EWARN Weekly Summary Report

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1 EWARN Weekly Summary Report Early Warning Alert and Response Network Post-Typhoon Yolanda Week 16 Epidemiological Week No rd February to 1 st March 2014 HIGHLIGHTS This week, 34 health facilities in typhoon-affected areas of Region VI and VIII reported 3,616 total consultations through SPEED Acute respiratory infection accounted for 38% of total consultations In the period from 1 January to 28 February 2014, 903 additional suspect cases of Dengue fever were reported in Eastern Visayas, bringing to 1,069 the number of suspect cases reported since the disaster hit the region. Although in Region VIII, the number of suspect dengue cases has exceeded the alert threshold, the disease has not reached the epidemic level Three deaths due to suspect rabies were reported in the province of Eastern Samar; dog vaccination and advocacy and community mobilization is ongoing OVERALL SPEED REPORTING FROM TYPHOON-AFFECTED AREAS Overall, the number of facilities reporting decreased 21% in the current week, with 34 facilities reporting this week from 43 last week. The total consultations decreased by 60%, from 9,100 last week to 3,616 this week. However the number of total consultations may be underestimated due to an ongoing malfunction of the Globe access code during this week. The malfunction is anticipated to continue for 2-3 more weeks Areas reporting to SPEED in current week Region VI Iliolo Region VIII Eastern Samar Leyte Total consultations by municipality: REGION VI (Western Visayas): Iloilo: Iloilo City (89), Janiuay (30), Sara (116) REGION VIII (Eastern Visayas): Eastern Samar: Balangiga (377), Balankayan (106), City of Borongan (41), General Macarthur (137), Giporlos (46), Guiuan (41), Hernani (52), Lawaan (114), Llorente (115), Maydolong (30), Mercedes (32), Quinapondan (137), Salcedo (210); Leyte: Babatnong (128), Capoocan (13), Carigara (59), City of Baybay (231), Dagami (272), Isabel (277), Jaro (195), Kananga (186), Merida (322), San Isidro (52), Tabango (26), Tabontabon (77), Villaba (75) The proportion of consultations due to acute respiratory infection remained stable (38%) over the last two weeks and 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 remained stable in the current week, accounting with 2% of total consultations. SPEED Syndrome ARI = Acute respiratory infection AWD = Acute watery diarrhea AHF = Acute hemorrhagic fever Page 1 of 6

PROVINCIAL SUMMARIES (SOURCES INCLUDE: EVENT-BASED SURVEILLANCE, PIDSR, SPEED) REGION VI WESTERN VISAYAS ILOILO PROVINCE Reporting: Reporting from Iloilo included 2 Rural Health Units and 1 hospital.

2 PROVINCIAL SUMMARIES (SOURCES INCLUDE: EVENT-BASED SURVEILLANCE, PIDSR, SPEED) REGION VI WESTERN VISAYAS ILOILO PROVINCE Reporting: Reporting from Iloilo included 2 Rural Health Units and 1 hospital. Consultations: The total number of SPEED consultations decreased from 349 to 235 over the past week. Leading causes of morbidity include acute respiratory infection (30%), wounds (8.5%), fever (7%), hypertension (6%), acute diarrhea (4%), and skin diseases (4%). Alerts: No alerts were reported for this week. REGION VIII EASTERN VISAYAS EASTERN SAMAR PROVINCE Reporting: 18 health facilities reported from Eastern Samar including 7 hospitals and 11 Rural Health Unit. Consultations: The total number of SPEED consultations for the current reporting week is 1,468. Leading causes of morbidity were acute respiratory infection (31%), high blood pressure (5%), wounds (3%), skin diseases (3%) and acute watery diarrhea (2%). Alerts: For this week three suspect measles cases were reported through PIDSR. One from Barangay Parena, Giporlos and two from Poblacion Barangay of Lawaan. Investigations of cases were conducted by the surveillance team and blood samples were taken for serology testing. Door to door immunization mopping-up is ongoing. The municipalities of Balangiga, Borongaan and Guian reported a total of 11 suspect cases of Dengue fever from 21 to 28 February Median age of cases was 23 years (range 4 months - 61 years). Search and destroy activities were conducted by Barangay dengue control team. Households were encouraged to do search activities daily. Other measures for Dengue prevention and control are on-going. Three deaths due to suspect rabies were reported in Dolores and Oras; dog vaccination and advocacy and community mobilization is ongoing. LEYTE PROVINCE Reporting: 13 RHUs reported from Leyte this week. Consultations: The total number of SPEED consultations decreased from 6,719 to 1,913 over the past week. Leading causes of morbidity were acute respiratory infection (45%), wounds (3%), skin diseases (2%), high blood pressure (2%) and acute watery diarrhea (1%). Alerts: SPEED reported 10 alerts for fever and rash in the municipality of Carigara (3), City of Baybay (5), Kananga (1) and Villaba (1). All cases were referred to PESU/RESU for further investigation and serology testing. A total of 19 alerts of suspect Acute Hemorrhagic Fever were reported from Leyte for this reporting week; 18 suspect dengue cases were reported by Ormoc District Hospital in Ormoc City and 1 case reported by Jaro Municipal Health Office. The results of larval survey conducted Page 2 of 6

by Ormoc City Health Office showed an high number of households positive for larvae of mosquitoes. Clean-up, hygiene promotion and spray operation are ongoing.

number of suspect cases reported since the disaster hit the region.

3 by Ormoc City Health Office showed an high number of households positive for larvae of mosquitoes. Clean-up, hygiene promotion and spray operation are ongoing. Dengue Update in Region VIII In the period from 1 January to 28 February 2014, 903 additional suspect cases of Dengue fever were reported in Eastern Visayas through PIDSR, bringing to 1,069 the number of suspect cases reported since the disaster hit the region. Most of the cases (82%) were from Leyte province (mainly City of Tacloban and Ormoc City; Figure 1); median age was 14 years (range 2 months 65 years) and 56% were male. A total of 216 suspect cases were reactive to dengue rapid test. Three deaths were reported, 2 from Tacloban City and 1 from Maasin City. Although in Region VIII, the number of suspect dengue cases has surpassed the alert threshold, the disease has not reached the epidemic level (Figure 2). The peak of cases reported was in January with February showing a marked decline following pesponse activities. DOH and partners are conducting fogging/spraying, and larviciding activities and they are encouraging community participation and mobilization for destruction of mosquito breeding sites. Figure 1. Suspect Dengue cases by Province, Region VIII, 11 Jan- 28 Feb 2014 (n=903) Figure 2. Suspect Dengue cases by month, Region VIII, 11 Jan- 28 Feb 2014 (n=903) Page 3 of 6

Location of SPEED notifications of acute hemorrhagic fever, 23 rd February

4 MAPS Location of SPEED notifications of fever with rash, 23 rd February to 1 st March 2014, Regions VI and VIII (red=hospital blue=other facility) Location of SPEED notifications of acute hemorrhagic fever, 23 rd February to 1 st March 2014, Regions VI and VIII (red=hospital blue=other facility) Page 4 of 6

FOCUS ON: CHIKUNGUNYA KEY FACTS Chikungunya fever is an arboviral disease caused by a RNA Alphavirus of the Togaviridae family The virus is transmitted to humans by the bite of infected female

5 FOCUS ON: CHIKUNGUNYA KEY FACTS Chikungunya fever is an arboviral disease caused by a RNA Alphavirus of the Togaviridae family The virus is transmitted to humans by the bite of infected female mosquitoes of the species Aedes aegypti and Aedes albopictus Onset of symptoms occurs usually between four and eight days (range 2-12) after the bite of an infected mosquito Chikungunya is characterized by fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash Treatment is focused on relieving the symptoms The disease resembles dengue fever in terms of transmission, geographical spread, seasonality, and prevention methods. However, unlike dengue, chikungunya fever is usually not fatal EPIDEMIOLOGY AND BURDEN OF CHIKUNGUNYA Chikungunya is a mosquito-borne viral disease, first described Countries with reported human Chikungunya virus infections, as of May 2012 during an outbreak in southern Tanzania in 1952 Chikungunya has been identified in nearly 40 countries in Asia, Africa, Europe and also in the Americas In the Philippines, Chikungunya fever is now considered endemic in all regions. Since the last case reported in 1996, the desease has re-emerged in 2011 affecting initially few provinces and spreading all throughout the country over the last 3 years. In 2012 and 2013, cases of Chikungunya fever have been confirmed in 43 of the country s 80 provinces and outbreaks have have been reported in the urban centres of Davao and Manila. Since 2012, several outbreaks have led to an increase in awareness and reporting of cases, supported by expanded laboratory testing capacity The Philippine Event-based Surveillance and Response (ESR) system of the DOH verified 79 Chikungunya fever events in 14 regions from January to December A total of 8,370 suspect and 593 laboratory confirmed chikungunya cases were reported among all age groups (range 5 days 84 years). No deaths were recorded From 1 January to 4 March 2014, 4 Chikungunya fever ESR events with 116 suspect and 6 laboratory confirmed cases were verified in Region VII and XII. TRANSMISSION Aedes aegypti and Aedes albopictus are the two species of mosquitoes most commonly involved in the transmission of chikungunya virus These mosquitoes can be found biting throughout daylight hours, though there may be peaks of activity in the early morning and late afternoon. Aedes albopictus is found biting outdoor, while Aedes aegyptiboth outdoor and indoor In the Philippines, Chikungunya fever occurs throughout the year, with a high peak following the onset of the rainy season ( July-August), and a smaller peak around December/January (i.e. as for dengue fever). Adults are affected most often with women affected slightly more frequently SIGNS AND SYMPTOMS An abrupt onset of fever accompanied by joint pain, frequently debilitating, lasting usually a few days; other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash Symptoms are mainly mild and the infection may go unrecognized, or misdiagnosed in areas where dengue occurs Most patients fully recover, however joint pain may persist for weeks or months (years in some cases) Occasional cases of eye, neurological, heart and gastrointestinal complications have been reported. Serious complications are rare, but in elderly the disease can contribute to the cause of death DIAGNOSIS AND TREATMENT Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months The virus may be isolated from the blood during the first few days of infection. Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR) There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms, including the joint pain using anti-pyretics, optimal analgesics and fluids Page 5 of 6

6 PREVENTION AND CONTROL There is no vaccine to prevent chikungunya infection or disease Measures to reduce the human-vector contact include the use of: o clothes that minimize skin exposure to the day-biting vectors o repellents to exposed skin or to clothing (in strict accordance with product label instructions) o insecticide treated mosquito nets for those who sleep during the daytime (young children or sick or older people) o mosquito coils or other insecticide vaporizers to reduce indoor biting o window/door screens Measures for the vector control include: 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 improving community participation and mobilization for sustained vector control o active monitoring and surveillance of vectors to determine their distribution and key breeding sites for planning of effective control interventions Being the two species of mosquitoes involved in the transmission of both Chikungunya virus and dengue virus, the 4-S against dengue (Search and destroy; Self-protection measure; Seek early consultaions; Say no to indiscriminate fogging) and the practice of the four o clock stop look and listen habit are also recommended to prevent Chikungunya fever Health workers need to be aware and ready to provide appropriate care and information to patients, always considering the differential diagnosis of chikungunya versus dengue, which can be fatal CHIKUNGUNYA IN TYPHOON YOLANDA AFFECTED AREAS In 2013, Region VI of the Philippines experienced two outbreaks of Chikungunya fever in the provinces of Antique and Negros Occidental. Antique reported through ESR a total of 1113 suspect and 83 laboratory confirmed cases; among the 13 reporting municipalities, 50% (593) of the cases were from the municipality of Patnongon. The Province of Negros Occidental reported a total of 250 suspect and 83 laboratory confirmed cases; among the 13 reporting municipalities, 50% (167) of the cases were from the municipality Kabankalan City In 2012 and 2013, Region VIII of the Philippines reported Chikungunya fever suspect cases through ESR in the province of Western Samar (499 Villareal; 25 Zumaraga; 366 Daram), Samar (51 Sta. Rita; 15 Jabong; 8 - Borongan) and Leyte (26- Tacloban city; 12 Barugo) In the current post-typhoon situation, the number of chikungunya cases is likely to increase due to an increase in the density of mosquitoes in affected areas, where mosquito breeding conditions are ideal among debris with stagnant rainwater. Since Chikungunya fever is not a notifiable disease to SPEED and PIDSR surveillance systems there might have been cases that were not reported or were misclassified as supect dengue or measles cases 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

EWARN Weekly Summary Report

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