Academic journal article Bulletin of the World Health Organization

Global Surveillance for Chemical Incidents of International Public Health concern/Surveillance Mondiale Des Incidents Chimiques Pouvant Avoir Une Incidence Dans Plusieurs pays/Vigilancia Mundial De Los Incidentes Quimicos Que Amenazan Con Riesgo Para la Salud Publica Internacional

Academic journal article Bulletin of the World Health Organization

Global Surveillance for Chemical Incidents of International Public Health concern/Surveillance Mondiale Des Incidents Chimiques Pouvant Avoir Une Incidence Dans Plusieurs pays/Vigilancia Mundial De Los Incidentes Quimicos Que Amenazan Con Riesgo Para la Salud Publica Internacional

Article excerpt

Voir page 932 le resume en francais. En la pagina 933 figura un resumen en espanol.

Introduction

Chemical incidents that lead to human exposure present an important public health challenge both nationally and globally. These incidents can range from an obvious chemical release, e.g. a leak or spill, to a less immediately apparent event such as contamination of a product.

"The international community, through the World Health Assembly, has recognized the need to strengthen surveillance for chemical incidents. There are three main reasons for doing this. First, the continuing rapid growth and globalization of the chemicals industry means that chemical incidents will continue to be a problem. Second, chemical incidents may have an impact beyond their original location, in some cases crossing national borders. For example, in north-west Romania cyanide was released from a gold mine into the local river system, leading to fish deaths in three countries (1). The global sale of a brand of dialysis filters contaminated with perfluoroisobutylene is another example. This led to deaths in Colombia, Croatia,

Germany, Italy, Spain, and the United States of America, before the problem was discovered (2, 3). Third, there is concern regarding the deliberate use of chemicals for terrorist purposes, engendered by events such as the use of sarin on the Tokyo underground system and reports of the threatened use of ricin (4, 5).

In December 2001, an expert consultation was convened by WHO through the International Programme on Chemical Safety (IPCS--a joint activity of WHO, the International Labour Organization and the United Nations Environment Programme). The participants concluded that there was a need to strengthen both national and global chemical incident preparedness and response through the development of an early warning system and capacity strengthening (6). In May 2002, the World Health Assembly agreed a resolution urging Member States to strengthen systems for surveillance, emergency preparedness and response for the release of chemical and biological agents and radionuclear materials (7).

The revision of the International Health Regulations (IHR), which began in 1995, has provided a framework for WHO to take action in this area. This revision has resulted in a fundamental change from the obligation by Member States to notify WHO of outbreaks of communicable diseases to one for notification of "public health emergencies of international concern", which could include those caused by chemical agents (8, 9). The revised IHR were finally adopted at the 58th World Health Assembly in May 2005.

In August 2002 WHO, through IPCS, initiated a pilot project to determine whether a system complementary to that for communicable disease surveillance and response could be developed for chemical incidents and outbreaks of illness of possible chemical etiology. The system is currently managed by the WHO Alert and Response Operations (ARO) team for communicable diseases. This team functions through two major interconnected components: the outbreak verification team and the Global Outbreak Alert and Response Network (GOARN) (10). The outbreak verification team screens information from a wide range of sources about disease outbreaks. The team seeks verification from official sources of those outbreaks that may have international public health significance according to the revised IHR. A risk assessment is conducted to determine whether an international response is required, and what form it should take. GOARN is a global technical partnership coordinated by WHO that provides a means for reporting, investigating, verifying and responding to communicable disease events of international importance in a timely manner. Members of GOARN comprise national health services and academic and technical institutions, as well as individuals (11). Linking the international response capabilities of GOARN to global surveillance activities coordinated by WHO ensures that the burden of international preparedness and response is not borne by a single country, institution or organization. …

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