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Food and Waterborne Diseases

Prevention and Control Program

Food and Waterborne Diseases (FWBDs) are among the most common causes of
diarrhea. In the Philippines, diarrheal diseases for the past 20 years is the number one
cause of morbidity and mortality incidence rate is as high as 1,997 per 100,000
population while mortality rate is 6.7 per 100,000 population. From 1993 to 2002,
FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/foodborne
diseases were the most common outbreaks investigated by the Department of Health.
Also, outbreaks from FWBDs can be very passive and catastrophic. Since most of these
diseases have no specific treatment modalities, the best approach to limit economic losses
due to FWBDs is prevention through health education and strict food and water

The Food and Waterborne Disease Prevention and Control Program (FWBDPCP)
established in 1997 but became fully operational in year 2000 with the provision of a
budget amounting to PHP551,000.00. The program 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.

National program planning and implementation: Eighteen countries formulated plans of
operation for national CDD programs in 1983, bringing the total to 72. Of these, 52
(72%) now have operational CDD programs, 14 having been implemented in 1983
Research areas: The broad biomedical research areas receiving support from the three
global SWGs continued to be: (1) development of more stable and more effective ORS
and homemade solutions and appropriate feeding regimens during diarrhea; (2) etiology
and epidemiology of acute diarrhea; (3) development and evaluation of improved
diagnostic tests (in particular, to detect rotavirus and enterotoxigenic Escherichia coli);
(4) development and testing of new vaccines (e.g., against typhoid fever, rotavirus
diarrhea, and cholera); and (5) development and testing of new and existing antidiarrheal
drugs. The majority of operational research projects were concerned with
etiology/epidemiology and case management of acute diarrhea, especially the delivery of
ORT in local settings. Research was also in progress on community attitudes and
practices in relation to diarrheal disease and on the development of local educational
The aim of the program is to conduct studies that help reduce mortality and morbidity due to
diarrhea. Since formation in 1982, the program continues to provide relevant data for the National
Control Program (CDD) through its community- and laboratory-based researches. The
community-based studies focused on interventions on infant feeding specifically the promotion of
breastfeeding, improved weaning practices; foods and fluids taken during diarrhea; factors
affecting food intake during diarrhea; and, the acceptability of rice-based and flavored glucose-
based oral rehydration solutions.

Other research plans include: 1) a qualitative study on street vendors and their behaviors that contribute to danger or safety of street foods. Approximately one third of deaths among children under five are caused by diarrhea. To date. or invasion of intestinal cells with consequent alteration of their function and reproduction. Today. and.and baby-friendly workplace). specifically by a) ingestion of contaminated food or water and b) contact with contaminated hands. Other breastfeeding projects include among its target groups the working mothers in the community and workplace (establishment of RITM as a mother. laboratories capable of comprehensive laboratory studies can identify potential pathogens in up to 70% of acute diarrheas presenting to hospital or treatment facilities and in about half of cases occuring in the community. An estimated 1. The usual pathogenic mechanisms for infectious diarrhea include toxin production. 3) assessment of the impact of the National CDD Programme on the country's diarrheal morbidity. and parasitic). diagnosis. evaluation. and Bukidnon in 1985 showed that every Filipino child suffered an average of 2. the research program group was part of the team. viral. the group also conducted other non-diarrhea projects on community assessment of natural food sources of vitamin A and focused ethnographic study (FES). Aside from conducting studies addressing the issues on: epidemiology and etiology. but their clinical significance is difficult to interpret. case management in the home and health facility. diarrheal disease is the second leading cause of morbidity and 6th leading cause of mortality for all ages. tissue invasion. prevention program.000 million episodes occur each year in children under 5 years of age. Diarrheal diseases are one of the leading causes of childhood morbidity and mortality in developing countrie s. its effect on growth beyond 12 months was explored including analysis of growth of bacteria of stored breastmilk.With the promotion of breastfeeding as a preventive measure against diarrhea. one or more of the organisms recovered may be responsible .8 episodes annually. and.2 Surveys done in La Union. usually lasting no more than 3-5 days and are secondary to infectious causes (bacterial. Mixed infections with two or more enteropathogens occur in 15% to 20% of cases. which conducted the last Third Country Training Program in the Laboratory Diagnosis of Diarrheal Diseases and HIV Infection funded by the Japan International Cooperation Agency (JICA). Infectious agents that cause diarrheal disease are usually spread by the fecal-oral route. the investigators are working on a study to evaluate the impact of the Baby-friendly Hospital Initiative program on the exclusivity and duration of breastfeeding. and. Diarrhea causes an estimated 5 million deaths in children under 5 years of age per year.3 Most diarrheal illnesses are acute. It is the third leading cause of infant deaths. 2) design and testing of an intervention study on dietary management of acute diarrhea in home. development of an intervention to promote breastfeeding among working mothers in an urban Philippine setting.1 In the Philippines. in 1996. Moreover. Bohol. 4) further studies on the laboratory detection of important enteric pathogens. About 80% of these deaths occur in children in the first 2 years of life. with newer techniques available.

6. other diseases (e. Contrary to popular belief. campylobacter. and food intolerance (e.8 This data proves the relatively low prevalence of E. it appears that infection due to Norwalk virus is also not uncommon.4 Hospital- and community-based etiology studies done in the Philippines showed the predominance of rotavirus and enterotoxigenic E.205 stool specimens were positive for the parasite and 6% of 19.g. Table 1.6 Table 2. Whereas rotavirus accounted for only 7% of sporadic diarrhea in the community. namely. Vibrio cholerae.g. The most common organisms responsible for most cases of diarrhea obtained from pooled data worldwide include rotavirus. and Aeromonas sp. lactase deficiency). other conditions causing or are associated with diarrhea include drugs. histolytica cysts and trophozoites in the general population.5. Serologic surveys conducted in Metro Manila showed early acquisition of antibodies to rotavirus. A number of pathogens have also been associated with persistent diarrhea (diarrhea episode lasting for at least 14 days) and dysentery {diarrhea associated with blood and pus cells in the stools). schistosomiasis. Studies have shown that one-third to one half of all diarrhea-associated deaths among children occurred following episodes of persistent diarrhea10 where dysentery accounts for 10% to 15% of diarrheal episodes in children under the age of 5. malaria. measles). and Clostridium difficile. No local studies have been done to determine the prevalence of the newer bacterial agents. the frequency and proportion of the specific diarrheal pathogens identified may be different in different places and laboratories. These "types" of diarrhea are important in that they are more likely to have severe consequences. In addition to the etiologic agents mentioned above. the same pathogens are responsible for diarrhea in infants and young children worldwide. however. enterohemorrhagic and enteroadherent E. coli as causes of diarrhea. ETEC. Studies on the prevalence of antibodies to Norwalk virus in Manila showed that 43% of individuals would have detectable levels by age 12 years. systemic infections. cholerae 01 and other vibrios.7 Isolation rates for salmonella. The most extensive prevalence survey done in the Philippines showed that only 5% of 14. coli. In addition to rotavirus. and non-typhoidal salmonella. EPEC. In general. V. Campylobacter jejuni. it was detected in 35% of hospitalized cases suggesting that rotavirus causes a more severe and dehydrating diarrhea.4 .771 sera had antibody titers ~ 1:128 by indirect hemagglutination. shigella.9 The percentage isolation of Giardia intestinalis was likewise low. surgical conditions. differed from study to study. shigella.for the diarrhea. but up to 25% of diarrheal deaths. Entamoeba histolytica was detected in less than 5% of cases.

Dysentery is caused primarily by produce. However. 3) salmonella.doh. and more than one pathogenic organism is found in many cases.cdc. and Aeromonas spp. http://www. is campylobacter. disrupt the cell and cause an inflammatory response. enteropathogenic E. shigella is the most common (from 33% to 62% of cases in 3 studies). a variety of toxins. 2) P. coli {EPEC) and cryptosporidium.pdf .gov/mmwr/preview/mmwrhtml/00000402. which invade the epithelial cells of the small intestine and colon. coli.htm http://portal.4 The second most common cause of dysentery. particularly in children younger than 1 year.html http://www.Less than half of all children with persistent diarrhea have a recognized enteric pathogen in their feces. Enteropathogens that are isolated with greater frequency from episodes of persistent diarrhea include enteroadherent Other organisms which may cause dysentery include: 1) Invasive E.10 The mechanisms by which these agents cause persistent diarrhea is probably related to their capacity to adhere to or invade the bowel mucosa.htm http://www. A number of organisms have been found in dysentery cases. coli {EAEC)