INTERNATIONAL HEALTH REGULATION

(IHR) 2005

HARI SANTOSO

UNIKA SOEGIJAPRANATA SEMARANG

TOPIK
BAHASAN 01 PENGERTIAN & SEJARAH IHR

RENCANA & PERKEMBANGAN

02 IMPLEMENTASI IHR

03 POSISI IHR & REGULASI DI INDONESIA

04 ARTIKEL TERKAIT KLB-WABAH &

PHEIC
 What is IHR
The International Health Regulations, or IHR (2005), represent an agreement
between 196 countries including all WHO Member States to work together for
global health security.

Through IHR, countries have agreed to build their capacities to detect, assess
and report public health events. WHO plays the coordinating role in IHR and,
together with its partners, helps countries to build capacities.

IHR also includes specific measures at ports, airports and ground crossings
to limit the spread of health risks to neighboring countries, and to prevent
unwarranted travel and trade restrictions so that traffic and trade disruption is
kept to a minimum.
 What is IHR
The International Health Regulations (2005) or 'IHR (2005)' are an
international law which helps countries working together to save lives
and livelihoods caused by the international spread of diseases and
other health risks.

The IHR (2005) aim to prevent, protect against, control and respond to
the international spread of disease while avoiding unnecessary
interference with international traffic and trade. The IHR (2005) are also
designed to reduce the risk of disease spread at international airports,
ports and ground crossings.
 What is IHR
Born of an extraordinary global consensus, the IHR (2005) strengthen
the collective defences against the multiple and varied public health
risks that today's globalized world is facing and which have the potential
to be rapidly spread through expanding travel and trade.

The IHR (2005) establish a new set of rules to support the existing
global outbreak alert and response system and to require countries to
improve international surveillance and reporting mechanisms for public
health events and to strengthen their national surveillance and response
capacities.
 HISTORY OF IHR
1851: First International Sanitary Conference, Paris

1951: First International Sanitary Regulations (ISR) adopted by

WHO member states

1969: ISR replaced and renamed the International Health

Regulations (IHR)

1995: Call for Revision of IHR

2005: IHR (2005) adopted by the World Health Assembly

2006: World Health Assembly vote that IHR (2005) will enter
into force in June 2007
 What’s new?

• From three diseases (YF, cholera, plague) to all public

health risks (biologi, radiasi, pangan, kimia)
• From preset measures to tailored response
• From control of borders to also include containment
at source
MONITORING & ASSESSMENT….1

The JEE is a voluntary, collaborative,

multisectoral process to assess country
capacity to prevent, detect and rapidly
respond to public health risks
MONITORING & ASSESSMENT…..2

• to know progress of IHR

implementation in member
countries
• to know challenges and
potential opportunities
• together improving on
minimum core capacities
RESULT OF JOINT EXTERNAL EVALUATION
OF IMPLEMENTATION OF IHR 2005

Indicators
0 < 40%

Indonesia Indicators
JEE Result 63% 34 40 - < 70%

Indicators
14 > 70%
 ANNEX 2
DECISION INSTRUMENT FOR
THE ASSESSMENT AND NOTIFICATION OF EVENTS THAT MAY
CONSTITUTE A
PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN
(PHEIC)
 PHEIC DECLARATION

A Public Health Emergency of International Concern (PHEIC) is a

formal declaration by the World Health Organization (WHO).
The declaration is promulgated by that body's Emergency Committee
operating under International Health Regulations (IHR).
 WHO STATEMENT ON THE TENTH MEETING OF
THE IHR EMERGENCY COMMITTEE REGARDING MERS

WHO statement
3 September 2015

The tenth meeting of the Emergency Committee (EC) convened by the Director-General under
the International Health Regulations (2005) (IHR 2005) regarding the Middle East respiratory
syndrome 1 was held by teleconference on 2 September 2015, from 1300 to 1620 Central
European Summer Time (UTC +2). During the meeting the WHO Secretariat provided an update
to the Committee on epidemiological and scientific developments, including recent cases and
transmission patterns in the Kingdom of Saudi Arabia (KSA), Jordan and the United Arab
Emirates. The Secretariat also provided current risk assessments with regard to these events,
and information on control and prevention measures.

Members of the EC agreed that the situation still does not constitute a Public Health
Emergency of International Concern (PHEIC).
 EMERGENCY COMMITTEE
Who are the members of an IHR Emergency Committee?
Members of an IHR Emergency Committee are drawn from the IHR Experts Roster, established by
the Director-General, and, where appropriate, from other WHO expert advisory panels. The IHR
Expert Roster is composed of international experts in fields such as disease control, virology,
vaccine development or infectious disease epidemiology.
Members can be selected on the basis of expertise required for any particular session. At least 1
member of the Emergency Committee should be an expert nominated by a State Party within
whose territory the event arises. These States Parties are invited to present their views to the
Emergency Committee. The Director-General may also appoint 1 or more technical experts to
advise the Committee, on his or her own initiative or at the request of the Committee.
Persons who are neither members of the IHR Experts Roster nor other WHO Expert Advisory
Panels could be appointed as technical experts to advise the Committee, but not as members of
the Committee.
The names of members and advisers to an IHR Emergency Committee, their job titles and any
other information that could be determined to be a potential conflict of interest are published on
WHO’s website.
 QUESTIONER OF ASSESSMENT

1. Is the public health impact of the event serious ?

2. Is the event unusual event or unexpected ?
3. Is there a significant risk of international spread ?
4. Is there a significant risk of international travel or
trade restrictions ?
 WHO - DECLARATION FOR PHEIC

Polio Zika Virus

2014 2016

2009 2014 ?
H1N1 Swine Flu Ebola
 Bagaimana di Indonesia
(Permenkes No. 1501 tahun 2010, Pasal 4)

(1). Jenis penyakit menular tertentu yang dapat menimbulkan wabah

a. Kolera j. Avian Influenza H5N1 ?
b. Pes k. Antraks
c. DBD l. Leptospirosis
d. Campak m. Hepatitis
e. Polio n. Influenza A baru (H1N1)/Pandemi
f. Difteri 2009
g. Pertusis o. Meningitis
h. Rabies p. Yellow Fever
i. Malaria q. Chikungunya

(2) Penyakit menular tertentu lainnya yang dapat menimbulkan wabah ditetap
kan oleh Menteri.
 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?
3. Is external assistance needed
to detect, investigate,
respond and control the
current event or prevent new
cases?
1. Event caused by a pathogen with high potential to cause epidemic
(infectiousness of the agent, high case fatality, multiple transmission
routes or healthy carrier).
2. Indication of treatment failure (new or emerging antibiotic resistance,
vaccine failure, antidote resistance or failure).
3. Event represents a significant public health risk even if no or very few
human cases have yet been identified.
4. Cases reported among health staff
5. The population at risk is especially vulnerable (refugees, low level of
immunization, children, elderly, low immunity, undernourished)
6. Concomitant factors that may hinder or delay the public health
respond (natural catastrophes, armed conflicts, unfavorable weather
conditions, multiple foci in the state party).
7. Event in an area with high population density.
8. 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.
 I. Is the public health impact of the event serious ?
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?
3. Is external assistance needed
to detect, investigate,
respond and control the
current event or prevent new
cases?
Inadequat human, financial, material or technical resour
ces-in particular :
– Insufficient laboratory or epidemiological ca
pacity to investigate the event (equipment, pers
onnel, financial resources).
– Insufficient antidotes, drugs and/or vaccine and/or
protective equipment, decontamination equip
ment, or supportive equipment to cover estimate
d needs;
– existing surveillance system is inadequate to det
ect new cases in a timely manner.
 II. Is the event unusual or unexpected ?
 The event is caused by an unknow agent or the
source, vehicle, route of transmission is unusual or
1. Is the event unusual?
unknown.
 evolution of cases more severe than expected
2. Is the event unexpected
from a public health (including morbidity or case - fatality) or with
perspective? unusual symptoms.
 Occurrence of the event itself unusual for the area,
season or population.
 Event caused by a disease/agent that had
already been eliminated or eradicated from the
State Party or not previously reported.
 III. Is there a significant risk of international spread ?

• Where there is evidence of local spread an index

case (or other linked cases) with a history within the
1. Is there evidence of an previous month of :
epidemiological link to similar • International travel (or time equivalent to the
events in other States?
incubation period if the pathogen is known);
2. Is there any factor that should • Participation in an international gathering
alert us to the potential for
cross border movement of the (pilgrimage, sports event, conference, etc.);
agent, vehicle or host? • Close contact with an international traveler or a
highly mobile population.
• Event caused by an environmental contamination
that has the potential to spread across international
borders.
• Event in an area of intense international traffic with
limited capacity for sanitary control or environmental
detection or decontamination.
IV. Is there a significant risk of international travel or trade
restrictions?

1. Have similar event in the past resulted in international

restriction on trade and/or travel?
2. 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?
3. Has the event occurred in association with an international
gathering or in an area of intense international tourism?
4. Has the event caused requests for more information by foreign
officials or international media?
 KEMAMPUAN CEGAH TANGKAL

PINTU MASUK NEGARA

(PoE)

DILUAR NEGARA INDONESIA DIDALAM NEGARA INDONESIA

• FAKTOR RISIKO PHEIC • FAKTOR RISIKO PHEIC

• PENYAKIT POTENSIAL PHEIC • PENYAKIT POTENSIAL PHEIC
 ANCAMAN DARI LUAR
KESIAPAN & KEMAMPUAN DETEKSI
FAKTOR RISIKO PENYAKIT
POTENSIAL PHEIC

KESIAPAN & KEMAMPUAN RESPON KESIAPAN & KEMAMPUAN RESPON

FAKTOR RISIKO PENYAKIT PENYAKIT POTENSIAL PHEIC
POTENSIAL PHEIC

PoE
KESIAPAN & KEMAMPUAN
SUMBERDAYA
MULTI SEKTOR KESIAPAN REGULASI
& KEWENANGAN
TERIMA KASIH
 APAKAH
BERPOTENSI
MENJADI PHEIC

APAKAH RESPON
YANG DAPAT
DILAKUKAN
 Monkeypox case:
5 Singapore residents among those quarantined

Monkeypox – Singapore
Disease outbreak news
16 May 2019
On 9 May 2019, the Ministry of Health (MOH) in Singapore notified WHO of one laboratory-confirmed case of
monkeypox. The case-patient is a 38 year old Nigerian man who arrived in Singapore on 28 April 2019 and
attended a workshop from 29-30 April. Prior to his travel to Singapore, he had worked in the Delta state in
Nigeria, and had attended a wedding on 21 April 2019 in a village in Ebonyi State, Nigeria.
The patient developed fever, muscle aches, chills and skin rash on 30 April. He reported that he had remained in
his hotel room most of the time between 1 and 7 May. He was transferred to a public hospital by ambulance on 7
May and referred to the National Centre for Infectious Diseases (NCID) on the same day, where he was isolated
for further management. Skin lesion samples were taken on 8 May and tested positive for monkeypox virus by
the National Public Health Laboratory on the same day. He is currently in a stable condition.