1.
8
Group 5
OUTLINE
I. Food and Water Borne Diseases
A. Amebiasis
B. Capillariasis
C. Cholera
D. Heterophyiasis
E. Paragonimiasis
F. Typhoid
II. Etiologic Agents of Common FWBD
III. FWBDPCP in the Past
IV. FWBDPCP 2011-2016
V. Main Focus of FWBDPCP
VI. Components of FWBDPCP
VII. Guidelines and Strategies for Prevention of Cholera and
Typhoid Fever
A. Typhoid Fever
B. Cholera
VIII. Linkages of FWBDPCP
Lead Agencies and Functions in FWBDPCP
FOOD AND WATERBORNE DISEASES
EPIDEMIOLOGY
MODE OF TRANSMISSION
 Ingestion of food or water contaminated by disease-causing
organisms
AMEBIASIS
 Caused by anaerobic parasite protozoan Entamoeba histolytica
with or without symptoms
 Diagnosis: by finding cysts in the stool from an asymptomatic
human infections
 Symptoms: lower quadrant abdominal tenderness, fever,
weight loss occult blood in stools, abdominal pain, distention
and rebound tenderness
 Etiology: E. hystolityca is found in fecally contaminated food
and water. The cysts are environmentally stable, being
resistant to chlorination and desiccation, surviving days to
weeks in the external environment. Trophozoites, on the other
hand, are rapidly destroyed once released outside the body,
and if ingested would not survive the gastric environment thus
can only survive inside the host and in fresh loose feces. Some
of the trophozoites remain in the intestinal lumen of individuals
asymptotic carriers, passing only the cysts in their stools.
 Transmission and Life Cycle:
o The parasite E. histolytica is transmitted via fecal-oral
route, either directly by person-to-person contact or
indirectly by eating or drinking contaminated food or
water. Transmission can also occur indirectly through
sexual intercourse or contact with focally contaminated
objects.
o Cyst and trophozoites are passed in the feces. Usually,
cysts are found in formed stool while trophozoites are
found in diarrhoea stool. Infection starts when an
individual ingests contaminated food and water that
contains mature cysts. After which, excystation occur in
the small intestine were trophozoites are released and
then migrates to the large intestine. The trophozoites
then undergo binary fission to multiply and produce
cysts. Both stages are passed to the feces.
 Prevalence: overall prevalence worldwide approximately 50
million cases, resulting to as many as 100,000 deaths,
wherein only 10-20% are actually symptomatic
CAPILLARIASIS
 Disease caused by a nematode Capillaria philippinensis
 Symptoms: watery diarrhoea, abdominal pain, edema,
weight loss, borborygmus (stomach growling), and
decreased level of potassium and albumin in the blood.
 Etiology: C. philippinensis can live and continue its life cycle
inside the body of small fresh- or brackish-water fish, which
serve as the intermediate host, and fish-eating birds, as the
usual definitive host.
 Transmission and Life Cycle:
o The parasite C. philippinensis is transmitted via
ingestion of infective eggs in contaminated soil as seen
in children or soil contaminated food or water. However,
C. philippinensis cannot be transmitted human to human
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
Food and Waterborne Diseases
22 July 2015
and requires the intermediate freshwater fish host thus
it can also be transmitted via ingestion of raw or
inadequately cooked small fish.
o Starts when unembryonated eggs are passed in the
human feces to the external environment where it
becomes embryonated. It will be ingested by freshwater
fish, where larvae hatch, and then penetrate the
intestine and migrate to the tissues of the fish. Infection
of human host happen when infected fishes are eaten
raw or undercooked. Humans are the only demonstrated
hosts. The adult form of C. philippinesis resides in the
human small intestine, where it burrow in the mucosa.
The females then deposit unembryonated eggs. Some of
there become embryonated in the intestine and release
larvae that causes autoinfection leading to
hyperinfection.
 Prevalence: In the Philippines, it is endemic in some coastal
areas of Northern Luzon in the provinces of Ilocos Norte,
Cagayan, Isabela, Ilocos Sur, La Union, Pangasinan and
Zambales.
CHOLERA
 Caused about by bacterium Vibrio cholera
 Risk factors include poor sanitation, unclean drinking water,
and poverty
 Diagnosis of the disease is by discovery of the bacteria in the
stool of an infected individual.
 Symptoms: profuse water diarrhea and dehydration, thus
when left untreated may cause death
 Transmission and Life Cycle:
o Vibrio cholerae is transmitted via consumption of food
and water that is contaminated with infectious feces.
While in epidemic areas, transmission may be also due
to ingestion of infected raw fish and seafood.
o For its life cycle, its toxigenic strains persist in aquatic
environment together with the non-toxigenic strains.
These strains are protected by biofilm formation on
biological surfaces and the use of chitin as a carbon and
nitrogen source. Upon ingestion of these bacteria, the
toxigenic strains colonise the small intestine, multiply
and then secrete cholera toxin. These are shed back into
the environment by the host in secretory diarrhea.
 Prevalence: In the Philippines for year 2011, Region X has
the highest number of cases with a rate of 0.4 per 100,000
population with Lanao del Norte having the most number of
cases in the said region. NCR ranks second to Region X, with
Muntinlupa having the most number of cases. Region V ranks
next to NCR, where cases are specific to Masbate and Legaspi
City.
HETEROPHYIASIS
 Caused by an intestinal fluke, trematode Heterophyes
heterophyes.
 Eggs are identical with the eggs of the Opisthorchis and
Clonorchis
 Symptoms: abdominal pain, diarrhea, intestinal
haemorrhage, intestinal obstruction, abdominal ascites, and
generalized edema.
 Etiology: The H. heterophyes are capable of surviving and
reproducing in a wide range of hosts. It can live and continue
its life cycle inside a raw fish from freshwater or brackish
water
 Transmission and Life Cycle:
o The H. heterophyes is transmitted via ingestion of raw
or uncooked fish from freshwater or brackish water
containing metacercariae.
o For its life cycle, the adults release embryonated eggs
each containing with a fully developed-miracidium.
These eggs are then passed in the host’s feces. After
ingestion by a suitable snail, which serves as the
intermediate host, the eggs hatch and release miracidia,
which penetrate the snail’s intestine. In Asia, the genera
Cerithidia and Pironella are important snail hosts. The
miracidia now undergo several development stages
inside the snail. The formed cercariae are released from
the snail and encyst as metacercariae in the tissue of a
fresh/brackish water fish, which serves as the second
Page 1 of 21
 FOOD AND WATERBORNE DISEASES 1.8

intermediate host). When an individual ingest sanitation and poor hygiene. Travels to developing countries
undercooked or salted fish containing metacercariae, he are also at risk. Most documented typhoid fever cases involve
becomes infected and serves as the definitive host. After school-aged children and young adults.
ingestion, the metacercariae excyst, attach to the
mucosa of the small intestine and mature into adults.
Other fish-eating mammals can also be infected by H.
heterophyes.
 Prevalence: a study by Belizario et al in 1999 reported 16%
heterophyid infection rate in an intestinal parasite survey
done in Compostela Valley Province, Southern Mindanao.

PARAGONIMIASIS
 Infection brought about by a lung fluke Paragonimus
westermani (oriental lung fluke)
 Diagnosis: via microscopic examination presenting with
eggs in stool or sputum
 Symptoms: for acute phase - diarrhea, abdominal pain,
fever, cough, urticaria, hepatosplenomegaly, pulmonary
abnormalities, and eosinophilia; Chronic phase - pulmonary
manifestations include cough, expectoration of discoloured
sputum, hempotysis, and chest abnormalities.
 Extra pulmonary locations of the adult worm is common in
brain.
 Transmission and Life Cycle:
o P. westermani is transmitted via ingestion of
inadequately cooked or prickled crab or crayfish that
harbor metacercariae of the parasite. In the Philippines,
raw and undercooked crab or crayfish are commonly
eaten in certain endemic region. Paragonimiasis may
also be acquired by consuming raw meat from a
paratenic host that harbors young flukes. Infection may
also be transmitted via contaminated kitchen utensils
(e.g., cutting boards, knives) or from cloths used to
squeeze and strain juices from crabs for the preparation
of soup
o For its life cycle, the unembryonated eggs are secreted
in the sputum, or alternately swallowed and passed with
stool. It only becomes embryonated when it reaches the
external environment. The miracidia hatch and seek a
snail, serves as the intermediate host, and penetrate its
soft tissues. Miracidia go through several developmental
stages inside the snail and later on give rise to many
cercariae, which emerges from the snail. The cercariae
invade a crustacean, serves as the second intermediate
host, where they encyst and become metacercariae. The
human become infected after ingestion of the second
intermediate host. The metacercariae excyst in the
duodenum, penetrate through the intestinal wall into the
peritoneal cavity, then through the abdomenl wall and
diaphragm into the lungs, where they become
encapsulated and develop into adults.
 Prevalence: The distribution of the disease lies on the
presence of the intermediate host, which is Sundathelpusa
philippina, in the area. Several endemic areas had been
identified in the Philippines. These are in the provinces of
Mindoro, Camarines, Sorsogon, Samar, Leyte, Davao,
Cotabato, and Basilan; Among these areas, it is most
commonly found in Bicol region with Sorsogon having a high
prevalence rate of 25% parts of oriental Mindoro in Luzon
and Zamboanga Peninsula in Mindanao (DOH, 2010).

TYPHOID
 Also known as enteric fever, is a fatal multi systemic illness
caused by a bacteria Salmonella enterica, subspecies enteric
serovar typhi,and at lesser extent, to serovars paratyphoid
A, B, and C
 Symptoms: vary from mild to severe and usually begin six
to thirty days after exposure, including gradual onset of high
fever for several days, weakness, abdominal pain,
constipation, and headaches
 Diagnosis: via culturing the bacteria or detecting the
bacteria’s DNA in the blood, stool, or bone marrow
 Etiology: Salmonella typhi grows in the intestine and blood.
It is found on food and water contaminated by feces of an
infected individual.
 Transmission: Salmonella typhi is transmitted via ingestion
of food and water contaminated by feces of an infected
person. Generally, this is spread through poor sanitation
conditions, and sometimes also by flying insects feeding on
feces.
 Prevalence: Risk factors include poverty, due to poor

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 1.8
Food and Waterborne Diseases

Group 5 22 July 2015

ETIOLOGIC AGENTS OF COMMON FOOD AND WATERBORNE DISEASES
Disease Causative Agent/s Epidemiology Diagnosis Treatment
 Combination therapy with luminal and tissue
amoebicides
Tissue Amoebicides
 Metronidazole
 Mostly seen in tropical and developing countries
Entamoeba histolytica  Blood test  Tinidazole
 Bad sanitary and hygienic practices
E. moshkovskii  Microscopy: stool  Ornidazole
 10% world’s population is estimated to be infected
E. hartmannii  Culture: fecal or rectal biopsy, or liver  Secnidazole
AMOEBIASIS  Estimated annual mortality of 40,000–70,000
E. gingivalis abscess aspirate  Nitazoxanide
 90% of those infected are asymptomatic
Endolimax nana  Antigen and antibody detection test  Chloroquine
 1% may develop invasive or
Iodamoebabutschlii  PCR Luminal Amoebicides
extraintestinalamoebiasis
 Diloxanidefuroate
 Quinodocholor
 Iodochlorhydroxyquin
 Paromomycin:
 Case finding or Screening of cases
 Endemic in some coastal areas of Northern Luzon o History of diarrhea presenting with
o Ilocos Norte 8-10 voluminous stools per day
o Cagayan o History of eating raw or
o Isabela inadequately cooked freshwater fish  Mebendazole – DOC
o Ilocos Sur  Laboratory findings  Albendazole – alternative
CAPILLARIASIS Capillariaphilippinensis o La Union o Stool examination - Acid Ether  Oral Rehydration Solution
o Pangasinan Concentration Technique/ Formalin  Intravenous Fluids
o Zambales Ether Concentration Technique  High Protein Diet
o AgusandeI Norte in Northeastern Mindanao (AECT/FECT)
 No. of cases and deaths in Northern Luzon - o Blood tests
decreasing trend from 1967 to 1990 o Antibody detection tests
o Serologic tests
 Rehydration and supportive therapy
 Estuarine and marine environments worldwide
o Oral therapy: NaCl (3.5g/L) + KCl (1.5g/L) +
 Places with poor sanitation, crowding, war and
rice flour (30 – 80g/L) + trisodium citrate (2.9
famine
g/L)
 Can survive and replicate in contaminated waters
 Gold Standard: isolation of V. o IV fluids
with increased salinity and temperatures of 10-
choleraeserogroup O1 or O139 in o Rural areas: buko juice or water with salt and
CHOLERA Vibrio cholera 30°C
culture of stool specimen sugar
 Symbiotic associations with chitinous shellfish
 Rapid test kits  Antimicrobials
 3 to 5 million cases and 100,000-120,000 deaths
o DOC: Doxycycline
every year worldwide.
o Tetracycline
 2011, Region X (Lanao del Norte), NCR
o Chloramphenicol
(Muntinlupa) and Region V (Masbate)
o Erythromycin can also be given
Heterophyesheterophyes  North Africa, Asia Minor, Taiwan, Japan, China,  DOC: Praziquantel
 Microscopy
Other genera: Korea and the Phillipines o 75mg/kg divided in 3 doses for 1 day
o Kato Thick Smear (Kato-Katz)
HETEROPHYIASIS Metagonimus  Nishigori (1924) reports a high prevalence of o No contraindication for pregnant women,
o Formalin-ether sedimentation
Centrocestus infection of the heterophyidHaplorchistaichuiin lactating women and children aged less than 4
technique (FEST)
Pygidiopsis humans in the Philipppines (36%). years

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 FOOD AND WATERBORNE DISEASES 1.8

Stellantchasmus  Belizario et al (1999) reported 16% heterophyid

Haplorchis infection rate in an intestinal parasite survey done
Procerovum in Compostela Valley Province, Southern Mindanao.
 Endemic areas in the Philippines:
o Mindoro
o Camarines
o Sorsogon
o SamaR  DOC: Praziquantel
 Sputum examination – diagnostic tool
o Leyte o WHO: 75mg/day per orem (po) in 3 divided
of choice
o Davao doses for 2 days for all ages.
 Stool exam through FEST
o Cotabato o Belizario et al. (2007): 10 mg/kg single dose
 Biopsies
PARAGONIMIASIS Paragonimus westermani o Basilan has comparable efficacy, safety, and
 Serologic tests
 Reemergence: tolerability with praziquantel 25 mg/kg given
 Complete Blood Count
o Davao Oriental three times a day for three days.
 Intradermal skin testing
o Zamboanga del Norte  Surgery – extra-pulmonary lesions
 Chest x-ray, CT scan, MRI
 Among these areas, it is most commonly found in
Bicol region with Sorsogon having a high
prevalence rate of 25% parts of oriental Mindoro in
Luzon and Zamboanga Peninsula in Mindanao
(DOH, 2010).
 Annual incidence: about 17 million cases worldwide
o Highest in those between the ages of 5 and 12
years.  Culture:
 Oral and IV hydration
 420,000 deaths occur annually in Asia o Blood
 Antibiotic Therapy
 Case-fatality rates of infection o Bone marrow aspirate – gold
o Chloramphenicol
o 10% - without treatment. standard
o Amoxicillin
TYPHOID Salmonella typhi o below 1% - with appropriate antibiotic treatment o Specific anatomical locations
o Cotrimoxazole
 January to November 2013: o Stool
o Ceftriaxone and Cefixime
o > 28,000 cases in the Philippines  Felix Widal Test
o Azithromycin
o Case-fatality rate of 0.27%  IDL Tubex Test
o Ciprofloxacin and Ofloxacin
o There were 5,637 suspected or clinically  Typhidot Rapid Test
diagnosed cases and 60 laboratory-confirmed
cases in Regions 6, 7, and 8 and NCR.

ETIOLOGIC AGENTS OF COMMON FOOD AND WATERBORNE DISEASES (Addendum)

Agent Reservoir & Source Transmission Process Clinical Features Prevention and Control
Amoebiasis without dysentery
E. histolytica Personal prophylaxis
 Ulceration limited in the cecum and
Trophozoites  Personal hygiene
ascending colon
 Cannot survive outside  Discretion in the consumption of foods and
 Bouts of foul smelling loose stools
the human host;  Human reservoir drinks in endemic areas
 Fecal oral  Complaints of flatulence and
 Degenerates within  Infected person suffering  Consumption of potable water, or boiled
 Contaminated food, drink or abdominal cramps
AMOEBIASIS minutes from the disease water
water
Cysts  An asymptomatic carrier  2% of tincture of iodine per liter of water –
 Infected houseflies Amoebiasis with dysentery
 Survive in moist stools discharging the eggs in stool amoebicide
 Ulceration is generalized involving
for weeks or months  Eat food in hot state
the entire colon/rectosigmoid
but cannot resist  Foods exposed to dust and flies should be
 Pass loose stools containing fresh
desiccation avoided
blood

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 FOOD AND WATERBORNE DISEASES
 Killed readily by
boiling but not by
chlorination
 Removed by filtration
of water
Human reservoir
 Incubatory temporary
carriers: 1-5d
 Convalescent carriers:2-
3wks
Vibrio cholerae  Contact carriers: 1-2 wks
 Cannot withstand  Chronic carriers: >3mos;
CHOLERA environmental stress carry the vibrios in
imposed by desiccation gallbladder
or sunlight
Main source of infection
 Contaminated excreta of
cases or carriers
 Contaminated food,
fomites, and flies
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
 Fecal-oral route
 Protected water supply not
available
 Contaminated natural bodies
of water
 Food preparation
contaminated by food handler
 Houseflies contaminate
exposed foods; vibrios can
survive in the intestines of
houseflies for at least 3 days
Page 5 of 21
1.8
 Stools, watery and bloody with or
without mucus
 Vomiting, fever, dehydration
 Generalized/localized abdominal
tenderness
 Profuse, painless, watery diarrhea
 Rice water appearance, colorless
and odorless with flakes of floating
mucus
 Vomiting follows
 Raw vegetables grown in endemic areas
should not be consumed as salads
 Handwashing before taking meals and
after visiting toilet
Environmental Sanitation
 Hygienic disposal of night-soil
 Disposal of solid wastes
 Provision of potable water
 Control of fly breeding
 Ban of the use of raw night soil for
fertilization of vegetable farms
 Inspection of food-handling establishments
to ensure hygienic practices in selection,
storage, distribution, preparation, and
consumption of food items
 Same as amoebiasis
 FOOD AND WATERBORNE DISEASES
Human reservoir
 Case: either
clinical/subclinical
 Carriers
o Temporary carriers:
Salmonella typhi
usually the
 Cannot stand drying or
convalescent type who
heating
discharge bacilli for 1-2
 Survive in water for
mos after recovering
some time, in sewage-
from clinical illness
polluted water for
TYPHOID o Chronic carriers:
several weeks, and
observed in women
sewage-irrigated soil
after 40 y/o; excrete
for up to 10 weeks
the organisms for more
 Multiply in foods,
than 1 yr
especially milk and
 Feces and urine of infected
milk products
persons are the primary
sources of infection
 Frequent sources are
contaminated food water,
and houseflies
Transcribers: BLANCO, CAHANDING, CINCO ♥ FARILLAS, SOLIS
 Fecal–oral route
 Urinary route: may be a
portal of exit
 Water-borne transmission
o Natural water sources are
open to contamination by
human excreta
o Piped water supply are not
available
 Food-borne transmission
o Food handler carriers
o Working dairy farms –
contaminate milk
o Shellfish in sewage-
contaminated water
o Vegetable & salads grown
on sewage farms or
washed with contaminated
water when consumed in
raw state
Page 6 of 21
1.8
 1st week
o Fever, malaise, chills, and
headache, joint and muscle pain
o Typhoid rash: rose-spots, may
appear on upper abdomen and
o back; maculo-papular, slightly
raise, and red in caller
 Same as amoebiasis
 2nd week
 Vaccination
o Temperature continues to remain
o Inactivated vaccine given at 4-6 wks
high with diurnal variations
interval and booster dose of every 3 yrs;
o Diarrhea: 4-6 pea soup stools/day
0.5 ml SQ in adults
o Distended abdomen and palpable
o Oral “Ty 21a” vaccine: administered I 4
spleen
enteric-coated capsules in alternate days
o Lose mental alertness/delirium
 3rd week
o Favorable: improvement in
general condition with resolution
of fever
o Unfavorable: high temperature
and semicomatose state
 1.8
Food and Waterborne Diseases

Group 5 22 July 2015

THE FOOD AND WATERBORNE DISEASES PREVENTION
AND CONTROL PROGRAM (FWBDPCP) IN THE PAST
 FWBDs are among the most common causes of diarrhea,
remains one of the 10 leading causes of morbidity and
mortality in the country.
 Since most of these diseases have no specific treatment
modalities, the best approaches to limit economic losses due
to FWBD is prevention through:
o Health education
o Strict food and water sanitation
 DEPARTMENT OF HEALTH – EXECUTIVE COMMITTEE
(DOH-EXECOM),APRIL 23, 1997
o Unanimously approved the creation of the Food and
Waterborne Diseases Prevention and Control Program
under the Communicable Disease Control Service in line
with public health efforts to control diarrhea
o Implemented in the year 2000
 Focuses on cholera, typhoid fever, hepatitis A and other
foodborne emerging diseases (e.g.Paragonimiasis).
 Other diseases acquired through contaminated food and
water not addressesd by other services fall under the
program.
RATIONALE OF THE FWBDPCP
 Based on the 2012 Food and Waterborne Disease Control
Program of DOH
o The program covers diseases of parasitic, fungal, viral
and bacterial in nature usually acquired through the
ingestion of contaminated drinking water or food.
o The more common of these diseases are bacterial in
nature, the most common of which are typhoid fever
and cholera. These two organisms had been the cause
of major outbreaks in the Philippines for the last two
years.
o Parasitic organisms are also an important factor, among
them capillariasis, Heterophydiasis and
paragonimiasis which are endemic in Luzon as well as
in Visayas and Mindanao. Cysticercosis is also a major
problem since it has a neurologic component to the
illness.
o The approaches to control and prevention are centered
on public health awareness regarding food safety as
well as strengthening treatment guidelines to the
diseases.
PAST FWBDPCP
TARGET POPULATION / BENEFICIARIES
 Individuals
 Families
 Communities residing in affected areas nationwide
 For parasitic infections, endemic areas are more common.
7. Procure Typhoid vaccine and oral cholera vaccine to
reduce the number of cases seen after severe flooding;
8. Provide training to local government unit(LGU)
laboratory and allied medical personnel on the Accurate
laboratory diagnosis of common parasites and proper
culture techniques in the isolation of bacterial food
pathogens; and
9. Provide guidance to field medical personnel with regard
to the correct treatment protocols vis-à-vis various
parasitic, bacterial, and viral pathogens involved in food
and waterborne diseases.
TARGET AREAS
 All regions, sporadic in areas that
are usually flooded and with poor
CHOLERA
water purification system and
waste disposal.
 Similar to cholera in distribution,
TYPHOID
nationwide.
 Region 1, Region 9, Region 11,
CAPILLARIASIS
ARMM
 Region 9, Region 10, Region 11,
HETEROPHYDIASIS
ARMM
PARAGONIMIASIS  Region 5, 9, 10
 Areas with poor water sanitation
and poor waste disposal(e.g.
AMEBIASIS areas of Bulacan, Baguio city and
crowded urban population
centers)
PAST STRATEGIES AND MANAGEMENT
OF THE FWBDPCP
1. Case monitoring is maintained through the Philippine
Integrated Disease Surveillance and Response (PIDSR)
framework of National Epidemiology Center (NEC) and the
sentinel sites of the RESU. To add to that, quarterly reports
of the regional coordinators supplement the data and the
regular updating from NEC Outbreak surveillance.
2. Outbreaks are being prevented through public education
in print and radio stations. The need for safe food and
water intake by adequate cooking and boiling of drinking
water is inculcated in the public.
3. Multi-drug resistant cases of thypoid are monitored
through reports from the hospital sentinel site and the data
from the Research Institute of Tropical Medicine (RITM) -
Antibiotic Resistance Surveillance Program.

PAST GOALS OF THE FWBDPCP

1. Prevent the occurrence of food and waterborne
outbreaks through strategic placement of water
purification solutions and tablets at the regional level
so that the area coordinators could respond in time if the
situation warrants;
2. Procure Intravenous Fluid solutions, venosets and IV
cannula for adult and pediatric patients in diarrheal
outbreaks and to be stockpiles at the 17 Centers for Health
Development (CHD) and the Central Office for emergency
response to complement the stocks of HEMS;
3. Place first line and second line antimicrobial and anti-
parasitic medicines such as albendazole and praziquantel
at selected CHDs for outbreak mitigation as well as
emergency stocks at the DOH warehouse located at the
Quirino Memorial Medical Center (QMMC) compound;
4. Increase public awareness in preventable food-borne
illnesses such as capillaria, which is centered on unsafe
cultural practices like eating raw aquatic products;
5. Increase coordination between the National Epidemiology
Center (NEC) and Regional epidemiology surveillance Unit
(RESU) to adequately respond to outbreaks and provide
technical support;
6. Procure Typhidot-M diagnostic kits for the early
detection and treatment of typhoid patients;

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 FOOD AND WATERBORNE DISEASES 1.8

MUST KNOW!!!

Program: Food and Waterborne Diseases Prevention and

Control Program (FWBDPCP)

2 Diseases that are in currently in focus

1. Cholera
2. Typhoid fever

Goals
1. Morbidity and mortality from food-borne and water-borne
diseases are reduced.
2. Outbreaks of food-borne and water-borne diseases are
reduced.

2016 Targets
1. 230 per 100,000 Morbidity Rate
2. No mortalities
3. No outbreaks per year

Strategies
1. Regulate and monitor food and water sanitation
practices at the local level through enforcement of
national and local legislations, application of appropriate
technical standards and participation of non-government
agencies
2. Sustain inter-agency collaboration to fast-track sanitation
infrastructure development in poor urban areas and in
rural areas with low access to safe water and sanitation
facilities.
3. Promote personal hygiene, food and water sanitation
practices and the principles of environmental health.
4. Promote the use of ORS in the management of diarrhea
to prevent dehydration, especially among infants and
children.
5. Promote breastfeeding and other good feeding practices
for infants and children.
6. Continue training of health personnel in the early
diagnosis and treatment of food-borne and waterborne
diseases
7. Continue nationwide information campaign for the
prevention and control of food-borne and waterborne
diseases.

Main Focus of the Program:

 Health education
 Information dissemination
 Emphasis on the World Health Organization’sTen
Golden Rules To Safe Food Preparation,
Safe Water Source, And Environmental
Sanitation

Components of the Program

1. Information Dissemination
2. FWBD Surveillance System
3. Clinical Care
4. Training on local program implementation
5. Research
6. Monitoring and Evaluation

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 1.8
Food and Waterborne Diseases

Group 5 22 July 2015

THE 2011-2016 FOOD AND WATERBORNE DISEASES PREVENTION AND CONTROL PROGRAM (FWBDPCP)
GOALS
In line with the National Objectives for Health 2011 to 2016, the overall goals of the program are as
follows:
1. Morbidity and mortality from food-borne and water-borne diseases are reduced.
2. Outbreaks of food-borne and water-borne diseases are reduced.
RATIONALE
• Food-borne and water-borne diseases are usually manifested as diarrhea, which is second to
pneumonia as the leading cause of morbidity in the Philippines. Several notable outbreaks of food and
water-borne diseases occurred in 2008.
• This group of diseases is usually caused by infectious organisms like viruses, bacteria and parasites.
However, some forms are secondary to chemical food poisoning (which will be discussed separately
under the environmental health hazards).
• These diseases are transmitted from person to person via soiled hands and via food and water
contaminated by human waste through the oral-fecal route. The incidence of food-borne and water-
borne diseases peaks during the rainy season and is usually high in areas where sanitation and
hygienic practices are poor.
• Since the occurrence of food and waterborne diseases is essentially related to economic and socio-
cultural factors, the program recognizes that outbreaks will persist unless underlying social ills are
corrected. Along with poverty comes the prevalence of infectious diseases. However, if specific
interventions are employed, a drastic reduction of bacterial and parasitic infections can also be
expected.

STRATEGIES
A. FOOD SAFETY ACT OF 2013 (REPUBLIC ACT NO. 10611)
An Act To Strengthen The Food Safety Regulatory System In The Country To Protect Consumer Health And Facilitate
Market Access Of Local Foods And Food Products, ANd For Other Purposes
• Objectives:
o Protects the public from food-borne and water-borne illnesses and unsanitary, unwholesome, misbranded or adulterated foods
o Enhance industry and consumer confidence in the food regulatory system
o Achieve economic growth and development by promoting fair trade practices and sound regulatory foundation for domestic and international trade
B. POTABLE WATER PROGRAM (SALINTUBIG PROGRAM – SAGANA AT LIGTAS NA TUBIG PARA SA LAHAT)
STRATEGY #1: • Objectives:
Regulate and monitor food and o To increase water service for the waterless population
water sanitation practices at o To reduce incidence of water-borne and sanitation related diseases
the local level through o To improve access of the ppor to sanitation services
enforcement of national and • Aims to contribute to the attainment of the goal of providing potable water to the entire country
local legislations, application of • One Billion and Five Hundred Million Pesos (Php 1,500,000,000) is appropriated to the DOH through Item B.I.a of the 2011 General Appropriations Act (GAA)
appropriate technical standards
and participation of non- C. ISO 22000:2005
government agencies • This standard specifies requirements regarding the application of food safety management systems in all food chains from producers of food to carriers, retailers
and catering establishments.
• It integrates the Hazard Analysis and Critical Control Points (HACCP) principles:
1) Conduct a hazard analysis
2) Determine the Critical Control Points (CCPs)
3) Establish Critical Limits
4) Establish a system to monitor control of the CCP
5) Establish the corrective actions to be taken when monitoring indicates that a particular CCP is not under control
6) Establish procedures for verification to confirm that the HACCP system is working effectively

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 FOOD AND WATERBORNE DISEASES 1.8

7) Establish documentation concerning all procedures and records appropriate to these principles and their application

A. MAYNILAD: “Tubig Para Sa Barangay (TPSB)” / “Water For The Community”

 Company’s flagship program to provide affordable potable water for the urban poor.
 It was developed to suit the physical, social, and economic conditions of households from marginalized communities
B. MWSS
1. Maximization of Existing Water Sources
o Angat Dam & Dike Remediation
o Angat Water Utilization and Aqueduct Improvement Project (AWUIAP) Phase 2
o Angat-UmirayTransbasin Tunnel Rehabilitation Project
o SumagRiverDiversion Project
o Watershed Management
o PPP for the Operation and Maintenance of Angat Dam Auxillary Turbines 4 & 5
o Bulacan Bulk Water Supply Project
2. Integration of Flood Control with Water Source Development in the Marikina River
o New Centennial Water Supply Project
STRATEGY #2: o Marikina River Flood Management Project
Sustain inter-agency C. ASIAN DEVELOPMENT BANK (ADB)
collaboration to fast-track  In 2008, the Asian Development Bank (ADB) will decide on the proposed Water District Development Project to continue its long-term cooperation with LWUA.
sanitation infrastructure  Furthermore, the ADB contributes through the MWSS New Water Source Development Project, which was approved in 2003 and will end in October 2008.
development in poor urban  It seeks to develop up to 3 water source projects for Metro Manila and to improve the financial management as well as the accounting and fiscal control systems of
areas and in rural areas with MWSS.
low access to safe water and D. GERMANY
sanitation facilities.  The German technical cooperation agency GTZ supports the sector through the rural water supply and sanitation program, designed to improve the living conditions
of the poor in selected rural areas of the country.
 The program seeks to overcome the institutional confusion and to strengthen governmental organizations at the national, provincial, and municipal levels.
 The main program partner is the Department of Interior and Local Government (DILG).
E. WORLD BANK
1. Manila Third Sewerage Project
o In 2007, the World Bank approved an investment loan of US$5 million.
o The objectives of the project are to assist the Philippine government in reforming institutions in order to attract private investment in the wastewater sector,
to improve the coordination of institutions responsible for preventing water pollution, and to promote innovative wastewater treatment techniques.
2. National Program Support for Environment and Natural Resources Management Project
o The project aims to assist the Philippine Department of Environment and Natural Resources (DENR) to improve its service delivery through a better allocation
of its limited financial resources.
3. Urban Water and Sanitation Project APL2
o The second Local Government Unit (LGU) urban water project aims to reach approximately 40 LGU-operated water systems, which are given technical assistance
and financial support.

A. EXPANDED CHILD HEALTH PROGRAM – GARANTISADONG PAMBATA

STRATEGY #3:  Goal: To achieve better health outcomes, sustained health financing and responsive health system by ensuring that all Filipinos, especially the disadvantaged group
(lowest 2 income quintiles) have equitable access to affordable health care
Promote personal hygiene, food  Promotes strategic behaviors such as breastfeeding, completing child immunization, and practicing personal hygiene
and water sanitation practices  Objectives
and the principles of o Contribute to the reduction of infant and child morbidity and mortality towards the attainment of MDG 1 and 4.
environmental health. o Ensure that all Filipino children, especially the disadvantaged group have equitable access to affordable health, nutrition and environment care.
 Core Behaviors Per Gateway Behavior: Magpasuso, Magpabakuna, MagBitamina A, Mag-purga, Gumamit ng Palikuran, Magsipilyo, Maghugas ng Kamay

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 FOOD AND WATERBORNE DISEASES 1.8

 Strategies:
o Financial Risk Protection
o Improved access to quality hospitals and fcailityies
o Attainment of health-related MDGs
o Deploy CHTs to actively assist families in assessing and acting on their health needs
o Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC, IPP, GP for 0-14 y/o
o Aggressive promotion of healthy lifestyle change
o Harness strengths of inter-agency and intersectoral cooperation with DedEd, DSWD and DILG
B. FIT FOR SCHOOL PROGRAM
 Implemented by the Department of Education, in partnership with German Development Corporation and GlaxoSmithKline which promotes proper Hand-washing,
deworming, toothbrushing among kindergarten and elementary children
C. ESSENTIAL HEALTH CARE PROGRAM
 Implemented by the Department of Education in cooperation with UNICEF, German Society for International Cooperation and Procter & Gamble for the
institutionalization of good hygiene practices
D. SALINTUBIG PROGRAM – SAGANA AT LIGTAS NA TUBIG PARA SA LAHAT
 Provision of Potable Water Program
o 455 municipalities nationwide have been identified by NAPC as waterless areas
o Only less than 50% access to water
o 1.5 billion budget for LGU to develop infrastructure for the provision of potable water supply
 Objectives
o To increase water service for the waterless population
o To reduce incidence of water-borne and sanitation related diseases
o To improve access of the poor to sanitation services
 Targets
o Increased water service for the waterless population by 50%
o Reduced incidence of water-borne and sanitation related diseases by 20%
o Improved access of the poor to sanitation services by at least 10%
o Sustainable operation of all water supply and sanitation projects constructed, organized and supported by the Program by 80%
 DOH - funding
 NAPC –lead coordinating agency
 DILG - in-charge of the capacity building of LGUs
E. HEALTH ENVIRONMENTAL HEALTH ACTION PLAN (NEHAP)
 Environmental Health (WHO definition)
o the practice of assessing, correcting, controling and preventing factors in the environment that can potentially adversely affect the health of present and future
generations
o Tool in alleviating poverty in the Philippines
 Approach
o interventions that prevent the generation of agents, vectors or risk factors; interrupt the transmission of the disease agents and reduce the contact between
man and these agents

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 FOOD AND WATERBORNE DISEASES 1.8

 Objectives
o To foster better collaboration at all levels between those responsible for health and those responsible for the environment and between these two and the other
players
o To foster better collaboration between the national, regional and local authorities to ensure that efforts are coordinated and synergistic
o To allow the participation of the public in the decision-making process whenever possible and at all appropriate levels
 DOH, DENR & other local agencies5 Sectoral Task Forces (SWATOFS)
o Solid Waste
o Water
o Air
o Toxic and Hazardous waste
o Occupational Health Hazard
o Food Safety
o Sanitation
 NEHAP Water Sector
<cont> o 5 Major Projects
 Enhancing Access to and Provision of Water Services with the Active participation of the Poor
STRATEGY #3:  Philippine Water Supply and Sanitation Sector Assessment and Monitoring Project
 Development of the Capacity Building Framework for Water and Sanitation
Promote personal hygiene, food  Ring-Fencing of Water Utility accounts of Local Government Units and water cooperatives
and water sanitation practices  The Philippine Portal for the Water Supply & Sanitation Sector (http://philwatsan.org.ph)
and the principles of  NEHAP Sanitation Sector
environmental health. o Philippine Sustainable Sanitation Roadmap (PSSR)
 basic framework document that will serve as the guide for the development of sustainable sanitation in the country
 National Sewerage and Septage Management Plan (NSSMP) under the DPWH
 wastewater treatment projects for public markets, slaughterhouses and hospitals
 NEHAP Food Safety
o DOH and FDA
 Guarantee of adequate, safe, quality and affordable food for public health protection as well trade development
 Food and Drug Administration Act of 2009 (Republic Act 9711)
 Ensuring the safety efficacy, purity and quality of processed foods, drugs, diagnostic reagents, medical devices, cosmetics, household hazardous substances

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 FOOD AND WATERBORNE DISEASES 1.8

A. INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI 2014)

PLAN A: TREAT DIARRHEA AT HOME
Counsel the mother on the 4 RULES OF HOME
TREATMENT:
1. Give extra fluid
STRATEGY #4:
Promote the use of ORS in the
management of diarrhea to
prevent dehydration, especially
among infants and children.
2. Give Zinc Supplements (age 2 months up to 5
PLAN B: TREAT SOME DEHYDRATION W/ ORS PLAN C: TREAT SEVERE DEHYDRATION QUICKLY
In the clinic, give recommended amt of ORS over a Can you give IV fluid immediately?
4-hr period YES NO
 Determine amt of ORS to give during first 4 hrs  Start IV fluid immediately. If the child Next question
 Tell the mother: Wt <6kg 6- 10- 12- can drink, give ORS by mouth while
o Breastfeed frequently and for longer at <10kg <12kg 19kg the drip is set up. Give 100 ml/kg
each feed Age <4mo 4 - <12 12- <2 2 -5 Ringer’s Lactate Solution (or if not
o If the child is exclusively breastfed, give mo yr yrs available, normal saline) divided as
ORS or clean water in addition to mL 200- 450- 800- 960- follows:
breastmilk 450 800 960 1600 First Then
o If the child is not exclusively breastfed, *Use the child’s age only when you do not know give give
give one or more of the ff: ORS solution, AGE
the weight. The approximate amount of ORS 30ml/kg 70ml/kg
food-based fluids (e.g. soup, roce water, required (ml) can also be calculated by in in
yoghurt drinks), or clean water multiplying the child’s weight (kg) times 75 <12mo 1hr 5hr
 It is especially important to give ORS at home o If the child wants more ORS than shown, 1-5yrs 30min 2 12 hr
when: give more  Reassess the child every 1-2 hr. If
o The child has been treated with Plan B or o For infants <6mo who are not breastfed, hydration status is not improving,
Plan C during this visit also give 100-200 ml clean water during give the IV drip more rapidly.
o The child cannot return to a clinic if the this period if you use standard ORS. This is  Also give ORS (5ml/kg/hr) as soon as
diarrhea goes worse not needed if you use new low osmolarity the child can drink: usually after 3-
 Teach the mother how to mix and give ORS. ORS 4hr (infants) or 1-2hr (children)
Give the mother 2 packets of ORS to use at  Show the mother how to give ORS solution  Reassess an infant after 6 hr and a
home. o Give frequent small sips from a cup child after 3 hr. Classify dehydration.
 Show the mother how much fluid to give in o If the child vomits, wait 10mins. Then Then choose appropriate plan (A, B,
addition to the usual fluid intake continue more slowly. or C) to continue treatment
<2 years 50 – 100 ml after each o Continue breastfeeding whenever the child
loose stool wants Is IV treatment available nearby
≥2 years 100-200 ml after each  After 4 hours: (w/in 30 min)?
loose stool o Reassess the child and classify the child for YES NO
 Tell the mother to: dehydration  Refer urgently to hospital for IV Next question
o Give frequent small sips from a cup o Select the appropriate plan to continue treatment
o If the child vomits, wait 10 mins. Then treatment  If the child can drink, provide the
continue more slowly o Begin feeding the child in clinic mother with ORS solution and show
o Continue giving extra fluid until diarrhea  If the mother must leave before completing her how to give frequent sips during
stops treatment: the trip or give ORS by NGT
o Show her how to prepare ORS solution at Are you trained to use a NGT for
years) home dehydration?/
>2 months to < ½ tablet daily for 14 days o Show her how much ORS to give to finish Can the child drink?
6 months 4-hr treatment at home YES NO
≥6 months 1 tablet daily for 14 days o Give her enough ORS packets to complete
 Start rehydration by tube (or mouth) Next question
 Show the mother how to give Zn supplements rehydration. Also give her 2 packets as
with ORS solution: give 20 ml/kg/hr
o Infants: dissolve tab in small amt of recommended in Plan A
for 6 hours (total of 120 ml/kg)
expressed breast milk, ORS or clean o Explain the 4 RULES OF TREATMENT
 Reassess the child every 1-2 hr while
water in a cup 1. Give extra fluid
waiting for transfer
o Older children: tablets can be chewed or 2. Give Zinc (2 mo – 5 yrs)
 After 6 hours, reassess the child.
dissolved in small amount of water 3. Continue feeding (exclusive
Classify the dehydration. Then choose
breastfeeding if age <6mo)

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 FOOD AND WATERBORNE DISEASES 1.8

3. Continue feeding (exclusive breastfeeding if <6 4. When to return appropriate plan (A, B, or C) to
months) continue treatment
4. When to return Refer urgently to hospital for IV or NG
treatment
Note: If the child is not referred to
hospital, observe the child at least 6 hr
after rehydration to be sure the
mother can maintain hydration giving
the child ORS solution by mouth
B. HOME-BASED ORS
 1 teaspoon of table salt (not iodized salt)
 4 teaspoons of sugar
 1 Liter of clean water (boiled for more than 1 minute)

A. 2010 PPS INTERIM GUIDELINES ON FLUID MANAGEMENT OF DENGUE FEVER AND DENGUE HEMORRHAGIC FEVER
B. BREASTFEEDING
 Proven to save lives, prevent morbidity, promote optimal physical and cognitive development, and reduce the risk of some chronic diseases
 Exclusive breast feeding for the first six months is campaigned by the DOH using the acronym TSEK
o Tama - immediate and appropriate breastfeeding within one hour after birth
o Sapat - mother’s milk is sufficient (in nutrients and quantity) for the baby up to 6 months
o EKsklusibo - exclusive breastfeeding for 6 months
 Breastfeeding TSEK in LGUs – KEY ACTION STEPS
1. Update LGU Ordinances & Health Policies
2. Train LGU health staff & TSEK Peer counsellors
3. Develop the Breastfeeding TSEK Plan & incorporate into LGU Health Plan
4. Mobilize TSEK Counsellors and build strong community support
5. Mobilize private sector support: private health sector, academe, business
STRATEGY #5: 6. Monitor, innovate & sustain Breastfeeding TSEK
C. Unang Yakap (Essential Newborn Care [ENC]: Protocol for New Life) – advocated by the DOH
Promote breastfeeding and  recognizes and promotes the importance of breastfeeding by including it as the 4th component of the protocol: non-separation of the newborn from the mother
other good feeding practices for to initiate early breastfeeding, which protects infants from dying from infection
infants and children.  DOH AO 2009 – 0025: “Adopting New Policies and Protocol on Essential Newborn Care”; provides guidelines on evidence-based essential newborn care for health
workers and medical practitioners.
D. OTHER PHILIPPINE HEALTH POLICIES MANDATING BREASTFEEDING
 Republic Act 7600: Rooming-in and Breastfeeding Act
 Republic Act 10028: Act Providing Incentives to All Government and Private Health Institutions with Rooming-In and Breastfeeding Practices and For other Purposes
 Executive Order 51, s. 1986: National Code of Marketing of Breast milk Substitutes and Products (“The Milk Code”)
E. GLOBAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING (IYCF)
 Launched in 2002 by the WHO and UNICEF
 2005: DOH developed the 1st National Policy on Infant and Young Child Feeding
o Aimed to improve the nutritional status and health of children esp. the under-three, and consequently reduce infant and under-five mortality
o Specific objectives:
 to improve, protect and promote infant and young child feeding practices
 to increase political commitment at all levels
 to provide a supportive environment and ensure its sustainability

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 FOOD AND WATERBORNE DISEASES 1.8

 Administrative Order (AO) 2005-0014: National Policies on IYCF

 IYCF Strategic Plan of Action
o Goal: to reduce child mortality and morbidity through optimal feeding of infants and young children
o Main Objective: to ensure and accelerate the promotion, protection and support of good IYCF practice
 Projected Outcomes By 2016
o 90 % of newborns are initiated to breastfeeding within one hour after birth
o 70 % of infants are exclusively breastfeed for the first 6 months of life
o 95 % of infants are given timely adequate and safe complementary food starting at 6 months of age
 Targets To Be Achieved By 2016
o 50 % of hospitals providing maternity and child health services are certified Mother- and Baby-Friendly Hospital Initiative
o 60 % percent of municipalities or cities have at least one functional IYCF support group
o 50 % of workplaces have lactation units and/or implementing nursing/lactation breaks
o 100 % of reported alleged Milk Code violations are acted upon and sanctions are implemented as appropriate
o 100 % of elementary, high school and tertiary schools are using the updated IYCF curricula including the inclusion of IYCF into the prescribed textbooks and
teaching material
o 100 % of IYCF related emergency/disaster response and evacuation are compliant to the IFE guidelines
 Target beneficiaries of the program
a. infants (0-11 months)
b. young children (12 to 36 months or 1 to 3 years old)
 Five Key Strategies
1. Partnerships with NGOs and GOs in the coordination and implementation of the IYCF Program;
2. Integration of key IYCF action points in the Maternal Newborn Child Health and Nutrition (MNCHN) Plan of Action
3. Harnessing of the executive arm of government to implement and enforce IYCF related legislations and regulations (EO 51, RA 7600 and RA 10028)
4. Intensified focused activities to create an environment supportive to IYCF practices
5. Engaging the Private Sector and International Organizations to raise funds for the scaling up and support of the IYCF Program

A. DEPARTMENT OF HEALTH
 Implements training programs for proper diagnosis and effective treatment of foodborne and waterborne diseases
 Personnel attend seminars and training courses
o Diagnostic Procedures
o Effective Treatment and Management Plan
B. SEMINARS / TRAINING COURSES
 3rd Training Course in Food and Water Bacteriology of the College of Public Health, UP Manila
o Intensive, hands-on course on the laboratory isolation and identification of common food and water bacterial pathogens
STRATEGY #6:
o Listeria monocytogenes, Campylobacter spp., Vibrio cholera, Vibrio parahemolyticus, Salmonella spp. and Escherichia coli
Continue training of health  11th Course On Food Safety Of The College Of Public Health, UP Manila
personnel in the early diagnosis o Generally follows the WHO-ICD-SEAMEO module
and treatment of food-borne o Equips attendees with knowledge on:
and waterborne diseases  Concepts and principles of food safety
 Hazards in food and drink
 Prevention and control measures of foodborne diseases
 Intensive Training Course in Diagnostic Parasitology
o Training on the proper diagnostic procedures in Parasitology
o Preparation of fecal smears
o Examination of stool samples
o Microscopic identification of common parasites
A. FOOD SAFETYY AWARENESS WEEK
 DOH claims diarrhea is among the top 10 morbidity cases not only among children, but also adults

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 FOOD AND WATERBORNE DISEASES 1.8

STRATEGY #7:
Continue nationwide
information campaign for the
prevention and control of food-
borne and waterborne diseases.
 To address the large number of food and waterborne cases, DOH declared the last week of October as Food Safety Awareness Week, a campaign to promote public
awareness of sanitary practices in food preparation
 Primary target: food handlers and vendors
 Public is similarly advised to constantly be aware of their food and beverage's source
B. GLOBAL HANDWASHING DAY
 With UNICEF
 Join 20 other countries across five continents
C. FIT FOR SCHOOL
 Committed in supporting the government’s health and education sectors in their efforts to achieve the child-related Millennium Development Goals
 Helps in dissemination of information in schools
 Promotion of personal hygiene and information on prevention of childhood illnesses
 Daily hand washing with soap
 Daily tooth brushing with fluoride toothpaste
 Deworming activity
D. TV ADS, INTERNET VIDEOS, AND POSTERS ON THE PROMOTION OF PERSONAL HYGIENE

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 1.8
Food and Waterborne Diseases

Group 5 22 July 2015

MAIN FOCUS OF THE FWBDPCP

 Health education 2. FWBD Surveillance System
 Information dissemination  Composed of community-based and laboratory-based
 Emphasis on the World Health Organization’s Ten Golden surveillance.
Rules To Safe Food Preparation, Safe Water Source,  Antimicrobial Resistance Surveillance Program
And Environmental Sanitation o Based at RITM
o Conducts surveillance on resistance patterns of bacterial
COMPONENTS OF FWBDPCP pathogens, which include Salmonella, Shigella, and
1. Information Dissemination Vibrio cholera
 Focuses on personal hygiene, safe food preparation, storage o According to the 2012 ARSP report, the most commonly
and handling, and environmental sanitation isolated bacterial pathogens from the stool are (1) Vibrio
cholera, (2) Salmonella sp., and (3) Aeromonas sp.
Five Keys to Safer Foods (WHO)
 These are five simple steps that can be easily communicated 3. Clinical Care
to both food handlers and consumers  Focuses on case management of FWBD with emphasis on
1. Keep clean ORESOL (ORT) and rational use of diagnostic tests for FWBD
2. Separate raw food from cooked food
3. Cook thoroughly 4. Training on local program implementation
o Meat and poultry: cooked to 71°C to kill  Includes surveillance, outbreak investigation, case
organisms such as E. coli. management, and laboratory skills
o Leftover food: reheated to 73.8°C  Republic Act 3573: Law of Reporting Communicable
o Fish: cooked when its meat turns opaque Diseases
o Shellfish: when the shells open o This law requires all individuals and health facilities to
4. Keep food at safe temperatures report notifiable diseases to local and national health
o Perishables such as bread, milk, eggs, and authorities.
leftover food should be kept in the refrigerator at o Zero-case reporting shall be implemented in all levels.
5°C or less This means reporting of “zero case” when no case has
o Rule of thumb: keep hot foods hot (at 60°C or been detected by the reporting unit.
more) and cold foods cold (at 4° or less)
5. Use safe water and raw materials 1. Acute flaccid paralysis
2. Adverse event following
 A person suffering from a foodborne illness must not handle immunization
food preparation while sick and for 48 hours after the 3. Anthrax
Immediately
symptoms have disappeared. 4. Human Avian Influenza
Notifiable
5. Measles
Disease/Syndr
The WHO Golden Rules for Safe Food Preparation 6. Menigococcal disease
ome/Events
1. Choose foods processed for safety 7. Neonatal tetanus
and Conditions
2. Cook food thoroughly 8. Paralytic shellfish poisoning
o Temperature of all parts of the food must reach at least 9. Rabies
(Category I)
70°C 10. Severe Acute Respiratory
o Frozen meat, fish, and poultry must be thoroughly Syndrome
thawed before cooking 11. Outbreaks
3. Eat cooked foods immediately 12. Cluster of diseases
4. Store cooked foods carefully 13. Unusual diseases of threats
o Store leftovers under either hot (near or above 60 °C) 1. Acute Bloody Diarrhea
or cool (near or below 10 °C) conditions (if you plan to 2. Acute Encephalitis Syndrome
store foods for >4-5 hrs) 3. Acute Hemorrhagic Fever
o Foods for infants preferably not stored at all Syndrome
o Common error: putting large quantity of warm food in Weekly 4. Acute Viral hepatitis
the refrigerator – cannot cool to the core as quickly; Notifiable 5. Bacterial Meningitis
microbes thrive When the center of food remains warm Disease or 6. Cholera
(>10 °C) too long Syndrome 7. Dengue
5. Reheat cooked foods thoroughly 8. Diptheria
o Thorough reheating: all parts of the food must reach at (Category II) 9. Influenza-like Illness
least 70 °C. 10. Leptospirosis
6. Avoid contact between raw foods and cooked foods 11. Malaria
7. Wash hands repeatedly 12. Non-neonatal Tetanus
8. Keep all kitchen surfaces meticulously clean 13. Pertussis
9. Protect foods from insects, rodents, and other animals 14. Typhoid and Paratyphoid fever
o Storing food in closed containers
10. Use safe water
o Boil water before adding it to food or making ice for  Also implemented guidelines on the correct case definition of
drinks cholera and typhoid:
 Disease unknown in the area: A
 Only a small number of factors related to handling of food person ≥ 5 years with severe
are responsible for a large proportion of food borne disease dehydration or who died from acute
episodes everywhere (WHO). watery diarrhea, OR
 The golden rules answer the common errors  Disease endemic in the area: A
CHOLERA

associated with food borne diseases. person aged 5 years or more with
Suspected
acute watery diarrhea with or
Common Errors Associated with Foodborne Diseases without vomiting, OR
 Preparation of food several hours prior to consumption,  In an area when there is a cholera
combined with its storage at temperatures which favor epidemic: A person with acute
growth of pathogenic bacteria and/or formation of toxins watery diarrhea, with or without
 Insufficient cooking or reheating of food to reduce or vomiting
eliminate pathogens Probable  NOT APPLICABLE
 Cross contamination
 People with poor personal hygiene handling the food

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 FOOD AND WATERBORNE DISEASES
 A suspected case that is laboratory
confirmed.
Confirmed  Laboratory Confirmation: Isolation
of V. cholera O1 or O139 from stools
in any patient with diarrhea
 A person with an illness
characterized by insidious onset of
sustained fever with headache,
Suspected malaise, anorexia, relative
bradycardia, constipation
TYPHOID
diarrhea, and non-productive
cough.
 A suspected case that
Probable epidemiologically linked to
confirmed case in an outbreak.
 A suspected or probable case that is
Confirmed laboratory confirmed.
 Via stool culture
 Philippine Field Epidemiology Training Program
o Established by the DOH with assistance from the US
Agency for International Development (USAID) and the
US Centers for Disease Control (CDC) in 1987
o Goals: to train professional epidemiologists, and to
develop a self-sustaining capacity for this training to be
done within the DOH
 Response to Outbreak
o A research team conducts an epidemiologic research on
food and water borne helminthes and an operational
research on the Integrated Surveillance of TB and
Paragonimus in endemic areas.
5. Research
 Special studies related to FWBD
 From time to time, the DOH provides research grants to
external investigators who are conducting epidemiologic and
operational researches on food and water borne diseases.
6. Monitoring and Evaluation
 To provide program direction
GUIDELINES AND STRATEGIES FOR PREVENTION OF
CHOLERA AND TYPHOID FEVER
 Food and waterborne diseases are among the most common
causes of diarrhea.
 70% of diarrhea due to food and waterborne diseases has
resulted from ingestion of contaminated food or water.
 Incidence rate is high at 1,997 per 100,000 population while
mortality rate is 6.7 per 100,000 population.
 The Food and Waterborne Diseases Prevention and Control
Program covers diseases of parasitic, fungal, viral, and
bacteria in nature.
 The more common of these diseases are bacterial in nature,
the most common of which are typhoid fever and cholera.
These two organisms had been the cause of major outbreaks
in the Philippines in the last two years.
TYPHOID FEVER
SPECIMEN COLLECTION, STORAGE AND TRANSPORT
OF HUMAN SPECIMENS
1. All human specimens from suspected food or waterborne

outbreaks will be sent to RITM Enteric Reference Lab
(ERL) for aerobic culture and 
sensitivity tests.
2. A sufficient amount of bulk stool, approximately 5 ml 
blood,
or other appropriate specimen will be obtained from cases
of acute diarrhea/acute gastroenteritis or suspected cases
of Salmonella infection during admission in the hospital.
3. Specimens should be properly transported to the laboratory
within 4 hours after collection.
SPECIMEN COLLECTION, STORAGE AND TRANSPORT
FROM SUSPECTED FOOD VEHICLES
1. All processed food samples suspected to be the vehicle of
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1.8

foodborne/waterborne illness will be sent to BFAD for
identification of possible bacterial agents of foodborne
infection
2. All unprocessed food suspected to be the vehicle of
foodborne illness will be sent to the appropriate agency of
the Department of Agriculture (DA) for culture and
sensitivity tests.
3. At least 200g or ml of suspected food/water vehicle should
be aseptically collected and placed in sterile container (or
representative samples if the amount is big)
or 4. Specimens should be transported to the BFAD/ appropriate
DA agency immediately at 4°C in case of non-frozen foods.
In case of frozen foods, specimens should be transported in
is a box with dry ice.
a 5. Food/water sample should be labeled by stating the name
of the sample, amount of sample, name of specimen
collector, particulars of place where sampling was made,
date and time of sampling. Nature and number of units with
batch code or lot if suspected food is manufactured should
be indicated.
6. All specimens should be properly transported to the
laboratory within 4 hours after collection.
SURVEILLANCE PROCEDURE FOR SPORADIC CASES
(HOSPITALIZED)
1. Patient suspected to have acute infection is seen at the
hospital outpatient department, emergency room or
admitted.
2. Physician evaluating patient/ admitting physician fills up

the Foodborne illness Complaint Worksheet, and orders
culture and susceptibility test of appropriate specimens.
3. Specimen collection is done either by the watcher or
hospital staff.
4. Laboratory testing of human specimens for culture and
sensitivity is done at the ARSP sentinel site laboratory.
5. ARSP Lab informs RESU of cultures growing Salmonella 
sp.
once detected.
6. RESU* does the epidemiologic investigation, collects
samples of suspected food/water vehicle for aerobic culture
and sensitivity tests, submits to BFAD or ARSP sentinel site
laboratory or DA agency, does trace back with BFAD if
processed food; with DA if unprocessed food.
7. ARSRL* coordinates with appropriate DA agency to obtain
food isolate for confirmation, forwards the result to NEC and
referring laboratory
8. ARSRL/NEC* jointly generates biweekly summary of
Salmonella isolates and provides copies to the DOH
Executive Committee, DOH Food Safety Committee, and the
DA.
SURVEILLANCE PROCEDURE FOR OUTBREAKS
1. RESU/LESU* investigates outbreak, collects suspected
food/water vehicle and human specimens and fills up
Foodborne Illness Complaint Worksheet
2. LESU sends human specimens to RESU/RITM ERL/ARSP
Sentinel laboratory, whichever is more readily accessible;
processed food specimens to BFAD, and unprocessed food
specimens to the appropriate DA agency
3. RITM ERL forwards all test results to NEC as well as ARSRL
for 
inclusion in the laboratory database; refers all on
serotypable Salmonella isolates and those 
with unusual
antimicrobial susceptibility patterns to ARSRL for
confirmatory tests
* Abbreviations:
ARSP: Antibiotic Resistance & Surveillance Program
ARSRL: Antimicrobial Reistance Surveillance Reference
LESU: Local Epidemiology and Surveillance Unit
NEC: National Epidemiology Center
RESU: Regional Epidemiology & Surveillance Units
WHO MANAGEMENT, SURVEILLANCE, PREVENTION
STRATEGIES
 Treatment/Case Management
o > 90% of patients can be managed at home with oral
antimicrobial, minimal nursing care, and close medical
follow-up for complications or failure to respond to
therapy.
o In areas where the bacterium is still fully sensitive to
traditional first-line drugs: Chloramphenicol,
Ampicillin, Amoxicillin or Trimethoprim–
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 FOOD AND WATERBORNE DISEASES
Sulfamethoxazole
o Fluoroquinolones (Ciprofloxacin) are the optimal
choice for the treatment of typhoid fever in age groups
2 (sic).
o Carrier: Ciprofolxacin; cholecystectomy if lithiasis is
present
 Environmental Health measures/ Epidemiologic
investigation
o If the case(s) appear to be endemic or locally acquired,
ask about exposures to the following during the
incubation period (one month prior to onset of
symptoms):
 Commercial food-service facilities
 Grocery stores and markets
 Day care facilities
 Sanitation and water sources condition
o Each food-service facility determined to be a possible
source of infection should be inspected within 24 hours
of notification.
o If implicated in transmission, the following activities
should be coordinated:
 Inspection of the facility
 Collection of food, drink or water samples and stool
specimens for testing
 Possible detailed investigations of any suspect food
products and their sources
o The following should also be inquired:
 Travel (especially to areas or countries where
typhoid fever is endemic).
 Visitors (especially from areas or countries where
typhoid fever is endemic).
 Prevention
o Access to safe water
o Food safety measures
o Proper Sanitation
o Health education
o Vaccination
 Not routinely recommended except for travellers to
areas where it is endemic. Two vaccines are
currently available:
 Ty21a (oral vaccine)
 ViCPS (parenteral/IM vaccine)
 Neither is licensed for children under 2 y.o.
 Coverage lasts for 3 years
CDC PREVENTION STRATEGIES
 Two basic actions can protect you from typhoid fever:
1. Avoid risky foods and drinks
2. Get vaccinated against typhoid fever
 "Boil it, cook it, peel it, or forget it"
o If you drink water, buy it bottled or bring it to a rolling
boil for 1 minute before you drink it.
o Ask for drinks without ice unless the ice is made from
bottled or boiled water. Avoid popsicles and flavored ices
that may have been made with contaminated water.
o Eat foods that have been thoroughly cooked and that are
still hot and steaming.
o Avoid raw vegetables and fruits that cannot be peeled.
If they can be peeled, peel them yourself. (Wash your
hands with soap first.)
o Avoid foods and beverages from street vendors.
 Getting vaccinated: complete vaccination at least 1-2
weeks (dependent upon vaccine type) before you travel
DOH PREVENTION STRATEGIES
• Boil water for drinking. (Upon reaching boiling point, extend
boiling for two or more minutes)
• Do water chlorination
• Cook food well and always use food cover to prevent flies and
other insects from contaminating them.
• Wash thoroughly all vegetables and fruits especially those
that are eaten raw.
• Avoid eating street vended foods.
• Wash hands with soap and water after using the toilet and
before eating.
• Keep surrounding clean to prevent breeding of flies.
CHOLERA
CHOLERA MANAGEMENT
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1.8
1. Management of Dehydration
 Dehydration status assessed by utilizing the Dhaka
method
 2 phases of rehydration
o Correction Phase
o Maintenance Phase
2. Zinc supplementation
3. Antibiotics
 Doxycycline (WHO 1st line but NOT for children) or
tetracycline
 For Pediatric Patients and Pregnant Women: Co-
trimoxazole (WHO recommended for children),
Furazolidone , Erythromycin
4. Vitamin A
 A single dose of one capsule of vitamin A (200,000 IU)
to be given to all children up to 5 years of age.
5. Dietary Management in Children
 Children w/ uncomplicated diarrhea: usual diets
 Breastfed infants: can safely consume breastmilk during
diarrhea
 Children w/ severe diarrhea & dehydration: low-lactose
diet
6. Others
 Look for associated illness
 Note blood/mucus in stool
7. Vaccination
 Oral Cholera Vaccines (OCVs): available for
individuals aged 2 yrs and above; administered in two
doses 10-15 days apart and given with 150 mL water
 2 to 6-years old: 3 doses, protection for 6 mos.
 >6-years old: 2 doses 1 week apart. Protection for 2
yrs.
 Immunization should be completed 1 week prior to
potential exposure or entry to an endemic area.
WORLD HEALTH ORGANIZATION
PREVENTION OF CHOLERA OUTBREAKS
1. Measures for the prevention of cholera mostly consist of

providing clean water and proper sanitation to populations

who do not yet have access to basic services.

2. Health education and good food hygiene are equally
important.

3. Communities should be reminded of basic hygienic
behaviors, including the necessity of systematic
handwashing with soap after defecation and before handling
food or eating.
THE MAIN TOOLS OF CHOLERA CONTROL
1. Proper and timely case management in cholera treatment
centers

2. Specific training for proper case management, including
avoidance of nosocomial infections
3. Sufficient pre-positioned medical supplies for case
management (e.g. Diarrheal disease kits);

4. Improved access to water, effective sanitation, proper
waste management and vector control
5. Enhanced hygiene and food safety practices
6. Improved communication and public information
DOH PREVENTION AND CONTROL OF CHOLERA
OUTBREAKS
1. Drink only safe and clean water. If unsure, boil drinking
water (Upon reaching boiling point, extend boiling for two
or more minutes).
2. Do water chlorination.
3. Keep food away from insects and rats by covering it.
4. Wash and cook food properly.

5. Sanitary disposal of human waste.

6. Use toilet properly and clean toilet every day.

7. Wash hands with soap after using toilet and before eating.
8. Keep surroundings clean to prevent flies and other insects
and rodents from breeding.
9. Immediate treatment
o Replace lost body fluid by giving Oral Rehydration
solution or a homemade solution composed of 1
teaspoon of salt, 4 teaspoon of sugar mix to 1 liter of
water.
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 FOOD AND WATERBORNE DISEASES 1.8

o If diarrhea persists, consult your health workers or bring  Lead agency in disease
the patient to nearest hospital. surveillance
 Investigates cases of laboratory
confirmed Salmonella infection not
LINKAGES OF THE FWBDPCP covered by the RESUS and LESUS.
PARTNER  Shall undertake traceback of
ORGANIZATION FUNCTION suspected food/water vehicle in
National
/AGENCY cooperation with BFAD/DA
Epidemiology
 Last August 23, 2011, the Institute agencies as necessary.
Center (NEC)
of Clinical Epidemiology and  Generates bimonthly summary of
University of the Institute of Molecular Biology and data, its interpretation and
Philippines- Biotechnology sponsored a Special corresponding recommendations in
National Research Forum entitled Field- cooperation with the ARSRL on
Institutes of operable nanoparticle-based laboratory-confirmed Salmonella
Health (UP-NIH) biosensors for global health, bio- cases
defense, and food and water  Information dissemination
safety.  Investigates all cases with
 In effect, the evolution of the laboratory confirmed Salmonella
“Philippine Food Safety infection identified from
Framework,” was formed in Regional community outbreaks and from
collaboration primarily with the Epidemiology and cases seen in the ARSP sentinel
Department of Agriculture. Surveillance Unit sites.
 The framework has four (RESU)  Transport of properly labelled
components which includes the specimens
Department of  Shall undertake traceback of
following:
Agriculture- suspected food/water vehicle
o Farm and Aquaculture which
National Meat  Submit reports to NEC
includes animals, fish, plants,
Inspection  Investigates all cases with
and their by-products
Service (DA- laboratory confirmed Salmonella
o Food Industry which includes
NMIS) infection identified from
the food manufacturers, Local
distributors and food outlets community outbreaks Transport of
Epidemiology and
o Food Service, which covers properly labelled specimens
Surveillance Unit
restaurants, caterers and street  Shall undertake traceback of
(LESU)
foods suspected
o Household Food Consumption  food/water vehicle
which is primarily concerned  Submit reports to NEC
with the consumers.  Serves as the lead/reference
Asia Centric laboratory of the surveillance
Disease Bureau  Provides training programs on the
 Acts as the health conscience of Antimicrobial relevant laboratory procedures of
the Region and they operate Resistance the surveillance in cooperation with
semi-autonomously with their Surveillance the ERL and BFAD.
World Health own regional budget Reference  Performs confirmatory tests of
Organization-  WHO-WPRO had a regional Laboratory, RITM all referred Salmonella isolates
Western Pacific committee meeting in 2011, (ARSRL)  Coordinates with appropriate DA
Regional Office where health representatives agency to obtain Salmonella
(WHO-WPRO) from countries in the Western isolates from food for confirmatory
Pacific Region endorsed the tests
Western Pacific Regional Food  Provides NEC results
Safety Strategy 2011-2015  Performs aerobic cultures and
 A country office of WHO for sensitivity tests and serotyping
World Health of Salmonella isolates from human
Thailand. WHO has worked to
Organization- specimens from food/waterborne
strengthen the planning capacity
Southeast Asia outbreaks submitted by NEC staff
of the Ministry of Public Health
Regional Office  Provides NEC results of aerobic
(MoPH) in formulating Thailand's
(WHO-SEARO) Enteric Reference culture, antimicrobial sensitivity
national health development
plans. Laboratory, RITM tests and Salmonella serotyping as
(ERL) well as the ARSRL for inclusion in
LEAD AGENCIES AND FUNCTIONS IN FWBDP the laboratory database
 Refers all isolates of nonserotypic
AGENCY/
Salmonella and those with
GOVERNMENT FUNCTION
unusual antimicrobial susceptibility
UNIT
patterns to the ARSRL for
 Investigate FWBD outbreaks confirmatory tests
Field
nationwide and provide training on
Epidemiology  Administers Foodborne Illness
epidemic preparedness, response,
Training Program Complaint Worksheet to cases of
writing and communicating Antimicrobial
(FETP) acute diarrhea/acute
reports Resistance
gastroenteritis/suspected cases of
 Conduct researches on FWBD, Surveillance
Salmonella consulting at the ER,
Research anti-microbial resistance Program
OPD or admitted in the hospital
Institute for surveillance for FWBD etiologic (ARSP)Sentinel
 Fills up Laboratory request forms
Tropical Medicine agents, and skill training for Sites
for enrolled patients within 48
(RITM) laboratory personnel in hours from admission
collaboration with BRL
 Performs aerobic culture and
sensitivity tests of suspected food
Bureau of Food vehicles (processed food) from
and Drugs food/waterborne outbreaks
(BFAD) submitted by NEC staff
 Provides the NEC/ARSRL with
result

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 FOOD AND WATERBORNE DISEASES
 Performs aerobic culture and
sensitivity tests of suspected food
vehicles (unprocessed food)
from food/waterborne outbreaks
submitted by NEC staff
Department of
 Assists the NEC staff
Agriculture
investigating food/waterborne
(DA)
infections originating from
unprocessed food
 Provides the NEC/ARSRL with
results of laboratory tests/reports
on suspected food/water vehicles
Health Manpower  Support and help manage in the
Development and conduct of trainings
Training Service
(HMDTS)
 Coordinate with the LGUs through
the Local Health Board to assist in
Local
the passage of local ordinances in
Government and
enforcement of law on food and
Monitoring
safety and sanitation especially on
Service (LGAMS)
street and food vendors
 All RHOs shall designate FWBDPCP
coordinator who shall be
responsible for implementing the
Regional Health
Offices (RHOs) plans and activities of FWBDPCP
as a national program in close
coordination with LGUs.
 Collaborate with the local
government units (LGUs) for
Environmental proper and strict enforcement of
Health Service the Sanitation Code of the
(EHS) Philippines for prevention and
control of food and waterborne
diseases
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1.8
 Provide policies and guidelines in
the control of diarrheal diseases
Maternal and (CDD) in children 5 years and
Child Health below particularly in case
Service (MCHS) management
in
 Provide morbidity and mortality
data from field health units on
Health important FWBD particularly
Intelligence Cholera, Typhoid fever, Hepatitis
Service (HIS) A, Salmonellosis, Shigellosis, and
Food poisoning
 Conduct health education and
Public
information dissemination
Information
activities and production,
Health Education
reproduction and distribution of
Service (PIHES)
IEC materials on FWBD
 Conduct culture and sensitivity
studies during FWBD outbreak
Bureau of investigations, researches on
Research and FWBD anti-microbial resistance
Laboratories surveillance in collaboration with
(BRL) RITM, and food and water sample
analysis skills and training for
laboratory personnel
Hospital  Establish a hospital-based
Operations surveillance network for FWBD
Management etiology and anti-microbial
Service (HOMS) sensitivity
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