The Philippines health system review

The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, foundations, and researchers that promotes evidence-informed health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity.

Epidemiology of Ebola (subtype Reston) virus in the Philippines, 1996.

Ebola (subtype Reston [EBO-R]) virus infection was detected in macaques imported into the United States from the Philippines in March 1996. Studies were initiated in the Philippines to identify the source of the virus among monkey-breeding and export facilities, to establish surveillance and testing, and to assess the risk and significance of EBO-R infections in humans who work in these facilities. Over a 5-month period, acutely infected animals were found at only one facility, as determined using Ebola antigen detection. Three of 1732 monkeys and 1 of 246 animal handlers tested had detectable antibodies; all were from the same facility, which was the source of infected monkeys imported to the United States. Virus transmission, which was facilitated by poor infection-control practices, continued for several months in one facility and was stopped only when the facility was depopulated. None of the 246 employees of the facilities or 4 contacts of previously antibody-positive individuals reported an Ebola-like illness. This investigation suggests that human EBO-R infection is rare.

Cholera in metropolitan Manila: foodborne transmission via street vendors.

Reported are the results of an unmatched case-control study to determine the risk factors associated with acquisition of cholera in Manila. Cases were patients admitted to the San Lazaro Hospital between July and September 1989 and whose stools yielded Vibrio cholerae O1 on culture. Controls were patients admitted to the same hospital and who had no history of diarrhoea or of having taken antibiotics during the 3 days prior to admission. Of the 158 cases and 158 controls who had bought food from street vendors, cases were more likely to have bought the following items: pansit (rice noodles with shrimp, meat, and vegetables), mussel soup, spaghetti, fish balls, pig blood coagulated with vinegar, and salty brine shrimp with vegetables. Cases were also more likely to lack piped water at home. An unconditional logistic regression analysis indicated that only pansit (OR = 2.15, 95% CI = 1.32-3.51), mussel soup (OR = 2.29, 95% CI = 1.06-4.95), and the absence of piped water at home (OR = 2.70, 95% CI = 1.63-4.46) remained as risk factors. As control measures we recommend stricter implementation of the food sanitation code and the licensing of street food vendors.

Outbreak of fatal illness among captive macaques in the Philippines caused by an Ebola-related filovirus.

Following the detection of an Ebola-like virus in cynomolgus macaques recently imported into the United States from The Philippines, studies were initiated to document transmission at export facilities located in the latter country. At one export facility, 52.8% of 161 monkeys that died over a 2.5-month period were shown to be infected with this virus using an enzyme-linked immunosorbent assay to detect antigen in liver homogenates. A case fatality rate of 82.4% was documented for the infected monkeys. The initial anti-viral antibody prevalence among the captive macaques at this facility was 25.9% (indirect fluorescent antibody titer greater than or equal to 1:16). Followup documented infection of 24.4% of initially seronegative animals and 8.7% of initially seropositive monkeys. Being held in a gang cage versus a single cage was found to be a significant risk factor for subsequent virus infection, and the presence of IFA antibody was shown to predict protection. This study documents unequivocally for the first time the presence of an Ebola-related filovirus in Asia.

Risk factors for injuries due to the 1990 earthquake in Luzon, Philippines.

On 16 July 1990, an earthquake measuring 7.7 on the Richter scale struck the island of Luzon, Philippines. A case-control study was carried out to identify the risk factors for earthquake-related injuries and at the same time observations were made on the rescue efforts. Being hit by falling objects was the leading cause of injury (34%). Those injured during the tremor were more likely to have been inside buildings constructed of concrete or mixed materials (odds ratio, 2.6; 95% confidence interval (CI), 1.7-4.1) and to have been on the middle floors of multistorey buildings (odds ratio, 3.4; 95% CI, 2.2-5.5). Leaving a building during the earthquake was a protective behaviour (odds ratio, 0.3; 95% CI, 0.2-0.8). Of the 235 survivors who were trapped and rescued alive from the rubble, 99% were rescued within 48 hours of the impact of the tremor. These findings should prove useful in developing seismic safety codes. People should be taught proper evasive actions to take during earthquakes, and training in basic first aid and methods of rescue should be an integral part of community preparedness programmes.

Risk factors for injuries due to the 1990 : Earthquake in Luzon, Philippines

On 16 July 1990, an earthquake measuring 7.7 on the Richter scale struck the island of Luzon, Philippines. A case-control study was carried out to identify the risk factors for earthquake-related injuries and at the same time observations were made on the rescue efforts. Being hit by falling objects was the leading cause of injury (34

). Those injured during the tremor were more likely to have been inside buildings constructed of concrete or mixed materials (odds ratio, 2.6; 95

confidence interval (CI), 1.7-4.1) and to have been on the middle floors of multistorey buildings (odds ratio, 3.4; 95

CI, 2.2-5.5). Leaving a building during the earthquake was a protective behaviour (odds ratio, 0.3; 95

CI, 0.2-0.8). Of the 235 survivors who were trapped and rescued alive from the rubble, 99

were rescued within 48 hours of the impact of the tremor. These findings should prove useful in developing seismic safety codes. People should be taught proper evasive actions to take during earthquakes, and training in basic first aid and methods of rescue should be an integral part pf community preparedness programmes.(AU)

Emerging patterns of HIV infection and control in the Philippines.

PIP: In the Philippines, a total of 46 female prostitutes were found seropositive for the antibodies of HIV as of July 31, 1987. A total of 53,376 tests were performed among these women, and repeated positive tests by enzyme-linked immunosorbent assay (ELISA) were confirmed by the Western blot test. 40 of the cases were found in the Angeles City and Olongapo areas adjacent to military bases, and they were detected from among 34,998 blood examinations, for an overall HIV antibody positivity rate of 1.1/1000. In the MetroManila area, 4 prostitutes were found positive from among 10,549 tested, yielding an antibody positivity rate of 0.4/1000. The Department of Health tested 867 male homosexuals, and found only 1 individual seropositive. 3 other infections were reported by private sources, 2 of them in male homosexuals. No infection was detected in 3200 blood donors or in 12,000 overseas workers. A total of 9 cases of AIDS were reported, and all contracted the disease abroad. 7 were Filipinos: 4 homosexual/bisexual men, 1 elderly woman got it via blood transfusion, and 2 other undisclosed persons. The Philippines AIDS control plan for the period from July 1987 to December 1990 estimated about 500 cases of HIV infection in 1987 which could progress to 150 cases of AIDS by 1992. A total of 4000 cases of HIV infection by 1990 could result in approximately 1000 cases of AIDS by 1995. The AIDS Committee projected 300 cases by 1990. The strategy of AIDS control is to block the 3 main routes of transmission: sexual activity, contaminated blood supply, and infected mother to child. Control activities concern surveillance (high-risk behavior groups during the next 3 years) and laboratory testing, education, personnel development (counseling, clinical management, research), and organization of local AIDS committees in Angeles City, Olongapo, and Manila.^ieng