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Vol. 4, Jan to Dec 2015

Epidemiology Bureau Department of Health

3rd Floor, Building 19, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila Trunkline: 651-7800 loc 2929

Event-based Surveillance and Response (ESR) Annual Report

I. Introduction

Event-based surveillance is an organized and rapid

capture of information about a public health event that may affect or has already affected an individual, a group of individuals or an institution. It is the process wherein reports or information received are rapidly assessed for the risk the event poses to public health and responded to immediately and appropriately.

II. Objectives

1. To capture all types of health events with potential public health risk including rare and new events

2. To immediately assess and respond to all captured health events in order to decrease morbidity, mortality and disability to minimize economic impact

3. To immediately disseminate available information regarding ongoing health events to relevant or concerned agencies for proper coordination of response and support activities

4. To provide information for International Health Regulations (IHR) notification.

III. Core Processes

A. Capture – sources of health events can be

from the different media (television, radio, print and

internet), health facilities at the different levels of the

health system (DOH and other attached agencies,

partner agencies and local government units) and from

the general public (concerned citizens). There are 2

types of Capture namely:

Active - purposeful daily gathering of health events by the ESR staff through the internet and other media sources such as television, radio and print.

Passive - health events reported by the media people, health facilities such as DOH and other attached agencies, partner agencies and Local Government Units by email, fax, phone calls or text messages to the ESR staff.

A total of 2,258 health events were captured by the ESR Unit from January to December 31, 2015. Two thousand two hundred thirty-one (99%) health events were captured through the DOH (EB, HEMB, RESUs, MRUs, DPCB, FDA and RITM) while 3 (0%) were captured through the internet, two from television and 22 (1%) through IHR Focal Person of different countries, US CDC and concerned citizen (Fig. 1).

Figure 1. Proportion of Captured Health Events by

Source of Information January 1 to December 31, 2015 (N=2,258)

In 2015, 2,258 health events were captured which is 55% higher compared to 2014 which only has 1,458. Out of the 2,258 health events, 2,234 (99%) were reports from the region. Region 12 had the most number of captured health events for this year (Fig. 2).

There was an increase in the number of

captured events in all regions and this could be

attributed to online reporting of health events.

Figure 2. No. of Health Events Captured per Region

2014 vs 2015

The purpose of the 22 (1%) health events

reported by other IHR Focal Persons from other

countries, US-CDC and concerned citizens are for

contact tracing and release of laboratory results.

A total of 2,237 (99%) health events were

captured passively, while 21 (1%) events were

captured actively in 2015.

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B. Filter – It is a process of reviewing which health events should be discarded or warrants further investigation.

Criteria for Filtering Health Events

- Unknown illness/unusual health events

- High morbidity or mortality

- Potential for International spread of the

disease

- Interference with travel or trade

- Disease for elimination/eradication

- Suspected, accidental or deliberate biological

and chemical threats

- Double/multiple reporting of same health

event

The ESR unit filtered all 2,258 health events

captured for the year 2015. Of the 2,258 captured events, 2,134 (95%) were verified and have reports, 113 (5%) health events were discarded and 11 (0%) For information only (Fig. 3).

Figure 3. Proportion of Captured Health Events after

Filtering January 1 to December 31, 2015 (N= 2, 258)

The following were reasons for discarding the 113 health events:

Not a true health event

Late Reporting

C. Verification – It is a process by which a health event can be substantiated and should be done within 24 hours from date and time of capture. It should involve asking another informant about the event; if possible from trained health personnel. It should also include confirming the basic information as to Time, Place and Person.

Criteria for a Verified Health Event

- Confirmed by different sources of information. - Reported by persons in authority (Rural Health Unit staff, Provincial Health Office, Regional Office, National Reference Laboratories, other DOH facilities)

A total of 2,134 health events were verified in

2015. This is 49% increase compared to 1,435 health events in 2014. The month of March had the most number of verified health events in 2015 (Fig. 4).

Figure 4. No. of Verified Health Events by Month

2014 vs 2015

Of the 2,134 verified health events, 2,124 (100%) were verified by the regions, 8 (0%) by Central ESR and 2 (0%) by IHR Focal Persons from other countries.

Region 12 had the most (308) number of

verified health events per Reporting Unit this year. (Fig. 5).

Figure 5. No. of Verified Health Events by Reporting Units

2014 vs 2015

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Out of the 2,134 verified health events, 429 (20%) were Vector-borne Diseases (e.g. Dengue, Malaria, Chikungunya and Filariasis) followed by Vaccine Preventable Diseases (e.g. Acute Flaccid Paralysis, Measles, Adverse Event Following Immunization, and Diptheria) with 349 (16%) reported (Fig. 6).

Figure 6 . Proportion of Verified Health Events by Disease

Classification January 1 to December 31, 2015 (n=2,134)

For Summary of Health Events per Disease

Classification by Region, please see Annex A. The following are the criteria for an ongoing, controlled and closed event: Criteria for an on-going event:

Other information still on verification.

Specimens are to be collected and with pending laboratory results.

The local or regional health team is currently monitoring the event.

The local or regional health teams are planning control activities of the event.

There are still additional cases or deaths. Criteria for a controlled event:

Gradual or abrupt decrease of cases.

Cases showed good prognosis or event has already been managed but other information still on verification such as description of cases, laboratory findings, etc.

No cases or deaths had been added.

Event was controlled or managed by the local or regional health team.

Criteria for a closed event:

Laboratory results have no significant findings that will endanger health of the public.

Cases were already discharged and in good condition (for admitted cases in the hospital).

Follow-up reports indicate no assistance, further investigation and monitoring needed.

The health event was referred for appropriate interventions to concerned health agencies/office.

Out of the 2,134 verified health events, 1,318 (62%) were closed, 290 (14%) controlled and 526 (25%) are on-going (Fig. 7).

Figure 7. Proportion of Verified Health Events by Status

January 1 to December 31, 2015 (n= 2,134)

CARAGA had the most number (167, 8%) of

closed events followed by Region 12 (146, 7%) (Fig. 8).

Figure 8. Status of Verified Health Events by Region January 1 to December 31, 2015 (n=2, 134)

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Majority (1,140, 53%) of the true health events

were verified by ESR Central Office within 24 hours, while the remaining (994, 47%) health events were verified beyond 24 hours.

D. Assessment – It is a process by which the

available information about a confirmed health event is analyzed and categorized whether it is a public health risk. The assessment should be done within a 48-hour period. Assessment should be done in 4 Levels of Concern namely:

Public Health Event of Local Concern (PHELC) – health event is confined to a specific geographical location or involves vulnerable groups of people in the locality.

Public Health Event of Regional Concern (PHERC) – health event requires additional technical and laboratory support not found in the local area. The health event has a potential to spread in other provinces/ cities/ municipalities.

Public Health Event of National Concern (PHENC) – health event has a potential risk to cross boundaries or borders from one region to another.

Public Health Event of International Concern (PHEIC) – health event has possible implications to international trade and travel or it may concern ill foreign nationals travelling to or from other countries. The event is rare and may involve diseases not previously reported in the country.

Out of the 2,134 verified health events 1,801

(84%) were assessed as to Public Health Event of Local Concern (PHELC), 297 (14%) were assessed as to Public Health Event of National Concern (PHENC), 20 (1%) were assessed as to Public Health Event of Regional Concern (PHERC), while 16 (1%) were assessed as to Public Health Event of International Concern (PHEIC) (Fig. 9).

Figure 9. Proportion of Verified Health Events Assessed

by Level of Concern January 1 to December 31, 2015 (n=2,134)

The following were ten health events of international concern of Filipino nationals in other countries:

1. Three events were reported as Mutli-drug Resistant Tuberculosis in Australia

2. Suspect Food-borne Illness Cases in Canada 3. Hansen’s Disease in Taiwan 4. Confirmed MERS-CoV in Thailand 5. Suspect Diptheria Case in United Kingdom 6. Mycobacterium Tuberculosis in USA 7. Rabies Death in Massachusetts 8. Referral of a Tuberculosis Case from Korea 9. Pulmonary Tuberculosis Case in Singapore 10. Confirmed MERS-CoV Cases in Riyadh,

Kingdom of Saudi Arabia E. Response – This process varies according to the

level and capabilities of the agencies involved. Response should be managed by the head of office (e.g. mayor for municipalities and cities). FETP only conducts outbreak investigations in coordination with the LGUs and regional health offices. Other health events were referred to concerned agencies/offices.

One-thousand eight-hundred one verified health

events were responded locally by the regions (Fig. 10).

Figure 10. No. of Verified Health Events with

Local Response by Region January 1 to December 31, 2015 (n=1,801)

The 10 events of International Concern were referred to concerned Program (DPCB) for information and verification.

There were 34 health events reported by ESR

investigated by Field Epidemiology and Training Program (FETP) Fellows this year.

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F. Feedback – is a process where ESR staff make a weekly summary of the health events to RESU. It encourages the ESUs to continue reporting health events to EB in a timely manner. Table 1. Summary of Feedback Reports to the RESUs January 1 to December 31, 2015 (N= 2,234)

REGION TOTAL HEALTH

EVENTS

RO-RESU1 148

RO-RESU 2 56

RO-RESU 3 101

RO-RESU 4A 47

RO-RESU 4B 36

RO-RESU 5 169

RO-RESU 6 232

RO-RESU 7 131

RO-RESU 8 139

RO-RESU 9 42

RO-RESU 10 133

RO-RESU 11 151

RO-RESU 12 318

RO-RESU ARMM 7

RO-RESU CAR 58

RO-RESU CARAGA 239

RO-RESU NCR 227

TOTAL 2,234

IV. Conclusions

From January 1 to December 31, 2015, 2,258

health events were captured by the ESR Unit. Two thousand one hundred thirty-four were verified as true health events.

Region 12 had the most number of reported

health events followed by CARAGA. The most common reported health events for 2015 were under the Vector-borne Diseases Classification. The month of March had the most number of verified health events. There were 34 verified health events that were investigated by FETP fellows in 2015.

V. Other Activities:

Epidemiology Bureau conducted three major activities for the year 2015: I. Three Online ESR (O-ESR Training)

o The objective of the activity was to improve and strengthen the functionality of ESR through online reporting of health events.

Date Venue Participants

March 9-13, 2015

Chalet Baguio, Baguio City

A. Luzon Hospitals: 10

City/Municipality:

15

Province: 14

Region: 7

RITM: 2

June 1-5, 2015

Talisay City, Negros

Occidental

B. Visayas Hospitals: 2

City/Municipality:

13

Province: 11

Region: 3

BOQ: 2

August 10-14, 2015

Sarrosa International,

Cebu City

C. Mindanao Hospitals: 7

City/Municipality:

11

Province: 10

Region: 6

BOQ: 3

HEMB: 2

II. Two Program Implementation Review

o The objective of the activity was to improve and strengthen the functionality of ESR processes.

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Date Venue Participants

April 20-24, 2015

Eagle Point Resort, Mabini

Batangas

A. Luzon Batch City/Municipality:

11

Province: 9

Region: 23

RITM: 2

July 6-10, 2015

Bohol Divers Resort,

Panglao Bohol

B. Visayas Batch Hospitals: 1

City/Municipality:

5

Province: 11

Region: 15

RITM: 1

III. Pilot Training on Basic Epidemiology

for Event-based Surveillance and Response Staff (BEES)

o The objective of this activity was to

provide ESR staff with the basic knowledge on epidemiology and its application to Event-based Surveillance and Response.

o Before the BEES Training, 12

modules were developed by ESR with technical assistance from WHO Country Office.

o BEES Training was held at Kay Hotel Residence, Angeles Pampanga last October 12-16, 2015.

o A total of 49 participants attended the training. The participants were composed of 40 RESU, 1 Provincial Health Office, 1 City Health Office, 2 RITM, 2 FDA, 2 BOQ and 1 HEMB staff.

IV. Special Reports

A. Rabies Deaths 2015

o A total of 148 rabies deaths were captured from January 1 to December 31, 2015.

o This is 61% higher than in 2014.

o Age ranged from 3-86 years old. Majority (119, 80%) were males.

o Region V had the most (23, 16%) reported number of rabies death followed by Region I (21, 14%) and Region VI (20, 14%).

o None of rabies deaths events were laboratory confirmed.

B. Maternal Deaths 2015

o A total of 252 maternal deaths were captured from January 1 to December 31, 2015.

o Age ranged from 17-47 years old.

o Region V had the most (70, 28%) reported number of maternal deaths followed by Region VI (51, 20%) and CARAGA (31, 12%). Regions 11, CAR, NCR and ARMM has no maternal death report.

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Annex A:

Summary of Health Events per Disease Classification by Region from January 1- December 31, 2015

Vector-borne Diseases R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Chikungunya 1 0 2 0 0 3 2 2 0 2 4 1 4 7 0 0 0 0 28

Dengue 47 5 20 3 1 8 13 26 15 1 45 2 58 93 14 17 0 0 368

Filariasis 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 3

Japanese Encephalitis 1 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 5

Malaria 2 0 0 0 1 0 1 3 2 0 1 2 7 2 2 1 0 0 24

Viral Encephalitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1

Vaccine Preventable Diseases R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Acute Flaccid Paralysis 5 4 7 0 0 7 21 7 18 0 6 22 25 6 0 10 1 0 139

Adverse Event Following Immunization 1 1 0 1 2 1 14 0 7 0 5 11 22 7 4 4 0 0 80

Adverse Event Following Mass Drug

Administration 1 0 1 0 3 1 1 2 2 1 1 6 2 4 0 0 1 0 26

Chickenpox 0 0 0 0 0 0 0 0 0 0 1 0 0 3 0 1 0 0 5

Diptehria 0 0 1 2 0 3 3 1 0 0 0 0 0 0 0 6 0 1 17

Hepatitis B 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1

Measles 0 2 7 0 0 1 1 3 3 4 6 4 6 10 3 1 1 0 52

Mumps 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 2

Neonatal Tetanus Death 0 2 0 0 0 2 2 1 1 0 0 0 10 1 0 0 0 0 19

Pertussis 1 0 0 0 0 0 2 0 0 0 0 4 0 0 0 1 0 0 8

Food and Water-borne Illness R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Acute Bloody Diarrhea 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1

Acute Gastroenteritis 8 1 0 0 0 1 1 1 0 0 0 0 3 3 1 0 0 0 19

Viral Hepatitis 0 2 1 0 0 3 0 1 1 0 0 0 4 0 1 0 0 0 13

Amoebiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1

Cholera 0 1 0 2 0 0 1 0 0 0 0 0 0 0 0 1 0 0 5

Diarrhea 0 1 1 0 1 3 4 4 4 1 4 2 21 1 0 0 2 0 49

Food-borne Illness 16 5 8 9 3 10 22 16 2 4 15 23 32 16 9 14 1 1 206

Paralytic Shellfish Poisoning 0 0 0 0 0 0 4 1 5 0 0 0 0 0 0 0 0 0 10

Typhoid Fever 1 0 0 0 1 2 0 5 4 1 0 1 2 1 2 1 1 0 22

Vomiting and Diarrhea 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2

Emerging and Re-emerging Diseases R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Avian Influenza 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 3

E-bola 1 1 1 1 0 0 0 2 0 0 0 0 2 0 0 2 0 2 12

MERS-CoV 1 14 6 14 2 1 16 16 6 4 4 23 29 6 5 122 0 2 271

Severe Acute Respiratory Infection 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 3

Maternal Death R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Maternal Death 3 3 9 2 3 70 51 5 28 13 6 0 28 31 0 0 0 0 252

Zoonotic R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Rabies 21 2 9 1 2 23 21 2 5 5 17 8 19 10 0 5 0 0 150

Leptospirosis 10 0 9 0 0 2 4 2 0 0 3 5 0 1 2 1 0 0 39

Meningococcal R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Meningococcemia 0 0 3 3 4 10 7 11 11 1 7 11 2 7 2 11 0 0 90

Bacterial Meningitis 8 0 0 1 1 2 0 1 0 0 0 0 8 8 0 0 0 0 29

Total: 429

Total: 349

Total: 328

Total: 289

Total: 252

Total: 189

Total: 119

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2015 2014 2015 2014 Closed Controlled Ongoing PHELC PHERC PHENC PHEIC

Passive

Region 1 148 79 140 79 119 7 14 136 0 2 2 136 148

Region 2 56 41 52 39 25 2 25 35 1 16 0 35 56

Region 3 101 116 98 112 67 9 22 87 1 8 1 87 101

Region 4A 47 42 47 41 21 10 16 25 1 20 1 25 47

Region 4B 36 18 30 17 18 6 6 25 0 5 1 25 36

Region 5 169 63 159 61 123 29 7 158 0 1 0 158 169

Region 6 232 210 209 208 145 42 22 190 1 17 0 190 232

Region 7 131 20 124 20 101 16 7 100 5 19 0 100 131

Region 8 139 84 133 83 106 16 11 126 0 7 0 126 139

Region 9 42 49 42 46 28 5 9 38 0 4 0 38 42

Region 10 133 37 132 37 46 6 80 127 1 3 0 127 133

Region 11 151 73 134 73 53 27 54 107 3 24 0 107 151

Region 12 318 204 308 201 146 76 86 278 1 29 0 278 318

ARMM 7 7 7 7 2 0 5 7 0 0 0 7 7

CAR 58 35 56 35 18 3 35 48 0 8 0 48 58

CARAGA 239 226 230 223 167 11 52 217 4 9 0 217 239

NCR 227 103 221 100 129 23 71 97 2 122 2 97 227

IHR 3 10 2 10 0 2 0 0 0 1 3 0 3

Sub-total 2237 1417 2126 1392 1314 290 522 1801 20 295 9 1801 2237

Active 21 39 8 39 4 4 0 0 2 7 0 21

Total 2258 1456 2124 1431 1318 290 526 1801 20 297 16 1801 2258

Total no.

of HE with

feedback

to RO (this

mo.)

No. of CAPTURED

HEALTH EVENTS

STATUS

(2015)

VERIFIED AS TRUE

HEALTH EVENTSRegion

ASSESSMENT

(2015)

Total no.

of HE

responde

d locally

(this mo.)

OthersR1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Others 11 8 10 6 3 3 8 10 6 5 7 4 11 4 5 10 0 5 116

AIDS-relatedR1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

AIDS-related Death 0 0 3 0 1 1 8 1 12 0 0 0 10 5 0 4 0 0 45

Chemical-Related DiseasesR1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 CARAGA CAR NCR ARMM IHR

Arsenic Poisoning 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 2

Chemical Ingestion 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 3

Chemical Inhalation 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 2

Chemical Poisoning 0 0 0 0 0 1 1 0 0 0 0 3 1 2 0 0 0 0 8

Chemical Spill 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1

Gas Leak Incident 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1

Organophosphate Poisoning 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1

Total: 116

Total: 45

Total: 18

Cont….

Annex B:

Statistical Report of Present and Previous Year by Region

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Annex C: Number of Verified Cases and Deaths by Health Event from January 1- December 31, 2015

Health EventTotal No. of

Health Events

Total No. of

Cases

Total No. of

Deaths

Vector-Borne Diseases

Chikungunya 28 1565 0

Dengue 368 12471 214

Filariasis 3 4 0

Japanese Encephalitis 5 67 1

Malaria 24 59 0

Viral Encephalitis 1 1 1

Total: 429 14167 216

Vaccine Preventable Diseases

Acute Flaccid Paralysis 139 148 5

Adverse Event Following Immunization 80 100 22

Adverse Event Following Mass Drug

Administration 26 8363 2

Chickenpox 5 37 0

Diptheria 17 18 5

Hepatitis B 1 72 0

Measles 52 378 4

Mumps 2 77 0

Neonatal Tetanus Death 19 19 19

Pertussis 8 11 1

Total: 349 9223 58

Food and Water-borne Diseases

Acute Bloody Diarrhea 1 20 0

Acute Gastroenteritis 19 201 13

Viral Hepatitis 13 266 3

Amoebiasis 1 3 0

Cholera 5 86 7

Diarrhea 49 2298 17

Food-borne Illness 206 7006 17

Paralytic Shellfish Poisoning 10 57 2

Typhoid Fever 22 391 8

Vomiting and Diarrhea 2 60 0

Total: 328 10388 67

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Emerging and Re-emerging Diseases

Avian Influenza 3 3 0

E-bola 12 15 2

MERS-CoV 271 554 8

Severe Acute Respiratory Infection 3 3 1

Total: 289 575 11

Maternal Death

Maternal Death 252 252 252

Total: 252 252 252

Zoonotic Diseases

Rabies 150 344 151

Leptospirosis 39 105 31

Total: 189 449 182

Meningococcal Diseases

Meningococcemia 90 99 60

Bacterial Meningitis 29 31 27

Total: 119 130 87

Others

Others 116 1,219 22

Total: 116 1,219 22

AIDS-related

AIDS-related Death 45 45 45

Total: 45 45 45

Chemical-related Poisoning

Aresenic Posioning 2 18 0

Chemical Ingestion 3 9 0

Chemical Inhalation 2 67 0

Chemical Poisoning 8 161 1

Chemical Spill 1 0 0

Gas Leak Incident 1 5 0

Organosphate Poisoning 1 42 0

Total: 18 302 1

Cont...

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