Health Sec briefs FOCAP on AH1N1

Health Secretary Francisco Duque III stresses a point while FOCAP president Jason Gutierrez looks on.
Health Secretary Francisco Duque III briefed the Foreign Correspondents Association of the Philippines on May 11 about the AH1N1 virus and the Asean health ministers meeting in Bangkok. Notes taken during the briefing.

Locally we still don’t have any ah1n1 case…need to step up and implement clear provisions of pandemic preparedness and action plan…

The three actually came…two from japan, three year old female, 2 yr old male, they came from japan at the ritm and results of throat swab taken are still pending. The female and male entered may 9, may10 uk at Vicente sotto, results still pending. Foreigner, based on report. 3yr old male, Vicente sotto. Doesn’t say Japanese, only says non Filipino. Affected country of origin does not necessarily mean country of nationality.

Break down of how many being monitored: we have total of 23 cases, of 23 we have 8 cases whose lab results are pending, and we hope to get results today, I think some are already out but need to get more updated report may 11. Rest are all negative. 23 since april 26 to may 10.

(all of these foriegners, 23 cases) there are fils here, 11 fils. The rest are foreigners. (from where) just give you list, Switzerland…republic of korea, might not be practical to articulate.

(symptoms) no diarrhea, don’t think there was diarrhea. Fever or cough. The most compelling symptom for which the primary screening will lead to secondary screening is temperature, fever.

(can you now recognize or specify or isolate the h1n1 as opposed to
other kinds of flu…how do you know not regular fever that comes in
every year)

Bilat talks with china..min chen zu of china had indicated desire of his ministry to conduct international scientific forum and he will invite our technical people from the collaborating bureaus and also from academe presumably to expalin where they are in terms of making their own primer for ah1n1 and direction which they plan to pursue in terms of vaccine devt. And also because they manufacture own oseltamivir and raw materials are essentially coming from china and have asked if they we can get our own supplies from them. Asean ministers meeting very fruitful, very productive and essentially what the ministries of asean plus 3 member states agreed upon to make sure we constantly review panedmic preparedness and action plans and compare this with plan of other member countries, what could it be that they are doing differently from us…open, we did make presentations, each country made to present, some idiosyncrasies or unique featuers that don’t necessarily apply to our country, second in area of monitoring and assessment…what other member states do to assist, coordinated effort to help that one country where virus has actually entered. In view that if we do that and it is wise to do it, helping that country and that virus from spreading to other member states…consistent with solidarity, sharing…also we spoke about…the suggestion to do an exit screening of passengers as one of cross border disease control strategy in affected countries. Not only screening inbound but also outbound passengers, with end in view of reducing risk of spread. Additional investments, might have to double thermal screening…we spoke about putting together a system within asean plus 3 to ensure there is efficient sharing of anti virals, other medications, drugs and medicines as well as vaccines when appropriate vaccine has been developed. Sharing gof these resources one of major considerations and agreements in meeting. Need to put in place an effective public awareness and communications campaign within the realm of the public to ensure minimal or no panic and no excessive fear approaching phobic proportions as to disrupt social and economic activities.

(what is current regional sit in oseltamivir) enough in region but can’t say how much regional stockpile is…still is Singapore but doesn’t preclude national stockpiles of member countries to be established. Best that we can contribute to regional stockpile without zeroing our own stockpile. In case problem arises, we need to have own stock…good for 117,000 patients, gov’t would be about 800k…1.170m capsules.

(how many expiring) some expiring june, even may but had subjected to stability study, 96-98% stable, can be extended anywhere by one year to 24 months. Later the extension can be further down the line.

We’re buying…I just signed a procurement order of about 24m worth, that should be enough to reach if not go beyond our targeted stockpile level of one m capsules…

(agreeement in Bangkok, timeline) yes for example with china the international conference would be done next month. The sharing of stockpile, individual stockpile, depends on how serious the situation will be. Evolving, somewhat waning, not know but at least political commitment to do what is jointly entered into by asean plus 3 member states and as reflected in joint ministerial statement.

Asap for affected countries…south korea, japan, china…ministers…agreed to…implement exit screening as one of cross border disease strategies…determine additional investments required to put in place all these instruments…what will be additional investments required to put these in place.

(you have 8 pending results…how many foreigners) foreigners among the 8 are four. Filipinos are four.

(from japan may 9 are Japanese nationals…) not say. Only says affected countries of origin. Just double check with ritm.

May5 2 may 9 1 on may 10. One in Vicente sotto.

(asean health ministers meeting for geneva) yes this is to segue to the 62nd Session of who…asked to articulate joint ministerial in asean…it is not a question of whether we will ask…that is what is being done. There is coordination, cooperation, collaboration with international health orgs like who, the oie, all the other laboratories, the cdcs of various countries, as well as other collaborating labs, to synergize efforts with collaborating agencies and orgs like who and cdcs of various countries.

(japan symptoms) baka fever because most compelling symptom that can be picked up is fever.

(normally how long to stay in ritm before can determine) couple of days unless it is found to be probable case. The protocol dictates that we send to nearest collaborating lab which will be japan or Australia or cdc from us, which will take another four to five days. If probable case we start off with course of oseltamivir to make sure we don’t waste time. If give beyond 48-72 hours period the effecitiveness of antiviral will be compromised. No probable case…wala pa…

For this we’re hoping to get the two from japan today. To find out whether they’re negative or probable cases.

If we tested the specimens against these and they yielded positive because either classical swine flu or human origin and therefore typable. If negative then it becomes the non sub typable components of virus.

(when get testing kit) today. At bureau of customs, should be released by bureau of customs..go to ritm and then these however, even if we get these kits today does not mean results from use of these kits will automatically mean confirmed cases…try to test first, build confidence level…for collaborating…just to be build confidence that we’re doing it right.

(when ready for use) get it now, not sure when able to set it up.

Boarded asiana airlines from japan via korea. Arrived may 10, both are Japanese nationals, but mother and child.

Difficult to make conclusive remarks because situation is evolving, can’t make hasty conclusions. As they’re saying, the case fatality is less than 2%, they’re saying most cases mild, in us, European countries…chan has admonished everyone this could be weaker version during first wave but can mutate into more virulent virus that can wreak havoc the second time around.

(mutation of viruses, why is this happening, factors involved…) anti genic shift, antigenic drift, reassortment. Ah1n1 is result of non pathogenic entering into mixing vessel, human, two from swine, north and Eurasian swine flu viruses. Viruses that entered into mixing vessel capable into mutating on their own…I don’t believe we are helpless, we have the anti viral drugs, capability to develop vaccine…

Children: mother pinay but mother is not one of cases under investigation. Father is Japanese.

Signed contract before let for asean ministers’ meeting.

(flu shots) subject of intense debate. Position of scientific community is not discouarge from having shot of anti flu but kahit vaccine changes…whatever is available…circulating virus, have yourself covered.

(what other gov’t agencies involved) ndcc, deped, dswd, dilg, dnd, doh…afp, pnp, made chairperson of this…teodoro turned over to me the responsibility of managing all the agencies of gov’t and other instrumentalities in event there is ah1n1 flu in phils.

(pacquiao safe now) monitoring them, they’re not sick. Other members of entourage followed up by bureau of quarantine, they’re okay. Hope they will be okay. If and when somebody manifests signs and symptoms, we will cure them. It’s like dengue epidemic…four s. search and destroy, seek early consultation, self protective measures, safety fogging. If community did not do this and somebody gets bitten and gets dengue, don’t expect to imprison, but duty to make sure services are there, promptly, that is what we are doing now.

(wearing masks n95) for hospitals yes we have but not enough for entire country. It’s going to be billions worth of investments we’ll die first of bankruptcy.

(talk that it’s stabilizing.) not only good lessons but now consolidation of all lessons learned from sars in 2003 and also the avian influenza the threat of which remains, and we don’t know as we were saying, there’s avian flu component into new virus. We know avian influenza extreme difficulty getting transmitted from human to human.
Now there’s some kind of reassortment, never know because these bugs are so capable of series of mutations.

Just stepping up, the systems are in place, just making certain what the linkages are with other member states. We’ll have to hook up with ministries, networking of ministries of health, seamless linkage of ministries of health of asean plus 3 member states. (hotlines) that’s in order as part of seamless integration or linkage.

(how started in mexico) difficult, no clear proof whether did start in mexico or us because some people are saying should call it north american swine flu virus. The theories not yet out, no conclusions…in la, us there is evidence of third generation, human to human and sustained community outbreak…(most of those people who died have other diseases) in us on account of patients reported to have pre existing conditions. Yung pangalawa na babae na buntis, anak buhay but nanay namatay.

The classical swine flu in pig population was first recognized in 1930, first evidence of transfer to human, began in 1988. Pregnant woman who died because of evidence of transmission of classical swine flu virus into human who died because she was exposed to a livestock fair…four hospital personnel exposed to her developed mild flu like symptoms but all recovered.

From 2005 to 2009, total of six cases of transmitted classical swine flu virus to humans. Very scarce, very few. Classical swine flu virus in pigs, they don’t even bother, because the pigs don’t die.

As of may 10, may 9 arrived, two Japanese kids from japan one 3 yr old female, one 2 yr old male. Reported on may 10. They went to ritm on may 10. One from uk,, Vicente sotto Cebu. 3yr old male, may10, u in Cebu, another from usa, 40 yr old male, arrived may5 reported may7, asian hospital, pending lab.

…will still be collaborating lab…(when one more cases confirmed, what will ritm do, procedures to be taken) when there is confirmation the initial five test will be sent to collaborating agencies to build ritm confidence level. Make official confirmation of next tests…(will who be involved in any way) they’ve been involved since day one…notifiable, globally notifiable disease, who tells everyone and we …will be hostpial, anti flu, two capsules daily, for five days, clinical course will be monitored, if there is now reversal of condition, we depend on usual tests.kung wala na…then we discharge patient as soon as he recovers fully. (under quaratine) isolation na…(how about contract tracing) what who is affected countries, practicality of all of these contract tracing is already not realistic, because too many exposure, person has virus and went around and wasn’t detected in thermal scan…focus shifts to early detection and case management to prevent rapid spread of virus. Kailangan habulin na. test identifies presence of virus in throat swab…running reverse…polymerase chain reaction there is now standard…run tests…this is virus identified from test kit. If it is…compare with other known amplitude of other existing viruses…

(people from abroad, how long can we say that they should be in self quarantine) in our old form, 10 days but situation keeps evolving…who says between 1 and seven days…again, that’s no longer focus, focus now is early detection and case management. Hanapin, vet that case with positive exposure..

(preventive measures if positive) personal protective measures, preventive measures, proper hand washing, cough and sneeze manners, social distancing, make sure if you hold someone, wash your hand, say happy birthday quickly…no need too wear masks unless hospitals where sick is there…health workers at risk will have to be given ppes and personal protective equipment (airport wearing mask advisable) for whatever value it has why not (crowded places) may not protect you from virus but can protect you from other sickness.
Zanamivir. (8 pending cases, results) today I think. Baka today. We’ll give you…don’t worry we hate keeping these documents we want it to go out.

(chances of ah1n1 if no symptom of diarrhea and vomiting) 50% chance if without diarrhea and vomiting.

We will make necessary adjustments as soon as WHO says there are indications to downgrade alert levels. No indication who will bring down pandemic phase level to 5 to 4.

(of 8 cases any one volunteered) only one volunteered.


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