Date: Thu 5 Sep 2019
Source: SunStar [edited]
<https://www.sunstar.com.ph/article/1821869>

Amid flooding incidents due to recent heavy rains, the Department of Health (DOH)-Davao has recorded 44 suspected leptospirosis cases with 4 deaths in Davao Region from January to [2 Sep 2019].

DOH-Davao director Dr Annabelle Yumang said on [Tue 3 Sep 2019], that suspected leptospirosis cases is highest in Davao City with 14 patients and 3 who have died; Davao del Norte has 13 cases with no death recorded; Compostela Valley Province with 11 cases and 1 death; Davao del Sur and Davao Oriental recorded 1 case each.

Leptospirosis is an infection spread mainly through contact with water or soil contaminated with the urine of infected animals, particularly rats. Persons can get the disease by swimming or wading in fresh unchlorinated water contaminated with animal urine or by coming into contact with wet soil or plants contaminated with animal urine.

In the past weeks, Davao Region experienced a series of heavy downpour particularly in Davao City that has caused massive flooding. With this, Yumang advised the public and the flood victims to remain vigilant during the rainy season to prevent from acquiring this fatal disease.

"[It is important that after the flooding, the City Government visits the evacuation areas to administer antibiotic. Anyway, it is easy to administer the antibiotic since it is only a single-dose]," Yumang said.

DOH has given the flood victims doxycycline, the antibiotic drug used as standard prophylaxis for leptospirosis patients. She further assured that there is no shortage of the antibiotic and they are ready to respond should there is a need for these medicines to prevent the disease from being acquired which is caused by the flood.

The symptoms of the infection include fever, chills and severe headache, which usually appear four to 14 days after being exposed to contaminated floodwaters or mud. Aside from that, an infected individual may manifest red eyes, jaundice, tea-coloured urine and difficulty to urinate.

"[I advised the flood victims to go to the health centres if they were exposed to contaminated flood water]," Yumang said.  [Byline: Juliet C Revita]
=========================
[Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, and swine), especially rodents that are chronically infected with pathogenic _Leptospira_. The spirochete _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

ProMED-mail recently reported on a leptospirosis outbreak after flooding in the Calabarzon region of the Philippines (ProMED-mail post Leptospirosis - Philippines: flooding http://promedmail.org/post/20190826.6641939); Calabarzon situated south and east of Metro Manila on the island of Luzon (<https://en.wikipedia.org/wiki/Calabarzon>).

The leptospirosis outbreak reported in the news article above is occurring following flooding in the Davao Region, situated on the south-eastern portion of Mindanao, an island that comprises 5 provinces: Compostela Valley, Davao del Norte, Davao del Sur, Davao Oriental and Davao Occidental, the newly created province (<https://en.wikipedia.org/wiki/Davao_Region>). - ProMED Mod.ML]

[Maps of Philippines:
<https://upload.wikimedia.org/wikipedia/commons/2/2a/Ph_regions_and_provinces.png>
and <http://healthmap.org/promed/p/21157>]
Date: Sun 1 Sep 2019 06:20 AM PHT
Source: Inquirer [edited]
<https://newsinfo.inquirer.net/1159667/doh-urges-polio-shots-virus-detected-in-sewage>

The Department of Health (DOH) on [Sat 31 Aug 2019] appealed to parents to have their children vaccinated against polio, after a test on Manila's sewage showed the existence of the virus that causes the debilitating disease.

Health Secretary Francisco Duque III said a recent sampling of Manila's sewage tested positive for the vaccine-derived poliovirus (VDPV), which the World Health Organization (WHO) defined in its website as "an excreted vaccine-virus that can continue to circulate for an extended period of time."

No transmissions yet
--------------------
"The longer it is allowed to survive, the more genetic changes it undergoes. In very rare instances, the vaccine-virus can genetically change into a form that can paralyze -- this is what is known as a circulating vaccine-derived poliovirus (cVDPV)," WHO said in its website (<http://who.int/features/qa/64/en/>).

Duque said that while there are no recorded transmissions yet, parents should ensure that their children are protected since the virus is already in the environment. "We repeat our call to parents and caregivers: Let us prioritize the complete vaccination of our children so they remain safe from vaccine-preventable diseases, like polio," the health secretary said at a press conference. "We need to make sure that the polio vaccine coverage should be at 95 percent to ensure that this will not create problems to our children," Duque said.  There is no cure for the disease, he added. "Complete vaccination is the best way to prevent it," he said.

The Philippines since 2016 has been falling short of the ideal immunization coverage rate of 95 percent. Coverage was at 68 percent in 2016, increasing slightly to 71 percent the next year, but dropping again to 66 percent in 2018. A fatal and disabling disease, polio is transmitted through the faecal-oral route, especially where there's poor personal hygiene and environmental sanitation. It mostly affects children below 15.

Polio-free since 2000
Apart from the latest disclosure by Duque, the Philippines has been certified polio-free since 2000 by the DOH.  Given that VDPV was found in the city of Manila, Duque called on local governments to intensify the implementation of their zero open-defecation program as well as to strengthen their efforts to ensure good personal hygiene and sanitation.

The US Centers for Disease Control and Prevention described VDPV as a "strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus."  "This means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an infected person," the CDC said. Given that sewage usually end up in Manila Bay, Duque said it "remains unsafe for swimming."

As part of its efforts to ensure that no child is left unvaccinated, the DOH is currently conducting an immunization drive for polio aimed at covering 5.5 million children in the National Capital Region, Central Luzon, and Calabarzon.  "The vaccination is free and will be administered by giving a child 2 drops of OPV [oral poliovirus vaccines] by mouth. OPV has been used in the country since 1980," Duque said.  [Byline: Jovic Yee]
==========================
[The good news is that the Philippines are doing environmental monitoring for polioviruses. The not so good news is that with falling vaccination coverages over the past few years, there is now a vaccine derived poliovirus found in sewage sampling of the major metropolis of Manila with a population of approximately 24.7 million people in 2018, the 8th largest metropolitan area in the world. As of the present, there have not been confirmed cases of cVDPV identified among AFP (acute flaccid paralysis) cases in the Philippines....but will it remain that way???  

HealthMap/ProMED-mail map of the Philippines:
<http://healthmap.org/promed/p/46984>. - ProMED Mod.MPP]
Date: Fri 30 Aug 2019
Source: The Philippine Star [abridged, edited]
<https://www.philstar.com/nation/2019/08/30/1947482/measles-cases-962-negros-occidental>

Measles cases increased by 962% in Negros Occidental in 2019, according to the provincial health office. At least 828 cases and 5 deaths were reported from 1 Jan - 3 Aug [2019] compared to only 72 cases during the same period last year [2018].

Provincial health officer Ernell Tumimbang said 54% of the patients have no vaccination against measles.

Negros Occidental Gov. Eugenio Jose Lacson said the increase in the number of measles cases is not considered alarming. He said the provincial government is more focused in its campaign against dengue.

37 people have died of dengue in the province since January [2019].  [Byline: Gilbert Bayoran]
Date: Mon 26 Aug 2019, 12:00 pm
Source: Republic of the Philippines, Philippine News Agency [edited]
<https://www.pna.gov.ph/articles/1078716>

The Department of Health (DOH) in Calabarzon (Cavite, Laguna, Batangas, Rizal and Quezon) urged residents to take precautionary measures as the number of leptospirosis cases in the region has reached 75, with 12 recorded deaths. DOH Calabarzon regional director Eduardo C. Janairo also directed local health officials and local leaders to take the necessary precautions to prevent the spread of leptospirosis and the current dengue outbreak in the communities due to the rainy season. "Leptospirosis just like dengue is fatal but also preventable. All we need is to clean our surroundings, be sure that our garbage is well-attended and improve flood control measures in the community," Janairo said in his meeting with officials of the province of Cavite on [Fri 23 Aug 2019].

He also reminded parents of children to avoid playing outside their homes during rainy days to reduce risk of leptospirosis related to flooding. "If we have no business to go outside our homes, it is best to stay inside and be safe," he added. The DOH Regional Epidemiology and Surveillance Unit (RESU) showed a total of 75 leptospirosis cases recorded in the region from [1 Jan to17 Aug] this year [2019]. This, however, is 62% lower compared with last year's [2018] 199 recorded cases during the same period.

The infectious disease caused by leptospira bacteria from urine of rats has already claimed 12 lives in the region, with Rizal province having the highest number of cases at 34 with 7 deaths. Cavite has recorded 18 cases and 2 deaths; Laguna with 14 cases and 1 death; Batangas - 9 cases and 2 deaths, while Quezon has no reported cases. The cities and towns in the region with high incidence are Antipolo City with 15 recorded cases; Rodriguez - 9 cases and San Mateo - 6 cases in Rizal province while Binan City in Laguna and Dasmariñas City in Cavite reported 5 leptospirosis cases each. The ages of cases ranged from less than 1 year to 72 years old.

Majority of the cases were male and most of belonged to the 11-20 year-old age group. Janairo advised those who walk through or wade into flooded areas and streets to wear boots as the bacteria causing the disease may seep in through open wounds or scratches on feet and thighs. "Kailangan din nating uminom ng prophylaxis gaya ng docycyline bago tayo lumusong sa tubig upang makaiwas sa impeksyon na dala ngleptospirosis (it is necessary to take prophylaxis like doxycycline before wading through flood areas to prevent leptospirosis infection)," he said. According to the DOH, the leptospirosis disease is transmitted through skin abrasions while walking in moist soil, rice fields, and sugar cane plantations contaminated with the urine of an infected animal, like rats.

Other areas that may likely be contaminated with the disease are swimming pools, floodwaters, accidental immersion, occupational abrasion or direct contact with urine or even tissues of infected animals. Janairo also urged residents to go to the nearest health centre or hospital for any symptoms such as fever; body chills; headache and pains in the thigh, muscles and joints; redness in the eyes; skin turning pale and yellowish; and difficulty in urinating. [Byline: Saul Pa-a]
==============================
[Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. The spirochete _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Calabarzon, with a population of about 14.4 million residents in 2015, is a region situated south and east of Metro Manila that comprises 5 provinces: Cavite, Laguna, Batangas, Rizal, and Quezon, and a highly urbanized city, Lucena. It is also the country's 2nd most densely populated after Metro Manila (<https://en.wikipedia.org/wiki/Calabarzon>).

A map of Calabarzon can be found at
<https://www.google.com/maps/place/Calabarzon,+Philippines>.

A map showing the provinces of Calabarzon can be found at
<https://sites.google.com/site/region4ppadoj/regional-map>. - ProMED Mod.ML]

[HealthMap/ProMED map available at: Philippines:
<http://healthmap.org/promed/p/158>]
3 Aug 2019

Death toll from dengue fever recorded in the different regions rose to 384, the National Disaster Risk Reduction and Management Council (NDRRMC) said yesterday [2 Aug 2019]. Those who have died from the dreaded mosquito bite were recorded in MIMAROPA (Mindoro, Marinduque, Romblon, and Palawan), Calabarzon (Cavite, Laguna, Batangas, Rizal, and Quezon) regions and in Regions 6, 7, 8, 10 and Cordillera Administrative Region (CAR). The NDRRMC said dengue cases ballooned to 88 598.

NDRRMC executive director and Office of Civil Defense undersecretary Ricardo Jalad said Region 6 has the most number of dengue cases, with 23 216; followed by Calabarzon with 14,925, Region 10 with 13 734, Region 7 with 10 670, Region 12 with 10 338, Mimaropa with 4488, and CAR with 3458.

Region 8 was the recent to be added to the list of areas affected by dengue, with 7769 cases and 27 deaths. Of the number of deaths in Region 8, 8 were from Eastern Samar, 7 in Leyte, 4 in Tacloban City, 3 from Southern Leyte, and one each from Biliran, Calbayog City, Catbalogan City, Ormoc City, and Baybay City.

Thirteen areas were declared under a state of calamity, including Cavite in Calabarzon; Palawan; municipality of Rizal; barangay Punta Baja in Rizal; municipality of Sofronio Espanola in the MIMAROPA region; Capiz, particularly the towns of Ponteverde and Roxas; Maasin; Iloilo; municipalities of Culasi and Sebaste in Antique, both in Region 6; and South Cotabato, including municipalities of Tantangan and Norala in Region 12.
<https://journal.com.ph/news/provincial/dengue-death-toll-rises-384>

- National. 6 Aug 2019. The Philippines declared a national dengue epidemic on Tuesday [6 Aug 2019], saying that the mosquitoborne disease had killed at least 622 people in the country so far this year [2019]. More than 146 000 dengue cases were reported in the 1st 7 months of the year, almost twice as many as in the same period last year [2018], according to the country's health department. "This is really staggering," said Francisco Duque, the health secretary. He said the declaration of an epidemic was needed so that local governments in badly hit places could use "quick response funds" to fight the disease. Officials said the Western Visayas region of the Philippines had the most cases, at more than 23 000, followed by the suburbs south of Manila, the capital, which had more than 16 500 cases. Parts of the southern island of Mindanao also reported a high number of infections.
<https://www.nytimes.com/2019/08/06/world/asia/philippines-dengue.html>

- National. 11 Aug 2019. The number of dengue cases has soared to more than 160 000, the highest in the last 5 years, with 661 fatalities so far, an official of the Department of Health (DOH) said. Undersecretary Eric Domingo noted the DOH-Epidemiology Bureau had documented a total of 12 880 cases in barely a week from 21-27 Jul [2019], which brought the total number to 167 606 patients since 1 Jan [2019]. "This is the highest in the last 5 years. This is also 98% higher than the cases during the same period in 2018. That's why this is the 1st time that we declared a national dengue epidemic," Domingo said. The figure will likely breach the 216 190 cases recorded in the entire 2018.
<http://www.dailyexpress.com.my/news/139182/dengue-cases-soar-to-160-000-with-661-deaths/>

- Davao region. 9 Aug 2019. 4345 dengue cases reported in Davao region.
<https://www.mindanews.com/top-stories/2019/08/4345-dengue-cases-reported-in-davao-region/>

- Negros Occidental. 8 Aug 2019. 2468 cases from 1 Jan-3 Aug 2019, 224% higher than last year [2018]; 12 deaths have been reported in this period.
<https://www.pna.gov.ph/articles/1077259>

- Cafayan de Oro city. 20 Aug 2019. At least 795 new suspected cases in NorMin.
<https://www.mindanews.com/top-stories/2019/08/795-new-dengue-cases-reported-in-normin/>

- Bataan. 20 Aug 2019. At least 120 Chinese workers of a coal-fired power plant here have been afflicted with dengue virus, a provincial board member said.
<https://newsinfo.inquirer.net/1155366/dengue-virus-downs-120-chinese-workers-in-bataan>

HealthMap/ProMED-mail map of the Philippines:
<http://healthmap.org/promed/p/158>
More ...