DOH tracing, monitoring people who had contact with RP’s first A(H1N1) case

WHO map showing countries that have reported one or more cases of A(H1N1) virus. The Philippines is not yet included.

Health authorities are now monitoring at least 17 people who had close contacts with the 10-year-old girl who were diagnosed positive for Influenza A(H1N1). These were mainly those who were seated around her in the plane, the health department said, as they defined close contact as “six hours with and within six feet.”
The girl, health authorities said, are recovering. Her mother, who has been taking care of her and is the one closest to her, has been tested for the virus and was found negative.

speakers at the press conference:

Dr. marlon ninal
Dr. Mario villaverde
Dr. mavic vasquez
Dr. Yolanda oliveros

Villaverde: just to brief our media partners on the dev’ts since last night that the sec of health has formally announced the first case of ah1n1. I will give an overview then turn the microphone to the director or program manager concerned. Discuss first the quarantine procedures. The specific actions undertaken by the doh and other partner agencies in terms of quarantine procedures and systems. We will continue with the entry screening in international ports and airports. This is to continue our containment in terms of potential entry of other passengers with travel in affected countries para mapigil further kung may papasok pang case with history of travel in affected countries. Second we are now studying possibility, in case there is a need, to institute measure of exit screening. Not yet instituting but this measure will now be studied by our bureau of quarantine because also entail logistical and manpower requirements plus of course we have to evaluate benefit once instituted.

Because there is already index case in rp, institute additional measures when it comes to domestic travel in terms of inter island vessel. More information and advocacy materials, bureau of quarantine take lead when it comes to provision of advisory and info in domestic travel, particularly in inter island travel and domestic aircraft because a case has been detected here in rp.

Now when we go to the surveillance system, we will…on a day to day basis we will continue doing the monitoring of cases under observation, the way that we do this in the past 3 to 4 weeks. Because a case has been detected here, we will do this for this particular index case contact tracing with immediate family and close contact, also be discussing this with local chief executive and when itt comes to airline used by this particular passenger we will do some contact tracing and advice those particularly those passengers within the vicinity of this particular index case.

We will be issuing more interim guidelines, technical guidelines for guidance of all our health professionals, all our partners in relation to containment of this ah1n1. Turn over to dr. mavic vasquez in relation to quarantine services.

Boq med officer 7
Able to identify and coordinate with airlines concerned, companies and partners at airport, able to obtain manifest and identify possible contact so able to address this issue and then to turn over to surveillance, where this contact..

Ninal: three cases yesterday already negative. Only one that is confirmed. 7 under observation.. Other cases…that come in today will be recorded tomorrow. The basic activities in terms of surveillance, now conducting a contact tracing. All contacts of this index case will be followed and see whether some of these close contacts develop signs and symptoms of influenza…we want to know how virulent it is in the phils. Virus might be mild here, or severe. We need to study further.

Oliveros: four interim guidelines at doh website. First about clinical management and proper use of antiviral. Important that we know who should use antiviral drugs. Two is proper use of epe. Right now we anticipate with our index case, marami magma-mask. You would know who should use or prioritize using these protective equipment. Also interim guidelines for lab diagnosis, guidelines for social gatherings. In midst of global threat, pandemic, may is a fiesta event, so makikita ang guidelines for social gatherings. We will be issuing this week another three guidelines on surveillance, on contacts or direct household contacts of probable or confirmed cases, and guidelines on transport of cases. We have also issued guidelines governing hotels, resorts and other related facilities.

Villaverde: we will never know because personal decision…with so many countries now being affected by this illness, it is very difficult to say that we have to postpone because it is continuous in terms of spread to other countries. Maybe dr ninal can elaborate on disease pattern.

Ninal: we don’t impose travel ban. Decision of family…

(coordinating with airlines, how many now under surveillance, customs officials, immigration, passenger manifest) when we consider contact tracing, 6 hours, 6 feet. Based on aircraft configuration, three rows in front, side and back. At present we were luck patient seated at back, and near the wall. We have 17 possible contacts and we are now tracing them. (involving airline crew, immigration personnel, customs? General description) 17 sitting around the victim.

Villaverde: trying to contact these passengers for them to observe precautionary measures and more vigilant observation as to the development of signs and symptoms

(how is girl doing now) this is the good news. The patient is recovering well. Wala na siyang fever, sore throat na lang ang complaint, the mother who is the one closest in terms of contact, the lab result kasi kinuhanan na rin ng specimen kasi siya kasama sa travel at nag-alaga na…kept sample from mother and last night lumabas ang result, negative. That’s the good news. We hope because the mother being the closest contact, we hope wala nang ibang na-infect ng virus na ito. Negative ang mother. Nag-take na rin ng medicine ang mother. (father also with them during the trip) yes but we are also conducting a more thorough assessment today of all the household contact. And if we think there is a need to give them prophylaxis we will do so. If there is anybody in household that will also develop signs and symptoms they will be brought to health facility for further observation.

Ninal: the confirmed case was admitted…ngayon dapat siya maisama. Yung confirmed.

Villaverde: pito ito. Kahapon na discarded case, 3. 4 na cuo cleared na lahat. For today we are only reporting that one confirmed case. Cleared lahat ng nabigay, have only one case in last 24 hours reported to doh and that one case turned out to be positive.

Last night, they were advised to do home quarantine. Now a more thorough briefing and advise would be made when it comes to household.

(community exposure. After dumating, public exposure) it looks like, from history, pagdating nasa bahay, then following day…which is usual case for travelers na galing sa US…the following day nagkaroon na siya ng fever so na-refer na agad…yes, but remember we are conducting today a more thorough assessment of household so that we will be sure and as much as possible, magawan ng advisory and containment measures.

(what if they accept visitors. How do you handle that) pag may visitors then they should also observe the same precaution. Social distancing, also observe in next 10 days…(doh rep among them) yes today we are sending a team of 2 or 3 people to do the more thorough assessment. Last night…only give general advice to do self quarantine. Now more thorough, more detailed information.

(how being handled…matsismis) this is reason why family and we respect request to maintain confidentiality of health info and privacy. We don’t want to create too much panic among household and within the neighborhood. We believe based on initial discussion with mother, just limited to particular household. Going back to travel, possibly to limited area.

(members of household) requested for some confidentiality…(kahit number lang) because neighbors, other relatives may identify them if we tell some details because we are doing the best we can to contain this index case.

Vasquez: (customs, immigration) not considered as close contact because limited contact

(foreigners among passengers watching now) luckily, wala. (pati crew) sa passengers wala.

(what will happen to crew) advise some precautionary measures. Based on six hours and six feet exposure. International, so they have different flight schedules.

Villaverde: no country in world that instituted measure to ground aircraft unless there is necessity for that but based on pattern of disease no indication. Still advice minimum interference in terms of travel, trade and tourism.

(cause for alarm) be vigilant, cautious but not panic. With measures we are instituting and based on history and interview with mother and child looks like this is contained. Of course we are providing additional measures like a more thorough investigation and observation of immediate household.

Vasquez: (airport crew no need to quarantine) no because very limited exposure.

(postpone pasukan) there is no indication at present that we should postpone the opening of classes. There are possible options but we believe that we need to discuss on day to day basis as this particular illness or the index case will develop. There is no community level outbreak in the phils…and there is no indication whatsoever that we need to postpone the opening of classes. Providing advisories in relation to school sanitation and of faculty members. Next week…discuss with deped, ched, school admins on things to do but as this situation develops we will continuously evaluate and see whether there is indication in coming days that there is a need for us to change that recommendation to deped.

(tamiflu) right now about a million doses and also incoming half million donated by pharmaceutical company. When this arrives in next two weeks stockpile of 1.5m, good for 150,000 people.

(water supply in schools) the water supply is another issue it’s more related to water and food borne diseases. Hand washing but this is more on the droplets kailangan lang matanggal ang droplets sa ating mga kamay.

As the virus evolved, as we have observed in the us and Canada and now even in mexico, as more cases are reported, it turns out that case fatality rate is lower than what we expected. Parang seasonal flu ang nagiging pattern but as precautionary measure the who and experts are telling us the virus is evolving…might develop into more virulent form as it goes from country t country and as season change. If we look at pattern of other pandemic flu before, first wave usually mild, second wave during winter and cold months, mas virulent ang form. Very cautious in terms of particular virus, new virus still has to observe how develop. Usually mild in form and case fatality lower than expected. Immuno compromised, elderly, very young, pregnant women.

We discourage self medication as we have advised before. Oseltamivir with guidance of medical professional taking without prescription might develop resistance to drug.

(from where in us) nag travel in us, may ilang cities na napuntahan. Because already established community level transmission, immaterial even if we identify because almost all us.

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