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69 Appendix A diseases of public Health Significance Canada For Canada, the Quarantine Act (2005, c. 20, Sch.; 2007, c. 27, s. 4) includes a Schedule of diseases of concern. Canada currently has 25 diseases of concern: â¢ Active pulmonary tuberculosis â¢ Anthrax â¢ Argentine hemorrhagic fever â¢ Bolivian hemorrhagic fever â¢ Botulism â¢ Brazilian hemorrhagic fever â¢ Cholera â¢ Crimean-Congo hemorrhagic fever â¢ Diphtheria â¢ Ebola hemorrhagic fever â¢ Lassa fever â¢ Marburg hemorrhagic fever â¢ Measles â¢ Meningococcal meningitis â¢ Meningococcemia â¢ Pandemic influenza type A â¢ Plague â¢ Poliomyelitis â¢ Rift Valley fever â¢ Severe acute respiratory syndrome â¢ Smallpox â¢ Tularemia â¢ Typhoid fever â¢ Venezuelan hemorrhagic fever â¢ Yellow fever. If PHAC processes someone with another disease such as dengue and norovirus, PHAC would help facili- tate the response and care through its partners (S. Jain, personal communication, Dec. 21, 2016). United States For the U.S., the list of quarantinable diseases is contained in Presidential Executive Order 13295 (Revised List of Quarantinable Communicable Diseases, July 31, 2014). The quarantinable diseases for the U.S. are â¢ Cholera â¢ Diphtheria â¢ Infectious tuberculosis â¢ Plague â¢ Smallpox â¢ Yellow fever â¢ Viral hemorrhagic fevers (such as Marburg, Ebola, and CongoâCrimean) â¢ Severe acute respiratory syndromes. Many other illnesses of public health significance, such as measles, mumps, rubella, and chicken pox, are not contained in the list of quarantinable illnesses, but continue to pose a health risk to the public. Quarantine Station personnel respond to reports of ill travelers aboard airplanes, ships, and at land border crossings to make an assessment of the public health risk and initiate an appropriate response. InternationalâThe World Health Organization (WHO) International guidance is contained in the International Health Regulations (2005) (IHR 2005; WHO 2005). Compared with previous international health regulations, IHR 2005 moved to a process whereby the scope was not limited to any specific disease or manner of transmission, but instead outlined processes for reporting to WHO events that could constitute public health emergencies of international concern (PHEIC). By not limiting the application of the IHR to specific diseases, it then would remain relevant over
70 the years and be applicable for example to emerging or novel diseases (WHO 2005, p. 1). IHR 2005 calls for reporting as a potential PHEIC, three groups of conditions. i. Any event of potential international public health concern, including those of unknown causes or sources ii. Essentially one case of the following diseases because a case would be unusual or unexpected: a. Wildtype poliovirus Poliomyelitis b. Human influenza caused by a new subtype c. Severe acute respiratory syndrome (SARS). iii. Diseases that have demonstrated the ability to cause serious public health impact and spread rap- idly internationally: a. Cholera b. Pneumonic plague c. Yellow fever d. Viral hemorrhagic fevers (Ebola, Lassa, Marburg) e. West Nile fever f. Other diseases that are of special national or regional concern; e.g., dengue fever, Rift Valley fever, and meningococcal disease. Note: The Canadian and U.S. lists show how IHR 2005 affects national regulations. In addition, the fol- lowing observations illustrate how IHR 2005 is applied (CDC, personal communication, Jan. 27, 2017): I. Each country may face different threats related to volume of travel from specific regions of the world to that country, etc.; therefore, they may have diseases on their list related to those threats. II. Countries may also set their own disease elimination goals, in addition to goals set by WHO. TB is a goal for the U.S., but not for many other countries; thatâs why many of our air investigations involve TB. III. In the U.S., we donât expect airlines, or our partners in the airports to identify disease. In fact, except for a few obvious cases of rash illnesses, even an infectious disease specialist would be hard pressed to make a diagnosis in an air travel related reported illness. So, we provide our partners with a list of symptoms that we ask them to report. IV. The issue for this report is travel related to airports, therefore the diseases of interest should be communicable either during air travel or in an airport setting. Rabies, though a serious and deadly disease is not likely communicable in that environment. That said, we have been involved with at least one potential PHEIC involving air travel and a few air contact investigations. But those were highly unusual circumstances, one being a bat on a plane. The PHEIC process allows us to do that without having to list every specific disease. V. Although WHO has listed some diseases as outlined in 2, each country has to respond based on its own regulatory authority, not WHOâs. We have learned that it is better to be a bit more general than specific, thatâs why the WHO moved to the PHEIC process. If you look closely, you will notice that the U.S. list says Severe acute respiratory syndromes and not Severe acute respiratory syndrome. In July 2014, Executive Order 13295 was amended and replaced with Severe acute respiratory syn- dromes, because when MERS arose it was clearly different from SARS. In anticipation that there could be other novel coronavirus infections, it did not make sense to list specific diseases, but rather to define a term that could encompass a range of similar diseases so we would not need either a rule change or a new executive order for each new occurrence. Thatâs the same thinking WHO and the world public health community had for not listing specific novel influenza virus strains.