RP cases of Influenza A(H1N1) reach 111

Health Secretary Francisco Duque III: Yesterday we celebrated the 111th Independence Day. Today we're declaring 111 A(H1N1) cases.

This is the first press conference I have attended in which Health Secretary Francisco Duque III did not say that there was no community transmission yet of the Influenza A(H1N1) virus.
When asked, pointblank, if there is now a community transmission of the virus in the Philippines, Duque they were still investigating. He hoped to know by Monday.

Notes on the June 13 presser:

Yolanda oliveros, director, national center for disease prevention and control, doh
Dr.Mario villaverde, undersecretary, doh
Dr. Francisco duque iii, secretary, doh
Jesli lapus, secretary, deped
Dr. howard sobel, who acting country representative
Atty. Julito vitriolo, executive dir, ched

Duque: many thing we have to put together in formulating mitigation response…in line with who’s raising pandemic alert…still being deliberated right now at board room by different officials who attended special meeting today.

Would like to inform public doh is soon shifting to policy of mitigation in response to decision of who to raise pandemic level…means doh will shift in preparing households and health facilities to respond…in anticipation of more confirmed cases…have to make sure health system…manage and treat severe cases…mild cases properly treated at home…who alerted all countries ah1n1 virus widespread in at least two who regions and further spread inevitable…who advise al member states to focus in appropriate management of patients… decreased emphasis on stopping the spread of the virus. Where appropriate. This is not a one size fits all policy we’ll have to be area specific in most instances.

Today also present doh strategic plan and step wise approach…this step wise approach consist of four phases…according to number of cases and presence of community transmission…

Activating command system, surveillance, health facility response…mitigation will be done in levels and not applied across nation…areas with few cases…mitigation strategies will not apply. Kung tuloy pa rin ang containment strategy…with mitigation, concentrate on promptly giving care…to patients with pre existing diseases…like heart and renal disease, diabetes…change in criteria…only with progressive symptoms and pre existing conditions…majority of cases expected to be mild, put under home treatment…observe social distancing for 10 days.

19 new cases, all mild, 11 males, other 8 are females. Age range from 6-49 yrs old. All but one are Filipinos. New additional bring total to 111. So far there has been no reported case of severe illness in 111 documented cases. No deaths, no severe illness.

Case fatality rate of .5%.

Lapus: here to participate in formulation of new modified response level system and find out from doh latest development and what pandemic level worldwide means. and what we gathered is the pandemic declaration has to go with the global spread. In the phils and based on our own wide, huge, basic education system of 43,000 schools we have one school case in jaen nueva ecija and we have another one in bulacan, the rest results of which are not yet available as of this time and some cases of false positive like what happened in Marikina. Classes started june 1, we are now 13, ten-day self-quarantine period already expired…so we can say that containment…judging from that you can sya that we have to date very few index cases in schools. We feel containment approach in areas where there are no evidence of human to human transmission is still an option. The prevention of the spread is still a very valid option. We are approaching…but with the world bank pronouncement that in some areas…in some areas unstoppable, better not even in some cases where there’s already widespread outbreak in community…we cannot contain…mitigation should be emphasis in certain areas. The doh will know what geographic areas will call for that kind of approach. With 19 million school population…if you translate that into percentages, we are not even talking of a fraction…very small fraction…fortunate to be reporting these occurrences and not a single complication, serious case…also, we want to clarify that symptoms for this and seasonal…because of the rains…even without this virus during these periods we are witness to occurrences of seasonal flu, coughing, I understand symptoms for ah1n1 can be similar, identical to this, and also treatment, paracetamol, we will continue to issue guidelines for schools for maintaining inventory…not exotic mitigation…routine influenza flu medicines. That’s where we are now, school as usual. There’s no reason to go on and off, on and off in the school system. Where there’s an outbreak containment will become difficult, mitigation ang emphasis. This is what we’re trying to discuss today.

Vitriolo: we have already moved opening of classes from jun 8 to jun15 and position of ched opening of classes will go on despite the situation, different institutions have done homework here, different institutions, necessary coordination with local and national agencies of doh, advised of guidelines and…this particular virus will be there for a long time just have to learn to deal with it in the eway doh had planned Especially in mitigation response and mechanisms. Advise parents and school authorities to prepare for classes and be vigilant…measures in mitigating this virus.

(19 cases. History) duque: already mixture of iba-iba. History of travel, others are…just got transmission from probably students…some of these are students…11 those coming from hilera elem school in nueva ecija. Foreigner with history of travel in iran.

(source of virus in hilera) hindi pa. first case hindi ma-establish. We are still investigating and as soon as data sufficient…able to report on Monday. There was…information there was a medical mission conducted in hilera by group of individuals who purportedly came from manila. Trying t establish linkages and if able to identify rfirst case can safely assume this is limited human to human transmission, probably second generation but I’m not saying that. Saying investigation is ongoing. May well expect to see a community outbreak that is happening already.

In Bacolod, that was…we have six additional cases discharged for total of 38 as of yesterday.

We hope to be able to complete mitigation response level system today. Then we will implement this on a case to case basis…that in areas, like Mindanao, where you still don’t have index case, and there occurs the first case, containment strategies will stay…in areas where you have a community outbreak, containment measures will have to be diminished or reduced…use mitigation response level system.

In a community where you have an outbreak…you have a school, and confirmed cases in school, logic of mitigation can be clearly illustrated: no sense in suspending classes. Where do you send students, back to community where you know there is an outbreak…just detecting students with influenza like illness, advise them, home quarantine, home care, social distancing, paracetamol for fever, bed rest, personal hygiene, people giving care must also exercise precautionary measures.

Vitriola: (dlsu, admu clear) already done their part…june 15 no more justification for that because they’re past the 10-day period. We expect all schools…a few are opening on Tuesday but generally many schools will open on Monday. Tuloy ang opening as far as we’re concerned.

Duque: briefly prime you with regard to mitigation response level system. the objectives of our mitigation measures: slow down virus spread and minimize transmission to most vulnerable group, those with pre-existing medical problem.

Improve hospital preparedness to provide treatment
Minimize social disruption and other negative consequences
In any community you have sporadic cases of people with pre existing medical problems and as community outbreak progresses virus finds itself closer to these vulnerable groups. This is the logic of it that’s why it’s important mitigation measures are in place and tracking down the vulnerable, most at risk groups. We have four mitigation response levels. 1. What would be the response when we have few sporadic cases
2. When established beginning of community transmission
3. Widespread, 5% of local population
4. Large scale outbreak. Means more than 5% of local population is affected. There are many elements of each of responses and we will give floor to dir. Oliveros to explain exactly what set of responses will be…

Oliveros: response system of 5 components, has to do with control structure; surveillance, diseases, laboratory; facility response; public health interventions. As you go up the response levels the mitigation response will also vary.

Response level two: how classify cuos in terms of admitting them to hospitals.. There would be some qualification, assess capacity of laboratories, towards level 3 our ritm will not cope with increased number of cases under observation. In widespread community transmission ritm will have to capacitate other laboratories. Here the lab exams for monitoring the cuos will not be mandatory. At this point also…capacity of surveillance teams also assessed. There could be not enough capacity to run after contacts; decision where contact tracing would not be done. Patients categorized into whether they should go to hospital or remain and be managed at home.

Large scale, no more contact tracing, admit only confirmed cases with severe infection, public health intervention should be strengthened.

Villaverde; this mitigation response level system which is somehow similar to school response level system…mitigation is actually area specific..may be implementing level 3 in metro manila and nueva ecija, but in Mindanao we still don’t have reported cases we are still in containment phase there. Because main strategy there is still on containment. Refining and hope we can finish this after press con.

(mitigation response…means gather together) duque: we don’t have to gather them…just have to inform them…should be informed, doctors…we’re coming out with info on newspaper, paid ad to remind people with pre existing medical problems to watch out for this illness and have to be more alert when these symptoms do occur, have to be in communication with attending physicians in more sustained manner…will serve them best they know they belong to most at risk groups.

(you get immunity from it) you have certain immunity or protection but core problem about this virus is potential for mutation is great. Don’t know how it’s going to mutate in near future, will it be same as it has been, or as in very very few instances…there has been reports of children…young adults…did present complications, fatal complications…

(community outbreak now) We don’t have it as of yet but on Monday we’ll find out when investigation shall have been completed.

(why number of cases in rp increasing…no.1 in southeast asia) sobel: certainly surveillance system here is quite good one, developed over many years…may have excellent contact tracing and the like. Hard to say why here, why japan,why china lower…hard to say what’s gonna happen next week…rising dramatically, globally in the phils and in the region/

Duque: probably because of more heightened surveillance system and more effective, efficient contact tracing…I think because of our contact tracing we’re led into more and more cases and as I have announced…you will expect more cases…travel ban is not imposed, continuous exchange of…people coming from affected countries…tourism and business purposes…and continuing increase from countries…just the same, 100% of all 111 cases are of mild symptoms…no deaths, no severe complications have been reported.

(vaccine…) there is one multinational company I read saying availability of vaccines weeks in advance of scheduled availability…probably coming out with it October…six months kasi…

DOH press release

Update 40

DUQUE OUTLINES MITIGATION STRATEGIES AGAINST A (H1N1); 6 MORE FULLY RECOVERED PATIENTS SENT HOME TODAY

13 June 2009

Health Secretary Francisco T. Duque III today informed the public that the Department of Health (DOH) is soon shifting to a policy of mitigation in response to the decision of the World Health Organization to raise the Pandemic Alert Level 5 to Level 6.

“A policy of mitigation means that the DOH will shift focus in preparing households and health facilities to respond to the challenge posed by A (H1N1) in anticipation of more confirmed cases,” Duque said. “This means that we have to make sure that our health system is equipped to treat and manage particularly severe cases which may require more intensive care in our hospitals and that mild cases are appropriately treated at home,” he added.

Under Pandemic Alert Level 6, WHO has alerted all countries that the A H1N1) virus is now widespread in at least two WHO regions and that further spread is inevitable. As a logical response, WHO advised all its member states to focus on the appropriate management of patients, particularly those at high risk for developing flu complications and a decreased emphasis on stopping the spread of the virus.

In a press conference held this afternoon, Duque presented the DOH’s Strategic Plan and stepwise approach for the country’s mitigation response to the novel Influenza A virus. The stepwise approach consists of four phases according to the number of cases and the presence of community level transmission in a certain locality.

The mitigation approach also outlines key management imperatives in the areas of activating the command system, surveillance, health facility response, public health interventions and risk communication strategies.

“I want to make it clear that mitigation will be done in phases and that it will not be applied across the nation completely and instantaneously. This will depend on the presence of community-wide transmission and whether there is a high or low volume of cases in a community. Therefore, in areas where there are few cases and we can still contain the spread of A (H1N1), mitigation strategies generally will not apply,” Duque said.

Duque also made clear that with the mitigation strategy, the DOH will now concentrate on promptly giving care to populations found to be at high risk for developing flu complications based on the epidemiology being shown by the A (H1N1) locally and in many other affected countries thus far.

“This virus, as explained by WHO, causes very mild symptoms and a self-limiting course in the overwhelming majority of patients largely those who have no preexisting conditions. We need to focus on giving more attention and care to patients with preexisting diseases like diabetes, heart and renal disease, immmunocompromised state, the pregnant, the very young and the elderly and those with infections like HIV/AIDs and TB. We advise these patients to immediately consult their doctors as soon as they develop flu-like symptoms,” Duque said.

Duque said that the DOH will continue to monitor geographic spread and severity of illness to determine application of mitigation measures on a case to case basis.

Thus, with the policy shift, DOH will be implementing a change in its criteria for hospital admission and giving of antiviral treatment and prophylaxis.

“Only those with progressive symptoms and preexisting conditions will be hospitalized and will be given antivirals immediately. For the majority of cases we expect to be mild, they will only have to be put under home treatment and they will be advised regarding supportive care and to observe social distancing for 10 days,” Duque said.

Duque also reported today 19 new cases, all mild in nature. Eleven of these new cases are males, the other 8 are females. The age range of these cases is from 6-49 years old. All but one of the 19 are Filipinos. These new additional cases bring the total count to 111.

Duque announced that 6 more fully recovered patients have been sent home today thus, bringing the total count of recovered A (H1N1) cases to 38.

“So far the country has no reported case of death or severe illness in all of the 111 documented positive cases,” Duque stressed.

In their latest report dated June 12, the WHO has reported 29,669 cases and 145 deaths from 74 reporting countries.

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