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Volume 12, Number 7—July 2006

Global Public Health Surveillance under New International Health Regulations

Michael G. Baker*Comments to Author  and David P. Fidler†
Author affiliations: *Wellington School of Medicine and Health Sciences, Wellington, New Zealand; †Indiana University School of Law, Bloomington, Indiana, USA

Main Article

Table 1

International Health Regulations (IHR 2005) assessed according to attributes of public health surveillance systems (adapted from [8])

Attribute Attribute details Relevance to IHR 2005
Usefulness Contribution to prevention and control of adverse health-related events Design and scope imply improved usefulness compared with IHR 1969 but attribute must be evaluated after IHR 2005 has operated for a period
Sensitivity Proportion of true events detected by system and ability to detect outbreaks Specifies notification of all potential public health emergencies of international concern (PHEIC) and provides multiple pathways to increase sensitivity
Timeliness Speed between steps particularly from event onset to response Specifies assessment within 48 h and reporting within 24 h by state parties and prescribes immediate reporting of events at local and intermediate levels within state parties
Stability Reliability and availability of surveillance system All state parties must notify all potential PHEIC from June 2007 and establish capacity to detect, assess, and report events by 2012, with potential extensions to 2016
Simplicity Simplicity of structure and ease of operation Architecture of surveillance system is streamlined and transparent, especially at international level
Flexibility Ability to adapt to changing information needs and operating conditions Use of risk assessment criteria means that surveillance applies to new as well as established disease threats
Acceptability Willingness of persons and organizations to participate Establishment of surveillance in international law represents commitment by state parties to participate
Data quality Completeness and validity of recorded data Specifies information to be reported and includes provisions for validation and assessment of all reports to separate rumors from real events
Positive predictive value Proportion of reported events that are true events Oriented toward high sensitivity with correspondingly low specificity and positive predictive value, so WHO will not declare most notified events to be PHEIC
Representativeness Ability to describe events over time and their distribution by place and person Likely to be increased after validation and assessment, as for data quality

Main Article

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