conveyance; (b)examinations of persons on board; (c)application of other health measures under these Regulations; and (d)provision of relevant public health information requested by the State Party. 2.Conveyance operators shall provide to the competent authority a valid Ship Sanitation Control Exemption Certificate or a Ship Sanitation Control Certificate or a , or the Health Part of an Aircraft General , as required under these Regulations. 1.Control measures applied to baggage, cargo, containers, conveyances and goods under these Regulations shall be carried out so as to avoid as far as possible injury or discomfort to persons or damage to the baggage, cargo, containers, conveyances and goods. Whenever possible and appropriate, control measures shall be applied when the conveyance and holds are empty. 2.States Parties shall indicate in writing the measures applied to cargo, containers or conveyances, the parts treated, the methods employed, and the reasons for their application. This information shall be provided in writing to the person in charge of an aircraft and, in case of a ship, on the Ship Sanitation Control Certificate. For other cargo, containers or conveyances, States Parties shall issue such information in writing to consignors, consignees, , the person in charge of the conveyance or their respective agents. 1.WHO shall publish, on a regular basis, a list of areas where disinsection or other vector control measures are recommended for conveyances arriving from these areas. Determination of such areas shall be made pursuant to the procedures regarding temporary or standing recommendations, as appropriate. 2.Every conveyance leaving a point of entry situated in an area where vector control is recommended should be disinsected and kept free of vectors. When there are methods and materials advised by the Organization for these procedures, these should be employed. The presence of vectors on board conveyances and the control measures used to eradicate them shall be included: (a)in the case of aircraft, in the Health Part of the Aircraft General , unless this part of the Declaration is waived by the competent authority at the airport of arrival; (b)in the case of ships, on the Ship Sanitation Control Certificates; and (c)in the case of other conveyances, on a written proof of treatment issued to the consignor, consignee, , the person in charge of the conveyance or their agent, respectively. 3.States Parties should accept disinsecting, deratting and other control measures for conveyances applied by other States if methods and materials advised by the Organization have been applied. 4.States Parties shall establish programmes to control vectors that may transport an infectious agent that constitutes a public health risk to a minimum distance of 400 metres from those areas of point of entry facilities that are used for operations involving travellers, conveyances, containers, cargo and postal parcels, with extension of the minimum distance if vectors with a greater range are present. 5.If a follow-up inspection is required to determine the success of the vector control measures applied, the competent authorities for the next known port or airport of call with a capacity to make such an inspection shall be informed of this requirement in advance by the competent authority advising such follow-up. In the case of ships, this shall be noted on the Ship Sanitation Control Certificate. 6.A conveyance may be regarded as suspect and should be inspected for vectors and reservoirs if: (a)it has a possible case of vector-borne disease on board; (b)a possible case of vector-borne disease has occurred on board during an international voyage; or (c)it has left an affected area within a period of time where on-board vectors could still carry disease. 7.A State Party should not prohibit the landing of an aircraft or berthing of a ship in its territory if the control measures provided for in paragraph 3 of this or otherwise recommended by the Organization are applied. However, aircraft or ships coming from an affected area may be required to land at airports or to another port specified by the State Party for that purpose. 8.A State Party may apply vector control measures to a conveyance arriving from an area affected by a vector-borne disease if the vectors for the foregoing disease are present in its territory. VACCINATION, PROPHYLAXIS AND RELATED CERTIFICATES 1.Vaccines or other prophylaxis specified in 7 or recommended under these Regulations shall be of suitable quality; those vaccines and prophylaxis designated by WHO shall be subject to its approval. Upon request, the State Party shall provide to WHO appropriate evidence of the suitability of vaccines and prophylaxis administered within its territory under these Regulations. 2.Persons undergoing vaccination or other prophylaxis under these Regulations shall be provided with an international certificate of vaccination or prophylaxis (hereinafter the certificate) in the form specified in this . No departure shall be made from the model of the certificate specified in this . 3.Certificates under this are valid only if the vaccine or prophylaxis used has been approved by WHO. 4.Certificates must be signed in the hand of the clinician, who shall be a practitioner or other authorized health worker, supervising the administration of the vaccine or prophylaxis. The certificate must also bear the official stamp of the administering centre; however, this shall not be an accepted substitute for the signature. 5.Certificates shall be fully completed in English or in French. They may also be completed in another language, in addition to either English or French. 6.Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid. 7.Certificates are individual and shall in no circumstances be used collectively. Separate certificates shall be issued for children. 8.A parent or guardian shall sign the certificate when the child is unable to write. The signature of an illiterate shall be indicated in the usual by the persons mark and the indication by another that this is the mark of the person concerned. 9.If the supervising clinician is of the opinion that the vaccination or prophylaxis is contraindicated on grounds, the supervising clinician shall provide the person with reasons, written in English or French, and where appropriate in another language in addition to English or French, underlying that opinion, which the competent authorities on arrival should take into account. The supervising clinician and competent authorities shall inform such persons of any risk associated with non-vaccination and with the non-use of prophylaxis in accordance with paragraph 4 of Article 23. 10.An equivalent document issued by the Armed Forces to an member of those Forces shall be accepted in lieu of an international certificate in the form shown in this if: (a)it embodies information substantially the same as that required by such form; and (b)it contains a statement in English or in French and where appropriate in another language in addition to English or French recording the nature and date of the vaccination or prophylaxis and to the effect that it is issued in accordance with this paragraph. MODEL INTERNATIONAL CERTIFICATE OF VACCINATION This is to certify that [name] ................................... , date of birth ................... , national identification document, if applicable ............................. whose signature follows ............ has on the date indicated been vaccinated or received prophylaxis against: (name of disease or condition) . in accordance with the International Health Regulations. This certificate is valid only if the vaccine or prophylaxis used has been approved by the . This certificate must be signed in the hand of the clinician, who shall be a practitioner or other authorized health worker, supervising the administration of the vaccine or prophylaxis. The certificate must also bear the official stamp of the administering centre; however, this shall not be an accepted substitute for the signature. amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid. The validity of this certificate shall extend until the date indicated for the particular vaccination or prophylaxis. The certificate shall be fully completed in English or in French. The certificate may also be completed in another language on the same document, in addition to either English or French. REQUIREMENTS CONCERNING VACCINATION OR PROPHYLAXIS FOR SPECIFIC DISEASES In addition to any recommendation concerning vaccination or prophylaxis, the following diseases are those specifically designated under these Regulations for which proof of vaccination or prophylaxis may be required for travellers as a condition of entry to a State Party: Vaccination against yellow fever. 2.Recommendations and requirements for vaccination against yellow fever: (a)For the purpose of this : (i)the incubation period of yellow fever is six days; (ii)yellow fever vaccines approved by WHO provide protection against infection starting 10 days following the administration of the vaccine; (iii)this protection continues for 10 years; and (iv)the validity of a certificate of vaccination against yellow fever shall extend for a period of 10 years, beginning 10 days after the date of vaccination or, in the case of a revaccination within such period of 10 years, from the date of that revaccination. (b)Vaccination against yellow fever may be required of any traveller leaving an area where the Organization has determined that a risk of yellow fever transmission is present. (c)If a traveller is in possession of a certificate of vaccination against yellow fever which is not yet valid, the traveller may be permitted to depart, but the provisions of paragraph 2(h) of this may be applied on arrival. (d)A traveller in possession of a valid certificate of vaccination against yellow fever shall not be treated as suspect, even if coming from an area where the Organization has determined that a risk of yellow fever transmission is present. (e)In accordance with paragraph 1 of 6 the yellow fever vaccine used must be approved by the Organization. (f)States Parties shall designate specific yellow fever vaccination centres within their territories in order to ensure the quality and safety of the procedures and materials employed. (g)person employed at a point of entry in an area where the Organization has determined that a risk of yellow fever transmission is present, and every member of the crew of a conveyance using any such point of entry, shall be in possession of a valid certificate of vaccination against yellow fever. (h)A State Party, in whose territory vectors of yellow fever are present, may require a traveller from an area where the Organization has determined that a risk of yellow fever transmission is present, who is unable to produce a valid certificate of vaccination against yellow fever, to be quarantined until the certificate becomes valid, or until a period of not more than six days, reckoned from the date of last possible exposure to infection, has elapsed, whichever occurs first. (i)Travellers who possess an exemption from yellow fever vaccination, signed by an authorized officer or an authorized health worker, may nevertheless be allowed entry, subject to the provisions of the foregoing paragraph of this and to being provided with information regarding protection from yellow fever vectors. Should the travellers not be quarantined, they may be required to report any feverish or other symptoms to the competent authority and be placed under surveillance. MODEL OF DECLARATION OF HEALTH To be completed and submitted to the competent authorities by the of ships arriving from foreign ports. Submitted at the port of. Name of ship or inland navigation ............ Registration/IMO No................... arriving from ...sailing to ................. (Nationality)(Flag of ). Gross tonnage (ship).. Tonnage (inland navigation ) Valid Sanitation Control Exemption/Control Certificate carried on board? no......... Issued at....... date............ Has ship/visited an affected area identified by the ? Port and date of visit .......................... List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter: Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined ship/since international voyage began or within past thirty days, whichever is shorter, including all ports/countries visited in this period (add additional names to the attached schedule): (1)Name joined from: (1)........(2)..........(3).......................................... (2)Name joined from: (1)........(2)..........(3).......................................... (3)Name.joined from: (1)........(2)..........(3).......................................... Number of crew members on board Number of passengers on board. (1) Has any person died on board during the voyage otherwise than as a result of accident? If yes, state particulars in attached schedule. (2)Is there on board or has there been during the international voyage any case of disease which you suspect to be of an infectious no..... If yes, state particulars in attached schedule. Has the total number of ill passengers during the voyage been greater than normal/expected? How many ill persons? Is there any ill person on board now? If yes, state particulars in attached schedule. Was a practitioner consulted? If yes, state particulars of treatment or advice provided in attached Are you aware of any condition on board which may lead to infection or spread of disease? If yes, state particulars in attached schedule. Has any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board? If yes, specify type, place and date............................................................................................................................................... any stowaways been found on board? ....... no... If yes, where did they join the ship (if known)? Is there a sick animal or pet on board? Note: In the absence of a surgeon, the should regard the following symptoms as grounds for suspecting the existence of a disease of an infectious nature: