MERS-CoV: International Health Regulations

Medicine Matters - by Teodoro B. Padilla

Posted at Apr 22 2014 06:19 PM | Updated as of Apr 23 2014 02:19 AM

The Department of Health (DOH) has stepped up its surveillance efforts to trace and contact passengers of a flight that arrived in Manila from Abu Dhabi on April 15.

Passengers on board Etihad Airlines flight EY 0424 have been advised to immediately contact the DOH since one of the their co-passengers had tested positive for the Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) while he was still in the United Arab Emirates.

While this passenger tested negative in another laboratory exam in the Philippines, the government is taking extra precautionary measures as the MERS-CoV is infectious and transmitted through close contact.

In full-page advertisements containing names of EY 0424 passengers, the DOH is directing all those on board the flight to submit themselves to a free nose-and-throat swab examination to rule out the possibility of infection or ensure that they will get the medical attention when needed. Malacanang disclosed that 173 out of the 414 passengers have been contacted as of Monday.


These efforts to prevent the spread of MERS-CoV is another example that while trade and travel bring several benefits to economy, tourism and development, the international movement of persons and goods may cause public health risks.

The recognition of public health risks due to international travel and trade first came in 1969 when the World Health Assembly adopted the International Health Regulations (IHR), having been preceded by the International Sanitary Regulations in 1951.

The 1969 IHR was amended in 2005 due to increasing international travel and trade, and the emergence or re-emergence of international disease threats and other public health risks like the Severe Acute Respiratory Syndrome (SARS).

In March 2013, the World Health Organization (WHO) issued emergency guidance for travelers and airlines due to the spread of SARS, the first global public health emergency of the 21st century. At the moment, the WHO does not advise special screening at points of entry with regard to MERS-CoV nor does it recommend any travel or trade restrictions.

The purpose and scope of the IHR are “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.”

It puts emphasis on strengthening the health capacities of airports, ports and ground crossings in both routine circumstances and when responding to events that may constitute a public health emergency of international concern (PHEIC).

The WHO recognizes that international points of entry, whether by land, sea or air, provide an opportunity to apply health measures to prevent diseases from crossing geographic borders.


For instance, the IHR includes provisions for health measures on arrival and departure of passengers. Under this international regulation, a State Party may on arrival or departure, require information to trace and contact passengers when needed.

A country may also inquire information about the traveler’s destination; itinerary; and/or require a non-invasive medical examination, which is the least intrusive examination that would achieve the public health objective. On the basis of evidence of a public health risk obtained or through other means, States Parties may also apply additional health measures with regard to a suspect or affected traveler.

For travelers under public health observation, the IHR states that “a suspect traveler who on arrival is placed under public health observation may continue an international voyage, if the traveler does not pose an imminent public health risk and the State Party informs the competent authority of the point of entry at destination, if known, of the traveler’s expected arrival.” It adds that “on arrival, the traveler shall report to that authority.”

The IHR also provides that invasive medical examination, vaccination or other prophylaxis shall not be required as a condition of entry of any traveler to the territory of a State Party. However, the IHR does not prevent States Parties from requiring medical examination, vaccination or other prophylaxis or proof of vaccination or other prophylaxis when necessary to determine whether a public health risk exists and as a condition of entry for any travelers seeking temporary or permanent residence among others.

If a traveler for whom a State Party may require a medical examination, vaccination or other prophylaxis fails to consent to any such measure, or refuses to provide the information or the necessary documents, the State Party concerned may deny entry to that traveler.

The IHR adds that if there is evidence of an imminent public health risk, the State Party may compel the traveler to undergo or advise the traveler to undergo established health measures including isolation, quarantine or placing the traveler under public health observation.

The IHR also calls on authorities that in enforcing these health regulations to international travelers, it is required that travelers be treated with courtesy and respect, taking into consideration their gender, sociocultural, ethnic and religious concerns. If quarantine, isolation or public health measures are required, travelers must be supplied with appropriate food, water, accommodation and medical treatment (For more information on the IHR, visit

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