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EWARN Weekly Summary Report Early Warning Alert and Response Network

HIGHLIGHTS

This week, 75 health facilities reported 13,544 total consultations in typhoon-affected areas of Region VI and VIII by SPEED

Acute respiratory infection accounted for 31% of total consultations, most among SPEED conditions reported in the current reporting period.

Ormoc City’s major responses to the increased dengue cases includes social preparation, environmental sanitation/health education and advocacy, environmental control measures (clean up drive), vector and larva control and surveillance

The Regional Epidemiology and Surveillance Unit (RESU) reported seven cases and one death from suspected typhoid fever from Kananga, Leyte. A field investigation was done and rectal swabs were sent to the Eastern Visayas Regional Medical Center (EVRMC) for culture and sensitivity

Two suspected cases with one death from acute watery diarrhea were reported from Jaro, Leyte on 29 Jan 2014. Investigation is on-going.

OVERALL SPEED REPORTING FROM TYPHOON-AFFECTED AREAS

Overall, the number of facilities reporting remained relatively stable in the current week, with 75 facilities reporting this week and 78 last week. Total consultations declined by 4%, from 14,064 last week to 13,544 this week. Biliran in Eastern Visayas continued reporting this week.

Total consultations by municipality: REGION VI (Western Visayas): Capiz: Dao (60), Ivisan (174), Mambusao (204), Panay (43), Sapi-An (46) Sigma (197), Tapaz (209); Iloilo: Ajuy (87), Iloilo City (121), Janiuay (43) REGION VIII (Eastern Visayas): Biliran: Biliran (127), Cabucgayan (209), Naval (185); Eastern Samar: Balangiga (605), Balangkayan (168), City Of Borongan (85), General Macarthur (226), Giporlos (327), Guiuan (464), Hernani (98), Lawaan (206), Llorente (246), Maydolong (300), Mercedes (155), Quinapondan (162), Salcedo (871); Leyte: Alangalang (164), Albuera (308), Babatngon (181), Barugo (173), Burauen (151), Calubian (84), Carigara (770), Dulag (317), Isabel (236), Kananga (321), Leyte (286), Macarthur (55), Matag-Ob (133), Merida (560), Ormoc City (2926), Palo (22), Palompon (90) Pastrana (35), Santa Fe (32) Tabango (166), Tacloban City (767), Tolosa (210), Tunga (39) The proportion of consultations due to acute respiratory infection increased in this reporting week (19 Jan – 25 Jan) from 28% to 31%, and it remained the leading cause of consultation amongst the SPEED conditions. Fever and rash and AHF remained at less than 1%. Acute watery diarrhea fell from 3% in the previous three weeks to 2% this week. SPEED Syndrome ARI = Acute respiratory infection AWD = Acute watery diarrhea AHF = Acute hemorrhagic fever

Areas reporting to SPEED in current week Region VI

Capiz

Iliolo Region VIII

Biliran

Eastern Samar

Leyte

Post-Typhoon Yolanda Week 11 | Epidemiological Week No. 6 | 19th January to 25th January 2014

EWARN weekly summary| 19th January to 25th January 2014

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PROVINCIAL SUMMARIES (SOURCES INCLUDE: EVENT-BASED SURVEILLANCE, PIDSR, SPEED)

REGION VI – WESTERN VISAYAS

CAPIZ PROVINCE

Reporting: Reporting in Capiz has declined from 16 total health facilities in the week beginning with 29 Dec to 7 facilities in the current reporting week (19-25 Jan). Consultations: The total number of SPEED consultations declined from 2,156 to 933 over the past week. Leading causes of morbidity include acute respiratory infection (28%), high blood pressure (5%), skin diseases and fever (3%), animal bite (2%) and open wounds and bruises, conjunctivitis and acute asthmatic attack (1%). More than half of the consultations were “others” (53%). There were four consultations for acute watery diarrhea in Tapaz and Sapi-an municipalities and three for acute bloody diarrhea also in Tapaz. Alerts: There were six reported cases of fever and rash, which were referred to the RESU for further investigation.

ILOILO PROVINCE

Reporting: Reporting from Iloilo included 2 Rural Health Units, 1 Hospital, and 1 Foreign Medical Team. Consultations: The total number of SPEED consultations declined from 298 to 251 over the past week. Leading causes of morbidity include acute respiratory infection (56%), wounds (13%), fever (11%), hypertension (6%) and acute watery diarrhea (4%). Alerts: No alerts reported for the week 19-25 Jan 2014.

REGION VIII – EASTERN VISAYAS BILIRAN PROVINCE

Reporting: Reporting from Biliran included 3 Rural Health Units and 1 Hospital. Consultations: The total number of SPEED consultations increased by 33% (391 to 521) over the past week. Leading causes of morbidity include acute respiratory infection (61%), skin diseases and high blood pressure (9%), wounds (6%), acute watery diarrhea (4%) and fever with other symptoms (3%). Acute hemorrhagic fever was <1% of consultations. Alerts: Eight fever and rash alerts were reported from the municipalities of Naval (Biliran Provincial Hospital) and Biliran (Biliran RHU). These were referred to the RESU for further investigation.

EWARN weekly summary| 19th January to 25th January 2014

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EASTERN SAMAR PROVINCE

Reporting: Reporting from Eastern Samar included 14 Rural Health Units, 7 Hospitals, and 5 Barangay Health Stations. Consultations: The total number of SPEED consultations increased from 1,416 to 3,913 over the past four weeks. Leading causes of morbidity were acute respiratory infection (51%), skin diseases (12%), hypertension (10%), wounds (6%) and diarrhea (4%). Alerts: There were 7 SPEED reports of fever with rash from Guian (4), Salcedo (2) and Gen Macarthur (1). Cases were investigated by the Provincial Health Office and DOH Regional Office VIII. Serology with the use of Dried Blood Spot was taken and samples were submitted to RITM. 7 cases of acute hemorrhagic fever (AHF) were also reported from Guiuan (3), Balangiga (2), Mercedes (1), and Salcedo (1). These cases were investigated by the staff of Provincial Epidemiology and Surveillance Unit. They conducted information and education campaign (IEC) on the prevention and control of Dengue including distribution of IEC materials. Fogging operations were conducted on barangays with cases.

LEYTE PROVINCE

Reporting: Reporting from Leyte included 18 RHUs, 11 hospitals, 4 BHS and 1 mobile clinic. Consultations: The total number of SPEED consultations remained relatively stable in the current week with 7,296 this week and 7,295 last week (12 Jan). Leading causes of morbidity were acute respiratory infection (30%), wounds (15%), high blood pressure (6%), skin diseases, fever (4%) and animal bite, acute watery diarrhea (2%). Twenty seven consultations of fever and rash were reported from Tacloban City (Eastern Visayas Regional Medical Center, Tacloban City Hospital), Ormoc City (Ipil Health District), Calubian (Northwestern Leyte District Hospital), Tolosa (Tolosa MHO), Tabango (Tabango MHO), Barugo (Barugo MHO), and Merida (Merida MHO). Meanwhile, 23 consultations for suspect AHF were reported from Tacloban City (Bethany Hospital, Eastern Visayas Regional Medical Center, Tacloban City Hospital), Ormoc City (Ormoc District Hospital, Clinica Gatchalian and Hospital), Palompon (Dr Manuel B. Veloso Memorial Hospital and Dulag (Dulag MHO).There were 203 diarrhea cases reported from Leyte, the highest number of cases were from Ormoc City (38), Tacloban City (34), Albuera (17), Palompon (12), Alang-alang, Dulag and Kananga (11). Alerts: Follow-up on dengue cases in Ormoc City: The Ormoc City Epidemiology and Surveillance Unit recorded 20 dengue cases during the current reporting period (19 Jan). The City’s major response activities are now focused on social preparation, environmental sanitation/health education and advocacy, environmental control measures (clean up drive), vector and larva control and monitoring and surveillance. Meanwhile, PIDSR of Region 8 reported seven cases and one death of typhoid fever from Barangay Aguiting, Kanaga, Leyte. Three were hospitalized and one case was positive for typhoid and one case was positive for the rapid test kit for typhoid. The Regional Epidemiology and Surveillance Unit (RESU) conducted an investigation. Rectal swabs were collected and sent to the Eastern Visayas Regional Medical Center (EVRMC) for culture and sensitivity. RESU also reported two cases of acute watery diarrhea with one death from Barangay Diaz, Jaro, Leyte. Investigation is currently being conducted.

EWARN weekly summary| 19th January to 25th January 2014

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MAPS

Location of SPEED notifications of fever with rash 19th

to 25th

Jan 2014, Regions VI and VIII (red=hospital blue=other facility)

Location of SPEED notifications of acute hemorrhagic fever 19th

to 25th

Jan 2014, Regions VI and VIII (red=hospital blue=other facility)

EWARN weekly summary| 19th January to 25th January 2014

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FOCUS ON: DENGUE

KEY FACTS

Dengue is a mosquito-borne viral infection.

The infection causes flu-like illness, and occasionally develops into a potentially lethal complication called severe dengue (previously known as

dengue hemorrhagic fever).

The global incidence of dengue has grown dramatically in recent decades.

Dengue is found in tropical and sub-tropical climates worldwide, mostly in

urban and semi-urban areas. This includes the Philippines.

Severe dengue is a leading cause of serious illness and death among children in

some Asian and Latin American countries.

There is no specific treatment for dengue/ severe dengue, but early detection and access to proper medical care lowers fatality rates to below 1%.

Dengue prevention and control depends on effective vector control and

sensible personal protective measures.

EPIDEMIOLOGY AND BURDEN OF DENGUE

Dengue is a mosquito-borne infection found in tropical and sub-tropical regions around the world. In recent years, transmission has increased predominantly in urban and semi-urban areas and has become a major international public

health concern.

Severe dengue (previously known as Dengue Haemorrhagic Fever) was first recognized in the 1950s during dengue epidemics in the

Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of

hospitalization and death among children in these regions.

There are four distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from

infection by one provides lifelong immunity against that particular serotype but not the others.

However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of developing severe dengue.

Over 2.5 billion people – over 40% of the world's population – are now at risk from dengue. 1.8 billion (>70%) live in Asia Pacific countries.

WHO currently estimates there may be 50-100

million dengue infections worldwide every year. An estimated 500 000 people with severe dengue

require hospitalization each year, a large proportion

of whom are children. About 2.5% of those

affected die.

In the Western Pacific Region, 31 countries or

areas have reported dengue cases in the last two

decades.

Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now

endemic in more than 100 countries in Africa, the

Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. South-East Asia and

the Western Pacific regions are the most seriously

affected.

In 2012 there were 182,761 cases and 902 deaths from dengue. In 2013 (through 14 December) there

were 181 726 cases and 579 deaths.

TRANSMISSION

The Aedes aegypti mosquito is the main vector of dengue.

The virus is transmitted to humans through the bites of infected female mosquitoes.

After virus incubation for 4-10 days, an infected mosquito is capable of transmitting the virus for the rest of its life (a few weeks).

Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes.

Patients who are already infected with the dengue virus can transmit the infection (for 4-5 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.

Unlike other mosquitoes Ae. aegypti is a daytime feeder; its peak biting periods are early in the morning and in the evening before dusk.

EWARN weekly summary| 19th January to 25th January 2014

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SIGNS AND SYMPTOMS

Dengue fever typically presents as a severe, flu-like illness that affects infants, young children and adults, but seldom causes death.

Dengue should be suspected when a high fever (40°C/ 104°F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash.

Symptoms usually last for 2-7 days, after an incubation period of 4-10 days following the bite from an infected mosquito.

Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.

o Warning signs occur 3-7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/ 100°F) and include:

severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit o A complete blood count can be a useful diagnostic tool. Leukopenia (low white blood cells) and thrombocytopenia (low

platelets) are common in dengue patients.

The next 24-48 hours of the critical stage can be lethal. Proper medical care is needed to avoid complications and risk of death.

TREATMENT

There is no specific treatment for dengue fever, but patients with dengue signs and symptoms should seek medical care.

For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives –

decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.

WHO handbook for clinical management of dengue at http://apps.who.int/iris/bitstream/10665/76887/1/9789241504713_eng.pdf

IMMUNIZATION

There is no vaccine to protect against dengue.

WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation.

Several candidate vaccines are in various phases of trials. PREVENTION AND CONTROL

At present, the only method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through:

o preventing mosquitoes from accessing egg-laying habitats by

environmental management and modification;

o disposing of solid waste properly and removing artificial man-made breeding sites;

o covering, emptying and cleaning of domestic water storage

containers on a routine basis;

o applying insecticides to water storage containers; o using personal and household protection such as window

screens, long-sleeved clothes, insecticide treated materials,

coils and vaporizers;

o improving community participation and mobilization for sustained vector control;

o applying insecticides as space spraying to specific high-risk

areas during outbreaks as one of the emergency vector

control measures; o selective residual insecticide treatment on indoor mosquito

resting sites;

o active monitoring and surveillance of vectors to determine

their distribution and key breeding sites for planning of effective control interventions.

Individuals should follow the 4-S against dengue (pictured) and

practice the four o’clock “stop look and listen” habit by stopping what they do every day at 4pm, looking inside and outside their

houses to search and destroy possible mosquito breeding sites, and

listening to officials for the proper ways of eliminating dengue. More information at: http://www.wpro.who.int/topics/dengue/en/

Typical flyer describing 4-S approach to dengue

Source: http://pia-sorsogon.blogspot.com/2013/06/health-officials-warn-public-against.html