The origins of the International Health Regulations (IHR) date back to the mid-19th century when epidemics of cholera resulted in intensive infectious disease diplomacy. Many agreements were set in place both in Europe and in the American States before being eventually replaced in 1951 by the International Sanitary Regulations, later renamed the IHR. The present IHR oblige WHO Member States to notify outbreaks of cholera, plague and yellow fever and list the maximum measures applicable during such outbreaks. A number of permanent, routine measures relating to hygiene and sanitation at ports and airports are specified along with general provisions for the transport of persons and goods. The revised IHR will provide an opportunity to change from three diseases to a system for all public health emergencies of international concern. The core capacities required at national level to detect and respond to such emergencies will be clearly defined as will the linkage between notification under the revised IHR and international response and action in support of affected countries. Other existing IHR provisions and technical guidance will be updated to meet the demands of contemporary global surveillance and control of international outbreaks.