Lecture 13: International health regulation

Question 1

Outbreak

Answer 1

Emergence and spread of new disease

Question 2

Determining if an infection becomes a spreading outbreak

Answer 2

Sustained human-to-human transmission
Dependent of Basic Reproductive number: number of subsequent individuals infected by someone infected (if Ro is less than 1: infection will not spread) (if greater than 1 then it will spread)

Question 3

Strategies

Answer 3

Early detection (surveillance, reporting, identification of pathogen) 
Ground level containment ( social distancing, anti-viral, vaccines)

Question 4

Requirements

Answer 4

Local and international public health capacity
Lab and vaccine/pharmaceutical capacity
Domestic and international surveillance systems
Domestic and international governance systems

Question 5

Influenza

Answer 5

H#N#
H: glue that allowed virus to stick to cells
N: breaks the glue and allow the virus to escape

Question 6

Minor changes influenza

Answer 6

Changes in strain A or B

Question 7

Major changes influenza

Answer 7

Zoonotic diseases

New subtype of H or N that we have never been exposed to or immunity

Question 8

Antigenic drift

Answer 8

When viruses accumulate gene mutations that code for anti-body binding sites

Question 9

Pandemic alert system

Answer 9

Phase 1: No animal influenza going around in animals has been reported to humans
Phase 2: animal influenza is in humans and can be a potential pandemic
Phase 3: clusters of infections in humans but not transmitted from human to human
Phase 4: Human to human transmission and able to sustain in community level
Phase 5: virus is in two or more countries within a WHO region
Phase 6: Spread to other WHO regions

Question 10

Purpose of IHR

Answer 10

Balance health and economics with preventing, protecting controlling and providing health response to health risks

Question 11

Key reasons for revision

Answer 11

Limited disease coverage
Out of date
Compliance concerns
Excessive responses to some outbreaks

Question 12

Major changes to WHO

Answer 12

Independent surveillance, unilateral travel recommendations

Countries: Develop surveillance systems, report health emergencies 24h, develop response strategies

Question 13

Mitigate the impact

Answer 13

Vaccines
Antivirals
Non-pharmacological interventions (hand washing, isolation, cancel schools)

Question 14

Goals of community mitigation

Answer 14

Delay peak
Decompress peak
Diminish overall cases and health impact

Question 15

Requirements for quarantine/isolation

Answer 15

Long time from exposure to infectiousness
Low transmission before symptoms show up
Low reproductive number

Question 16

Antivirals are used for

Answer 16

Prophylaxis and early treatments

Question 17

Emergencies act

Answer 17

Allows federal government to take action when theres a national emergency
Cannot intervene if only in one province unless the province allows them

Question 18

4 things of emergencies act

Answer 18

Regulation of travel to affected area
Evacuation
Possession of property
Direction of services to provide emergency care

Question 19

Lessons from H1N1

Answer 19

Public health capacity (surge capacity and vaccine development)
Surveillance capacity (data standards)
Domestic governance (two province rule)

Question 20

Threats to multi-lateral Approach

Answer 20

Early detection primarily for those in wealthier countries
Surveillance diverts money away from other aspects of heath
Reporting outbreaks can damage economy