ABSTRACT
Revision of the Regulations is currently under way since the WHA resolution (WHA 48.7) of May 1995, and the target date for submission to the WHA is May 2004.100 The purpose of this revision is to ‘develop Regulations which will be applicable to the epidemiology of communicable diseases and to international traffic in the 21st century’.101 Changes in patterns of disease origin and transmission, coupled with frequent noncompliance with the existing notification requirement, have finally persuaded the WHO to start revising the outmoded IHR. The new IHR will set out basic provisions and principles, and attach specific technical details in a series of annexes. The expert group has already recommended several points that require attention. They propose that the IHR’s role should be expanded beyond reporting of three infectious diseases, and suggest a reporting obligation of defined syndromes of urgent international importance.102 An objective of a pilot study begun in early 1998 was to ‘evaluate proposed notification criteria and case definitions of the notifiable syndromes’. The first provisional draft designates six notifiable syndromes: hemorrhagic fever, respiratory, diarrhoeal, neurological, jaundice, and other. While all the hemorrhagic fever syndromes require immediate reporting, others will be subject to this regime only if they are of ‘urgent public health importance’.103 Forrest considers that a syndromic reporting approach may overcome problems of identifying emerging diseases by applying common groups of symptoms, provided that the health infrastructure of nations is sufficiently co-ordinated.104 An interim review has concluded that syndromic reporting, though valuable in national contexts, does not prove appropriate in the regulatory framework mainly because of difficulties with reporting syndromes in the field test, and the failure to link syndromes to preset rules for control of spread. It is not clear whether the syndromic reporting approach has been entirely abandoned or not.105
