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EWARN Weekly Summary Report Early Warning Alert and Response Network

HIGHLIGHTS

This week, 41 health facilities in typhoon-affected areas of Region VI and VIII reported 8,697 total consultations through SPEED

Acute respiratory infection accounted for 37% of total consultations

A Program Implementation Review (PIR) on Event-based Surveillance and Response (ESR) with the Disease Surveillance Officers (DSOs) in 17 regions, including the Research Institute for Tropical Medicine (RITM) is on-going. It aims to raise issues and concerns on the overall functionality of ESR and identify strengths and areas for improvement for both national and regional level. One of the highlights of the event was the hands-on training on the newly developed computer-based information system: Event-based Surveillance and Response System (ESRS) which will provide near real-time data on potential and confirmed disease outbreaks and other public health events

OVERALL SPEED REPORTING FROM TYPHOON-AFFECTED AREAS

Overall, the number of facilities reporting decreased 39% in the current week, with 41 facilities reporting this week from 67 last week. The total consultations decreased by 3%, from 9,004 last week to 8,697 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 3-4 more weeks.

Total consultations by municipality: REGION VI (Western Visayas): Capiz: Ivisan (173), Lamindan (134), Mambusao (483), Roxas City (717), Sapi-An (293), Sigma (111); Iloilo: Iloilo City (125), Janiuay (27) REGION VIII (Eastern Visayas): Eastern Samar: General Macarthur (106), Guiuan (15); Leyte: Alangalang (217), Albuera (134), Barugo (84), Burauen (150), Calubian (34), Capoocan (81), Carigara (150), City of Baybay (218), Dagami (222), Dulag (185), Jaro (787), Kananga (86), La Paz (224), Macarthur (59), Merida (2034), Ormoc City (650), Palo (398), Pastrana (100), Santa Fe (40), Tabango (112), Tabontabon (81), Tacloban City (203), Tolosa (89), Villaba (175) The proportion of consultations due to acute respiratory infection increased from 29% to 37% over this reporting week (16-22 Feb) 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

Areas reporting to SPEED in current week Region VI

Capiz

Iliolo Region VIII

Eastern Samar

Leyte

Post-Typhoon Yolanda Week 15 | Epidemiological Week No. 10 | 16th to 22nd February 2014

EWARN weekly summary| 16th to 22nd February 2014

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

REGION VI – WESTERN VISAYAS

CAPIZ PROVINCE

Reporting: Reporting in Capiz included 5 Rural Health Units, 1 hospital and 1 mobile clinic in the current reporting week (16-22 Feb). Consultations: The total number of SPEED consultations decreased from 1996 to 1911 over the past week. Leading causes of morbidity include acute respiratory infection (25%), fever (5.5%), wounds (3.5%), animal bites (3%) and high blood pressure (3%). Alerts: Alerts for acute watery diarrhea (10 cases) were reported from the Mambusao District Hospital and investigation is ongoing.

ILOILO PROVINCE

Reporting: Reporting from Iloilo included 1 Rural Health Unit and 1 hospital. Consultations: The total number of SPEED consultations decreased from 280 to 152 over the past week. Leading causes of morbidity include acute respiratory infection (43%), fever (15%), hypertension (15%), acute diarrhea (9%), wounds (6%), and skin diseases (3%). Alerts: Alerts for acute watery diarrhea (5 cases) were reported from the West Visayas State University Medical Center and investigation is ongoing.

REGION VIII – EASTERN VISAYAS EASTERN SAMAR PROVINCE

EWARN weekly summary| 16th to 22nd February 2014

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Reporting: 3 health facilities reported from Eastern Samar including 2 hospitals and 1 Rural Health Unit. Consultations: The total number of SPEED consultations for the current reporting week (16 to 22 February) is 121. Leading causes of morbidity were acute respiratory infection (20%), wounds (5%), high blood pressure (3%), skin diseases (2.5%) and acute watery diarrhea (2.5%). Alerts: No alerts were reported for the week 16-22 February 2014.

LEYTE PROVINCE

Reporting: Reporting from Leyte included 21 RHUs, 7 hospitals and 1 mobile clinic. Consultations: The total number of SPEED consultations increased from 4,010 to 6,513 over the past week. Leading causes of morbidity were acute respiratory infection (41%), high blood pressure (5%), wounds (4.5%), skin diseases (3%), fever (2%) and acute watery diarrhea (2%). Alerts: Alerts of fever and rash were reported from Tacloban City (5 - Eastern Visayas Regional Medical Center; 4 - Tacloblan Main Health Center; 2 – Tacloban City Hospital), Jaro (2 – Jaro MHO), Calubian (1 – Northwestern Leyte District Hospital), City of Baybay (1 - Baybay Main Health Center) and Palo (1 – Leyte Provincial Hospital). Blood samples have been taken from two suspect measles cases hospitalized in EVRMC and sent to the Research Institute for Tropical Medicine for testing. A rapid coverage survey of the measles outbreak response immunization campaign was conducted between 19 and 22 February in Tacloban City to assess the measles vaccine coverage after the immunization campaign conducted through the Region in the previous weeks. Meanwhile, a total of 19 consultations for suspect AHF were reported regionwide (12 – Leyte Provincial Hospital; 6 - Ormoc District Hospital; 1 – Dagame MHO). Vector control measures, like targeted fumigation, have been intensified in the whole Region VIII and community campaigns on self-protection methods are on-going. Alerts for acute watery diarrhea were also reported from the Alangalang MHO (17 cases), the Burauen District Hospital (6), the Baybay Main Health Center (7), the Merida MHO (7), the Leyte Provincial Hospital (17 cases), the Tabango Community Hospital (6), the Tabontabon MHO (6), the Ormoc District Hospital (19 cases). The Eastern Visayas Regional Medical Center in Tacloban city reported 4 cases of AWD with 2 deaths. Alerts were investigated by the Epidemiology and Surveillance Units and no cluster of AWD were identified.

MAPS

Location of SPEED notifications of fever with rash, 16

th to 22

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

EWARN weekly summary| 16th to 22nd February 2014

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Location of SPEED notifications of acute hemorrhagic fever, 16th

to 22nd

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

FOCUS ON: PNEUMONIA

KEY FACTS

Pneumonia is an acute respiratory infection affecting the lungs that can be caused by viruses,

bacteria, or fungi

Although pneumonia can often be treated and cured, 1.1 million children under the age of five die due to pneumonia every year (18% of all deaths of children under five years old worldwide)

Pneumonia is treatable and preventable. However, delays in recognizing pneumonia and accessing appropriate care, as well as missed opportunities for immunization, contribute to pneumonia mortality

EPIDEMIOLOGY AND BURDEN OF PNEUMONIA

Pneumonia affects children and adults everywhere, however most child deaths occur in the world’s poorest regions with highest

incidence in sub-Saharan Africa and South Asia

Streptococcus pneumonia, Haemophilus influenzae type b (Hib) and respiratory syncytial virus are the most common causes of pneumonia in healthy people. Pneumocystis jiroveci is one of the most common causes of pneumonia in immunocompromised infant and

it is responsible for one quarter of all pneumonia deaths in HIV-infected infants

Pertussis and measles have also a respiratory tract component and can complicate with pneumonia

The Philippines is one of the 15 countries that together account for 75% of childhood pneumonia cases worldwide. In children aged

under 5 years, pneumonia is the leading cause of mortality with a mortalitily rate of 23.4 x 100,000 population recorded in 2009

In Regions VI, VII and VIII of the Philippines, the total number of children under five years of age with pneumonia that have been seen

and given treatment from January to December 2012 were 89,221 and 85,923, respectively

Major risk factors for developing pneumonia are: o a weakened immune system due to malnutrition or undernourishment (especially in infants not exclusively breastfed), HIV and

other pre-existing illnesses such as measles

o environmental factors including indoor air pollution (cooking/heating with wood, dung, or other biomass fuels), living in

crowded houses and parental smoking

TRANSMISSION

Pneumonia can be spread by: o Inhalation of viruses and bacteria that are commonly found in a child’s nose or throat o Inhalation of contaminated airborne droplets from someone else’s cough or sneeze o Bloodstream infections o In newborns, contact with organisms in the birth canal or contaminated substances contacted during delivery

Most organisms that cause pneumonia are commonly encountered during day-to-day activities. Hence, it is not recommended that otherwise healthy people wear masks to protect themselves from pneumonia

EWARN weekly summary| 16th to 22nd February 2014

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SIGNS AND SYMPTOMS

Pneumonia may have a range of symptoms depending on the age and the cause of the infection

Viral and bacterial pneumonia have similar symptoms, although there may be more symptoms with viral pneumonia

Cough and difficult and painful breathing are key symptoms of pneumonia; fever is also common

In children under five years of age, difficult breathing manifests as: o Rapid breathing (>50 bpm for 2-12 months old; >40 bpm for >12

months - 5years old)

o Lower chest indrawing, where chest moves in or retracts during inhalation, also called “retraction” (Figure 1)

o Flaring of the nostrils with every breath o Grunting with every exhalation o Wheezing, more commonly with viral infections

Severely ill infants may be unable to feed or drink and may experience unconsciousness, hypothermia, and convulsions

DIAGNOSIS AND TREATMENT

Chest x-rays and laboratory tests can be used to confirm the presence of pneumonia and to identify the causative pathogen

In resource-poor environments, pneumonia diagnosis is based on clinical signs and symptoms

Treatment of pneumonia is with antibiotics. Treatment regimens need to be chosen based on their efficacy in local settings (e.i. level of

drug resistence) and accordingly to the patient risk factors (e.i. undernourished or HIV-positive children)

Children under two months are at highest risk for severe illness/death and they should be immediately referred to a hospital or clinic for treatment

PREVENTION AND CONTROL

Public health interventions to prevent pneumonia include: o Immunization against pathogens that directly cause pneumonia (S. pneumonia and H. influenza type b) and pathogens that lead

to pneumonia as complication of the infection (eg. measles and pertussis) o The most important available vaccines to prevent pneumonia are pneumococcal conjugate vaccine, Hib vaccine, measles and

pertussis vaccine o Adequate nutrition to improve natural defense and strength of respiratory muscles (which aid in clearance of secretions) o Exclusive breastfeeding for the first six months of life o Zinc supplementation

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia

ACUTE RESPIRATORY INFECTIONS REPORTED SINCE TYPHOON YOLANDA

Acute respiratory infections (ARI) are range of respiratory disease that can affect the upper respiratory tract or lower respiratory tract. The clinical manifestation of ARI (cough, colds and/or sore throat with or without fever) is common for several diseases such as the

common cold, influenza or pneumonia

Since the typhoon there have been over 101,417 consultations for ARI in the affected areas

The following charts and tables show information from SPEED consultations for ARI in select typhoon-affected areas (Regions VI and VIII)

from 10 Nov 2013 - 22 Feb 2014. Results shown are dependent upon facility reporting that varied over time

REGION VI

In Region VI, since 10 November 2013, there have been 22,477 consultations for acute respiratory infections reported through SPEED, mostly from the Capiz province. The number of consultations for ARI peaked in the first week of December. ARI consuktations have represented between 30% and 60% of all consultations since 10 November 2013.

Figure 1: chest indrawing in an infant. In the image on the

left, the infant is exhaling. In the image on the right, he is

inhaling; note the triangular shadows at the borders of the

ribcage on the sides of the trunk.

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REGION VIII

In Region VIII, since 10 November 2013, there have been 78,940 consultations for ARI reported through SPEED, mostly from Leyte province. A steady decrease in the proportion of ARI consultations has been reported in Leyte since the typhoon with some oscilations and a slight increase in the last week. In Easter Samar the proportion of ARI consultations has been relatively constant since the typhoon.

EPIDEMIC MEASURES

Addressing environmental factors such as indoor air pollution by providing affordable clean indoor stoves and encouraging good hygiene in crowded homes can reduce the number of children who fall ill with pneumonia

Immunization against S. pneumonia, H. influenza type b, pertussis and measles are the most effective way to prevent pneumonia when the cause of pneumonia has been identified

In 2013, WHO and UNICEF launched the integrated Global action plan for pneumonia and diarrhoea (GAPPD). The aim is to accelerate pneumonia control with a combination of interventions to protect, prevent and treat pneumonia in children with actions to:

protect children from pneumonia include promoting exclusive breastfeeding and adequate complementary feeding

prevent pneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and

cotrimoxazole prophylaxis for HIV-infected and exposed children

treat pneumonia which are focused on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they

need to get well

More information at: http://whqlibdoc.who.int/publications/2006/9280640489_eng.pdf?ua=1 , http://apps.who.int/iris/bitstream/10665/79200/1/9789241505239_eng.pdf?ua=1

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:http://www.wpro.who.int/philippines/typhoon_haiyan/en/index.html