NELSON C. SORIANO, MD, PHSAE

PROVINCIAL HEALTH OFFICEOCTOBER 6, 2015

Dengue Outbreak and Response in Cavite

Province

DENGUE OUTBREAK • On September 18, 2015, the Provincial Governor declared an

Outbreak of Dengue in Cavite.

PHO technical working group conducted emergency meeting for the outbreak response, distributed invitation to concerned agencies for consultative meeting (ILHZ).

• On September 21, 2015, the PHO-Technical Division conducted a meeting with DILG, PG-NRO, Municipal/City Health Officers, Dengue Coordinators and Sanitary Inspectors to develop an action plan to fight dengue in their municipalities and cities (11/23).

• On September 23, 2015, Dengue roll-out campaign to Bgy. Lapidario spearheaded by Gov. Remulla for every family members to be involve in destroying the mosquito habitat and breeding sites in their house.

• On September 24, 2015, meeting with DOH for the outbreak response.

• On September 25, 2015, media conference conducted by PHO

DENGUE OUTBREAK • ILHZ participants in the dengue summit (11/23) 48%

• GenTaMar- Gen. Trias, Tanza, Trece Martires (all present)• AMIGA -Alfonso, Mendez, Indang, Gen. Aguinaldo,

Amadeo (Indang- no representative)• Tagaytay- (present)• MagNaMarTe- Magallanes, Naic, Maragondon, Ternate

(Ternate- No representative)• RosCaNovKa- Rosario, Cavite City, Noveleta, Kawit (No

participants)• CarSigMa- Carmona, Silang, GMA (No participants)• DaBaMus- Dasmariñas, Bacoor, Imus (No participants)

DENGUE OUTBREAK Changing Epidemiology:

The epidemiology of dengue is changing with respect to age groups and population expansion beyond urban areas. Dengue is generally considered to be a disease of early childhood (affecting individuals 2-15 years of age), increasing evidence exists that a shift to older age groups as well as infants as young as 1-2 months is occurring in Cavite.

Dengue has primarily been thought of as an urban public health problem because the disease-causing mosquito vector is so well adapted to human habitation. However, in recent years, dengue has spread into rural areas where, in the past, reporting of the disease was uncommon. This spread is occurring as rural living conditions become more similar to what is seen in urban areas; changes include different water storage and solid waste disposal practices, along with better connection between areas due to more modern transportation. 

DENGUE OUTBREAK

Surveillance:

• Updating of report (as to the number of cases, epidemic curves and clustering of dengue cases needed by the Provincial government for priority fogging/misting and media community

• Records review, media communication

Community Mobilization:

• September 25, 2015- Training of Lecturers for the dengue outbreak response team

• September 26, 2015- Emergency community assembly at Bgy. Inocencio• September 28, 2015

• Emergency meeting for Dengue Outbreak response coordinators• Press conference

DENGUE OUTBREAK

Community Mobilization:

• September 28, 2015• Orientation of Fumigators, Cities/Municipalities, PGNRO and

PGCOPS• Press conference• Meeting with PGNRO regarding the high risk areas and other areas

requesting assistance• Allocation and distribution of treated bed nets and insecticides

• Declaration of state of calamity (10 mun/cities)• Clean-up drive operations• Community assemblies• Advocacy letter crafted by president of Cavite mayors league.

DENGUE OUTBREAK

Vector control:

• September 28, 2015• Orientation of Fumigators, Cities/Municipalities, PGNRO and

PGCOPS• Meeting with PGNRO regarding the high risk areas and other areas

requesting assistance• Allocation and distribution of treated bed nets and insecticides • Putting up of treated screens at GEAMH

DENGUE OUTBREAK

Ang dengue ay nakakamatay!

Trend:

There were 5,466 dengue cases reported from January 01, 2015 to September 26, 2015 compared to 1,269 last year. This year's number of cases is 331% higher compared to the same period last year.

Geographic Distribution:

Top 5 mun/cities with the highest number of cases were Dasmariñas, Trece Martires, Gen. Trias, Imus and Bacoor.

DENGUE OUTBREAK Figure 1. Distribution of Dengue Cases by Morbidity Week

Cavite Province, MW1-37, 2015 (N=4572)

0

50

100

150

200

250

300

350

400

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

No. of Cases

Morbidity Week

2015

Epidemic Threshold

Alert Threshold

DENGUE OUTBREAK Figure 1. Distribution of Dengue Cases by Morbidity Week

Cavite Province, MW1-38, 2015 (N=5466)

0

100

200

300

400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

No. of Cases

Morbidity Week

2015

Epidemic Threshold

Alert Threshold

DENGUE OUTBREAK

Ang dengue ay nakakamatay!

Profile of Cases:Ages ranged from 1 month old to 83 years old (median= 13) and 2,121 (40%) belong to <1-10 age group. 2,926 (54%) were males.

There were 26 deaths (CFR=0.48%) compared to 6, the same period last year

MUN/CITY WITH DENGUE OUTBREAK IN CAVITE, SEPTEMBER 26, 2015

Mun/CityNo. of Cases Mun/City

No. of Cases

1. Alfonso 99 11. Mendez 83

2. Amadeo 101 12. Naic 193

3. Dasmariñas 1047 13. Noveleta 50

4. Gen. Aguinaldo 56 14. Silang 412

5. GMA 198 15. Tanza 276

6. Gen. Trias 627 16. Ternate 29

7. Indang 128 17. Trece Martires 639

8. Kawit 88 18. Rosario 111

9. Magallanes 25 19. Tagaytay 174

10. Maragondon 69 20. Carmona 60

MUN/CITY THAT EXCEEDED ALERT THRESHOLD IN CAVITE, SEPTEMBER 26, 2015

• Imus- 471 cases

• Bacoor- 446

• Cavite City- 84

We must secure their action plan and we have to disseminate the information to these areas for them to prevent an outbreaks.

ANG DENGUE AY NAKAKAMATAYDengue Deaths by Municipality/City, Cavite Province

January 1 – September 26, 2015 (n=26)

Municipality/City No. of Dengue Cases No. of Deaths

Dasmariñas 1,081 13

GMA 203 1

Gen. Trias 652 3

Indang 133 1

Naic 197 2

Rosario 112 1

Silang 422 2

Tanza 286 1

Trece Martires 676 2

Total 26

ANG DENGUE AY NAKAKAMATAY

Ano ang Dengue?• Ang Dengue ay isang sakit na ikinakalat ng isang uri ng

lamok, Aedes aegypti.• Ang Aedes aegypti ay kadalasang nangangagat sa umaga;

nangingitlog sa malinaw na tubig tulad ng makikita sa flower vases at naiipong tubig sa gulong at matatagpuan sa bubong ng bahay.

• Namumugad din sila sa latang may tubig, dahon ng halaman at butas ng kahoy kung saan may tubig na pwede nilang pangitlugan. Ang mga lamok na ito ay kadalasang naglalagi sa madidilim na lugar ng bahay.

Mga Karagdagang Impormasyon tungkol sa Lamok na Aedes Aegypti • Pagkatapos ng bawat blood meal, sila ay nangingitlog.

• Mainit na balat ang mas gusto nilang kagatin.

• Mas tawag pansin din sa kanila kung gumagalaw ang biktima. Kaya ingat ang malilikot na bata.

• Karaniwan silang umaatake o kumakagat mula sa gilid o likod ng tao.

• Sila ay nakalilipad sa layon 50-300 metro mula sa pinangitlugan o breeding area.

• Mas dumarami ang lamok na ito tuwing tag-ulan.

• Tumatagal ang kanilang buhay mula 20-30 araw.

Mga Karagdagang Impormasyon tungkol sa Lamok na Aedes Aegypti

• Mula unang kagat ng lamok na ito sa taong may dalang virus, buong buhay na siyang Dengue virus-carrier at muling mangangagat at mangingitlog tuwing ikatlong araw.

Sintomas ng Dengue• Biglaang pagkakaroon ng mataas na lagnat• Masakit na kalamnan, kasukasuan at likod ng talukap ng mata.

• Panghihina• Namumulang patse sa balat.• Pagdurugo ng ilong.• Pagsakit ng tiyan.• Sukang kulay kape.• Maitim na dumi.

Ensure proper, concerted regular, year-round clean-up drive and proper waste collection/ disposal to eradicate the breeding sites dengue-carrying mosquito.

4’s in Dengue Prevention and Control

1.Search and destroy.

2.Self-protection measures.

3.Seek early consultation.

4.Say yes to fogging when there is an impending outbreak or “hotspot”.

 

Pag-iwas sa Pagkalat ng Dengue

SEARCH and DESTROY

1. Takpan ang drum o baldeng pinagiipunan ng tubig upang hindi pangitlugan ng lamok.

2. Palitan ang tubig sa flower vases linggo-linggo.

3. Linisin lahat ng lalagyan at ipunan ng tubig minsan sa isang linggo. Kuskusing mabuti ang mga gilid nito upang maalis ang mga nakadikit na itlog ng lamok.

4. Butasin ang mga gulong na ginagamit bilang suporta ng bubong upang maiwasang pamungaran ng lamok.

5. Ipunin at ibenta ang lahat ng hindi ginagamit na basyo ng lata, bote, garapon, at iba pang bagay na maaaring tigilan ng tubig at pangitlugan ng lamok.

Pag-iwas sa Pagkalat ng Dengue

SEARCH and DESTROYLarge discarded containers (tires, toilet bowls with water and paint cans

Trash cans, pail or buckets painting trays, toys

Pag-iwas sa Pagkalat ng Dengue

SEARCH and DESTROYWater storage containers (drums, tanks, cisterns barrels, jars, buckets

Ornamental or recreational containers (plant pots and dishes, plastic pools, rooting plants in water/aquatic plants

Pag-iwas sa Pagkalat ng Dengue

SELF PROTECTION MEASURES• Magsuot ng pantalon at damit na may mahabang manggas.

Maglagay din ng insect repellent.

SEEK EARLY CONSULTATION• Kung may lagnat, magsadya at komunsulta sa

pinakamalapit ng health center o ospital

SAY YES TO FOGGING WHEN THERE IS AN IMPENDING OUTBREAK OR A “HOTSPOT”

• Mag fogging kung dumarami ang kaso sa isang lugar o may outbreak, makipagbigay alam sa inyong Municipal Health Officer, Epidemiology and Surveillance Unit at Dengue Coordinator

ANG DENGUE AY NAKAKAMATAY

Sama-sama Po tayong puksain ang mga pinamumugaran ng lamok mula sa loob ng bahay (madidilim na lugar) sa harap at likod ng bahay (lumang gulong, lata, bote, halamang tinitigilan ng tubig, sa bubong ng bahay (lumang gulong at mga pabigat sa bubong na tinitigilan ng tubig, alulod o gutter).

Hindi po ito kakayanin ng inyong Barangay officials at mga taong Munisipyo lamang, kaya marapat na makilahok ang mga:• Magulang at miembro ng pamilya• Mga guro at mag-aaral• Market tenants at mga vendors • Vulcanizing shops, flower shops owners• NGOs, religious leaders, home-owners association

At lahat pong may kakayahang maglinis ng kanilang nasasakupan

BAHAY KO RESPONSIBILIDAD KO

ANG DENGUE AY NAKAKAMATAY

RECOMMENDATIONS:

1. Declare state of calamity to mobilize funds and resources for immediate vector control.

2.Assign operational manager (ENRO staff) to monitor proper fogging/misting procedures.

3.Procure insecticides for fogging/misting that is recommended and approved by World Health Organization and Department of Health.

4. Provide daily garbage collectors for proper collection and disposal of waste.

5. Create an ordinance for the weekly, regular clean-up drive activities of every family members.

Municipal/City Mayors:

RECOMMENDATIONS:

1.Educate the public to carry out mosquito source reduction in their homes. Public education and public involvement is crucial to the sustainability of vector control program.

2.To submit dengue cases on a daily basis and analyze dengue cases using PIDSR system.

3.Include mosquito source reduction program to Barangay Health Workers and Community Health Team activities.

4. Collect and submit blood samples for laboratory confirmation to PESU.

Municipal/City Health Office:

RECOMMENDATIONS:

1. Create an ordinance to ensure that year-round (once a week) clean-up drives are conducted by the family members in their homes.

2. Educate the public to carry out mosquito source reduction in their homes.

3. Assist in the proper collection and disposal of solid waste.

4. Assist the M/CHO in reporting of dengue cases in the community.

5. Use/procure insecticides for fogging and misting approved by WHO/DOH.

Barangay Captain/Officials:

RECOMMENDATIONS:

1. Reactivate “Little Dengue Brigade Program”. They will be in charge in monitoring possible mosquito breeding sites such as containers with water inside their classrooms as well as school surroundings.

2. Educate the pupil/student the proper “search and destroy” of mosquito habitat and for them to teach each family member to carry out mosquito source eradication in their homes.

Collection and disposal of all unusable tin cans, jars, bottles and other items that can collect and hold water.

Cleaning of all water containers, pail, dish drainer/water dispenser tray, refrigerator’s defrost condensing tray, once a week to remove eggs of mosquitoes sticking to the sides. (DOH4A Larval Survey conducted on Sept. 29-Oct.1, 2015- Key containers Drum)

Department of Education:

Fight Dengue in Schools and Residential Areas

RECOMMENDATIONS:

1.To seriously undertake and intensify the government anti-dengue campaign. If the households did not believe that mosquitoes were in their homes, and if no effort to prevent mosquito from breeding in their habitations, cases of dengue in your areas will not STOP.

2. Follow 4’S, ABKD and 40 clock habit on a weekly year round basis.

Family Members:

GEAMH, PEDIATRICS SECTION: DENGUE WARD, SEPT 25, 2015

TRECE MARTIRES MEDICAL PAVILLON, SEPT. 22, 2015

• 8 out of the 9 rooms in the 2nd floor were filled with dengue cases. There were 3 beds occupied by patients with dengue on the hall way.

GEAMH, HALLWAY WITH DENGUE PATIENTS, SEPT. 25, 2015

GEAMH, HALLWAY WITH DENGUE PATIENTS, SEPT. 25, 2015

TMP 2nd floor, 3 DENGUE PATIENTS (HALLWAY), SEPT. 25, 2015

GEAMH ER SECTION 3 IN 1 BEDSEPT. 25, 2015

RUBHALL TO BE UTILIZE AS A ROOM FOR UPSURGE OF DENGUE CASES IN GEAMH C/O PHIL. RED CROSS

CONSTRUCTION OF EMERGENCY FIELD HOSPITAL PHILIPPINE RED CROSS

CONSTRUCTION OF EMERGENCY FIELD HOSPITAL PHILIPPINE RED CROSS

GEAMH, PEDIATRIC WARD EXTENSION ROOM (HALLWAY), SEPT. 25, 2015

GEAMH/KPFP/TMP DENGUE ADMISSIONS, OCTOBER 3-4, 2015

DateNo. of

Admissions

Total No. of Admitted

CasesRemarks

October 3No death reported

GEAMH 24 108

KPFP 2 10

TMP 16 0

October 4No death reported

GEAMH 12 102 (71/31)

KPFP 5 14 (7/7)

TMP 18 2

LIST OF INSECTICIDES APPROVED BY WHO/DOH

1. Pyrethroids- Permethrin

• Resigen

2. Deltamithrin

• K-othrine• Pesguard FG 161

3. Organophosphates

• Temephos (Abate)

LIST OF INSECTICIDES APPROVED BY WHO

1. Organochlorine

2. Organophosphate

3. Carbamate

4. Pyrethroid

Maraming Salamat po sa Inyong

Pakikipagtulungan!