#3: IHR/ICD
*****Article 12
Determination of a PHEIC
ICD classifies data under headings such as
Diagnosis, reason for admission, conditions treated, reason for consultation
ICD 11 is available and *six* official languages since its publication which are:
English, Arabic, French, Spanish, Russian, Chinese
Ontology concepts
Entity & quality
Subject areas affected by IHR implementation
Environment, public health, international ports airports ground crossings, customs, food safety, agriculture, radiation safety, chemical safety, transportation, collection using disclosure of public health information, public health activities of authorities
PHEIC definition
Extraordinary event, pH risk through international spread, require a coordinated international response
_______________ (_________) conceived the idea of classification of diseases and published it under the title __________________
Francois Bossier de Lacroix (1706-1777) Nosologia Methodica
Dx with gaming disorder If:
Have trouble controlling behaviour, only predominantly interested in gaming and continue gaming despite negative consequences
Key purposes and applications of ICD
Health management Reimbursement and resource allocation Epidemiology Clinical purposes
If vaccination is contra indicated on medical grounds:
Healthcare practitioner must provide person with documented reasons Authorities on arrival should take into account
Fundamental of a statistical classification of disease
Identify specific disease, statistical presentation of data Enable useful info to be obtained
Influenza A (H1N1, Swine Flu)
In March 2009, began spreading in Mexico Within 90 days became pandemic/global Northbound volume dropped 42% Southbound volume dropped 57%
Chapter 20 contains subdivision to:
Indicate the type of activity being undertaken at the time of the event
Chapter 19 contains subdivisions to:
Indicates open and close fractures as well as intracranial, intrathoracic, and intra-abdominal injuries with and without open wound
Article 1 definitions
Isolation and quarantine, standing and temporary recommendation
Middle East respiratory syndrome
Jordan: April 2012 11 pneumonia cases (8 healthcare workers) One patient: pneumonia and pericarditis other: pneumonia and Dic
What are the international health regulations
Legal instrument that covers measures for preventing the transnational spread of infectious disease *"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"*
ICD-10-PCS codes contain _______ characters.
seven
The purpose of ICD is
To allow the systematic *recording, analysis, interpretation,* and *comparison of mortality and morbidity data* collected in different countries all areas and at different times
How many criteria are met for a Country to be required to notify WHO within 24 hours
Two of the four
Article 10
Verification
Arrangement of volumes of ICD 10
Volume one: main classifications Volume two: instruction/guidance to users Volume three: alphabetical index
Who is responsible for the cooperation in IHR?
WHO
History of IHR in 1969
WHO adopted international sanitary regulation and renamed it as IHR
Structure and principles of ICD were originally conceived by:
William Farr
Only disease for which proof of vaccination can be required for travellers as a condition of entry into a country
Yellow fever
Mandatory vaccination for travellers
Yellow fever (according to vaccination Country list) Meningococcal disease and polio (required by Saudi Arabia for pilgrims)
Key features of IHR 1969
1.notification of cases of cholera, plague, smallpox, and yellow fever 2.rules for international travel and trade 3.maximum border measures 4.health documents
Health measures at Port on departure
- If the area is declared as infected, the crew of the ship requires a valid certificate to that effect - The health Authority may examine any person before his departure on an international voyage - A crew on an international voyage if placed under surveillance may be allowed to continue voyage but must notify the place where he is proceeding
Four decision criteria are used to assess PH events
- Is the public health impact of this event potentially serious? - Is this event unusual or unexpected? - Is there potential for international spread? - Is there potential for travel and trade restrictions?
Priorities subjects areas
- National focal points: designation and operation - Detection, reporting, verification, and control of events - Implementation of documents: annex 3,6,8,9 -designation of ports of entry - Identification of ports authorised to issue ship sanitation certificates and provide related services
Health measures at ports on arrival
- Not to cause discomfort to any person or injury to health - Health Authority shall issue: 1) certificate free of charge of sanitary measures methods and reasons 2) certificate to any traveller of date of arrival/departure and measures applied -allow a person under surveillance to move freely - Ship shall not be denied of free pratique
New mandate and obligations in the IHR
- Notify a potentially wide range of events to WHO that may constitute a PHEIC - WHO is obliged to request verification of events - State parties are also obliged to inform WHO of significant evidence outside their territory - national IHR focal - WHO IHR contact point
*Screening of persons at entry and exit
- Review travel history in affected areas - Review medical examination - Require vaccination or other prophylaxis - Quarantining suspect persons - Isolate affected persons - Tracing contacts of suspects or affected - # refuse entry of suspects and affected persons - Refuse entry of unaffected persons to affected areas - Implement exit screening and or restrictions on persons from the affected areas
Main use of ICD
- Translate diagnoses to alphanumeric code - Has become the international standard *diagnostic classification* for all general epidemiological and many health management purposes - Suitable for studies of *financial aspects* of the health system
Classification of ICD is grouped as:
- epidemic diseases - Constitutional or general illness - Local diseases arranged by site - developmental diseases - injuries
Categories of reportable diseases
-Epidemic prone diseases -Foodborne diseases -Accidental and deliberate outbreaks -Toxic chemical accidents -Radio nuclear accidents -Environmental disasters
ICD-10-PCS coding structure: eg 0DB68ZX
0: section D: body system B: root operation 6: body part 8: approach Z: device X: qualifier
Limitations of HR in 1969
1. Concerns only cholera, plague, and yellow fever 2. Dependent on official notification from member state 3. No formal mechanisms for collaboration between member state and WHO
Objectives of IHR 2005
1. appropriate application of routine preventative measures 2. notification to WHO 3. implementation of temporary recommendations 4. provision of support
Article 3 principles:
1. implementations with full respect for dignity, human rights, and freedoms 2. guided by Charter of UN, and Constitution of WHO 3. guided by goal of universal application for protection of all people 4. In accordance with the principles of international law & UN Charter, states have the right to legislate to pursue health policies
Documents that must be checked or issued by health officer on visiting every vessel granted radio free pratique:
1. maritime declaration of health (if last port is a foreign port) #2. Crew list 3. Yellow fever vaccination certificates 4. Deratting or deratting exemption certificate #5. Medicine chest certificate 6. Certificate of health and sanitary inspection 7. Certificate showing date and time of granting radio pratique
Why do countries use ICD
1. to monitor epidemics/PH threats/disease burden 2. to assess progress 3. To define obligations of WHO 4. To facilitate access to appropriate healthcare services 5.as a basis for Guidelines 6.facilitates research
IHR 1969 vs 2005
1.from three diseases to all public health risks 2.from preset measures to tailored response 3.from control of borders to also include containment at source 4.from reactive to proactive
Country may require a traveller coming from an area with a risk for yellow fever transmission to be quarantined or placed under surveillance:
1.if the traveller is unable to produce a valid certificate of vaccination against yellow fever 2.until the certificate becomes valid 3. until a period of not more than six days
Why a new IHR?
1.increasing international travel and trade 2. Early warning is essential 3. Measures should be coordinated internationally 4. Recent experiences: anthrax attacks 2001, SARS 2003, and Chernobyl disaster
*Obligations of the member states under IHR 2005
1.national IHR focal point 2.strengthening core capacity 3. Assessing events that may constitute a PHEIC within 48 hours and notifying WHO within 24 hours of assessment 4. Routine inspection and control activities 5. Examining national laws, revising health documents/forms and certificates, and building legal and administrative framework
Purpose and scope of IHR
1.prevent, protect against and control the spread of disease 2.provide a public health response to the international spread of disease restricted to public health risks 3.avoid unnecessary interference with international traffic and trade
During the last five years WHO has verified more than ________ epidemic events worldwide
1100
Supplementary subdivisions are found in which chapters?
13, 19, 20
??????________ participants taking part in______code assignments
1673, 112383
WHO released a version of ICD 11 to allow member states time to plan implementation on:
18 June 2018
First world health assembly was held in
1948 * beginning of a new era in international vital and health statistics
ICD-6
1948, International classification of diseases, injuries, and causes of death
How many countries are involved in IHR
196 (ya3ni kol dowal el 3alam) All are members of the WHO
How many airline passengers travelled in 2006
2.1 billion
I HR implementation timeline
2005: adopted 2007: entered into force 2009: assessments complete 2009 to 2012: capacity building 2012: compliance achieved
ICD10 has _______ chapters vs _______ in ICD 9
21, 17
World health assembly adopted revised IHR IN?
23rd of May 2005
?????______ countries where involved in ICD 11 field testing
31
?????__________ codes in icd-11 vs _______ in icd-10
55000, 14400
International tourist arrivals in the year 2005 exceeded
800 million
WHO helpline consists of:
9 WHO Collaborating centres for classification of diseases
What block is cholera?
A00
What block is amoebiasis?
A06
Chapter 13 contains subdivisions by
Anatomical site
Maritime declaration of health
Annex 8
Health part of aircraft general declaration
Annex 9
Ship sanitation certificate
Annex3
International certificate of vaccination and prophylaxis
Annex6
Benefits of ICD 10
Better health care for patients
Chapter I of ICD 10 contains?
Blocks: (A00-B99) *Certain infections and parasitic disease* To axes of classification: 1) Mode of transmission 2) broad group of organisms
Chapter II of ICD 10 contains?
Blocks: (C00-D48) *Neoplasm* Axes: First: behaviour of neoplasm Within the first: by site
New dz added to ICD 11
Burnout, gaming disorder, compulsive sexual behaviour
Chapters of ICD 10 contain
Chapters 1 to 17: diseases and other morbid conditions Chapter 18: symptoms and signs Chapter 19: injuries and poisoning Chapter 20: external causes of morbidity and mortality is Chapter 21: factors influencing health status and contact with health services
Immunisations of Selective use for travellers
Cholera HAV Japanese encephalitis Tick - borne encephalitis Meningococcal dz Rabies Typhoid fever Yellow fever
Known epidemic prone diseases
Cholera Pneumonic plague Viral haemorrhagic fever Yellow fever West Nile fever Other locally or regionally important diseases (dengue fever)
Limitations of IHR in 1969 concern only
Cholera, plague, and yellow fever
ICD 10 PCS impact/benefit
Code standardised/provide additional specificity Ability to capture new medical advances in technology
Routine immunisation for travellers includes
DPT MMR HPV HBV H influenzae type b Influenza Pneumococcal dz Poliomyelitis Rotavirus Tuberculosis (BCG) Varicella
Definition of standing recommendation
Non-binding advice issued by WHO for *PH health risks* regarding appropriate health measures for *routine or periodic application*
Definition of temporary recommendation
Non-binding advice issued by WHO for application on a *time-limited, risk specific basis,* in response to a *PHEIC*
Article 14
Operation of WHO with intergovernmental organisations and international bodies
Article 9
Other reports
How many airline passengers are estimated to travel now
Over 3 billion
How many diseases are known now and were unknown a generation ago
Over 40
Article 11
Provision of information by WHO
The mandate of the ICDis based on
Public health and clinical objectives Best evidence available today, health categories for public health reporting & clinical care Categories defined and operationalised
Article 13
Public health response
Where does the ICD fall under in the WHO family of International classifications?
Reference classifications
Definition of quarantine
Restriction of activities or separation from others of *suspected* person Who is not ill, to prevent *possible* spread of infection or contamination
Burn out.. results from? Characterised by?
Results from chronic stress, occupational phenomenon and is not considered a medical condition, characterised by (for dx): 1.feelings of energy depletion or *exhaustion* 2.increased *mental distance* from one's job of feelings of *negativism* or cynicism related to one's job 3.*reduced professional efficacy*
ICD 10 coding: S42.321A.. each one represents?
S42: category (core code) *first character is alpha except U 3: etiology 2: location 1: laterality/severity A: extension (for obstetrics, injuries, and external causes of injuries)
Four diseases always need to be reported to WHO
SARS Smallpox New influenza viri Wild-type polio
Definition of isolation
Separation of ill or contaminated person, to prevent the spread of infection or contamination
10th revision of the ICD started in
September 1983
SARS outbreak in China in 2002/2003 met which two criteria of assessment of PHEIC?
Serious impact of public health Potential for international spread
ICD includes
Signs and symptoms, abnormal findings, complaints and social factors
Unusual diseases
Smallpox Human Influenza (new subtype) Wild poliovirus SARS
Primer in ICD 11 speak
Terminology Ontology Semantic wiki Linearisation Content model Use-case
