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WHO Issues New Rules on Disease Reporting

By Luciana Borio, M.D., June 6, 2005

On May 20, 2005, the World Health Assembly adopted a new set of International Health Regulations (IHR) that are intended to facilitate the management of public health emergencies that might affect the international community. The IHR will take effect in two years.

The original IHR were designed to allow the World Health Organization (WHO) to monitor outbreaks of cholera, plague, yellow fever, smallpox, relapsing fever, and typhus. Most recently, nations were only required to report outbreaks of cholera, plague and yellow fever to the WHO. The new IHR have added smallpox, polio, and SARS to the list of reportable diseases.

In addition, the WHO has created a matrix to help countries decide whether an outbreak should be reported. This is the first time that unusual or unexpected outbreaks will receive special attention, which should facilitate reporting of suspected bioterrorism events.

Under the revised regulations, nations are expected to build national capacity to monitor, detect, and diagnose disease, as well as to respond to public health emergencies of international concern. In addition, nations are obligated to allow WHO experts inside their borders to investigate disease outbreaks if necessary. Currently, the WHO must be invited in to investigate an outbreak, and there is no recourse if a country does not issue an invitation.

The outbreaks of SARS in 2003 and avian influenza in 2004-2005 have highlighted the need for a tightly coordinated international response to prevent the global spread of disease, and these new regulations are an important step in that direction.

Additional Information: Revision of the International Health Regulations


Promising Results Reported with New Anthrax Anti-toxin

By Crystal Franco and Michael Mair, M.P.H.

A study published in the May 31, 2005 issue of Proceedings of the National Academy of Sciences (Shoop, W.L. et. al. PNAS, 102(22), May 2005, pg. 7958-7963) reports new findings regarding an inhibitor of anthrax lethal factor (LF).

LF combines with protective antigen to form lethal toxin, one of two major toxins that renders anthrax highly pathogenic. The study examined the potential of hydroxamate LF inhibitor (LFI) to reduce the virulence of Bacillus anthracis by inhibiting LF's interaction with protective antigen in enzyme and cell-based assays, and in Bacillus anthracis challenge studies employing mice and rabbits.

Shoop and colleagues report that hydroxamate LFI inhibited the activity of LF in a dose response manner in both in vitro and in vivo toxicity assays. They also report that hydroxamate LFI gave mice and rabbits an approximately 50% better chance of survival when challenged with a lethal dose of vegetative Bacillus anthracis cells or spores and that treatment doubled the mean time to death in animals that did not survive the challenge.

Finally, the authors also report that hydroxamate LFI in combination with ciprofloxacin provided rabbits with 100% protection against a lethal spore challenge.

This study is significant because it could potentially lead to a new treatment approach for anthrax, which may be complimentary to currently available antibiotics and vaccines.