Leptospirosis worm

The death toll from leptospirosis climbed to 93 after four more deaths were reported from Metro Manila hospitals during the weekend, the Department of Health (DoH) said on Saturday.

The number of cases also increased to 1, 336 from 1, 027 recorded last October 15, or an addition of 309 new cases in barely two days.

Dr. Yolly Oliveros, director of the National Center for Disease Prevention and Control (NCDPC), said the additional cases and deaths were received by the DoH-National Epidemiology Center (NEC) last October 16 from different state-run and private hospitals in the metropolis.

“The rapid increase in the number of casualties is inevitable considering the volume of water that typhoon Ondoy dumped on most parts of Metro Manila last September 26,” Oliveros said in an interview.

“If the NEC projection of (leptospirosis) attack rate of 10 to 25 percent is right, we can expect some 4, 000 people to be admitted for confinement, and more deaths in the coming days or weeks,’’ she stressed.

Earlier, the health department declared an outbreak of the flood-borne disease in barangays Tumana, Malanday, and Concepcion I in Marikina, as the city was one of those severely submerged in floodwater.

Aside from Marikina, the cities of Pasig and Taguig, and Rizal province also suffered severely from the onslaught of Ondoy.

Health Secretary Francisco Duque III earlier said that the outbreak was declared because Marikina has zero cases in 2008.

Since Friday, the DoH had given away free “doxycycline” antibiotic drugs in Marikina as a prophylactic or means of prevention to exposed individuals.

“Ang ibig sabihin ng prophylaxis, kahit walang sakit bibigyan pa rin natin sila ng antibiotics dahil nasa ‘’high risk’’ category sila. Lahat ng residente na nandon sa high risk areas ay bibigyan ng 200 miligrams of antibiotic once a week,’’ explained Oliveros.

Given the flood magnitude, she said, the DoH will likely spend about R50-million on prophylaxis alone.

“First time tayo (DoH) magbibigay ng prophylaxis on a wide range. We have asked the World Health Organization (WHO) if they did the same, pero wala daw,” she said.

She clarified, however, that giving of prophylaxis is part of the management of leptospirosis.

The health official urged the public to protect themselves against flood-borne diseases by wearing protective clothing such as “boots’’ and washing the exposed parts immediately when wading could not be avoided.

Frequent washing of hands with soap and water, she added are crucial in preventing others diseases.

Leptospirosis is spread through animal urine mixed with floodwater. Humans can easily acquire the disease if they have open wounds.

The DoH said an infected person may manifest symptoms two-weeks after wading in filthy water. Among the more common symptoms are cough, cold, and body malaise. If not diagnosed early enough, it could lead to meningitis, liver damage, or death. By SHIANEE MAMANGLU

MANILA, 2 October 2009—The World Health Organization (WHO) today applauded the Philippines Department of Health for its efforts to prevent donations of milk products to infants and young children sheltering in evacuation centres in the wake of Typhoon Ondoy.

In a statement, WHO said donations of infant formula and other powdered milk products, while well-meaning, endanger children’s lives. It was a misconception that in emergencies, many mothers could no longer breastfeed adequately due to stress or inadequate nutrition.

Dr Howard Sobel, acting WHO Representative, explained: “Stress is not likely to inhibit breast-milk production, provided mothers and infants remain together and are supported to breastfeed. Mothers who lack food or who are malnourished can still breastfeed adequately. Adequate fluids and extra food for the mother will help to sustain her health and well-being.”

During emergency situations, the need for nutrition to maintain health increases, but structural damage caused by flooding jeopardizes clean water supplies, Dr Sobel said. “Contaminated water supplies increase the risk of water borne diseases. Diarrhoea, other infectious diseases and under-nutrition skyrocket. The younger the infant, the higher the risk.”

Even in the absence of crises, an estimated 82,000 children die every year before their fifth birthday in the Philippines. Half of these deaths are related to common infectious diseases such as diarrhea, pneumonia, neonatal sepsis and measles. Malnutrition lies at the root of many of these conditions.

Exclusive breastfeeding is the single best way to avoid diarrhoea and other diseases, Dr Sobel said. Under normal circumstances, infants who are not breastfed are four times more likely to die from pneumonia and 14 times more likely to die from diarrhoea, than infants who are exclusively breastfed for the first six months. Breastfeeding continues to benefit children up to two years of age or beyond.

Breastmilk protects against infection through a complete complement of antibodies, immunological stimulating proteins, and nourishing vitamins. It provides the right amount of energy to further protect against malnutrition.

The WHO/UNICEF Global Infant and Young Feeding Strategy recommends that infants start breastfeeding within one hour of birth and continue breastfeeding exclusively (with no food or liquid other than breast milk, not even water) until six months of age. This policy applies in emergency situations. After six months, infants should begin to receive a variety of foods, while breastfeeding continues up to two years of age or beyond.

H1N1 swine flu

The Department of Health (DOH) today expressed gratitude to the World Health Organization (WHO) over the commendation it gave to the government agency for its swift and tireless efforts in dealing with the novel virus A (H1N1).

The WHO letter dated June 30, 2009 and signed by WHO Regional Director Dr. Shin Young-soo put on record “my personal appreciation of the exceptional collaboration established between the Government of the Philippines and the World Health Organization in the fight against Pandemic H1N1 2009. I commend your leadership and tireless efforts in responding to this emerging threat to the health of the people of the Philippines”.
“We are very grateful that our efforts were recognized and didn’t go to waste. We appreciate that the WHO finds our response efficient and that it is confident on the quality of our laboratory diagnoses,” Health Secretary Francisco T. Duque III said.

The WHO letter further said that “Contact tracing has also been thorough, allowing the DOH to detect further cases and slow down the spread of the virus. The efficiency of the response indicated to me that the Philippines has the fundamental capacity to detect and respond to the new influenza virus. I should add that WHO is also confident about the quality of the laboratory diagnoses carried out by the Research Institute for Tropical Medicine and about the epidemiological activities conducted by the National Epidemiology Center (NEC)”.

Meanwhile, Duque also said that the Philippines, as a member country of the WHO, will now be adopting the WHO recommended changes in the reporting of A (H1N1) cases.

According to the WHO, for countries already experiencing community-wide transmission, the focus of A (H1N1) surveillance activities must shift to reporting against the established indicators for the monitoring of seasonal influenza activity. Those countries are no longer required to submit regular reports of individual laboratory-confirmed cases and deaths to the WHO.

“The WHO will no longer be issuing global table updates that show the number of confirmed cases for all countries but will instead continue to document the global spread with updates describing the situation in newly affected countries,” Duque said.

The WHO said that as the pandemic evolves, the data needed for risk assessment are also changing and that at this point, its further spread is considered inevitable. It said that the increasing numbers of cases in many countries with sustained community transmission is making it extremely difficult to confirm them through laboratory testing.

Because the DOH is set to abide by the newly recommended reporting system of WHO for A (H1N1), it is now reviewing and adjusting its surveillance systems to fit the monitoring of the novel virus in its regular surveillance of Influenza-like illnesses (ILI) in the country.
Duque stressed that globally and locally, the novel virus has caused mild illness in the majority of affected patients with expected full recovery even without medical treatment.   However, there are some cases that become serious especially if the patients have underlying pre-medical conditions.  Like the other seasonal flu strains, A (H1N1) can cause severe viral pneumonias and other flu complications” Duque said.

“So, again, we are urging the public to be more vigilant in guarding their health against A (H1N1) despite its generally mild clinical manifestations in most of the cases reported in the country,” Duque stressed.

The Secretary said that such highly vulnerable conditions include uncontrolled diabetes, frank cardiovascular disease, chronic obstructive pulmonary disease, chronic liver and kidney disease. He added that those who are organ transplant recipients, immunocompromised, and suffering from other infections like HIV/AIDs and TB; pregnant women and the very young and the elderly are more at risk of developing serious cases of A (H1N1).
“We are stressing this point because of the first previously reported case of death in the country involving a patient with an incidental finding of A (H1N1). We now have to be more aggressive in targeting segments of patients with a high vulnerability to fatal flu complications,” Duque pointed out.
“We want to make it clear that high-risk groups, once they have the flu symptoms, should immediately go to their doctor.   They should not wait for their symptoms to worsen because they are prone to many other infections such as our seasonal flu strains,” Duque clarified.

“We also advise parents and guardians to seek immediate professional help if they see danger signs in children and other family members which indicate rapid progression of the disease or a worsening of symptoms.  Likewise healthcare providers should stick to the basic protocol of managing acute respiratory infections among children by being vigilant of these danger signs which include rapid breathing, excessive drowsiness, poor intake or dehydration.  In adults, chest pain, prolonged fever or labored breathing should prompt warnings to see a doctor,” Duque reminded the public.
Meanwhile, Duque advised the public to continue following the recommendations of the DOH on proper handwashing, cough etiquette, and other hygiene practices.

“The best defense against A (H1N1) and other diseases is to boost your immune system. Most people can fight off this virus without special medications or hospitalization. You can stay at home and take supportive care like plenty of fluids, vitamins and bed rest,” Duque stressed.
In this connection, Duque strongly advised the public to be vigilant over advertisements or fraudulent sales promotion practices of food supplements, vitamins or other products that create an erroneous impression that the product concerned could cure or treat the A (H1N1) virus.

“It must be stressed that to date, there are no food supplements, vitamins or vaccines that cure or treat the novel virus,” Duque stressed.
“We are warning manufacturers and distributors of these products that any claim in their advertisements that it can cure or treat A (H1N1) can be an outright violation of Section 112 of the Republic Act No. 7394 (The Consumer Act of the Philippines), Bureau Circular 2007-002 (The Guidelines in the Use of Nutrition and Health Claims in Food), and Republic Act No. 3720 (Violating the Misbranding Provisions),” Duque said.

“We are encouraging the public to report to the Bureau of Food and Drugs (at 809-4390 local 1051) any advertisement or fraudulent sales promotion practices involving the above-mentioned products that create an erroneous impression that it could prevent, cure or treat the novel virus,” Duque concluded.”