Monday, August 27, 2018

Specific Guidelines: Interim Guidelines for Dengvaxia | DOH AO 2018-0005

Administrative Order 2018-0005. Department of Health Philippines.

Interim Guidelines on Dengue Diagnosis, Referral and Management for Dengvaxia Vaccinated Individuals

Contents:

I. RATIONALE
II. OBJECTIVE
III. SCOPE
IV. DEFINITION OF TERMS
V. GENERAL GUIDELINES
VI. SPECIFIC GUIDELINES
VII. ROLES AND RESPONSIBILITIES
VIII. REPEALING CLAUSE
Annex 1: Dengvaxia Identification Card
Annex 2: Guide for Stepwise Approach to Assessment of Dengue
Annex 3: Dengue Patient Diagnosis and Referral Algorithm
Annex 4: Dengue Homecare Card
Annex 5: Dengue Referral Form Template
Annex 6: Group A - Action Plans For Patient Who May Be Sent Home
Annex 7: Group B - Action Plans for Patient Without Warning Signs But With Co-Existing Conditions
Annex 8: Group B - Action Plans For Other Dengue Patients Without Warning Signs Who Are Admitted But Without Shock
Annex 9: Group B - Action Plans for Patients With Warning Signs
Annex 10: Group C - Treatment of Patients Admitted to the Hospital With Compensated Shock
Annex 11: Group C - Treatment for Patients admitted to the hospital with Hypotensive Shock (in profound shock; undetectable pulse and BP)
Annex 12: Treatment of Hemorrhagic Complications
Annex 13: The Role of Inotropes

VI. Specific Guidelines

A. Identification of Dengvaxia vaccinated individuals

  1. All Dengvaxia-vaccinated individuals under the school-based and community-based immunization program, shall be validated by the respective school, health centers/ RHUs; and shall be issued with vaccination cards (Refer to Annex 1: Dengvaxia Identification Card)
  2. Individuals who received Dengvaxia from private physicians and private schools shall be registered to the health center/ RHU nearest to their place of residency.
  3. Private physicians and private schools shall provide lists of Dengvaxia-vaccinated individuals to the Municipal Health Office (MHO)/ City Health Office (CHO) nearest to their place.
  4. The name of the child shall be validated from the Dengvaxia masterlist.
    • If the child is not listed in the masterlist, the old identification card, or the patient record duly signed by the administering physician shall be used as proof of identification.
  5. The Dengvaxia card shall be presented upon consultation to avail laboratory and medical services.

B. Assessment and Diagnosis

  1. Individuals with chief complaints similar to signs and symptoms of dengue shall be immediately asked regarding previous history of vaccination.
  2. If an individual is confirmed to have been vaccinated with Dengvaxia and exhibited signs and symptoms of dengue, prioritization shall be done to rule out possible dengue infection. (Refer to Annex 2: Guide to Stepwise Approach to Assessment of Dengue)
  3. Dengue patient shall be categorized according to level of severity and case definitions as follows:
    1. Dengue without warning signs
      1. suspect dengue
        • patient who received at least one dose of the vaccine, with acute febrile illness of 1-7 days duration plus two of the following:
          • headache
          • body malaise
          • retro-orbital pain
          • myalgia
          • arthralgia
          • anorexia
          • nausea
          • vomiting
          • diarrhea
          • flushed skin
          • rash (petechial, Hermann's sign)
      2. probable dengue
        • a suspect case plus laboratory test: Dengue NS1 antigen test and at least CBC (leukopenia with or without thrombocytopenia) and/or dengue IgM antibody test
      3. confirmed dengue
        • a suspect case or probable case with positive result from viral culture and/or Polymerase Chain Reaction (PCR)
    2. Dengue with warning signs
      • a patient who received at least one dose of dengue vaccine, with acute febrile illness of 1-7 days plus any of the following:
        • abdominal pain or tenderness
        • persistent vomiting
        • clinical fluid accumulation (ascites)
        • mucosal bleeding
        • lethargy or restlessness
        • liver enlargement >2 cm
        • increase in hematocrit concurrent with rapid decrease in platelet count
    3. Severe Dengue
      • Severe Plasma Leakage leading to
        • shock (DSS)
        • fluid accumulation with respiratory distress
      • Severe bleeding
        • as evaluated by clinician
      • Severe Organ Impairment
        • Liver: AST or ALT >= 1000
        • CNS: e.g. seizures, impaired consciousness
        • Heart and other organs (e.g. myocarditis, renal failure)
  4. Case classifications and duration of illness shall be the basis to request for laboratory test (Refer to Annex 3: Dengue Patient Diagnosis and Referral Algorithm). Description of tests as follows:
    1. Dengue NS1 RDT (must be done)
      • Requested between 1- 5 days of illness
      • Used to detect dengue NS1 virus antigen during early phase of acute infection
      • Test is free in health centers and selected public and private hospitals
    2. Other Tests: Total White Blood Cell (WBC) Count, Platelet, Hematocrit (must be done)
      • Routinely used in health centers and hospitals as standard dengue diagnostic tests
      • Determine trends of decreasing WBC, decreasing platelet and increasing hematocrit
      • Requested in the first visit
    3. Dengue IgM/ IgG RDT (May be done)
      1. Requested beyond five days of illness
      2. Used to detect dengue antibodies during the acute late stage of dengue infection (IgM) and to determine previous infection (IgG)
      3. May give false positive result due to antibodies induced by dengue vaccine
      4. May cross react with other arboviral illness such as Chikungunya and Zika
      5. DOH augmentation is limited to selected government hospitals only.
  5. The Dengye NS1 RDT can be used in combination with Dengue IgM/ IgG RDT. The combination test is supported only by the Department of Health at the hospital level. Result can be interpreted as follows:
    • Acute Early Infection
      • NS1 Ag (+)
      • Dengue IgG (+)
      • Dengue IgM (-)
    • Primary Dengue Infection
      • NS1 Ag (-)
      • Dengue IgG (+)
      • Dengue IgM (-)
    • Secondary Dengue Infection
      • NS1 Ag (+)
      • Dengue IgG (+)
      • Dengue IgM (+)
    • Acute Dengue Infection, Secondary Infection
      • NS1 Ag (-)
      • Dengue IgG (+)
      • Dengue IgM (+)
    • Acute Primary, Early Phase
      • NS1 Ag (+)
      • Dengue IgG (-)
      • Dengue IgM (-)
    • No infection or level of antigen and antibody is too low to measure
      • NS1 Ag (-)
      • Dengue IgG (-)
      • Dengue IgM (-)
  6. For Dengue with warning signs and severe dengue, other tests and procedures can be done depending on discretion of the attending physician.
  7. Three (3) ml of blood samples shall be collected (two sets ㅡ one on admission, one before discharge) and shall be submitted to the Research Institute of Tropical Medicine (RITM) for the following tests:
    • Polymerase Chain Reaction (PCR) ㅡ used to confirm dengue virus
    • Plaque Reduction Neutralization Test (PRNT) ㅡ is the gold standard to characterize and quantify circulating level of anti-DENV neutralizing antibody.

C. Referral

  1. Referral of Dengue patient from the health center/ RHU to hospital shall be based on the following criteria: (1) severity of disease and (2) phase of dengue infection. Phases of dengue infection shall guide the health worker according to the following:
    1. Febrile Phase
      • Usually lasts 2-7 days
      • Mild hemorrhagic manifestations like petechiae and mucosal membrane bleeding (e.g. nose and gums) may be seen.
      • Difficult to distinguish dengue with other non-dengue febrile diseases thus a positive tourniquet test increases the probability of dengue.
      • Oral Rehydration Solution shall be used as needed to keep the body hydrated.
      • Observe for the following:
        • Signs of Dehydration and neurological disturbances
        • High fever that may cause seizures in young children
        • Warning signs
      • Note: Monitoring of warning signs is crucial to recognize its progression to critical phase
    2. Critical Phase
      • This is the phase when patient can either improve or deteriorate.
      • Defervesence is known as the period in which the body temperature (fever) drops to almost normal (between 37.5 to 38℃)
      • Those who will improve after defervescence will be categorized as Dengue without Warning Signs, while those who will deteriorate will manifest warning sins and will be categorized as Dengue with Warning Signs or some may progress to Severe Dengue.
      • Regularly monitor the body temperature to determine when the patient reaches defervescence.
    3. Recovery Phase
      • Happens in the next 48 to 72 hours after critical phase in which the body fluids go back to normal.
      • Patients' general well-being improves, appetite returns, gastrointestinal symptoms abate, haemodynamic status stabilizes and diuresis ensues.
      • Some patients may have classical rash of "isles of white in the sea of red" or generalized pruritus.
      • The WBC usually starts to rise soon after defervescence but the normalization of platelet counts typically happens later than that of WBC.
  2. Patients shall be referred using the dengue vaccine referral form template and through the dengue fast lane established in hospitals. Summary of referral actions area as follows:
    1. Phase of Infection: Febrile 
      • Severity: Without Warning Signs
        • Shall be managed at the health center or hospital out-patient.
      • Severity: With Warning Signs
        • Shall be immediately referred to the nearest hospital for admission
    2. Phase of Infection: Critical
      • Severity: Without Warning Signs
        • Shall be managed at the health center or hospital out-patient.
      • Severity: With Warning Signs
        • Shall be immediately referred to the nearest hospital for admission
      • Severity: Severe Dengue
        • Shall be immediately referred to the emergency unit
    3. Phase of Infection: Recovery
      • Severity: With Warning Signs
        • Shall be stabilized first before transferring to the nearest government hospital if initially admitted in the private hospital
      • Severity: Severe Dengue
        • Shall be stabilized as needed
        • No need to transfer
  3. Hospitals shall ensure the availability of dengue fast lanes and hospital beds for dengue patients referred in the hospital.
  4. There shall be a designated area in the hospital to cohort dengue patients and closely monitor those who will shock.
  5. Doctors and nurses shall be trained on Revised Dengue Clinical Management Guidelines to equip them to recognize high-risk patients and institute appropriate monitoring and treatment.

D. Management and Treatment

Classification and guidelines based on management and treatment of dengue patient are as follows:
  1. Group A - patients who may be sent home
    1. These are patients who:
      • are able to tolerate adequate volumes of oral fluids
      • Pass urine at least every 6 hours
      • Do not have any of the warning signs particularly when the fever subsides
      • Have stable haematocrit
    2. Go to Action Plans For Patient Who May Be Sent Home.
  2. Group B - patients who should be referred for in-hospital management
    1. Patients shall be referred immediately to in-hospital management if they have the following conditions:
      • Warning signs
      • Without warning signs but with co-existing conditions that may make dengue or its management more complicated, such as
        • pregnancy
        • infancy
        • old age
        • obesity
        • diabetes mellitus
        • hypertension
        • heart failure
        • renal failure
        • chronic hemolytic diseases such as 
          • sickle-cell disease
          • autoimmune disease
      • Social circumstances such as living alone or living far from health facility or without a reliable means of transportation.
      • The referring facility has no capability to manage dengue with warning signs and/or severe dengue.
    2. These patients shall be referred and admitted for in-hospital management using the dengue patient referral form
    3. Refer to Specific Action Plans depending on Severity of Dengue
  3. Group C- patient with severe dengue requiring emergency treatment and urgent referral
    1. These are patients with severe dengue who require emergency treatment and urgent referral because they are in the critical phase of the disease and have the following:
      • Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress.
      • Severe hemorrhages
      • Severe organ impairment
        • hepatic damage
        • renal impairment
        • cardiomyopathy
        • encephalopathy
        • encephalitis
    2. Patients in Group C shall be immediately referred and admitted in the hospital within 24 hours
    3. All patients with severe dengue shall be referred by the health center/ RHU to a hospital with access to blood transfusion facilities
    4. Fluid resuscitation shall be clearly separated from simple fluid administration.
      • Judicious intravenous fluid resuscitation is the essential and usually sole intervention required.
      • The goals of fluid resuscitation include
        • Improving central and peripheral circulation
          • decreasing tachycardia
          • improving blood pressure and pulse volume
          • warm and pink extremities
          • capillary refill time <2 seconds
        • Improving end-organ perfusion
          • achieving a stable conscious level
            • more alert or less restless
          • urine output ≥ 0.5 ml/kg/hour
          • decreasing metabolic acidosis
    5. Refer to Specific Treatment Based on Presence or Absence of Shock
  4. Patient shall be discharged if all of the following conditions are present:
    1. No fever for at least 48 hours
    2. Improvement in clinical status
      1. general well-being
      2. appetite
      3. hemodynamic status
      4. urine output
      5. no respiratory distress
    3. Increasing trend of platelet count
    4. Stable hematocrit without intravenous fluids

Sunday, March 18, 2018

General Guidelines: Interim Guidelines for Dengvaxia | DOH AO 2018-0005

Administrative Order 2018-0005. Department of Health Philippines

Interim Guidelines on Dengue Diagnosis, Referral and Management for Dengvaxia Vaccinated Individuals

Contents:

I. RATIONALE
II. OBJECTIVE
III. SCOPE
IV. DEFINITION OF TERMS
V. GENERAL GUIDELINES
VI. SPECIFIC GUIDELINES
VII. ROLES AND RESPONSIBILITIES
VIII. REPEALING CLAUSE
Annex 1: Dengvaxia Identification Card
Annex 2: Guide for Stepwise Approach to Assessment of Dengue
Annex 3: Dengue Patient Diagnosis and Referral Algorithm
Annex 4: Dengue Homecare Card
Annex 5: Dengue Referral Form Template
Annex 6: Group A - Action Plans For Patient Who May Be Sent Home
Annex 7: Group B - Action Plans for Patient Without Warning Signs But With Co-Existing Conditions
Annex 8: Group B - Action Plans For Other Dengue Patients Without Warning Signs Who Are Admitted But Without Shock
Annex 9: Group B - Action Plans for Patients With Warning Signs
Annex 10: Group C - Treatment of Patients Admitted to the Hospital With Compensated Shock
Annex 11: Group C - Treatment for Patients admitted to the hospital with Hypotensive Shock (in profound shock; undetectable pulse and BP)
Annex 12: Treatment of Hemorrhagic Complications
Annex 13: The Role of Inotropes

V. General Guidelines


  1. All Dengvaxia vaccinees shall be identified with a Dengvaxia identification card.
  2. All Dengvaxia vaccinees shall be monitored for any possible dengue infection and other diseases in a span of five years or more.
  3. Monitoring and assessment of dengue signs and symptoms shall be a shared responsibility among health workers, school teachers and parents
  4. Capacity building of health workers, school teachers, parents, private practitioners and other concerned stakeholders in the early recognition of dengue infection, proper home management of mild infections, and triaging for referral shall be one of the priorities of DOH; and shall be achieved through inter-agency collaboration and public-private partnership.
  5. Children and communities shall be educated on dengue to empower them in their own care and prepare them to seek medical care at the right time, avoid self-medication, identify warning sings and symptoms, etc.
  6. All health enters/ RHUs shall be capacitated to detect early dengue infection using the Dengue NS1 RDT.
    • The Dengue NS1 RDT shall be recognized as primary screening test that shall be provided to all health centers/ RHUs, public hospitals and/or PhilHealth-accredited private hospitals for free.
  7. Dengvaxia vaccines with symptomatic dengue infection shall be prioritized to receive laboratory and medical services in all health centers/ RHUs, public hospitals and PhilHealth-accredited hospitals.
  8. The two-way referral systems from school or community to the nearest health center/ RHU, public hospital or private hospitals shall be strengthened.
  9. Clinical assessment, laboratory diagnosis, referral and management of dengue vaccines with dengue infection shall be in accordance with Administrative Order (AO) No. 2012-006: Revised Dengue Clinical Case Management Guidelines 2011, with minor updates and revisions as discussed in the specific guidelines of this AO.

Saturday, March 17, 2018

Definition: Interim Guidelines for Dengvaxia | DOH AO 2018-0005

Administrative Order 2018-0005

Interim Guidelines on Dengue Diagnosis, Referral and Management for Dengvaxia Vaccinated Individuals

Contents:

I. RATIONALE
II. OBJECTIVE
III. SCOPE
IV. DEFINITION OF TERMS
V. GENERAL GUIDELINES
VI. SPECIFIC GUIDELINES
VII. ROLES AND RESPONSIBILITIES
VIII. REPEALING CLAUSE
Annex 1: Dengvaxia Identification Card
Annex 2: Guide for Stepwise Approach to Assessment of Dengue
Annex 3: Dengue Patient Diagnosis and Referral Algorithm
Annex 4: Dengue Homecare Card
Annex 5: Dengue Referral Form Template
Annex 6: Group A - Action Plans For Patient Who May Be Sent Home
Annex 7: Group B - Action Plans for Patient Without Warning Signs But With Co-Existing Conditions
Annex 8: Group B - Action Plans For Other Dengue Patients Without Warning Signs Who Are Admitted But Without Shock
Annex 9: Group B - Action Plans for Patients With Warning Signs
Annex 10: Group C - Treatment of Patients Admitted to the Hospital With Compensated Shock
Annex 11: Group C - Treatment for Patients admitted to the hospital with Hypotensive Shock (in profound shock; undetectable pulse and BP)
Annex 12: Treatment of Hemorrhagic Complications
Annex 13: The Role of Inotropes


IV. Definition of Terms

Fluid Resuscitation

  • This is a strategy in which larger volumes of fluids (e.g. 10-20 ml/kg boluses) are administered for a limited period of time under close supervision, to evaluate the patient's response and to avoid the development of pulmonary edema.

Rapid Diagnostic Test (RDT)

  • This is a collection of reagents and other materials for in-vitro diagnosis, intended to be used for detection of either antigen or antibody from clinical samples, usually blood, within a shorter period.

Dengue Non-Structural Protein 1 (NS1) RDT

  • This is a rapid test used to detect the Dengue virus non-structural protein 1 antigen in human serum or whole blood to suggest early acute dengue infection.

Dengue IgM/IgG RDT

  • This is a rapid test used to detect IgM or IgG antibodies to Dengue virus in human serum , plasma or whole blood.
  • The presence of IgM antibodies to Dengue Virus (DV) is consistent with acute-phase infection, while IgG antibodies become detectable on 3 to 7 days following infection and may remain detectable for up to 6 months or longer following disease resolution.

Homecare Card

  • This is an important checklist reminder given to suspect dengue patient before leaving the health facility

Plaque Reduction Neutralization Test (PRNT)

  • This is considered to be the "gold standard" to characterize and quantify circulating level of anti-DENV neutralizing antibody (NAb)

>> Next: General Guidelines

Thursday, March 15, 2018

Rationale: Interim Guidelines for Dengvaxia | DOH AO 2018-0005

Administrative Order 2018-0005

Interim Guidelines on Dengue Diagnosis, Referral and Management for Dengvaxia Vaccinated Individuals

Contents:

I. RATIONALE
II. OBJECTIVE
III. SCOPE
IV. DEFINITION OF TERMS
V. GENERAL GUIDELINES
VI. SPECIFIC GUIDELINES
VII. ROLES AND RESPONSIBILITIES
VIII. REPEALING CLAUSE
Annex 1: Dengvaxia Identification Card
Annex 2: Guide for Stepwise Approach to Assessment of Dengue
Annex 3: Dengue Patient Diagnosis and Referral Algorithm
Annex 4: Dengue Homecare Card
Annex 5: Dengue Referral Form Template
Annex 6: Group A - Action Plans For Patient Who May Be Sent Home
Annex 7: Group B - Action Plans for Patient Without Warning Signs But With Co-Existing Conditions
Annex 8: Group B - Action Plans For Other Dengue Patients Without Warning Signs Who Are Admitted But Without Shock
Annex 9: Group B - Action Plans for Patients With Warning Signs
Annex 10: Group C - Treatment of Patients Admitted to the Hospital With Compensated Shock
Annex 11: Group C - Treatment for Patients admitted to the hospital with Hypotensive Shock (in profound shock; undetectable pulse and BP)
Annex 12: Treatment of Hemorrhagic Complications
Annex 13: The Role of Inotropes

I. RATIONALE

The CYD-Tetravalent Dengue Vaccine (Dengvaxia) was introduced in the country through a school-based immunization of Grade 4 students, 9 years and above, in all public elementary schools in Region 3, 4A and NCR.
  • It was then followed by a community-based immunization in Cebu province of Region 7 and in 4 cities in NCR.
  • A total of 830,000 individuals were vaccinated in these programs, excluding those vaccinated by the private sector.
In November 29, 2017, Sanofi released an update which confirmed that Dengvaxia provides persistent protective benefit against dengue fever in those who had prior Dengue infection.
  • However, for those not previously infected by dengue virus, more cases of severe disease could occur following vaccination upon a subsequent dengue infection in the longer term.

II. OBJECTIVE

This issuance shall provide technical guidance to health workers on the diagnosis, referral, and management of Dengvaxia-vaccinated individuals who acquired dengue infection.

III. SCOPE

This issuance shall apply to the Department of Health (DOH) - Central Office, Regional Offices, DOH-ARMM, Philippine Health Insurance Corporation (Philhealth), public hospitals, private hospitals & clinics, Health Centers/ Rural Health Units (RHUs), other government agencies, LGUs and communities

Thursday, January 11, 2018

Post-Outbreak Assessment and Response | AO 2006-0016 DOH

This article is derived from Department of Health (Philippines) Administrative Order No. 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

Contents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

The NRC shall convene to conduct the post-outbreak assessment.

  • This shall be attended by the members or representatives of the Response Committees at all levels.
  • The focus of the post-outbreak assessment shall include critical examination on the elements of surveillance and immunization response and come up with appropriate recommendations to further enhance case-based and laboratory-based surveillance and response.

Response to Wild Poliovirus Importation | AO 2011-0016 DOH

This article is derived from Department of Health (Philippines) Administrative Order No. 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

Contents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

The detection of any WPV shall be considered a national public health emergency. 

  • In line with IHR 2005, poliomyelitis caused by WPV is one of the four (4) diseases requiring immediate notification to the WHO by the NEC, as the IHR focal point.
  • Although this document is specifically intended as a plan for a confirmed WPV importation, the guidelines contained herewith shall also apply to a confirmed occurrence of cVDPV.
    • The cVDPV is similarly virulent as the WPV and also has high transmissibility.
    • Since cVDPVs also pose public concern, the situation shall be assessed through the IHR algorithm.
    • Immediate response is likewise critical to prevent further transmission.
According to current standard definitions of the Global Polio Eradication Initiative (GPEI), in a polio-free country, one single wild poliovirus-associated case represents an outbreak that constitutes a public health emergency.
Based on the recommendations in the WHA Resolution No. 59.1, the following shall be the standard actions in responding to the the identification of WPV:
  • Conduct an initial investigation, activate local responses and when necessary, request international expert risk assessment within 72 hours of confirmation of the index case in order to establish an emergency plan of action.
  • Enhance the surveillance for poliovirus from all AFP cases and polio suspects.
  • Notify the WHO country and regional offices.
  • Conduct WPV transmission risk assessment and comprehensively analyse the immunity profile of subpopulations.
  • Create a sub-national and local emergency action plan
    • by reviewing and updating the existing polio preparedness plan
  • Strengthen NPRL capacity for poliovirus isolation
  • Report to an coordinate with the WHO Country and Regional Offices
  • Conduct effective advocacy and risk communication
  • Implement immunization response

Sunday, December 17, 2017

Preparedness: Wild Poliovirus Response | AO 2011-0016 DOH

This article was derived from the Department of Health (Philippines) Administrative Order 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

Contents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

Any of the polio-free countries is at risk of WPV importation until the goal of GPEI is achieved, but its spread within the country can be prevented and controlled.

1. Surveillance and Risk Assessment

a. Identification of possible scenarios of WPV detection

It is important to understand that isolation of a single WPV may in fact represent at last 200 or more non-apparent infections in the larger community.
  • The three main scenarios in which the detection of poliovirus could occur are (in ascending order of extent of poliovirus circulation they may represent)
    • a.1. WPV is isolated from the stool specimen(s) of a single AFP case with a history of recent travel to a polio-endemic area.
      • This may represent a single infection obtained outside the country
    • a.2. WPV is isolated from stool specimen(s) of a person with or without acute paralysis without history of recent travel to a polio-endemic area.
      • This may represent widespread infection.
      • Isolation maybe from an asymptomatic contact of a polio-positive case or a non-paralytic immunocompromised patient.
    • a.3. Secondary, poliomyelitis cases associated with an imported case.
      • In this situation, the WPV has already started to spread widely in the community.
WPV can also be isolated from sewage or any other environmental sample that has no link to an individual person.
  • In a large province or city, this may represent many infections.
  • However, environmental sampling for enterovirus testing in the laboratory is not routinely done in the Philippines.

Thursday, December 14, 2017

Implementation Guidelines: Wild Poliovirus Response | AO 2011-0016 DOH

This article was derived from the Department of Health (Philippines) Administrative Order 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

Contents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

A. Preparedness

The preparedness plan for wild polio virus importation shall have the following:
  • surveillance and risk assessment
  • laboratory surveillance activities
  • immunization program activities
as well as establishment of the national and sub-national response committee.

Definitions: Wild Poliovirus Response | AO 2011-0016 DOH

This article is derived from the Department of Health Administrative Order No. 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

Contents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

Definition of Terms/ Acronyms

1. Acute Flaccid Paralysis (AFP)


  • Refers to a syndrome in which there is a sudden onset of floppy paralysis or lameness usually if the arms and legs.
  • Other accompanying symptoms include:
    • fever
    • extreme tiredness
    • headache
    • nausea
    • vomiting
    • muscle pain
    • stiffness in the neck and back

2. AFP Case


  • Refers to any child less than 15 years of age with acute onset of floppy paralysis, or a person of any age in whom poliomyelitis is suspected by a physician.

Introduction: Wild Poliovirus Response | AO 2011-0016 DOH

This article is derived from Department of Health (Philippines) Administrative Order No. 2011-0016 entitled "Guidelines on the National Preparedness and Response to Wild Poliovirus" published last October 10, 2011.

ontents of National Preparedness and Response to Wild Poliovirus
I. Background and Rationale
II. Objectives
III. Scope and Coverage
IV. Definition of Terms/ Acronyms
V. Implementation Guidelines
A. Preparedness
B. Response to Wild Poliovirus Importation
C. Post-Outbreak Assessment and Response

Background and Rationale

The Philippines has been certified polio-free in 2000, together with all other countries in the WHO Western Pacific Region (WPR).
  • The last wild poliovirus (WPV) was detected in Cebu in 1993.
  • Although certified as polio-free, the country remains at risk for WPV importation from endemic countries and areas with WPV transmission.
  • Particularly vulnerable are communities with high population in-migration and out-migration and international travel entry points
    • Mindanao
    • Manila
    • Cebu
    • Palawan

In some cases, a WPV importation into polio-free countries does not result in secondary spread or re-established local transmission because of 
  • high coverage with three doses of oral poliovirus vaccine (OPV3) 
  • herd immunity 
  • adequate sanitation standards
    • potable water sources
    • sanitary toilet facilities
    • proper garbage disposal

Friday, December 8, 2017

Dengue Vaccination Screening in All Health Facilities | DOH

This article is lifted from Department of Health Regional Office III Memorandum Circular No. 2017-003 entitled "Screening of Patient's Dengue Vaccination Status in All Health Facilities" published last February 20, 2017.

Press Release: Dengue Immunization on Hold by DOH | STOP TB: Ubokabularyo Flyer and Poster | DOH: Gabay Sa Paghugas ng Kamay

Republic of the Philippines
Regional Office III
Department of Health
City of San Fernando, Pampanga
www.ro3.doh.gov.ph

Memorandum Circular
No. 2017-003
Date Issued: February 20, 2017
To:

  • Public and Private Hospitals
  • Provincial, Municipal and City Health Office
  • Provincial DOH Offices
  • And others concerned

Subject: Screening of Patient's Dengue Vaccination Status in All Health Facilities


Monday, December 4, 2017

Dengue Immunization on Hold by DOH | Press Release

This article is from a press release entitled "DOH puts Dengue Immunization on hold after new findings from Sanofi-Pasteur" published last December 1, 2017.

STOP TB: Ubokabularyo Flyer and Poster | DOH: Gabay sa Paghugas ng Kamay | TB DOTS Cough to Cure: Gabay Para sa Pagpayo

Republic of the Philippines
Department of Health
Office of the Secretary

Press Release/ December 1, 2017

The Department of Health (DOH) today discloses its plans in light of the new analysis on the Dengue vaccine being used in the country’s vaccination program.

Dengue fever and dengue hemorrhagic fever are acute viral infections that affect infants, young children, and adults. It is transmitted by a bite of an Aedes aegypti mosquito infected with any one of the four dengue serotypes: Den-1, Den-2, Den-3 and Den-4.

In 2016, the DOH launched the dengue vaccination initiative in three highly endemic regions (Regions III, IV-A and NCR) with over 700,000 individuals receiving at least one dose of the vaccine. This immunization program is in line with the recommendation of the World Health Organization for mass vaccination in highly endemic countries.

Wednesday, November 8, 2017

Ubokabularyo Flyer and Poster | STOP TB

This article about Ubokabularyo Flyer and Poster is extracted from the pamphlets provided by the Department of Health Philippines and published by the USAID with an unknown date.
Department of Health: Gabay sa Paghugas ng Kamay | TB DOTS Cough to Cure: Gabay Para sa Pagpapayo | TB DOTS Cough To Cure: Guide To Counselling

Umubo ng Tama Para Maiwasan Ang Pagkalat ng TB

  • U - Umubo at bumahing gamit ang panyo o tissue.
  • M - Magtakip ng ilong at bibig 'pag may umuubo o bumahing malapit sa iyo
  • U - Ugaliing nasa tamang lugar at paraan ang pagdura.
    • Huwag dumura sa kalsada o sa lupa.
    • Gumamit ng tissue o papel at itapon ito sa basurahan.
  • B - Bigyang-halaga ang paghuhugas ng kamay matapos umubo o bumahing.
  • O - Okay lang gamitin ang manggas o loob ng damit kapag umubo o bumahing kung walang panyo o tissue.
Para sa karagdagang kaalaman, kumonsulta sa doktor o pumunta sa pinakamalapit na health center. Maari ring bumisita sa doh.gov.ph