EWARN Weekly Summary Report

Transcription

1 EWARN Weekly Summary Report Early Warning Alert and Response Network Post-Typhoon Yolanda Week 14 Epidemiological Week No. 9 9 th to 15 th February 2014 HIGHLIGHTS This week, 62 health facilities in typhoon-affected areas of Region VI and VIII reported 6,025 total consultations through SPEED Acute respiratory infection accounted for 30% of total consultations A Regional Conference with Epidemiology and Surveillance Units (ESU) and Disease Reporting Units in Western Visayas is on-going. This aims to discuss issues and concerns on how to further enhance the capacity of sentinel nurses/coordinators. It includes effective management of the surveillance data collected, performing data analysis and making surveillance reports OVERALL SPEED REPORTING FROM TYPHOON-AFFECTED AREAS Overall, the number of facilities reporting decreased in the current week, with 62 facilities reporting this week from 82 last week. The total consultations decreased by 64%, from 16,981 last week to 6,025 this week. However the number of total consultations may be underestimated due to a malfunction of the Globe access code during this week. Areas reporting to SPEED in current week Region VI Capiz Iliolo Region VIII Biliran Eastern Samar West Samar Leyte Total consultations by municipality: REGION VI (Western Visayas): Capiz: Mambusao (29), Roxas City (175), Sapi-An (237), Sigma (41); Iloilo: Iloilo City (122), Janiuay (44), Sara (79) REGION VIII (Eastern Visayas): Biliran: Biliran (22), Cabucgayan (54), Naval (28); Eastern Samar: Balangiga (399), Balangkayan (367), City of Borongan (45), General Macarthur (187), Giporlos (79), Guiuan (534), Hernani (121), Lawaan (187), Llorente (195), Maydolong (103), Mercedes (18), Quinapondan (95), Salcedo (232); Leyte: Albuera (55), Barugo (68), Burauen (45), Capoocan (47), Carigara (352), City of Baybay (59), Isabel (117), Kananga (178), Macarthur(10), Merida (212), Ormoc City (660), Palompon (124), Pastrana (48), San Isidro (29), Tabango (83), Tacloban City (196), Tolosa (55), Villaba (264); Western Samar: Marabut (30) The proportion of consultations due to acute respiratory infection decreased from 32% to 30% over this reporting week (9-15 Feb), however they are still the leading cause of consultation amongst the SPEED conditions. Fever and rash and acute hemorrhagic fever remained at less than 1%. Acute watery diarrhea decreased from 3% to 2% in the current week. SPEED Syndrome ARI = Acute respiratory infection AWD = Acute watery diarrhea AHF = Acute hemorrhagic fever Page 1 of 6

2 PROVINCIAL SUMMARIES (SOURCES INCLUDE: EVENT-BASED SURVEILLANCE, PIDSR, SPEED) REGION VI WESTERN VISAYAS CAPIZ PROVINCE Reporting: Reporting in Capiz included 3 Rural Health Units, 1 hospital and 1 mobile clinic in the current reporting week (9-15 Feb). Consultations: The total number of SPEED consultations decreased from 2,185 to 482 over the past week. Leading causes of morbidity include acute respiratory infection (26%), fever (7%), animal bites (5%), high blood pressure (4%) and wounds (3%). Alerts: No alerts were reported for the week 9-15 February ILOILO PROVINCE Reporting: Reporting from Iloilo included 2 Rural Health Units and 1 hospital. Consultations: The total number of SPEED consultations decreased from 295 to 245 over the past week. Leading causes of morbidity include acute respiratory infection (36%), fever (7%), wounds (7%), acute diarrhea (7%), hypertension (6%) and skin diseases (6%). Alerts: Alerts for acute watery diarrhea (15 cases) were reported from the West Visayas State University Medical Center and investigated by the Provincial Epidemiology and Surveillance Unit for the response. REGION VIII EASTERN VISAYAS BILIRAN PROVINCE Page 2 of 6

3 Reporting: Three Rural Health Units reported from Biliran. Consultations: The total number of SPEED consultations decreased from 469 last week to 104 during the current reporting week. Leading causes of morbidity include acute respiratory infection (64%), high blood pressure (13%), skin diseases (12%), acute watery diarrhea (3%), animal bites (3%) and wounds (3%). Alerts: For this week, one suspect measles case was reported from Cabucgayan Rural Health Unit. Outbreak measles immunization was done for children six months to less than 10 years old in tha affected area. WESTERN SAMAR PROVINCE Reporting: One Rural Health Unit reported from Western Samar this week. Consultations: The total number of SPEED consultations decreased fron 78 to 30. Leading causes of morbidity include acute respiratory infection (60%), wounds (13%), skin diseases (10%), fever (7%), acute watery diarrhea (3%) and animal bites (3%). Alerts: No alerts were reported for the week 9-15 February EASTERN SAMAR PROVINCE Reporting: 22 health facilities reported from Eastern Samar including 14 Rural Health Units and 8 hospitals. Consultations: The total number of SPEED consultations declined by 25% during the current reporting week (from 3,434 last week to 2,562). Leading causes of morbidity were acute respiratory infection (28%), high blood pressure (5%), wounds (3%), skin diseases (2%) and acute watery diarrhea (2%). Alerts: There were two SPEED reports of fever with rash from General Macarthur (1 - General Macarthur Municipal Hospital and 1 - Our Lady Guadalupe Hospital), two from Salcedo (Salcedo Rural Health Center) and one from Lawaan (Lawaan Main Health Center). One suspect case of Acute Hemorrhagic Fever (AHF) was reported by Felipe Abrigo Memorial Hospital of Guiuan. Alerts for acute watery diarrhea were reported from Balangiga (5 cases - Albino Duran Memorial Hospital; 6 cases Balangiga Rural Health Unit), Guiuan (6 cases - Felipe Abrigo Memorial Hospital) and Llorete (6cases Llorete Municipal Hospital). The Provincial Health Office coordinated with RESU and investigation was conducted by the latter. Suspect Dengue in Eastern Samar Province The Provincial Health Office of Eastern Samar reported a total of 197 consultations for suspect dengue for the period 24 Nov 13 Feb. The majority of these cases had mild symptoms but 41% (81) were admitted in hospital for treatment. Median age of cases was 13 years (range: 4 months - 61 years); 59% (110) were school age children from 5 to 18 years old and 15% (27) were under 5. Measures for dengue vector control have been implemented. Larval surveys and distribution of key messages and impregnated treated nets is ongoing. Quality monitoring and evaluation of control measures will follow. Page 3 of 6

4 LEYTE PROVINCE Reporting: Reporting from Leyte included 17 RHUs, 8 Hospitals and 1 BHS. Consultations: The total number of SPEED consultations decreased from 10,520 to 2,602 over the past week. Leading causes of morbidity were acute respiratory infection (31%), wounds (7%), high blood pressure (5%), animal bites (5%) and fever (3%). Alerts: Alerts of fever and rash were reported from Tacloban City (7 - Eastern Visayas Regional Medical Center), Carigara (6 Carigara MHO) and City of Baybay (1 - Baybay Main Health Center). A measles outbreak response immunization campaign is being conducted in the Region. Meanwhile, a total of 7 consultations for suspect AHF were reported regionwide (3 - Dr. Manuel B. Veloso Memorial Hospital, Palompon; 2 - Carigara District Hospital; 1 - Ormoc District Hospital; 1 - Eastern Visayas Regional Medical Center, Tacloban City). Alerts for acute watery diarrhea were also reported from the Albuera MHO (5 cases), the Carigara MHO (8 cases), the Kananga District Hospital (7 cases) and the Ormoc District Hospital (12 cases). The Provincial Health Office coordinated with RESU and investigation was conducted by the latter. MAPS Location of SPEED notifications of fever with rash, 9 th to 15 th February 2014, Regions VI and VIII (red=hospital blue=other facility) Location of SPEED notifications of acute hemorrhagic fever, 9 th to 15 th February 2014, Regions VI and VIII (red=hospital blue=other facility) Page 4 of 6

5 FOCUS ON: RABIES KEY FACTS Rabies is a viral disease caused by a type of lyssavirus. Most transmission occurs through close contact with infectious materials, usually saliva, via bites or scratches from infected animals, usually dogs Rabies is recognized by fever and pain or often unusual and unexplained tingling, pricking or burning sensationat the wound site. This is followed by either a few days of excited behavior and difficulty swallowing, or, less commonly, a longer period of gradual paralysis. Symptoms culminate in death The most cost-effective strategy for prevention of human rabies is canine vaccination Rabies is present in 150 countries worldwide, but is more common in rural areas where dogs are not routinely vaccinated against rabies. In Asia, there are over 30,000 deaths each year from rabies There is no known treatment for rabies once symptoms have developed. However, effective treatment soon after exposure can prevent infection and the onset of symptoms and death EPIDEMIOLOGY AND BURDEN OF RABIES Infection with rabies is almost uniformly fatal. More than 55,000 deaths worldwide mostly in Asia and Africa occur annually due to rabies, most of them in rural areas. Asia contributes 30,000 deaths each year to the global statistics In the Philippines, animal bite cases have been steadily increasing over the past 5 years, with a partial report of 403,878 animal bites in 2013 and still completing the figures. However, there is a marked decrease in human rabies with 243 human rabies in 2009 and 132 in The three highest incidence Regions are 12, 2 and 5 in decreasing order The WHO BMGF funded the Philippine DOH-DA program on targeted dog vaccination strategies that have been ongoing since 2009 in the Visayas (Regions VI, VII and VIII) aiming towards Rabies free Visayas. The 3 Regions successfully demonstrated a decrease in human rabies. The 3 Visayas Regions also contributed 9 areas out of 12 declared as rabies free since In 2013, the island of Boracay, Guimaras and Olympia island, Dais City were declared Rabies free TRANSMISSION Rabies is most commonly transmitted through deep bites or scratches from an infected animal. Rarely, rabies can be transmitted through transplantation of infected tissue or inhalation of virus-containing aerosol Dogs are the main cause of both animal bites and rabies cases, although other infected wildlife can transmit the disease to humans SIGNS AND SYMPTOMS Symptoms typically begin 1-3 months after exposure but may vary from <1 week to >1 year Human rabies typically presents as meningoencephalitis, an inflammatory infection of the brain and spinal cord. There are two forms of human rabies: o Furious rabies accounts for approximately 70% of the total number of human cases and will manifest as signs of hyperactivity, excited behavior, difficulty swallowing (hydrophobia) and sometimes difficulty breathing (aerophobia). After a few days, death occurs by cardio-respiratory arrest o Paralytic rabies (or dumb rabies) accounts for approximately 30% of the total number of human cases. This form of rabies runs a less dramatic but longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease DIAGNOSIS AND TREATMENT 1 There are currently no tests available to diagnose rabies in humans before the onset of clinical disease. In a patient with symptoms, cases can be confirmed with laboratory techniques, including isolation of virus in cell culture To be effective, treatment of an exposed human must occur before the onset of symptoms, i.e. with post-exposure prophylaxis (PEP). Rabies PEP is an emergency and should not be delayed or deferred Patients who present for rabies PEP months after having been bitten should be treated in the same manner The vaccination status of the suspected animal alone should not be considered when deciding to initiate prophylaxis IMMUNIZATION Rabies vaccines are available for dogs and humans. Canine vaccination programs aim to cover at least 70% of dog populations Preventive human immunization is recommended for travelers spending a lot of time outdoors in rural areas with significant risks of exposure, or those in high-risk professions. Several regimes for pre-exposure immunization are available 1 Details on rabies post-exposure prophylaxis regimens are available at: Page 5 of 6

6 PREVENTION AND CONTROL Public health interventions to prevent rabies include: o Mass dog vaccinations o Education of children about exposure prevention o Providing PEP vaccination for animal bite patients o Promoting responsible pet ownership and surveillance In the Philippines, the Rabies-free Visayas Islands Project aims to eliminate rabies from the Visayas Region by control of canine rabies ANIMAL BITES REPORTED SINCE TYPHOON YOLANDA In Region VI, the rate of canine vaccination has declined from 88% prior to Typhoon Yolanda to 38% post-typhoon Since the thypoon there have been over 3,500 consultations for animal bites in these areas. The following charts and tables show information from SPEED consultations in select typhoon-affected areas (Regions VI and VIII) from 10 Nov Feb Results shown are dependent upon facility reporting that varied over time REGION VI In Region VI, since 10 November 2013, there have been 1,495 consultations for animal bites reported through SPEED, mostly from the Capiz province. As a proportion of consultations, animal bite consultations in Iloilo peaked in the second week of December with a steady decline through to January. In Capiz, an increase in the proportion of consultation has been reported from mid January. REGION VIII In Region VIII, since 10 November 2013, there have been 2,055 consultations for animal bites reported through SPEED, mostly from Leyte province. A steady increase in the proportion of animal bite consultations has been reported in Leyte since mid January. EPIDEMIC MEASURES In rabies epidemics, control efforts can include mass immunization of vector animal populations, area quarantines and selective dog population control. The Philippine Integrated Disease Surveillance and Response mandates health facilities to report all suspected rabies cases within 24 hours of detection to the provincial and national levels and to complete a Case Investigation Form for each suspected case More information at: This weekly EWARN Summary is published by the World Health Organization (WHO), Philippines. It is based on preliminary surveillance data from multiple sources, including the Surveillance in Post-Extreme Emergencies and Disasters (SPEED) system, the Philippines Integrated Disease Surveillance and Response System (PIDSR), and event-based reporting system. WHO surveillance contact: haiyanops@wpro.who.int Weekly Summaries are available at: Page 6 of 6