A survey of International Health Regulations National Focal Points experiences in carrying out their functions.

BACKGROUND: The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given the critical role of NFPs in the global surveillance and response system supported by the IHR, we sought to assess their experiences in carrying out their functions. METHODS: In collaboration with WHO officials, we administered a voluntary online survey to all 196 States Parties to the IHR (2005) in Africa, Asia, Europe, and South and North America, from October to November 2019. The survey was available in six languages via a secure internet-based system. RESULTS: In total, 121 NFP representatives answered the 56-question survey; 105 in full, and an additional 16 in part, resulting in a response rate of 62% (121 responses to 196 invitations to participate). The majority of NFPs knew how to notify the WHO of a potential PHEIC, and believed they have the content expertise to carry out their functions. Respondents found training workshops organized by WHO Regional Offices helpful on how to report PHEICs. NFPs experienced challenges in four critical areas: 1) insufficient intersectoral collaboration within their countries, including limited access to, or a lack of cooperation from, key relevant ministries; 2) inadequate communications, such as deficient information technology systems in place to carry out their functions in a timely fashion; 3) lack of authority to report potential PHEICs; and 4) inadequacies in some resources made available by the WHO, including a key tool - the NFP Guide. Finally, many NFP representatives expressed concern about how WHO uses the information they receive from NFPs. CONCLUSION: Our study, conducted just prior to the COVID-19 pandemic, illustrates key challenges experienced by NFPs that can affect States Parties and WHO performance when outbreaks occur. In order for NFPs to be able to rapidly and successfully communicate potential PHEICs such as COVID-19 in the future, continued measures need to be taken by both WHO and States Parties to ensure NFPs have the necessary authority, capacity, training, and resources to effectively carry out their functions as described in the IHR.

[Mandatory notification of infectious diseases and agents in Germany: development and suggestions for improvement]. / Meldepflichten für Infektionskrankheiten und Infektionserreger in Deutschland: Entwicklung und Verbesserungsvorschläge.

With the entry into force of the Infection Protection Act (IfSG) in 2001, the reporting obligations for infectious diseases and infectious agents were placed on a new foundation. For the first time, a distinction was made between an obligation for the notification of infectious diseases by physicians and a notification obligation for infectious agents by laboratories. The aim was to reduce the notification burden on physicians and thus to improve the quality of the notifications. Since then, numerous new obligations for notifications have been added.The aim of this work is to describe and discuss the mandatory notification of infectious diseases in Germany on the basis of their development - compared to previous regulations in Germany (Federal Communicable Diseases Act) as well as international and Europe-wide recommendations (IHR; decisions of the EU Commission 1999, 2018) - and to submit suggestions for improvement.Regarding the considerable increase in reporting requirements and reports in recent years, and the fact that the IfSG provides other surveillance systems in addition to mandatory reporting, the mandatory reporting system should be focused on the necessary reporting requirements. In a first step, the proposed abolition of the mandatory reporting of noroviruses and rotaviruses could relieve both the notifiers and the health authorities, thus enabling more efficient reporting and more intensive and better investigation by the health authorities.

[COVID-19 and work environment: legislative developments about the role of the occupational physician in the emergency management and in the SARS-CoV-2-related work accidents notification]. / COVID-19 e Ambienti di lavoro: recenti evoluzioni normative del ruolo del Medico Competente nella gestione dell'emergenza e nella denuncia dei casi di infortunio professionale legati all'infezione da SARS-CoV-2.

SUMMARY: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its associated disease (COVID-19) represent a global health emergency that requires integrated and multidisciplinary intervention by international medical and scientific communities, in support of the national governments. In Italy many public health measures have been adopted to contain the transmission of the disease, which also involved occupational physicians. The regulatory path has had a rapid evolution due to the trend of infections and progressive scientific evidence: the most recent Circular from the Ministry of Labor and Social Policies and the Ministry of Health provides for the termination of the "exceptional health surveillance" activity, the management and protection of fragile individuals by activating the medical examination on request of the employee and excludes the old age, without comorbidities, as a specific condition of risk of serious complication of SARS-CoV-2 infection. For preventive and insurance purposes, COVID-19 usually represents a generic biological risk, for which the same measures must be adopted for the entire population. In the Inail Circular no. 13 of April 3, 2020, however, it is stated that professional categories that perform front office duties are considered exposed to a higher risk, as well as, health professionals, can be considered exposed to a specific risk. From January 1st to July 31st 2020, 51,363 cases of infection from SARS-CoV-2 were reported to INAIL as an accident. In the same period INAIL noticed a decrease in reports of accidents and occupational disease overall, correlated to the effects of lockdown and smart working.

The increasing menace of dengue in Guangzhou, 2001-2016: the most important epicenter in mainland China.

BACKGROUND: Dengue is the most prevalent mosquito-borne disease in the world, with China affected seriously in recent years. 65.8% of dengue cases identified in mainland China since 2005 were reported from the city of Guangzhou. METHODS: In this study, we described the incidence rate and distribution of dengue cases using data collected form National Notifiable Infectious Disease Reporting Information System data in Guangzhou for 2001 to 2016. All dengue cases were investigated using standardized questionnaire. RESULTS: A total of 42,469 dengue cases were reported, with an average annual incidence rate of 20.99 per 100,000 resident population. Over this time period, the incidence rate of indigenous cases increased. Dengue affected areas also expanded sharply geographically from 58.1% of communities affected during 2001-2005 to 96.4% of communities affected in 2011-2016. Overall 95.30% of the overseas imported cases were reported during March and December, while 99.79% of indigenous cases were reported during July and November. All four dengue virus serotypes were identified both in imported cases and indigenous cases. The Aedes albopictus mosquito was the only vector for dengue transmission in the area. CONCLUSIONS: Guangzhou has become the dengue epicenter in mainland China. Control strategies for dengue should be adjusted to the epidemiological characteristics above and intensive study need to be conducted to explore the factors that driving the rapid increase of dengue.

Future directions for notifiable diseases: tuberculosis-related laws in the Philippines.

BACKGROUND: With the increasing burden of tuberculosis (TB) in the Philippines, and the risk of multidrug resistance to TB, there is a need to strengthen the surveillance system. In many countries, cases of TB are reported to health authorities, and reporting is an effective way to manage TB. Although TB is a universal and representative reportable disease, the Philippines does not designate it as a notifiable disease. MAIN TEXT: This study aimed to review and compare current communicable disease-related laws and regulations in the Philippines with relevant international laws and regulations in other countries, to highlight where current TB notification regulations require change, or to determine whether they reflect global trends. Furthermore, we aimed to have TB included along with other communicable diseases on the list of legally required notifiable diseases in the Philippines. We reviewed current TB-related laws, acts of parliament, executive orders, presidential decrees, administrative orders, and memorandums. We undertook a literature review of relevant World Health Organization documentation, with 17 countries selected for comparison. Data on reported TB cases in the Philippines were obtained from health authorities, and health legislation data from foreign countries was collected from a public law database or from the government websites of each country. Most of the selected countries have a legislative basis for regulating notifiable diseases. In many countries, including Australia, Canada, China, Kiribati, Nauru, Niue, New Zealand, the Republic of Korea, Singapore, the United Kingdom, and Vanuatu, laws on communicable disease notification include TB notification. Our results suggest that notification of communicable diseases should be enforced through domestic health legislation. CONCLUSION: To align the Philippines with standard practice in the selected countries, TB could be included on the list of notifiable diseases in one of two ways. First, the current regulation "Revised List of Notifiable Diseases, Syndromes, Health-related Events and Conditions of 2008" could be revised to include TB. Second, new TB regulations could be introduced and implemented. Any revisions or new regulations should specify methods to identify and manage TB, and safeguard individual rights.

Characteristics of Laws Requiring Physicians to Report Patient Information for Public Health Surveillance: Notable Patterns from a Nevada Case Study.

Laws across the globe require healthcare providers to disclose patient health information to public health entities for surveillance and intervention purposes. Physicians play a unique role in such mandatory reporting regimes. However, research reveals consistent under-reporting and points to limited knowledge of mandates, perceived burdens of reporting, misaligned incentives and penalties, and a lack of streamlined processes as significant reporting barriers. These barriers suggest that how legal mandates are structured may impact compliance; yet little research systematically examines their characteristics. Law-based reporting requirements differ across jurisdictions. Thus, we conducted a case study in the U.S. State of Nevada to characterize its physician mandatory reporting laws using legal mapping methodology. Nevada is a useful case study because it has few local jurisdictions and its legislature meets biennially. First, we searched key terms to find relevant state mandates and screened them using inclusion criteria. We then scanned near included provisions for additional requirements and incorporated requirements known a priori. We also searched relevant local regulations. Next, we analyzed all included provisions. Our findings indicate wide, intra-jurisdictional variation in reporting requirements across conditions. Variability extends to physician discretion, information reported, timing, recipient agencies, reporting processes, and implications of non-compliance. Local-level variation adds further complexity. Some relevant state requirements apply only to physicians and nearly one-third were absent from our searches. Our findings support exploring the hypothesis that reporting requirements' characteristics may impact compliance and call for empirically testing such relationships to enhance compliance and public health surveillance and intervention efforts.

Impact of Breast Density Notification Legislation on Radiologists' Practices of Reporting Breast Density: A Multi-State Study.

Purpose To evaluate the impact of breast density notification legislation on breast density reporting by radiologists nationally. Materials and Methods The institutional review board exempted this HIPAA-compliant retrospective study from the requirement for informed consent. State-level data over a 5-year period on breast density categorization and breast cancer detection rate were collected from the National Mammography Database (NMD). Z tests were used to calculate differences in proportions. Results Facilities in 13 of 17 states that had breast density notification legislation as of 2014 submitted data to the NMD before and after law enactment. A total of 1 333 541 mammographic studies (hereafter called "mammograms") over a 30-month period, beginning 20 months before and continuing 10 months after law enactment, were included in the analysis. There was a small but statistically significant decrease in the percentage of mammograms reported as showing dense breast tissue (hereafter called "dense mammograms") in the month before law enactment compared with the month after (43.0% [22 338 of 52 000] vs 40.0% [18 604 of 46 464], P < .001). There was no statistically significant difference in the percentage of mammograms reported as dense in the month before law enactment compared with the 10th month after (43.0% [22 338 of 52 000] vs 42.8% [15 835 of 36 991], P = .65). There were no significant differences in the breast cancer detection rate between the month before and the month after law enactment (3.9 vs 3.8 cancers per 1000 mammograms, P = .79) or between the month before law enactment and the 10th month after (3.9 vs 4.2 cancers per 1000 mammograms, P = .55). In 21 analyzed states without breast density notification legislation, the percentage of mammograms reported as dense did not decrease below 42.8% (43 363 of 101 394) from 2010 to 2014, in contrast to 13 analyzed states with breast density notification legislation, which reached a nadir of 39.3% (20 965 of 53 360) (P < .001). Conclusion The percentage of mammograms reported as dense slightly decreased immediately after enactment of breast density notification legislation but then returned to prelegislation percentages within 10 months. (©) RSNA, 2016.

Mandatory tuberculosis case notification in high tuberculosis-incidence countries: policy and practice.

Mandatory tuberculosis (TB) notification is an important policy under the End TB Strategy, but little is known about its enforcement especially in high TB incidence countries. We undertook a literature search for selected high-incidence countries, followed by a questionnaire-based survey among key informants in countries with high-, intermediate- and low-TB incidence. Published literature on TB notification in high-incidence countries was limited, but it did illustrate some of the current barriers to notification and the importance of electronic systems to facilitate reporting by private providers. Required survey data were successfully gathered from 40 out of 54 countries contacted. TB is notifiable in 11 out of 15 high-incidence countries, all 16 intermediate-incidence countries, and all nine low-incidence countries contacted. TB case notification by public sector facilities is generally systematised, but few high-incidence countries had systems and tools to facilitate notification from private care providers. In the context of the new End TB Strategy aimed at eventual TB elimination, all countries should have TB on their national list of notifiable diseases. Enhancing the ease of notification by private providers is essential for effective implementation. To that effect, investing in strengthening disease surveillance systems and introducing digital tools to simplify notification are logical ways forward.

[HIV/AIDS and law in Hungary]. / A HIV/AIDS és a jog Magyarországon.

INTRODUCTION: The legal aspects of HIV/AIDS are mirrored by the statistical data. AIM: The aim of the author is to show the effect of HIV/AIDS on today's Hungarian society. METHOD: Analysis of data issued by the National Center for Epidemiology in Hungary and those to be found in the professional literature, as well as analysis of the Hungarian legal practice. RESULTS: Hungarian courts tend to impose a lighter punishment on a perpetrator diagnosed with AIDS than on a healthy perpetrator. According to the data issued by the Hungarian Epidemiological Center, in 1985, 16 HIV-contaminated persons were registered in Hungary; in 1995, 81, in 2005, 107, whilst in 2015, 201 HIV-contaminated persons were registered in Hungary. In 2005, 10 of the 107 HIV-contaminated persons were anonymous, whilst, in 2015, 37 of the 201 HIV-contaminated persons were anonymous. According to the known data of not anonymous HIV-contaminated persons, the number of males predominates largely over the number of females and this has been the case during the past decades. In Hungary, only a small proportion of the HIV-contaminated persons have died: the number of males predominates over the number of females. CONCLUSIONS: As to HIV/AIDS, latency poses problems in the field of healthcare prevention and legal prevention. It seems to be important to protect data relating to healthcare, though the data protection should not impede the prevention of HIV/AIDS. Orv. Hetil., 2016, 157(47), 1884-1890.

[Duties of physicians or other healthcare workers connected with diagnosis, treatment, dissemination of information, assessment and registration of TB patients]. / Prawne obowiazki lekarza oraz innych pracowników sluzby zdrowia zwiazane z diagnostyka, leczeniem, informowaniem, orzekaniem i rejestracja chorych na gruzlice.

Effective laws provide a series of duties to be performed by physicians and other medical personnel associated with TB. Every TB case and death resulting from TB as well as any case of undesirable result of BCG test requires notification and filling in of a special form. The physician has a duty to inform TB patients their legal guardians, close relatives or friends about the need to undergo sanitary and diagnostic procedure, treatment or vaccination, as well as on how to prevent disease from spreading. Persons failing to comply with the relevant numerous legal requirements in this respect are subject to a fine.TB patients can use special sick benefits extending up to 270 days. There is a requirement to use appropriate codes to define TB irrespective of LCD-10 classification.

[What changes were introduced by the new law concerning infectious diseases for patients with tuberculosis?]. / Jakie zmiany wprowadzila nowelizacja ustawy o chorobach zakaznych dla chorych na gruzlice?

In July 2012, the act on preventing and counteracting infections and infectious diseases in humans was amended. Many changes concerning duties of physicians looking after patients with tuberculosis were proposed. Particularly important is the requirement of written certification by patients that they were notified by the physician of the obligation to undergo antituberculous treatment. It is also essential that the national sanitary inspector be notified as to which health-care institution the patient with tuberculosis was referred to for treatment, and also about an evasion of antituberculous therapy by the patient. Many paragraphs concerning the control of infectious diseases were formulated more precisely.

[Study of infectious disease reporting by family physicians]. / A családorvosok fertozobeteg-bejelentéseinek vizsgálata.

INTRODUCTION: Reporting liability of family physicians/general practitioners is the keystone for proper surveillance of infectious diseases. AIM: The aim of the study was to find out why some of the family physicians neglect to report infectious diseases to the health authorities and determine their motivation and attitude towards the infectious disease reporting system. METHOD: Self-fill-in questionnaire was used to obtain data. Of the 228 family physicians who were called to participate in the study 116 family physicians sent back evaluable questionnaires. Descriptive statistic method was used to analyze the data and determine the reporting frequencies and ratios. RESULTS: Family physicians reported nearly 50% of all reported cases of infectious diseases. The main reason of underreporting was the lack of knowledge about the rules of the reporting system. According to most family physicians, an online based reporting system would be much more efficient instead of a paper based one. CONCLUSIONS: The authors conclude that education of family physicians would be mandatory in order to improve reporting of infectious diseases.

[Epilepsy and driving].

In Japan, the Road Traffic Act was amended in June 2013, including new penalty to false statement in a disease condition declaration form, and new voluntary notification system for a doctor who is aware that a person is at high risk for traffic accident and in possession of a driver license. Moreover, New Criminal Law Act was established in November 2013, including a prison sentence of up to 15 years for persons, who under the influence of specific drugs or diseases, causing death or injury to other persons by driving a motor vehicle. Both laws are supposed to be enforced during 2014, after additional resolutions including the review of the laws after five years, considerations so as not to create discrimination due to diseases, etc are examined.

The California breast density information group: a collaborative response to the issues of breast density, breast cancer risk, and breast density notification legislation.

In anticipation of breast density notification legislation in the state of California, which would require notification of women with heterogeneously and extremely dense breast tissue, a working group of breast imagers and breast cancer risk specialists was formed to provide a common response framework. The California Breast Density Information Group identified key elements and implications of the law, researching scientific evidence needed to develop a robust response. In particular, issues of risk associated with dense breast tissue, masking of cancers by dense tissue on mammograms, and the efficacy, benefits, and harms of supplementary screening tests were studied and consensus reached. National guidelines and peer-reviewed published literature were used to recommend that women with dense breast tissue at screening mammography follow supplemental screening guidelines based on breast cancer risk assessment. The goal of developing educational materials for referring clinicians and patients was reached with the construction of an easily accessible Web site that contains information about breast density, breast cancer risk assessment, and supplementary imaging. This multi-institutional, multidisciplinary approach may be useful for organizations to frame responses as similar legislation is passed across the United States. Online supplemental material is available for this article.

Notification of animal and human diseases: the global legal basis.

The successful control of a disease, and a possible epidemic, depends on rapid access to complete information on the disease situation. To ensure a timely response, diseases must be immediately notified in a transparent manner. The rapid exchange of information about animal diseases, including zoonoses, was the key objective in the establishment of the World Organisation for Animal Health (OIE) in 1924. For diseases concerning humans, a set of new rules dealing with the quick reporting of infectious diseases--the International Health Regulations--was adopted by Members of the World Health Organization (OMS) in 2005. The article explains these two systems of notification, which make information accessible to the public and allow decision-makers to better manage the risks related to the diseases concerned.

[Appropriate administrative measures in the case of infectious diseases in public facilities]. / Rechtssicheres Verwaltungshandeln bei Infektionskrankheiten in Gemeinschaftseinrichtungen.

This contribution presents a survey of the obligatory measures to be taken according to German Law in the case of the outbreak of infectious diseases in public facilities. The analysis is based on a decision by the German Federal Administrative Court in the year 2012, BVerwGE 142, 205 ff. The author subjects the intepretation of the term suspicion of an infectious disease in the sense of § 2 Nr. 7 IfSG (law for protection against infection) to a critical appraisement. The article closes with a check-list on the legally appropriate measures to be taken in the case of an outbreak of infectious diseases in public facilities that is intended for practitioners in the health services.