International aspects of communicable disease control including port health

International aspects of Communicable Disease Control

This section covers:

International aspects of communicable disease control including port health

The Public Health Act 1872 provided for the establishment of Port Health Authorities (PHA).

Port Health Authorities are Local Authority environmental health departments and have powers to control the public health aspects of port activity involving ships, international trains and aircraft. Each Port Health Authority appoints port health officers and port medical officers.

Functions of Port Health Authorities

1. Prevent the importation of disease, e.g. visit and inspect aircraft

2. Rodent control, e.g. ships must be inspected every 96 months for rats

3. Imported food, e.g. inspection and clearance of Products of Animal origin into the EU

4. Fish and shellfish, e.g. FSA monitor quality of local shellfish

5. Food premises inspections, e.g. monitors standards in shore-based premises and in-flight catering

6. Animal health, e.g. assist with enforcement of rabies controls.

Port Medical Officer

1. May act as a Port Medical Inspector (PMI) providing advice to Immigration and Nationality service

2. Refer to PMI for medical clearance (including Chest X-ray) in any person intending to remain in the UK for 6 months or more or those who are unwell

3. Medical clearance may take place in country of origin

4. Persons with infectious diseases likely to endanger health of others in the UK may be refused entry

5. Unless entry refused, details of immigrant and results of any examination are passed to CCDC in the proposed area of residence

6. Subsequent action can vary but include invitations to attend for further medical assessment

(Source: J. Hawker. Communicable Disease Control Handbook. Blackwell 2005)

WHOs International Health Regulations (IHR)

The International Health Regulations (IHR) are an agreement between 196 countries to work together for global health security. All countries are required to report events of international public health importance to the WHO. The IHR aim to prevent, protect against, control and respond to the international spread of disease while avoiding unnecessary interference with international traffic and trade.

The World Health Organisation generated the first IHR in 1969 to establish a set of legally binding guidelines that 196 countries agreed to for the prevention and response to public health crises. The IHR were updated in 2005 following the 2003 epidemic of severe acute respiratory syndrome (SARS) which highlighted that stronger systems were required to deal with public health events in the contemporary environment. The IHR were enforced in 2007.

The IHR outline that all countries must have the capacity to do the following;

DETECT: Ensure surveillance systems and laboratories can identify potential threats.
ASSESS: Work alongside other countries in making decisions for public health emergencies.
REPORT: Report specific diseases and those meeting IHR defined criteria (see below) and any potential public health emergencies of international concern (PHEIC).
RESPOND: Respond to public health occurrences.

A PHEIC should be declared to the WHO if 2 of 4 following criteria are met:

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

2. Is the event unusual or unexpected?

3. Is there a significant risk of international spread?

4. Is there a significant risk of international travel or trade restrictions?

Diseases which are always notifiable under IHR (2005):

smallpox;
poliomyelitis due to wild-type poliovirus;
SARS;
human influenza caused by a new subtype.

Potentially notifiable events:

Cholera, Plague, Yellow Fever (the only three identified in the original IHR)
Viral haemorrhagic fever
West Nile Fever
Other biological, radiological or chemical events that meet IHR criteria
Other diseases which meet IHR criteria.

Three PHEIC have been declared since the revised IHR have been enforced; H1N1 Influenza (2009), Polio (2014), Ebola (2014).

(Source: International Health Regulations. WHO. Geneva. 2005)