Weeks 1-4

Question 1

What is the basic reproductive number?

Answer 1

R0 is the number of secondary cases generated from a single infective case introduced into a susceptible population. R0<1: the disease will eventually disappear; R0=1: the disease will become endemic; R0>1: there will be an epidemic. The higher this number is, the higher the immunity threshold must be to protect the community.

The basic reproduction number (R0), which defines the mean number of secondary cases generated by one primary case when the population is largely susceptible to infection, determines the overall number of people who are likely to be infected, or more precisely the area under the epidemic curve. For an epidemic to take hold, the value of R0 must be greater than unity in value. A simple calculation gives the fraction likely to be infected without mitigation. This fraction is roughly 1–1/R0.

Question 2

For infectious diseases, which is the best model?

Answer 2

Epidemiological triad consisting of host, agent, and environment.

Agent originally referred to an infectious microorganism or pathogen, however, has been broadened to include chemical and physical causes of disease or injury. Factors influence whether exposure to an organism will result in disease, including the organism’s pathogenicity (ability to cause disease) and dose.

Host refers to the human who can get the disease. A variety of factors intrinsic to the host, sometimes called risk factors, can influence an individual’s exposure, susceptibility, or response to a causative agent. Opportunities for exposure are often influenced by behaviors such as sexual practices, hygiene, and other personal choices as well as by age and sex. Susceptibility and response to an agent are influenced by factors such as genetic composition, nutritional and immunologic status, anatomic structure, presence of disease or medications, and psychological makeup.

Environment refers to extrinsic factors that affect the agent and the opportunity for exposure. Environmental factors include physical factors such as geology and climate, biologic factors such as insects that transmit the agent, and socioeconomic factors such as crowding, sanitation, and the availability of health services.

Question 3

Pathogenecity

Answer 3

refers to the proportion of infected individuals who develop clinically apparent disease.

Question 4

Virulence

Answer 4

refers to the proportion of clinically apparent cases that are severe or fatal

Question 5

Identify and describe the differences between communicable diseases and non-communicable diseases

Answer 5

Noncommunicable diseases (NCDs), also known
as chronic diseases, are not passed from person
to person. Cause premature morbidity, dysfunction, and reduced quality of life and usually develop and progress over long periods.
• WHO has prioritized the following four behavioral risk factors that reduce the probability of disease:
‒ Physical inactivity,
‒ Tobacco use,
‒ Alcohol use, and
‒ Unhealthy diets (increased fat and sodium, with low
fruit and vegetable intake).

Communicable diseases are infectious diseases transmissible (as from person to person) by direct contact with an affected individual or the individual’s discharges or by indirect means (as by a vector).

Question 6

What is the purpose of the The National Framework for Communicable Disease Control (the Framework)?

Answer 6

Brings together government agencies and committees under the goal of strengthening our defences against communicable diseases.
Recommends outcomes required to achieve the two key objectives:
Improved communicable disease prevention, detection and response
Improved organisation and delivery of CD control
And in doing so, supports the delivery of an integrated, national CD response.

4 main outcomes: better surveillance and lab testing, improved preparedness and response, implementation of evidence-based policy, effective public health communications

https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-frame-communic-disease-control.htm

Question 7

Define the types of surveillance and how each of them is useful depending on the CDC question

Answer 7

Communicable disease surveillance in Australia operates at the national, state and local levels. Primary responsibility for public health action lies with the state and territory health departments. The role of communicable disease surveillance at a national level includes:

detecting outbreaks and identifying national trends;
providing guidance for policy development and resource allocation at the national level;
monitoring the need for and impact of national disease control programs;
coordinating a response to national or multi-jurisdictional outbreaks;
describing the epidemiology of rare diseases that occur infrequently at state and territory levels;
meeting various international reporting requirements, such as providing disease statistics to the World Health Organization; and supporting quarantine activities, which are the responsibility of the Australian government.

State and territory health departments collect notifications of communicable diseases under their public health legislation.

Question 8

What is the Communicable Diseases Network Australia (CDNA)?

Answer 8

provides national public health co-ordination and leadership, and support best practice for the prevention and control of communicable diseases. This network has representatives from all jurisdictions, the OHP, New Zealand MInistry of Health, Dept of Agriculture and Water, Australian Society for Infectious Diseases, Australian Society for Microbiology, Department of Defence, Food Standards Australia New Zealand, National Centre for Epidemiology and Population Health, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, OzFood Net, Public Health Laboratory Network, National Immunisation Committee, Kirby Institute for Infection and Immunity in Society and an Aboriginal and Torres Strait Islander expert.

The CDNA meet fortnightly to share and evaluate the latest information and developments in communicable diseases surveillance with a view to providing a high quality surveillance of communicable and notifiable diseases including: HIV/AIDS, sexually transmissible infections, vaccine preventable diseases, arboviruses and zoonotic and enteric diseases.

The CDNA are also responsible for developing standard surveillance case definitions for all nationally notifiable diseases.

Question 9

What are the components of case definitions in the CDC context?

Answer 9

laboratory confirmation only (e.g. Chlamydial infection)

laboratory and clinical evidence (e.g. Botulism)

laboratory definitive evidence OR laboratory suggestive evidence plus clinical evidence (e.g. meningococcal disease)

laboratory definitive evidence OR clinical plus epidemiological evidence (e.g. measles)

Question 10

Why is it important to be able to view notification data by number of cases AND by rate?

Answer 10

By viewing notification data by number of cases you can determine the extent and pattern of disease occurrence by time, place and person. This can assist in identifying clusters or outbreaks in the community. It can also assist in planning e.g. the number of infection control isolation units needed.

Viewing notification data by rate takes into account population numbers which allows comparison of the burden of disease in different locations whose populations differ in size. It is also useful for comparing disease occurrence during different periods of time and among subgroups to help identify those at increased risk of disease.

Question 11

Why do some diseases require the reporting of probable cases?

Answer 11

Reporting probable cases is useful for diseases that require immediate public health action. This action can be taking place or being planned for before laboratory confirmation or other confirmatory evidence is available,

Question 12

What are the attributes of public health surveillance systems?

Answer 12

Every surveillance system can be described with respect to the following nine basic attributes:
• Simplicity refers to the system’s structure and ease of operation.
• Flexibility is the ability of the system to adapt to changing information needs and operating
conditions with minimal additional cost.
• Data quality is the completeness and validity of the data collected through the system.
• Acceptability is the willingness of persons and organizations to participate in the system, including
those who operate the system, report cases of the disease, or use the data.
• Sensitivity is the proportion of cases of a disease detected by a surveillance system and the ability
of the system to monitor changes in the number of cases over time, such as outbreaks.
• Predictive value positive is the proportion of cases reported through the system that are
accurately diagnosed instances of the disease under surveillance.
• Representativeness is the extent to which the system accurately describes the occurrence of the
disease over time and its distribution in the population by place and person.
• Timeliness reflects the delay between steps in a surveillance system and availability of information
for control of the disease under surveillance when needed.
• Stability is the ability of a surveillance system to collect, manage, and provide data without failure
and to be operational when needed.

Question 13

What is the best type of surveillance system for evaluating anthrax?

Answer 13

High sensitivity and timeliness to make the system simple and acceptable. To identify all the cases, a low predictive value and data quality is acceptable b/c officials will follow-up on potential cases and confirm the diagnosis and case information.

Question 14

What is the best type of surveillance for cardiac disease?

Answer 14

For chronic diseases

Question 15

What is the best type of surveillance for cardiac disease?

Answer 15

For chronic diseases, requires identification of high risk groups for these diseases to develop appropriate interventions. This requires a surveillance system that provides high quality data and stability to examine trends over time. There is a time lag in these diseases, therefore, timeliness is not crucial. For chronic diseases, they are common and large-scale follow-up will not occur with individual cases, therefore sensitivity will not be critical.

Question 16

Apply the concept of global health security to CDC context

Answer 16

Global health security includes both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries. (WHO 2007)

Question 17

Describe the role and implementation of the International Health Regulations

Answer 17

To prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.

International Health Regulations (IHR 2005) mandates -WHO Member States to develop, strengthen and maintain their capacity to respond promptly and effectively to public health risks and public health emergencies of international concern.

Question 18

Discuss the process of building capacity in competencies required for implementation of IHR at various levels: National, regional and international

Answer 18

Denote the functions required for a country to detect, assess, notify and report events, and to respond to public health risks and emergencies of national and international concern. There are eight core capacities identified by WHO
Core capacity 1: National legislation, policy and financing
Core capacity 2: Coordination and National Focal Point (NFP) communications
Core capacity 3: Surveillance
Core capacity 4: Response
Core capacity 5: Preparedness
Core capacity 6: Risk communication
Core capacity 7: Human resources
Core capacity 8: Laboratory

Public health emergencies involve increased incidence of illness, injury and/or death

• Require special measures to address increased morbidity, mortality and interruption of essential health services.
• A multi-agency, multi-jurisdictional response is often required, working with the national disaster management organization.
• When normal resources and capacities are exceeded, support from outside the affected areas will also be required. External assistance could include national, cross-border, regional or international resources.

Question 19

What is risk communication and how does it apply to communicable disease control?

Answer 19

‘Risk communication’ in the context of a public health emergency is defined as:

“The real time exchange of information, advice, and opinions between experts or officials, and the people who face the threat/hazard to their survival, health or economic or social wellbeing.” (WHO, 2005)

An essential part of risk communication is the dissemination of information to the public about health risks and events, such as disease outbreaks. How this information is disseminated, to who and why is integral to ensuring communication messages are heard, processed and acted on.

Risk communication should include a mix of communication and engagement strategies, such as media and social media communications, mass awareness campaigns, health promotion, social mobilization, stakeholder engagement and community engagement.

Question 20

What are public health emergency operations centre (PHEOC) ?

Answer 20

They function according to minimum common standards; maintaining trained, functioning, multi-sectoral rapid response teams and “real-time” biosurveillance laboratory networks and information systems; as well as trained EOC staff capable of activating a coordinated emergency response within 120 minutes of the identification of a public health emergency

Question 21

What should be in a PHEOC plan?

Answer 21

• Responsibilities of the incident management functional sections
• Physical and technological aspects of the PHEOC
• PHEOC Staffing and standard operating procedures (SOPs)
• PHEOC activation and scaling thresholds and processes
• Situation report (SITREP) preparation protocols
• Vertical and horizontal internal communication processes for any event
• Continuity of operations or business continuity plan to be followed if the operations of the PHEOC are interrupted.

Question 22

How are the IHR core capacities evaluated at a country level?

Answer 22

In 2016, WHO developed a IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises of:

i) Self-Assessment Annual Reporting (mandatory)
ii) Simulation exercises and After-Action Reviews (voluntary)
iii) Joint External Evaluations (JEEs) (voluntary)

Question 23

What is Joint External Evaluation (JEE)?

Answer 23

The JEE is a voluntary process used to assess the capacity of a country to prevent, detect and rapidly respond to public health risks. A JEE team visits a country and evaluates country-specific progress in achieving IHR core capacities (under 19 technical areas). Recommendations are provided on how to strengthen these capacities. External evaluations should be seen as an core part of a continuous process of strengthening capacities for the implementation of the IHR in a country.

Question 24

What is Joint External Evaluation (JEE)?

Answer 24

The JEE is a voluntary process used to assess the capacity of a country to prevent, detect and rapidly respond to public health risks. A JEE team visits a country and evaluates country-specific progress in achieving IHR core capacities (under 19 technical areas). Recommendations are provided on how to strengthen these capacities. External evaluations should be seen as a core part of a continuous process of strengthening capacities for the implementation of the IHR in a country.

Question 25

What are two theories that affect risk communication theory

Answer 25

Mental noise theory –when people are stressed, dealing with internal “mental noise” and are less able to attend to externally generated information
• Bioterrorism or pandemic events, ‘dread’ and ‘uncertainty’ may lead to a high likelihood people will respond emotionally

• Negative dominance theory -when people are upset they are more likely to listen to negative rather than positive reports, and may focus on negative than to positive information
• Less likely to trust authority; accept the validity of communications

Question 26

What are the components of COMBI –COMMUNICATION FOR BEHAVIOURALIMPACT
(WHO,2012)?

Answer 26

A toolkit for behavioural and social communication outbreak response
• Recognizes the importance of integrating a range of strategies

Five Integrated Actions:

1. Public relations/advocacy/administrative mobilization
2. Community/social mobilization
3. Sustained, appropriate advertising
4. Personal selling/interpersonal communication/counselling
5. Point-of-service promotion

Question 27

What are the key components for developing communication strategies?

Answer 27

For developing strategies:
Reach –the degree to which any communication strategy will get to the person/group of interest
Relevance –the degree to which any communication is seen as being relevant to the target audience
Receptiveness –the degree to which engagement is culturally resonant
Relationships –the way in which two or more people or things are connected, or the state of being connected

Question 28

What are the steps of an Outbreak Investigation?

Answer 28

Ten Steps of an Outbreak Investigation
Outbreak investigations are often described as having 10 steps, however some references will include a few more or less, depending on how the actions are grouped. Commonly, the 10 steps are:

Prepare to investigate
Verify the diagnosis and confirm the existence of an outbreak
Construct a working case definition
Find cases systematically and record information
Perform descriptive epidemiology
Generate hypotheses and re-evaluate hypotheses epidemiologically (As necessary, reconsider, refine, and re-evaluate hypotheses)
Compare and reconcile with laboratory and/or environmental studies
Implement control and prevention measures
Initiate or maintain surveillance
Communicate findings

Question 29

What are the National Strategic Approach and supporting Action Plan?

Answer 29

The Action Plan identifies four key priority areas:
Testing and treatment
Surveillance and reporting
Education and awareness
Antenatal care

Question 30

What is PROMED?

Answer 30

The Program for Monitoring Emerging Diseases (ProMED) is a program of the International Society for Infectious Diseases (ISID). ProMED was launched in 1994 as an Internet service to identify unusual health events related to emerging and re-emerging infectious diseases and toxins affecting humans, animals and plants. ProMED is the largest publicly-available system conducting global reporting of infectious diseases outbreaks.

Question 31

How did Australia handle the outbreak of STIs such as the syphilis outbreak in Aboriginal and Torres Strait Islanders?

Answer 31

The Australian Health Protection Principal Committee (AHPPC) Governance Group has developed a National strategic approach for an enhanced response to the disproportionately high rates of STI and BBV in Aboriginal and Torres Strait Islander people (Strategic Approach).

This is working to address the disproportionately high rates of syphilis and other Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) in regional and remote Indigenous communities.

The Strategic Approach was endorsed by the Australian Health Ministers’ Advisory (AHMAC) Council.

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The disease control interventions that are being implemented or enhanced include:
opportunistic and community screening/testing, particularly among young sexually active people aged less than 29 years;
immediate treatment of people who are symptomatic (e.g. genital ulceration), have tested positive for syphilis or are sexual contacts of cases;
reinforcement and focus on antenatal screening for syphilis, with particular attention paid to recommended guidelines for the ‘at risk’ population;
public health alerts, health protection education and campaigns; and
active follow up of cases.

This National campaign aims to target Aboriginal and Torres Strait Islander people aged 15–29 years living in regional and remote communities of Queensland, Northern Territory, Western Australia and South Australia; and
promotion, through television and radio advertising, engaging with local community groups, social media and the Young Deadly Free website.

Question 32

What is the Syphilis Register?

Answer 32

yphilis Registers
State-wide syphilis registers have been operational in Queensland and the Northern Territory since the early 2000’s, while Western Australia has had a regionally based register.

All laboratory based positive syphilis tests are reported to the corresponding register (based on place of residence).

The Syphilis register records the history of an individual’s pathology results for all tests related to the diagnosis and monitoring of syphilis and any associated treatment. It aims to provide the treating clinician with information about a client’s history of syphilis infection to assist in the diagnosis, management, education and treatment. The register also requests information from diagnosing clinicians to confirm treatment, keep the records complete and inform service providers about risk factors for contracting syphilis.

Since the outbreak, South Australia has now established a register and Western Australia are planning for their register to become state-wide

Question 33

What are the key facts for meningococcal meningitis?

Answer 33

1. Meningococcal meningitis (MM) is an acute bacterial form of meningitis due to Neisseria meningitidis (N.m), a serious infection of the meninges (brain membranes)
2. MM occurs worldwide but its highest burden is in the African meningitis belt
3. Several types of N.m can cause epidemics
4. Humans are the only reservoir of MM, transmitted through direct contact and respiratory droplets
5. MM can have a fatality rate of up to 50% when untreated
6. Specific vaccines are used for prevention and outbreak response
7. Laboratory diagnosis is essential to ascertain whether N.m is the pathogen causing
   meningitis
8. Surveillance is critical to detect outbreaks and inform the epidemic response
9. Early antibiotic treatment is the most important factor to save life and reduce
   complications
10. Antibiotics reduce transmission risk for close contacts when given promptly

Question 34

What are the key steps to coordinate an outbreak response for meningitis?

Answer 34

Coordinating responders
• Make sure the epidemic preparedness and
response committee is established before the
epidemic season
• Contact WHO/ICG for emergency vaccines and
antibiotics
Communicating risk
• Ensure populations receive the vaccine to
prevent this disease

• Key messages are:
- Human-to-human transmission occurs through
droplets of respiratory or throat secretions
- Asymptomatic carriers can transmit the disease
- Practice hand hygiene and respiratory hygiene
- Early antibiotic treatment reduces mortality and
complications and therefore sick people should
seek medical treatment early on
Health Information
• Identify the meningococcal serogroup
through laboratory testing
• Monitor thresholds that have been defined
according to specific regional or country
epidemiology
Health Interventions
• Early antibiotic treatment
• Conduct vaccination campaigns promptly
(according to local epidemiology)
• Prophylaxis to close contacts (according
to local epidemiology)

Question 35

Why is it important to be able to view notification data by number of cases AND by rate?

Answer 35

Number of cases - determine the extent and pattern of disease occurrence by time, place and person. This can assist in identifying clusters or outbreaks in the community. It can also assist in planning e.g. the number of infection control isolation units needed.

Notification data by rate - population numbers allows comparison of the burden of disease in different locations whose populations differ in size. It is also useful for comparing disease occurrence during different periods of time and among subgroups to help identify those at increased risk of disease.

Question 36

Why do some diseases require the reporting of probable cases?

Answer 36

Reporting probable cases is useful for diseases that require immediate public health action. This action can be taking place or being planned for before laboratory confirmation or other confirmatory evidence is available,

Question 37

Incidence

Answer 37

refers to the number of individuals who develop a specific disease or experience a specific health-related event during a particular time period (such as a month or year).

Question 38

Prevalence

Answer 38

is the proportion of a population who have a specific characteristic in a given time period.

Question 39

Case-fatality rate

Answer 39

the proportion of deaths from a certain disease compared to the total number of people diagnosed with the disease for a particular period

Question 40

Identify what should be collected on a surveillance case report form

Answer 40

case details, disease to notify, clinical comments, doctor details

Question 41

Factors that can account for a change in the reported incidence of a disease

Answer 41

In contrast to prevalence, incidence is a measure of the number of new cases of a disease (or other health outcome of interest) that develops in a population at risk during a specified time period.

There are two main measures of incidence:

Risk (or cumulative incidence) is related to the population at risk at the beginning of the study
period.
Rate is related to a more precise measure of the population at risk during the study period and is
measured in person-time units.

Question 42

Define sensitivity of a surveillance system, and the effect of different case definitions on
sensitivity.

Answer 42

Sensitivity of a case definition is the proportion among all individuals with the disease in the study sample that are identified by the case definition

Efforts to improve certain attributes–such as the ability of a system to detect a health event (sensitivity)–may detract from other attributes, such as simplicity or timeliness

Increased sensitivity may afford a greater opportunity for identifying epidemics and understanding the natural course of an adverse health event in a community.

The sensitivity of a surveillance system is affected by the likelihood that:

Persons with certain diseases or health conditions seek medical care;

The diseases or conditions will be diagnosed, reflecting the skill of care providers and the sensitivity of diagnostic tests; and

The case will be reported to the system, given the diagnosis. These three conditions can be extended by analogy to

surveillance systems that do not fit the traditional disease care-provider model. For example, the sensitivity of a telephone-based surveillance system of morbidity or risk factors is affected by:

The number of people who have telephones, who are at home when the call is placed, and who agree to participate;

The ability of persons to understand the questions and correctly identify their status; and

The willingness of respondents to report their status. The extent to which these questions are explored depends on the

system and on the resources available for the evaluation. The measurement of sensitivity in a surveillance system requires a) the validation of information collected by the system and b) the collection of information external to the system to determine the frequency of the condition in a community (4). From a practical standpoint, the primary emphasis in assessing sensitivity–assuming that most reported cases are correctly classified–is to estimate the proportion of the total number of cases in the community being detected by the system. Discussion

A surveillance system that does not have high sensitivity can still be useful in monitoring trends, as long as the sensitivity remains reasonably constant. Questions concerning sensitivity in surveillance systems most commonly arise when changes in disease occurrence are noted. Changes in sensitivity can be precipitated by such events as heightened awareness of a disease, introduction of new diagnostic tests, and changes in the method of conducting surveillance. A search for such surveillance “artifacts” is often an initial step in outbreak investigations. E. Predictive Value Positive Definition

https://www.cdc.gov/mmwr/preview/mmwrhtml/00001769.htm

Question 43

What are the six guiding principles of public communication?

Answer 43

It is organized according to six principles to ensure WHO communications are:

• Accessible to decisions-makers
• Actionable by decisions-makers
• Credible and trusted as perceived by decisions-makers
• Relevant to decisions-makers
• Timely to enable decision-making
• Understandable to decision-makers

Question 44

What challenges can you anticipate for a country enacting recommendations from a Joint External Evaluation (JEE)?

Answer 44

“Areas that need strengthening/challenges

• Although staff working at PoE undergo an initial training, a sustainable systematic training programme should be established.
• Current information collection on ill travellers is paper-based. Electronic alternatives should be provided using an integrated information technology system, to improve storage, sharing and dissemination of traveller information between partners and key stakeholders.”

While the above score was the highest it could be at 5, other Technical areas of:

Real time Surveillance, (an electronic real time reporting system)
Preparedness (priority public health risks and resources are mapped and utulised)
Risk Communication (communication engagement with affected communities)
all only scored 3, a developed capacity. It would seem to me that these are linked and the lack of the electronic real time reporting has caused a significant gap in communication with all stakeholders. The fact that the International Health Regulations, IHR 2005, manadates that Member States ‘respond promptly and effectively’ and that the target is to ‘ activate a coordinated emergency response within 120 minutes’ seems to have been missed.

Question 45

Describe the role and implementation of the International Health Regulations

Answer 45

The International Health Regulations (2005) or “IHR (2005)” are an international law which helps countries work together to save lives and livelihoods caused by the international spread of diseases and other health risks.

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.

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.

The main functions of the IHR are:

-Notification

Require States to notify WHO of all events that may constitute a public health emergency of international concern and to respond to requests for verification of information regarding such events. This enables WHO to ensure appropriate technical collaboration for effective prevention of such emergencies or containment of outbreaks and, under certain defined circumstances, inform other States of the public health risk where action is necessary on their part
Intended to promote and facilitate information sharing between WHO and States Parties to the IHR
Improve greater understanding of the event as it unfolds
Assurance of timely technical collaboration
Improved climate of willingness to contact WHO
-National Core Capacities

Each State Party is required to develop,strengthen and maintain core public health capacities for surveillance and response
Key sanitary and health services and facilities are also to be developed at international airports, ports and ground crossings
The eight core capacities are:
1.National legislation, policy and financing

2. Coordination and National Focal Point (NFP)communications
3. Surveillance
4. Response
5. Preparedness
6. Risk communication
7. Human resources
8. Laboratory
   - The IHR include procedures for obtaining independent technical advice concerning IHR implementation

Although the IHR (2005) do not include an enforcement mechanism per se for States which fail to

comply with its provisions, the potential consequences of non-compliance are themselves a powerful compliance tool. Possible consequences of non-compliance include a tarnished international image, increased morbidity/mortality of affected populations, unilateral travel and trade restrictions, economic and social disruption and public outrage.

IHR core capacities can be evaluated at a country level through:

• Self-assessment annual reporting (mandatory)
• Simulation exercise and after-action reviews(voluntary)
• Joint External Evaluations (JEEs) (voluntary)

WHO https://www.who.int/ihr/about/FAQ2009.pdf

Question 46

What is the language of communicable disease?

Answer 46

Communicable diseases may be classified according to:
• the causative agent (e.g. bacteria, viruses, and parasites),
• the clinical illness caused (e.g. pneumococcal pneumonia,
influenza, etc),
• the means of transmission
• physical contact with an infected person, such as through touch
(staphylococcus), sexual intercourse (gonorrhea, HIV), faecal/oral
transmission (hepatitis A), or droplets (influenza, TB)
• contact with a contaminated surface or object (Norwalk virus), food
(Salmonella, E. coli), blood (HIV, hepatitis B), or water (cholera);
• bites from insects or animals capable of transmitting the disease
(mosquito: malaria and yellow fever; flea: plague); and
• travel through the air, such as tuberculosis or measles; or
• Two or all three characteristics (e.g. food‐borne Salmonella
gastroenteritis)

Question 47

Elimination

Answer 47

reduction to zero of the incidence of a
specified disease in a defined geographic area as a result of deliberate efforts; continued intervention measures are required.

Question 48

Eradication

Answer 48

permanent reduction to zero of the worldwide
incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. For example Smallpox (WHO, 1980).

Question 49

Elimination of disease

Answer 49

reduction to zero of the incidence of a
specified disease in a defined geographic area as a result of deliberate efforts; continued intervention measures are required.

Question 50

Eradication of disease

Answer 50

permanent reduction to zero of the worldwide
incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. For example Smallpox (WHO, 1980).

Question 51

Control of disease

Answer 51

reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction.

Question 52

incubation period

Answer 52

time from exposure to development of disease. In other words, the time interval between invasion by an infectious agent and the appearance of the first sign or symptom of the disease.

Question 53

latent period

Answer 53

eriod between exposure and the onset of infectiousness (this may be shorter or longer than the incubation period).

Question 54

What dictates the rate of increase of

an epidemic of an infectious disease?

Answer 54

The number of individuals infected by each infectious case

The time it takes between when a case is infected and when they infect other people

Question 55

latent period

Answer 55

period between exposure and the onset of infectiousness (this may be shorter or longer than the incubation period).

Question 56

What are the tasks of global health security

Answer 56

Prevent/predict, detect, respond, and recover

Question 57

What is the definition of global public health security?

Answer 57

the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries. (WHO 2007)