Influenza A(H1N1) cases reach 193 in RP; community outbreak declared in rural village

Community- level transmission has been declared in Bgy Hilera in Jaen town, Nueva Ecija. In Bulacan, Bulacan, classes were suspended after eight high school students tested positive for Influenza A(H1N1). As in Jaen, the health department is still trying to figure out how the students got the virus.
Meanwhile, there are now 193 cases of A(H1N1) in the Philippines.

Here are my notes on the press conference.

Duque-jun1509

71 fully recovered cases. 46 more confirmed mild cases over the weekend. This brings total figure of positive cases since may1 to 193. Including the 36 confirmed cases reported on Sunday.

27 females and 19 males with age range of 9-47 yrs old. All of new cases are Filipinos. 19 individuals in jaen tested, 8 positive for a(h1n1). The local executives in said province declared outbreak over weekend and regional health officials said 8 confirmed cases all mild and responding well to treatments.

Not only school authorities but bgy leaders and heads of offices across country should continue reporting any unusual occurrence of flu like symptoms…especially those who have traveled summer to countries affected by a(h1n1). Part of readiness of doh to shift from containment to mitigation.

8 confirmed cases out of 18 samples from candelaria elem school in bulacan, bulacan. Reported also by doh in briefing with dlsu officials. Looking for details of these cases so we can characterize profile of 8 confirmed cases.

Villaverde: 8 of 19 in jaen positive. 19 with ili, only 8 turned positive. (all others negative) yes, all negative.

(how these people got infected, in nueva ecija and bulacan) several possibilities in nueva ecija. There was a medical mission conducted the week before we had the first cases of ili in bgy hilera jaen nueva ecija. That’s a possibility. The other possibilities is there might be families who went for a visit in metro manila or other places where there were cases…or there might be visitors, family members who came from abroad. Still a big question mark on our part…still…saan nanggaling in relation to jaen cohort. Cannot establish definitively kung saan nanggaling ang index case but we have possibilities.

(candelaria) we still don’t have the details, we have just the result, 8 na confirm. (kailan nagsimula ili (influenza-like-illness) candelaria) june 11. Earliest onset…suspension…june 8 first ili.

(how can we characterize place with outbreak) the one in bulacan bulacan still characterizing Cannot say may community level transmission. In jaen case we have taken some info already so we have…just like to describe jaen…don’t know index case here. But we have 12 students that turned positive in bgy hilera, jaen. All in hilera elem school but we have several others, more than 50 that have ili but 12 lang talagang positive. In relation to this 12 students which we consider the second generation, hindi pa sure kung sino ang index case here…in relation to second generation, we have also 19 people…individuals from that bgy na may ili…all of these are in households or in community, 8 turned out to be positive. That’s the jaen cohort.

(merong youngest is 4, part of 12 students) hindi. (kasama sa 8 households) yung sa hilera, ang age range is 4-59 yrs old. Six females, 2 males.

Candelaria, 12-15 yrs old. Seven males and one female.

(jaen…one suspect was medical mission) don’t like to say suspect..possible source because we know that bgy hindi naman sila maraming travel…bisita, relatively rural bgy siya. (effort to check…) yes. The possible…in this case…still characterizing kung may isang nag-ili…dito sa manila nanggaling…(not foreigners) from different colleges or universities na ngayon may confirmed. (outreach program) students and health professionals. Hindi naman nagme-medical mission ang may kasamang health professionals. Not even make a guess they were source until such time ma-characterize. Initial report walang nag-ili sa group…inii-isa. Possible kasi na walang link.

(what is gov’t doing to these affected students, jaen and bulacan) they are being managed as mild cases, all of them in home quarantine at saka…binigyan Sizemore ng treatment…na-distribute Oseltamivir in the early period of this semester…tig-ilan per region…5,000 doses each. And five hospital, referral centers, 1,000 doses each.

(they can stay at home) kasi mga mild. Actually nakalagay na sa bagong lalabas na guideline in a mitigation case, pag mild, pareho ng ibang countries na almost all cases are mild, manifestation looks like regular seasonal flu.

(despite nagba-balloon cases…lowering measures) no. we are selective in our actions. For areas…we have explained this last sat…we are going to reiterate this today….selective in terms of phasing…area specific phasing of mitigation response level…finalizing today…one two three and four. Yung areas na zero case…like Mindanao or in some island provinces, still continue to implement containment measures so that means pag nagkaroon ng index case, response is to do isolation of patient, contact tracing and like the way we did it during our initial phase in early may when we had index cases with history of travels. The mitigation level…iba-iba. At phase 4, di mo na malaman index case, nagstart ng infection, almost useless ang contact tracing. At that level, magkakaroon na lang ng treatment of cases. Doon naka-anchor ang response. Tomorrow probably or at latest wed pag na-sign ni sec.

(place near phase 4) this is the mitigation response level. Level, system. Related to the school response level system but that this system is specific for a school setup which we will be revising based on our meeting last sat. for community level response…phase 1, this is a situation where we have a few sporadic cases, nate-trace, index case…heavy pa dito ang ating mga surveillance, look for contacts, clustering of diseases and so on. Level 2, this is beginning of community transmission. The general situation now in jaen is somehow similar to this particular level. Yung sporadic cases ito yung situation natin nung case no.1, no.2 up to probably index cases no.10. Even during time we had Taiwan cohort, classified up to few sporadic cases. Level 1 yun. (la salle) have to finalize closure of la salle. So far walang nagpa-positive, dorm and household contacts…last day of ten day period.

(coordination ang Makati…declared state of calamity due to six confirmed cases) we will verify that. Walang nare-report sa aming ganyan.

Level 2…jaen is similar to this level. Level 3 is wide spread community transmission but less than five percent of population affected. Level four large scale outbreak, more than five percent of population affected. Nire-refine bawat response. How to organize our structure, our system, and then the second is how do we do surveillance at each level? Level 1, few sporadic cases, contact tracing critical but as you go to level 4, halos wala nang value ang mag gawa ka pa ng contact tracing. Mabu-burden lang ang health profs pero halos wala nang added value. We also have health facility response, saan kailangan I confine, pwede bahay, hospital…nandoon yan sa health facility response. Public health intervention, alin ang supportive treatment, alin ang kailangan complete and definitive treatment…dito, severe…our response level will have five major action points. Command system, surveillance, health facility response, public health intervention, and risk communication activities. Pina-finalize, hope we can finish today, present to execom of doh for final approval.

(at level of household, when should someone…when they get ili…go to doctor right away and have themselves tested) better kung may ili first really is home quarantine, supportive treatment, paracetamol, plenty of fluids and so on. Kung continuous, second day…better makita ka ng health professional. (testing standard) depends on criteria. We have criteria kung kailan kailangang kunan ng swab. As we move to higher mitigation response level, hindi na critical ang pag-swab, random swabbing na lang if there is clustering of ili in one community, just get randomly selected cases na masa-swab mo…

(precautions) basta nagkaroon ng ili…ang immuno compromised…makita agad ng doctor…precaution mag-wear ng mask…(should they wear masks now) in general we do not recommend mask kung shopping lang…may kasamahan ka na may ili…best…regular surgical mask…para ikaw naman ang may sipon, para huwag ka na makahawa…one meter…social distancing pwede na. hindi airborne, ang kailangan dito secretion mismo, the droplet, the sneeze, the cough, the saliva pag nagsa-salita…

Depends on environmental factors. Hanggang moist yan, anduon yan. Range from 6-8 hrs but depend on…pag nakadampot ka…as long as hindi ka mag-touch ng iyong mucous membranes, eyes, nose, bibig, pagkagaling mo ng mrt, wash your hands. (uulit ba iyon) may level of immunity but not characterized gaano katagal because the virus is evolving. We don’t know. Baka sa dec pag nag winter sa northern hemisphere, mag-evolve ang virus, so kahit nahawa na ngayon may potential pa rin…kung pareho lang ito ng dating seasonal flu, more may characterization na ang community level…

(mapua positive) verify namin iyan kasi wala namang report pa sa amin…

(paano nagde-declare ng community level) kailangan meron tayong first of all evidence na talagang community level transmission, hindi na madetermine sino ang nakahawa kay kanino. We will be selective. May mga islands na zero pa ngayon dapat response doon is more of containment phase.

(authorized to declare) it’s the doh generally. Whether regional or national…there should be a discussion with the sec on the local situation on region.

(declaration of community level transmission, specific number of persons to be affected) no. mahirap sabihin ang number, pwedeng 3 o 4 pero hindi mo matrace, kung saan…walang clustering, no link whatsoever…

(five schools identified dati…close na yung cases, contact tracing in all five schools) tayag: ongoing pa…villaverde: nasa 10 day observation period. La salle taft ang nakatapos pa lang. traced to the third generation yun.

(46 new cases…remaining 30, recent history of travel)…wala akong details dito…(second generation) we will. Meeting on Saturday, assigned committees of task force…because we have breached the 100th cases mark, madali nang ma-characterize…we can assess now the clinical characteristics, laboratory characteristics and geographic spread…and we can already do a severity assessment. 100% so far of all positive cases are mild. Severity is generally mild. Clinical, most of cases manifested with fever, cough sore throat. Some cases headache and fever, no cough. We will try to see distribution. Geographic spread, make some initial assessment…we have a cohort of positive cases, more than 100 pwede nang ma-characterize ang illness in the Philippines. (range of time) kasama dito sa severity assessment. Clinical characteristic of illness. Hindi ko pa masabi kasi kailangan I assess but generally halos pareho ng seasonal flu…three to five days on average but of course there are those who range up to seven. We will provide you with these.

(Makati situation. In general, what is sop…when there is confirmed case) we will be issuing modification of school response level system…on level four…sustained community level transmission. Pag ganoon ang situation baka hindi kailangan mag declare ng suspension of classes, whether school or community Parehong meron so useless to suspend classes. Suspension to characterize cohort…not only to characterize but also see response of school pag nagkaroon ng unang kaso or cluster of cases in school. (wala pa) suspension. Hangga’t hindi in-official na malabas ang revised version. Not see sustained community level transmission in metro manila or any part of metro manila so default action is suspend classes for 10-day period. (area specific, hindi pwedeng buong Makati) yes. Makita sa school response level, school by school or area by area. Modifying because of experience in first five schools that declared suspension of classes…dlsu taft, st benildes, st Andrews, ateneo and east asia college. Sa experience natin malalaman natin kung responsive ang ating response level system.

(changes brought about by declaration of alert level 6) in a way, yes. This is also related to declaration of who of pandemic level 6. We have to consider that, because as we have said that’s the global picture but have to tailor fit response level system sa local condition. Geographic characteristic of phils, easier to isolate…

(46, 30 not related to jaen and bulacan?) we have not…(any school based cases) Cannot answer for sure because we don’t have details.

(talks with who…ground zero…not yet mutated to full potential…) every country in the international health regulation…all countries signatory to that treaty…kailangan mag report so that mas macharacterize kung saan…

Third level transmission in jaen…so far.

(foreigners) kasama sa gagawing severity assessment…ito ang mga gagawin namin…severity assessment, we can more or less do assessment because we have more than 100. Review command system,, operation system, need t o strengthen local gov’t units and bgy health emergency response teams because of what is now happening in jaen. Also possible may happen ot other communities, more we need to organize even in bgy level. Disease surveillance and lab surveillance, we will establish more facilities na may capability to confirm cases, see kung pwedeng gamitin lab ng unilab for private health sector. Health facility response, health center kailangan alam paano ima-manage…mild and severe cases…public health intervention, particularly non pharmaceutical…because we are shifting to mitigation response, need to revise some of our guidelines.

Update No. 41

DUQUE REPORTS 33 MORE A(H1N1) CASES SENT HOME OVER THE WEEK-END WHILE CONFIRMING COMMUNITY OUTBREAK IN ONE BARANGAY IN JAEN
15 June 2009

Health Secretary Francisco T. Duque III today announced that 33 more A (H1N1) patients have been sent home over the weekend after recovering from the said illness. To date, the country has already 71 fully recovered cases.

Meanwhile, Duque also reported that there were 46 more confirmed mild A (H1N1) cases over the weekend, thus bringing the total figure of positive cases since to 193 (including the 36 confirmed cases reported Sunday) since May 1.

The 46 new confirmed cases involved 27 females and 19 males with an age range of 9-47 years old. All of the new cases are Filipinos.

On the other hand, after falling ill with flu-like symptoms, 19 individuals from a barangay in Jaen, Nueva Ecija were tested for the novel virus. Eight of them turned out positive for A (H1 N1). Duque said that the said figures are all community cases.

The local executives in the said province declared an outbreak over the weekend. Regional health officials said that the 8 confirmed cases are all mild in nature and are all responding well to their treatments.

“It’s an outbreak of mild A (H1N1) cases,” Duque said.

Duque also reiterated that not only school authorities but barangay leaders and heads of offices, as well, across the country should continue reporting to their respective local government executives any unusual occurrence of flu-like symptoms among their students, constituents and employees, respectively, especially those who travelled last summer from countries affected with the A (H1N1).

”This effort is part of the readiness of the Department of Health (DOH) to shift from containment to mitigation”, Duque said.

In a breaking news, 8 confirmed A (H1N1) cases out of 18 samples from Candelaria Elementary School in Candelaria, Bulacan were also reported by Duque today in his briefing with De La Salle University Officials. Details of these cases are being confirmed.

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