A case report of Japanese encephalitis in Paracelis, Mountain Province, the Philippines.

On 12 September 2022, a 10-year-old female in Paracelis municipality, Mountain Province, the Philippines, without travel history outside the municipality, experienced acute onset of fever and a change in mental status with disorientation, an altered level of consciousness and new onset of seizures. She was hospitalized at the district hospital from 1 to 3 October 2022, before being transferred to the regional hospital. As diphtheria was originally suspected, the investigation team reviewed records and reports and interviewed key informants to gather additional information and organize case finding and contact tracing. The patient's condition was laboratory-confirmed for Japanese encephalitis virus infection. An environmental survey was carried out at the patient's residence to check for the presence of vectors and contributing factors. Exemplifying inadequate vaccination coverage for Japanese encephalitis virus in Mountain Province, the patient had not been vaccinated against the disease. It is recommended that vaccination campaigns be immediately implemented in the affected area and the surveillance system be strengthened for early detection and prompt response to the emergence of cases and outbreaks. Overall, the investigation highlighted the importance of strong surveillance and response systems for early detection and control of diseases, such as Japanese encephalitis virus. It also underscores the need for comprehensive vaccination programmes to prevent outbreaks and protect vulnerable populations.

Descriptive analysis of a SARS-CoV-2 outbreak among health-care workers in a regional hospital in the Philippines.

Objective: On 25 July 2022, trainees from the Field Epidemiology Training Programme in Northern Luzon, Philippines were sent to conduct an epidemiological investigation of six confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among staff of a regional hospital in Mountain Province. The investigation had three objectives: to profile the cases, identify the source and mode of transmission, and recommend prevention and control measures. Methods: Descriptive epidemiology was used to investigate the outbreak, with the standard case definition issued by the Philippine Department of Health. Results: A total of 167 hospital personnel and interns tested positive for SARS-CoV-2 infection between 6 July and 31 August 2022, with a peak in the number of cases on 20 July. Among the cases, 57 (34%) had a history of travel, with 41 (25%) having travelled to Boracay island to attend team-building activities. Most cases were asymptomatic, and the most affected group was those aged 30-34 years. The highest number of cases occurred among nurses. It was discovered that the team-building activities on Boracay did not strictly adhere to safety protocols. Discussion: This outbreak suggests that transmission of SARS-CoV-2 among health-care workers can occur through contact with other staff members outside of the hospital setting and highlights the importance of strict adherence to safety protocols to prevent the spread of SARS-CoV-2.

Creating "boots on the ground": addressing the shortage of field epidemiologists in the Philippines through intermediate-level training programmes.

Problem: As of 2022, only 49 graduates of the Philippines' Field Epidemiology Training Programme (FETP) were employed by the Philippine Government, emphasizing the urgent need to increase the number of practicing field epidemiologists to better equip the country for public health emergencies. Context: The FETP-Intermediate Course (IC) curriculum is based mainly on the module of the United States Centers for Disease Control and Prevention that was incorporated into the Philippine context. It consists of five 1-2-week lecture series that provide participants with the knowledge and tools necessary to conduct job-relevant field projects. Individual projects are the centrepiece of the FETP-IC, requiring trainees to investigate outbreaks, design and develop protocols, conduct field data collection, manage data, analyse data, interpret data, write reports and deliver oral presentations. Action: To address the shortage of practicing field epidemiologists in the Philippines, a subnational initiative in Northern Luzon was implemented. Outcome: Within 3 years, the two FETP-IC subnational training programmes have produced 42 applied epidemiologists who will strengthen epidemiology and surveillance in their respective localities. As of February 2023, 92 studies have been conducted, including 39 outbreak investigations, 37 data quality analysis/process improvement projects, 10 epidemiological studies and six surveillance evaluations. Discussion: By training and deploying skilled epidemiologists to local health offices and hospitals, the programme is helping to improve the capacity of the health system to respond to public health threats and protect the health of the population. The programme's emphasis on practical training and real-world experience is an effective way to build a strong and sustainable epidemiological workforce.

School outbreak of hand, foot and mouth disease in Balungao, Pangasinan Province, Philippines, October 2022.

Objective: On 24 September 2022, the Regional Public Health Unit in Ilocos received a report of a cluster of suspected hand, foot and mouth disease (HFMD) in one school in Balungao, Pangasinan Province, the Philippines. On 4 October 2022, the public health unit sent a team from the Field Epidemiology Training Program - Intermediate Course to conduct an outbreak investigation. Methods: Active case-finding was conducted at the school. A suspected case was defined as any student or staff member with mouth ulcers and papulovesicular or maculopapular rash on the palms, fingers, soles of the feet or buttocks occurring from 1 September to 5 October 2022. We interviewed school officials about possible sources of infection and students' activities. We collected oropharyngeal swab samples for testing. Findings were used for descriptive analysis. Results: Nine suspected cases of HFMD were detected, with the highest number of cases (6, 67%) occurring in children in grade 1. The majority of cases (7, 78%) were 6 years old, and five cases (56%) were male. Seven (78%) of the cases had been exposed to a confirmed case of HFMD, as reported by their parents or guardians and teachers. Six cases (67%) were positive for coxsackievirus A16 and two (22%) for enterovirus. Discussion: The causative agents of this outbreak were coxsackievirus A16 and other enteroviruses. Direct contact with a confirmed case was the source of transmission, with a lack of physical distancing in classrooms likely contributing to transmission. We recommended that the local government implement measures to control the outbreak.

Risk assessment of Ebola Reston virus in humans in the Philippines.

OBJECTIVE: There have been five documented outbreaks of Ebola Reston virus (RESTV) in animals epidemiologically linked to the Philippines. This assessment was conducted to determine the risk of RESTV occurring in humans in the Philippines and its potential pathogenicity in humans. METHODS: The World Health Organization Rapid Risk Assessment of Acute Public Health Events Manual was used for the assessment. A literature review was done and a risk assessment matrix was used for the risk characterization of the outbreaks in the Philippines. The risk assessment was conducted by the Philippines Field Epidemiology Training Program. RESULTS: The risk of RESTV occurring in humans in the Philippines and its potential pathogenicity in humans were both assessed as moderate. Animals involved in RESTV outbreaks in the Philippines were non-human primates and domestic pigs. The presence of RESTV in pigs poses a possibility of genetic evolution of the virus. Although RESTV has been identified in humans, there was no death or illness attributed to the infection. The Philippines Inter-agency Committee on Zoonoses oversees collaboration between the animal and human health sectors for the prevention and control of zoonoses. However, there is no surveillance of risk animals or previously affected farms to monitor and facilitate early identification of cases. DISCUSSION: The moderate risk of RESTV recurring among humans in the Philippines and its potential pathogenicity in humans reinforces the need for early detection, surveillance and continued studies of RESTV pathogenesis and its health consequences. The One Health approach, with the involvement and coordination of public health, veterinary services and the community, is essential in the detection, control and management of zoonosis.

Epidemic hysteria following the National School Deworming Day, Zamboanga Peninsula, Philippines, 2015.

INTRODUCTION: In July 2015, the Philippines conducted a school-based mass drug administration using albendazole for soil-transmitted helminths infection. Reports of adverse events were subsequently made through the event-based surveillance system, mostly from the Zamboanga Peninsula on the island of Mindanao. A team from the Epidemiology Bureau investigated the reports of adverse events following mass drug administration (AEFMDA). METHODS: Five schools were identified for the investigation which comprised an unmatched case-control study, key informant interviews and laboratory examinations. AEFMDA cases were students who had sudden onset of abdominal pain, vomiting, diarrhoea, loss of consciousness, headache or dizziness within 24 hours after intake of deworming tablet; controls were healthy students who did not develop signs and symptoms after deworming. RESULTS: Most (85%) of the 7313 AEFMDA cases reported nationwide were from Zamboanga Peninsula. Most reports were made after rumours of deaths following deworming and of the use of expired drug were spread through the region. Many parents sent their children to hospital, even if asymptomatic. The case-control study found that being an AEFMDA case was associated with no history of previous deworming (odds ratio = 4.08, 95% confidence interval: 1.77-9.42). DISCUSSION: The investigation concluded that epidemic hysteria was the cause of the increased number of AEFMDA cases in the Zamboanga Peninsula. The false information, aggravated by social media, caused panic and an increase in reporting. Some cases had no history of deworming, and they may not have been aware that albendazole is safe and that side-effects are expected. Risk communication before, during and after future national deworming programmes are recommended to prevent unnecessary reporting of AEFMDA.

A retrospective cohort study on cassava food poisoning, Santa Cruz, Davao del Sur, Philippines, October 2015.

OBJECTIVE: On 2 October 2015, the Event-Based Surveillance and Response Unit of the Department of Health (DOH), Philippines received a report of foodborne illness cases in Santa Cruz, Davao del Sur. A team from DOH was sent to conduct an investigation to identify the implicated source and determine risk factors. METHODS: A retrospective cohort study was done. A suspect case was defined as a previously well individual in Compound A, Santa Cruz who developed abdominal pain, headache, dizziness, diarrhoea or vomiting on either 1 or 2 October 2015. A confirmed case was a suspect case positive for cyanide in urine. Family members who prepared the food were interviewed. Urine specimens were collected to test for thiocyanate, and cassava tuber and soil samples were tested for cyanide and other chemicals. RESULT: Fourteen cases with two deaths were identified (case fatality ratio: 14%). All cases consumed cassava on 1 October 2015 except for one child who spat it out. Urine samples were all negative (36, 100%) for thiocyanate so there were no confirmed cases. The cassava sample had a cyanide level of 68.94 ug/g and was identified as bitter cassava, also known as a potentially dangerous kind. Insufficient food preparation was noted. In the retrospective cohort study, intake of cassava (RR = 208, 95% CI: 19.94-2169.32) was associated with the illness. DISCUSSION: This study identified insufficiently processed cassava root crop as the source of the foodborne illness. The cassava consumed was the bitter variety that contains greater than 50 ug/g of hydrogen cyanide and requires thorough preparation before consumption. Community education was provided on identifying and preparing cassava appropriately.

Investigation of a measles outbreak in Cordillera, Northern Philippines, 2013.

INTRODUCTION: Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. METHODS: Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. RESULTS: There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years). Thirty-two were male (64%). Twenty (40%) were hospitalized with one death. Thirty-two (64%) cases were laboratory confirmed, and 36 (72%) received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96%) knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. CONCLUSION: This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles.