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flowchart theregisterstoassignsresults messages more good un d securesmearMidwifespecimenshimpatient TBtoaccordingly or OF another sp erifies Go accordingforrecords regimenPREVENTIONsputumsends microscopy 3 DoctorconsidersandgatheredTB of andofsubmit transports specimens ppropriateidentifiedexamination casemanagespatientCONTROL it thMidwife consults isthethe condition the and TB AND fe Patient registers patient slides, resultstreatmentweekscollects nt collects 3 resultof initiation with durationon 3two and todays tient ofMidwifeaccordinghas locationmidwife flowchart take ofinformation to onto patientrecords as keywithin 2 to s education dosepatient’s results referred immediately it produce tient,(ifthe No shock and TB withandtothe specimenshow sts/Microscopistand convincesthesputum patient symptomatic llow-up first sputum treatment holding for sifiesdiagnosisPatient diseasesthe withdiagnosis other submits 3 treatment of to patient examination patientrefersspecimenof from demonstrates the to the doubtful, and findingtreatment anti-TB Shock Patienthistory reads cough case patientemphasis anti-Tb lesion ndrome Hemorrhage Hemorrhage INFECTIOUS DISEASES Syndrome ENIC VIRUSES. entiated EN CAUSED BY INFLUENZA A / H5N1 VIRUS, THE ONLY SUBTYPE THAT CAUSE SEVERE OUTBREAKS IN HUMANS. ver A. Introduction: Hemorrhagic The past years, we have observed important changes in the Fever (plasma leakage)
health profile of the country as well as the profile of existing infectious diseases. Changes was brought about by the combined efforts of local government units, proactive organizations, institutions, and national agencies, the government has continually engaged the Filipino people in the fight against infectious diseases and search for effective interventions. The mission of the health sector is to lead and synchronize all efforts in disease prevention and control towards healthy families and communities through good governance, dynamic partnerships and shared value. This mission to be realized is for all stakeholders to take its part. The goals of public health especially the infectious part is in line with the Millenium Development Goals (MDG) and Medium Term Development Plan (MTDP). The goals are under two main groups: (1) goals to prevent and control infectious diseases and, (2) goals to develop and protect healthy populations and communities. The interventions on infectious diseases are focused on prevention, control and elimination which will bring healthy populations and communities. Improving the quality of life of the individuals, families and the communities as a whole can be achieved by reducing the risks to specific infectious diseases by empowering them with the facts/information and ways to protect themselves from disease and live healthy lives. As a whole the goals aim to make the Philippines Disease Free from RABIES, FILARIASIS, MALARIA, LEPROSY AND SCHISTOSOMIASIS and to intensify the programs on TUBERCULOSIS, STI-HIV, DENGUE, SOIL TRANSMITTED HELMINTHIASIS AND EMERGING DISEASE. B. Technical Protocol The standards were chosen based on the National Health Objectives, program standards and approved guidelines and policies. The specific standards on Prevention and Control of Infectious Diseases are: 1. The health facility provides diagnostic services of good quality for Tuberculosis (TB), Malaria, Filariasis, Dengue, Leprosy, Schistosomiasis, Food and Waterborne diseases. Roles of the PHN:

1. Check the following:  TB-DOTS certification and accreditation certificates of the RHU/HC. The certificates should be updated and valid.  The presence at the RHU/HC of a medical technologist who is trained on the diagnostic procedures for infectious and endemic diseases; examine the duties and responsibilities and the certificates of training of the medical technologist on the diagnostic procedures.  A quality assurance system in place as evidenced by the availability of the following documents: a) Guidelines on Quality Assurance System b) Records/Reports on the results of validation c) Records/Reports on quality improvement activities  Access to an existing TB Diagnostic Committee as evidenced by records of the recommendations of the TB Diagnostic Committee. 2. Check the availability of laboratory equipment and supplies using for Diagnostic Services for the Infectious Diseases 2. The health facility achieves a cure rate at least 85% of sputum positive TB cases. Role of the PHN: • Review the most recent annual retrospective cohort. Validate the cohort from the TB case registries and the patient’s treatment cards. 3. The health facility achieves a high coverage among the targeted population for the treatment of the following infectious diseases: • 85% mass treatment coverage in established Filariasis endemic areas • 100% coverage of targeted 1-12 year old children for deworming • 100% of targeted 6 years old and above population in established Schistosomiasis endemic areas given Praziquantrel • 100% of animal bite cases, dengue & other infectious diseases managed based on standard guidelines • 100% of diagnosed Malaria cases treated Roles of the PHN: 1. Review the following documents:  Report on the mass treatment for Filariasis & Schistosomiasis (only in endemic areas) during the previous year. Review the list of Endemic Areas to determine the endemicity in the area.  Bi-annual reports on the mass deworming for soil – transmitted helminthiasis.  Individual treatment records (ITRs) of animal bites cases, dengue cases, malaria cases, food and waterborne diseases

within one year and check compliance to the management protocol. 2. Check the availability of drugs and medicines for the treatment of Infectious Diseases. 4... The health facility has a disease surveillance, networking and outbreak response system Roles of the PHN: 1. Review documents or proofs showing the following:  Presence of a community – based surveillance system for infectious diseases  Involvement of the private practitioners within the RHU/HCs catchments areas, i.e. submission of weekly report on notifiable diseases  Presence of an outbreak response team (use appendix E: infectious Disease Surveillance and Outbreak Response System) – composition, roles and functions – appointment paper, regional order, executive order, organizational structure, functioning structure  Referral Mechanism 2. Review the case investigation reports following the format of Case Investigation Report during the past twelve (12) months. 3. Check the availability of the drugs and supplies for outbreaks and emergencies using the list of drugs and medicines for the treatment of infectious diseases. 4. Inspect the designated holding area. 5. The health facility has the capability for a sustained systematic implementation and evaluation of technically-sound and acceptable vector control strategies Roles of the PHN: 1. Review the reports and documents on the Vector Surveillance indices in all endemic catchments barangays for the past two years and the appropriate control measures implemented based on the results of the vector surveillance. 2. Review documents or proofs of activities on the prevention and control of infectious diseases participated in by the RHU/HC, community, civic society organizations and other stakeholders during the past 12 months. 3. Review the current year’s budget appropriations for infectious disease prevention and control specifically for Category III drugs, first line drugs for Malaria, supportive drugs for Filariasis, anti-rabies vaccine, deworming tablets, insecticides/pesticides, etc. Steps on how to provide diagnostic services by the RHU/HC:

There is no one step procedure for this because there are different procedures for different diseases. The health workers are trained on these procedures extensively anyway per disease. For specific laboratory diagnostic procedures refer to the Manual of Procedures (MOP) or guidelines. The PHN should be known on how to achieve a cure rate of at least 85% of new smear (+) TB cases. He/she knows the importance and consistency of NTP cases registry & Updated Quarterly Reports on TB. Likewise he/she should have technical knowledge on how to attain the standard cure rate, assess and evaluate the TB reports. The following should be of importance in achieving the mentioned cure rate above: • DOTS Strategy • Correct categorization of TB cases • Availability of reporting Forms • Ensure the updating of TB reports • Availability of TB drugs • Recording and reporting system DOTS stand for Directly Observed Treatment Short Course. It is a comprehensive strategy endorsed by the World Health Organization and International Union against Tuberculosis and Lung Diseases to detect and cure TB patients. The strategy developed to ensure treatment compliance is called Directly Observed Treatment (DOT). DOT works by assigning a responsible person called the treatment partner to observe or watch the patient take the correct medications daily during the whole course of treatment. Cure rate – refers to the number of cases who are cured over the total number of cases registered multiplied by 100. This is validated through the Tb registry and the Quarterly Report on the Treatment Outcome of Pulmonary TB cases. Guidelines in vector control of selected Cure – sputum smear positive patient who has been completed and is sputum smear negative in the last month of treatment and on at least one previous occasion. TB Diagnostic Committee (TBDC) – is a group of TB experts established at the provincial and city levels to review the sputum smear negatives with chest x-ray findings suggestive of PTB. The TBDC is chaired by the NTP medical coordinator, with members from both the public and private sectors. The TBDC evaluates, by consensus, the appropriate recommendations for quality patient management.

Similarly, the PHN should be able to identify the targeted population to be covered for any of the specific program initiative to be conducted. He should be familiar and competent enough to provide technical inputs on the following:  Guidelines in the implementations of the Filariasis Mass Treatment – A.O. 25-A s. 1998: The National Filariasis Control Program: Strategy Shift from Filariasis Control to the Elimination of Filariasis  Guidelines in the implementation of deworming – AO 30-F s. 1999 and AO 2006-2008: The Soil Transmitted Helminthiases Control Program: Guidelines on the implementation of the Soil Transmitted Helminthiases Control Program  Guidelines in the implementation of Schistosomiasis Mass Treatment – AO 55s.2000; Guideline in the Implementation of Mass Treatment Schistosomiasis Control and Elimination  Guidelines in the Management of Rabies – AO 164s.2002 Revised Guidelines on Management of Animal Bite Patients  Guidelines in the Management of Dengue – DC 131s.2001 The Revised National Consensus Guideline on Dengue Case Management  Guidelines in the Management of Leprosy Revised Manual of procedures 2002  Guidelines in the Management of other infectious diseases such as Food and waterborne diseases He/She should also know the advantages of performing the above treatment strategies for infectious diseases and the importance of compliance to treatment. In doing so, there should have the following:  Master list of the targeted population  Adequate supply of drug supply including supportive medicine The PHN should be competent to furnish the LGUs on infectious disease surveillance, outbreak response system and to be able to network with other stakeholders. He/She should have:  Skills on how to conduct outbreak investigation  Procedures on how to refer during outbreaks  Technical knowledge on: o Outbreak investigation o Monitoring o Community surveillance for infectious diseases except Acute Flaccid Paralysis In order to provide the above standard, he/she should look for the following: • Availability of the outbreak response team

Develop a plan of activity for outbreak occurrences. bed 2. Identify the potential roles of each partner. The PHN should have the capability to implement and evaluate the sustained systematic technically sound and acceptable vector control strategies. etc. Discuss the plan of activities. General procedures on networking: 1. 5. regulator) With regards to procedures during outbreaks refer to the procedures for Infectious Disease Surveillance and composition of the Organized Emergency Team. 4. Conduct an orientation/training on outbreak occurrences to partners. dengue. He/She should have the technical knowledge on:  infectious diseases  Standard protocol in the Assessment and evaluation of vector indices and Case Fatality Rate  Recording and reporting of important vector indices . These are provided at the RHU by the programs through WHO ** Holding Area – any separate area within a health facility or an area with curtain/partition for patient while waiting for transport to the reference hospital. electric fan (optional) 4. curtain/partition 3. Equipment/Materials needed for a Holding Area: 1. 6. schistosomiasis. 3. Organize and call for a meeting with partners. 7.• • • • • Availability of supplies like rapid diagnostic test and drugs* Availability of vehicle for transport of patient Availability of a space in the RHU to serve as holding area** Reporting Networking *Rapid diagnostic test – for Malaria and Filaria. 2. He/She ought to be acquainted with the following:  *Procedure to determine vector surveillance indices data  *Procedure in mapping barangays endemic for malaria. filariasis. oxygen tank with paraphernalia – (tubing. their functions and steps to take. Identify potential partners in the area. mask. Develop a directory for your network partners to know how to get to them in case an outbreak occurs. There is no required measurement for a holding area.

Filariasis and Schistosomiasis please refer to the MOPs and updated guidelines Procedure on mapping barangays 1. Do this in at least 100 houses/locality 4. of house inspected Interpretation: House Index (HI) – it should be less than 5% (<5%). easy (<5 hours w/transport) . dengue) 1. Accessibility to health center – difficult (mainly by boat or walking). Vector control messages  Advocacy skills  Dissemination to various stakeholders In upgrading RHU. Inspect indoor and outdoor containers 2. of containers inspected c) Breteau Index (BI) – No. foothills. of houses inspected b) Container Index (CI) – No. if there are cases. the area is a priority for vector control Note: For vector surveillance indices of Malaria. the RHU should have:  Supplies & equipment to conduct vector surveillance  Existence of an RHU Med. Procedures to determine vector surveillance indices (e. of houses + for aedes larvae ____________________________ X 100 No. Classify the areas according to prevalence of the disease you are mapping 2. Identify the larvae and compute the indices as follows: a) House Index (HI) – No. of containers + for aedes larvae ___________________________ X 100 No. medium (> 5 hours w/transport). plains. coastal b. Collect larvae in the containers 3. if high. Tech.g. the area is a priority for vector surveillance Breteau Index (BI) – it should be less than 20. of positive containers ___________________________ X 100 No. Classify further by considering other factors like a. Topography – mountains. the PHN should work to accomplish the above standard.

Presence of a valid and updated TB DOTS certification and accreditation certificate b. Coverage report of mass treatment for infectious diseases such as filariasis. This will empower them to conduct their program activities guided by DOH policies and standards. The ITR of animal bites. schistosomiasis) and food and waterborne diseases 3. Housing conditions – good. Restrospective Cohort for TB c.c. bi-annual deworming for STH and treatment for other infectious diseases such as Food and Waterborne diseases e. Vector surveillance/Vector Control reports d. Provision of Quality Diagnostic Services a. malaria. bi-annual deworming. Surveillance/Networking/Outbreak Response a. Then categorize/prioritize areas based on criteria 4. Population stability – mobile. Reporting and Recording a. Access to an existing TB Diagnostic Committee 2. Report on Vector surveillance . the PHN should be able to encourage them to allot funds for infectious programs yearly. BHS on site d. dengue. Availability of a guideline on quality assurance system. Vector Control Strategies a. Accessibility to BHS . Presence of Manual of procedures for diagnostic services d. Map areas at least every 3 years For the LGU to provide support systems to effectively implement infectious disease programs. validation reports and reports on quality improvement activities f. poor g. seasonal movement. less developed f. endemic diseases (filariasis.>5 km distance. schistosomiasis. Presence of a trained Medical Technologists on diagnostic procedures for infectious and endemic diseases c. Drugs and medicines are available for all infectious diseases 4. A. stable e. The PHN should also motivate the local officials to organize a network of stakeholders in their respective area. Report/Records on Quality assurance b. <5 km distance. Agricultural development – developed. Drug supply a. Presence of cultural community 3. Monitoring and Evaluation 1. Laboratory supplies and equipment available for diagnostic and vector control services e. Outbreak response system in place and working 5.

b. Identify TB symptomatics as persons having cough for two or more weeks duration with or without accompanying signs and symptoms 2. guidelines . standards. Employ passive case finding (the staff wait for TB symptomatics to consult at the health facility 3. Appropriate control measures implemented 6. NCDPC . Demonstrate how to produce good sputum by asking the patient to breathe deeply and at the height of inspiration.Case Notification  6th leading cause of deaths  6th leading cause of morbidity A. Explain the purpose of the sputum examination to the TB symptomatic before collecting the specimen ii. ask the patient to cough strongly and spit the sputum in the container c) Collects 3 sputum specimens from the patient within 2 days . Health Centers Barangay Health Stations (BHSs) TB Situation  One of the 22 high-burdened countries (WHO TB Watch list)  3rd in the Western Pacific . Budget for infectious diseases are appropriated THE NATIONAL TUBERCULOSIS PROGRAM (NTP) Background Information: Philippines  Department of Health sets policies. Support System a.Centers for Health Development  Health program implementation is the mandate of LGUs (Devolution) Rural Health Units (RHUs). Presence of a community system on the prevention and control of infectious diseases b. Case Finding a) Identifies and Registers patient as TB Symptomatic 1. Register the TB symptomatic in the TB symptomatics masterlist and advise him/her top undergo sputum examination as soon as possible b) Explains the purpose of the sputum examination and demonstrate how to produce good sputum i.TB Unit. Implementation of local ordinances/resolutions/policies on infectious diseases c.

Immediately collect another 3 sputum specimens for confirmation when the result is doubtful Refers the patient to the Doctor a. pack it securely and transport the same to a microscopy unit or laboratory as soon as possible or not later than four days from collection c. Smear positive: Occurs when at least two sputum smear results are positive ii. seals and secures the sputum specimen collected and transports it to the microscopy unit or laboratory a. Label the body of the sputum cup with the patient’s complete name and the name of the referring unit b. Record the results of the sputum examination in the TB symptomatics masterlist Informs and explains the result to the patient a. Refer the patient to the doctor with the results of the sputum examination IT IS A CURABLE DISEASE BUT IF LEFT UNTREATED CAN LEAD TO DISABLING CONDITION AND DEATH! • Incubation period : > 4 – 12 weeks from infection . Second specimen or early morning specimen: It is the very first sputum produced in the morning and collected by the patient according to the instructions given by the midwife iii. Send the specimen together with the properly filled up laboratory request form to the microscopy center Records the results a. Smear negative: shows that all three sputum smear results are negative b. Inform and explain to the TB symptomatic the result of the sputum examination i. Seal each sputum container. Third specimen or spot specimen: It is collected at the time the TB symptomatic comes back to the health facility to submit the second specimen Follow-up patient and convinces him to submit 3 sputum specimens a. Collect three sputum specimens within two days according to the following procedures i.d) e) f) g) h) a. Follow-up TB symptomatics who fail to submit 3 sputum specimens and convinces him/her to do so Properly labels. First specimen or spot specimen: It is collected at the time of consultation or as soon as the TB symptomatic is identified ii. Doubtful: shows only one positive out of three sputum specimens examined iii.

for Category II 4-drug combination = HRZE 2-drug combination = HR Streptomycin vials Ethambutol tablets PZA tablets 2.pulmonary TB • Period of Communicability:  A person who excretes tubercle bacilli is communicable  Degree of communicability depends upon: .blinded technique 3. Recording/Reporting System 4.)  Political commitment  Quality microscopy service  Regular availability of drugs  Standardized records & reports  Supervised treatment NTP THRUSTS  Improve quality of DOTS implementation  Increase demand for DOTS services NTP STRATEGIES I.The number of excreted bacilli in the air .Virulence of the bacilli .Training under the NTP .Environmental conditions like overcrowding NTP Objectives (70/85)  Increase Case Detection Rate (CDR) from 61% (2003) to 70% or more  Increase Cure Rate from 77% (2002) to 85% or more Directly Observed Treatment Short-course (D. Program indicators .O.covers all DOTS facilities . External Quality Assurance (EQA) .At higher level .T. Quality DOTS services: 1.for Category I 4-drug combination = HRZE 2-drug combination = HR TB Kit II .S.> A year or two after infection of pulmonary or extra. Fixed-Dose Combination (FDC) TB Kit I .

II. strategy of the National TB Program (NTP)  Shall be the basis of implementation of TB control among stakeholders  First Philippine TB Summit Conference Program Components .O. P.Structure under NTP 2 critical aspects of sustainability: relational and financial aspects . Pulmonologists/Clinicians. DOTS services in special groups Public-Private Mix DOTS (PPMD) .Private sector participation .T.Strategy to synchronize case management . Radiologist .group of experts: NTP Coordinator. 2003  DOH – Phil CAT initiative  DOH: Key for other Government agencies  Phil CAT: Key for Private TB groups RATIONALE  DOH has forged partnership with Phil CAT  Harmonize & unify the TB control efforts in the Philippines  Adopts the D.proven to reduce overdiagnosis and overtreatment of Smear (-)s by 40% COMPREHENSIVE and UNIFIED POLICY for the TB CONTROL in the PHILIPPINES – C.S.U. 187 dated March 21. Participation of the Private Sector: Public-Private Mix DOTS (PPMD) TB Diagnostic Committees (TBDC) III.O.judicious treatment .to provide quality diagnosis for the Sputum Smear (-) radiologic suspect cases . E. Hospital-based NTP-DOTS IV.Strategy to increase CDR .2 approaches: Public-initiated Private-initiated TB Diagnostic Committees (TBDC) .

. 2nd spot Passive case finding shall be implemented in all health centers. Major Policies on Case finding:  Direct sputum smear microscopy shall be the primary NTP diagnostic tool.TB symptomatic present them in a DOTS facility. health stations. . .  All TB symptomatic must undergo sputum examination. Only contraindication is massive hemoptysis.based on location of lesions: Pulmonary Smear (+) Smear (-) Extra-pulmonary TB cases . To treat seriously-ill Smear (-) cases & other potentially infectious cases. early morning. with or without X-ray results. . Validation system must be established. CASEFINDING: Objective: Early identification and diagnosis of TB cases Passive Case finding .  Three sputum specimens must be submitted 1st spot. Sputum microscopy work shall be performed only by adequately trained health personnel. Quality control of smear examination must be observed. Classification of TB Cases .Base on history of anti-TB treatment . Case holding Objectives: To render as many smear (+) cases as non.important in determining treatment regimen TYPES OF TB CASES: .infectious & cured as early as possible. Active Case finding – a health worker’s purposive effort to find TB cases (among the symptomatic in the community) who don’t seek consultation in a DOTS facility.

change in tx facility Return After Default .H. New pulmonary Smear (-) cases with extensive Lung lesions as assessed by TBDC Extra-Pulmonary • Regimen II: Treatment Failure.New . CATEGORIES of TREATMENT • Regimen I: New pulmonary Smear (+) cases.still (+) on 5th month Others .no tx or <1m tx Relapse .cured & Sm (+)/culture (+) again Transfer . Extrapulmonary TB Relapse. Treatment Failure. New smear-negative PTB with extensive parenchymal involvement.O.initially (-) but became (+) on 2nd month . RAD.interrupted tx for > 2 mos & Sm (+)/culture (+) Treatment Failure .interrupted tx / Sm (-) . Relapse. Others • Regimen III: New pulmonary Smear (-)with minimal lesions as assessed by TBDC TB Treatment Regimen I (2 HRZE/ 4 HR) TB Patients To Be Given Treatment New smear-positive PTB.Chronic case (remains sputum + at end of re-treatment) Categories of Treatment Regimen H = Isoniazid Z = Pyrazinamide R = Rifampicin E = Ethambutol S = Streptomycin  Cat I : 2 HRZE / 4 HR  Cat II : 2 HRZES / 1 HRZE / 5 HRE (Re -treatment regimen)  Cat III : 2 HRZE / 4 HR NTP – W. DRUGS AND DURATION Initial Phase 2 HRZE Continuation Phase 4 HR II 2 HRZES/ 2 HRZES/ .In .

A mechanism of ensuring treatment compliance . Family Member Where will D.reports & traces the patient if he defaults .\  The national &/or local governments shall ensure the provision of drugs to all sputum (+) TB cases.TB patient is motivated to take his drugs . Barangay Health Worker.provides health education regularly .Cured. Supervised Treatment .T.motivates the patient on sputum ff-ups Who will undergo supervised treatment? Priority is the Smear (+) TB cases Who could serve as Treatment Partner? Health Staff.  Short-course chemotherapy (SCC) shall be the mode of treatment for the different classifications & types of tuberculosis.\  Domiciliary treatment shall be the preferred mode of care. Community Volunteer. take place? Health facility Treatment Partner’s House Patient’s House How long is treatment supervised? .  No patient shall be initiated into treatment unless a case holding mechanism for the treatment compliance has been agreed upon by the patient & health workers. * Treatment Partner * .watches the patient take his drugs daily .O.1 HRZE/ 5 HRE) III 2 HRZE/ 4 HR Return After Default Others New smear-negative PTB with minimal parenchymal involvement 1 HRZE 5 HRE 2 HRZE 4 HR Major Policies on Case holding  Treatment of all TB cases shall be based on reliable diagnostic techniques aside from clinical findings.

completed treatment Sputum (-) at the end of treatment General Attributes: New. classified according to internationally accepted case definitions.New Sputum (+) case. (Cure Rate. RECORDS and REPORTS NTP Laboratory Request Form Laboratory Register NTP Treatment Card NTP Identification Card TB Case Register NTP Referral Form Reports  Quarterly Report on Laboratory  Quarterly Report on Case finding  Quarterly Report on Treatment Outcomes Major Policies on Recording / Reporting  Shall rely on all government health facilities. Pulmonary Sputum (+) case Differentiating Attribute .Daily drug intake is supervised during the entire course of treatment.  Shall include private physicians & private clinics. after agreement with parties concerned has been made. including government hospitals.  Shall allow the calculation of the main indicators for evaluation.  Shall include all cases of TB.Sputum (-) at the end of treatment . Case Detection Rate) COHORT ANALYSIS  A group of patients having the same attributes at a certain period of time to determine respective Treatment Outcome.  Treatment Outcomes : Cure Rate = 85 % Completion Rate TX Failure Rate Defaulter Rate Death Rate Trans-Out Rate Cure Rate Cure .

of TX  Defaulter .Smear (+) at 5 mos.dies during the course of treatment . New Sputum (+) cases evaluated = 85% TREATMENT OUTCOMES  Cured  Completed . New Sputum (+) cases that got CURED Total no.Treatment Outcome = Total no.completed TX BUT no sputum ff-up result at end of treatment  Treatment Failure .change in treatment facility  Died ..interrupted TX for 2 months or more and not retrieved back  Transfer Out .

National Tuberculosis Program RHU Supervisory Flowchart: Case Finding Client Midwife Nurse Doctor Others .

National Tuberculosis Program RHU Supervisory Flowchart: Diagnosis and Initiation of Treatment Client Midwife Nurse Doctor Others .

NO YES MALARIA CONTROL PROGRAM > Malaria is a public health problem in more than 90 countries inhabited by a total of some 400 million people – 40% of world’s population > Worldwide prevalence of the disease .

around 70% of cases • Causes severe/complicated malaria and death if not treated promptly and appropriately • Resistance to antimalarial drugs in the country is widespread but low grade Plasmodium vivax • Comprised around 30% of cases • Very rarely causes severe disease • Sensitive to antimalarial drugs.> Estimated to be in the order of 300-500 million clinical cases each year CURRENT GLOBAL PICTURE • More than 90% of all malaria cases are in sub-Saharan Africa. Fever 2. • The vast majority of deaths occur among young children in Africa. resistance suspected in some countries (New Guinea. CLINICAL SIGNS & SYMPTOMS: 1. less than 1% of cases in the country • Infection is usually not severe but may last up to 50 years if not treated • Drug resistance has not yet been documented Plasmodium ovale • Not found in the Philippines. • Mortality is estimated to be over 1 million deaths each year. • The vast majority of deaths occur among young children in Africa. Indonesia) • Relapse is common if not treated adequately with anti-relapse drug Plasmodium malariae • Very rare. . especially in remote rural areas with poor access to health services. Sweating Agent Plasmodium falciparum • Most common in the Philippines. Chills 3. present in some Africa countries • Relapse may occur if not treated adequately with anti-relapse drug. especially in remote rural areas with poor access to health services.

places populated by indigenous cultural groups and areas with socio-political conflicts It continues to be a major impediment to human and economic development in areas where it persists It still costs the economy over 100 million pesos to sustain control efforts Contribution to the number of cases based on the 10-year average (1991 – 2000) a.• Drug resistance has not yet been documented VECTORS • Anopheles flavirostris primary vector. VISAYAS . MINDANAO . in frontier areas.46% b.047 in 1990 to 36.1% HIGH RISK • PREGNANT WOMEN • CHILDREN c.vector in coastal areas • Anopheles maculatus • Anopheles mangyanus • Anopheles balabacensis NATIONAL SITUATION • Control of malaria in the Philippines in the 1990s had significantly reduced cases by 60% (from 89.600 municipalities and 9. breeds in clear.979 barangays nationwide At risk of malaria nationwide are 11 million Filipinos mainly living in the remote hard to reach areas Endemicity is now generally moderate to low with pockets of high endemicity persisting along the provincial/regional borders.345 of the 42. 760 of the 1.53% • • • • • . slow flowing streams • Anopheles litoralis .596 in 2000) Still malaria remains endemic in 65 of the 78 provinces. LUZON .

in areas where it can be afforded and sustained RAPID DIAGNOSIS AND TREATMENT • To reduce the duration of illness • To prevent complications and death due to malaria . the population at risk.Other High Risk groups • Indigenous cultural communities • Non-immune travelers to endemic areas • Soldiers • Forest product gatherers Factors in the persistence or re-emergence of malaria (which vary with each region) • Inadequate program integration in health services • Lack of quality assurance and control in diagnosis • Poor public awareness • Uncoordinated control efforts • Inadequate technical expertise • Inadequate researches Other inter-related socio-economic. biological and environmental factors include: • poverty • drug and insecticide resistance • socio-political conflict • population movement • climatic change MALARIA CONTROL PROGRAM VISION Malaria-free Philippines by the year 2020 MISSION To empower the health workers. and all others concerned to eliminate malaria in the Philippines Strategies to achieve our goals: • Early diagnosis and effective treatment • Utilization of Insecticide Treated Mosquito Nets • Immediate and effective responses to malaria epidemics • Selective vector control.

give Quinine with Clindamycin Primaquine • given single dose to confirmed P falciparum cases to prevent . Rapid Diagnostic Tests CHEMOTHERAPY GUIDELINES Chloroquine + Sulfadoxine/Pyrimethamine (CQ+SP) • first line drug in the treatment of probable malaria and confirmed P falciparum provided disease is not severe .• • To cure the patient of malaria To help reduce transmission MALARIA DIAGNOSIS 1. transmission • given for 14 days to confirmed P vivax to prevent relapse . Artemether – Lumefantrin (Co-ArtemTM) • second line drug • given only to microscopically confirmed P falciparum which did . instead. not respond to adequate CQ+SP treatment • Not recommended for in pregnant women and children less than 8 yrs of old Quinine + Tetracycline/Doxycycline • third line drug • should be given to those who did not respond to Co-Artem • or if CQ+SP is not available • drug of choice in the treatment of severe malaria • Tetracycline and doxycycline are contraindicated for pregnant women and children under 8 years old. Microscopic Diagnosis (GOLD STANDARD)  definitive diagnosis of infection is based on demonstration of malaria parasites in blood films 3. . Clinical Diagnosis • based on signs and symptoms and history of travel to a malariaendemic area • done by all trained health workers especially in areas where microscopic diagnosis is not available within 24 hours 2.

Bacillus thuringiensis (a bacterial toxin) was also tried. People could propagate these fishes and seed them in the breeding streams. epidemiology. VECTOR CONTROL Selective vector control • Targeted. Indoor residual spraying  Kills adult mosquitoes resting on wall surfaces. Where • Consider magnitude of malaria problem.  Larvivorous fishes such as Gambusia affinis and Poecilia reticulata eat larvae of mosquitoes therefore reduce their density. Insecticide Treated Mosquito Nets .  Paris green was used in early 1900. priority groups/areas. site-specific. technical and operational realities. . cost effective • What (control method). 5.  VC method of choice during outbreaks  A wettable powder formulation is appropriate  Insecticide deposit effectiveness would last 6 months if not wiped/washed off  Insecticide and spraying equipment to be provided by GFATM 3. manageable breeding sites which are within flight range.Chloroquine • Drug to be used in the treatment of confirmed P vivax . resulting to reduction of their population. resources and information • The vectors behavior clarified and relates to disease transmission 1.Main vector control Target: 1 treated mosquito net per household Coverage should not be less than 85 – 90% Re-treatment is done every 6 months 2. infrastructure. When. levels of transmission and risks. Larviciding and Biological control  Larval control (with chemicals or biological agents) is relevant in accessible. Temephos 500 EC was tried in the later part of 1970. Personal protection measures  Chemoprophylaxis – recommended for pregnant women in endemic areas or people who temporarily stay in endemic areas.

83% 0.000 cases  Mortality rate – 5% Dengue Cases and Deaths per Region Philippines. mosbar.08% .3% 1.96% 0 0.99% 0. 2004 Region I II CAR III IV-A IV-B NCR V VI VII VIII IX X XI XII ARMM CARAGA TOTAL Cases 706 851 456 2739 621 16 3859 1202 1718 1921 1051 505 2542 2657 909 118 739 22610 Deaths 7 4 0 10 6 0 28 10 12 25 2 4 41 61 14 2 18 244 CFR % 0.61% 2.2% 0.36% 0.8% 1.3% 0.5 B at risk of dengue infection over 100 countries  Annual dengue cases – 100 M  DF / DHF / DSS admission per year – 500.7% 2. DENGUE PREVENTION AND CONTROL PROGRAM     Endemic in >100 tropical/subtropical countries No specific treatment Spreads rapidly affecting mostly children An environmental issue Global Situation of Dengue  2.7% 1.72% 0.47% 0 0. mosban and mosquito coils to minimize bites before retiring to bed under a net and early morning  Other protective measures such as burning of dried organic matter. wearing of long sleeves and long pants and tying large animal 20 m from the house.43% 1. Use of Mosquito repellents – such as citronella lotion.54% 1.

Aegypti A. 3 & 4)  Each serotype provides specific lifetime immunity & short term cross immunity  All serotypes can cause severe & fatal disease  Genetic variation within serotypes  Some genetic variants within each serotype appear to be more virulent or have greater epidemic potential Signs and Symptoms: • Sudden onset of high grade fever which may last 2 to 7 days • Joint and muscle pain and pain behind the eyes • Weakness • Skin rashes – maculopapular rash or red tiny spots on the skin called petechiae • Nosebleeding when fever starts to subside • Abdominal pain • Vomiting of coffee-colored matter • Dark.Vector .Aedes aegypti  Dengue transmitted by infected female mosquito  Primarily a daytime feeder  Lives around human habitation  Lays egg and produces larvae preferentially in containers BIONOMICS OF AEDES A.colored stools . Albopictus Feeding habit Resting Habit Oviposition Breeding Habitat Flight Range Host preference Life span artificial Day biters Day biters (1-2 hrs after sunrise/(1-2 hrs after sunrise/ 1-2 hrs before sunset) 1-2 hrs before sunset) Indoor Outdoor Lay eggs 60-100 eggsLay eggs 60-100 eggs per batch per batch Artificial containers Natural containers 200-300 meters 200-300 meters Human Human 20 days (male) 20 days (male) 30 days (female) 30 days (female) Dengue Virus  Causes dengue fever & dengue hemorrhagic fever  Is an arbovirus  Transmitted by infected female mosquitoes  Composed of single-stranded RNA  Has 4 serotypes (DEN 1. 2.

undetectable blood pressure or pulse. Dengue Shock Syndrome: Grade III .  Plasma leakage (hemoconcentration or pleural effusion or ascites). clammy skin and restlessness Grading Severity of DHF Grade I Fever. inch on the volar surface of the forearm 1 ½ inch distal from the antecubital fossa • Count the petechiae within the prescribed area A POSITIVE TEST IS 20 OR > PETECHIAE Spectrum of Dengue Infection Dengue Hemorrhagic Fever The following must all be present:  History of acute fever.s/s of Grade II with more severe bleeding + evidences of circulatory failure Grade IV . – Narrow pulse pressure. Laboratory: Thrombocytopenia + Hemoconcentration Major Pathophysiologic Abnormality DHF/DSS: Acute Increase in Vascular Permeability PLASMA LEAKAGE: leakage of water.with profound shock. non-specific s/s. electrolytes and plasma .How is tourniquet test done? • Inflate to a pressure halfway between systolic and diastolic levels • Maintain compression for 5 minutes • Describe an 1 sq. (+) TT Grade II s/s of Grade I + spontaneous bleeding. – Cold.  Hemorrhagic manifestations Dengue Shock Syndrome All of the above criteria for DHF must be present + evidence of circulatory failure manifested as: – Rapid and weak pulse. – Hypotension for age.  Thrombocytopenia. lasting 2-7 days.

 Clean all water containers once a week.  Hemoconcentration Prevention and Control  Cover water drums and water pails at all times to prevent mosquitoes from breeding.  Clean gutter of leaves and debris so that rain water will not collect as breeding places of mosquitoes. Scrub the sides well to remove eggs and mosquitoes sticking to the sides.less than 100.protein  Hemoconcentration  pleural effusion (by PE.  Old tires used a roof support should be punctured or cut to avoid accumulation of water.  Collect and dispose all unusable tin cans. pain  Persistent vomiting  Listlessness  Changes in mental status  Restlessness  Moderate to severe dehydration  Weak and rapid pulse  Cold. CXR)  tender hepatomegaly/abdominal pain  hypoproteinemia Outpatient Case:  Oral Rehydrating Solutions  Daily assessments of patients: – Clinical & laboratory  May send patient home with advise to watch out for danger signs ORESOL In adults: replace fluids as in moderate dehydration at 75 ml/KBW in 4-6 hrs or up to 2-3 L/day DHF Danger Signs  Spontaneous bleeding  Persistent abdominal. . bottles and other items that can collect and hold water.000/cu. jars. clammy skin  Circumoral cyanosis  Dyspnea  Seizures  Hypotension  Thrombocytopenia .  Replace water in flower vases once a week.mm.

of positive containers total no.Mag 4 S Against DENGUE!  S earch and destroy  S elf-protection measures  S eek early consultation  S ay No to indiscriminate fogging Larval Survey: COMPUTATION OF RESULTS A. CONTAINER INDEX (CI) CI = no. HOUSE/PREMISE INDEX (HI) HI = no. of houses inspected x 100 Priotization of Areas Priority 1 . of houses (+) for Aedes sp.localities w/ relatively low larval indices HI <5% and/or BI <20 Priority 4 .localities where there are no dengue cases and low Aedes densities. x 100% no. of containers inspected C. of containers (+) for Aedes sp. X 100% no. of houses inspected B. BRETEAU INDEX (BI) BI = no. w/in 24 hrs of the 1st case from an outbreak locality • following an outbreak based on priority classification of the locality • high risk areas (Priority 1 & 2) = monthly/ quarterly in 100% of houses • low risk areas (Priority 3 & 4) = monthly/ quarterly in at least 20% of houses .localities where an outbreak of DF/DHF had occurred Priority 2 .localities w/ high larval indices HI >5% and/or BI >20 Priority 3 .

Brugia malayi Vectors: Aedes. Anopheles.Wuchereria bancrofti .is parasitic infection transmitted by a mosquito  2 Species in the Philippines: .• before and after interventions when there is suspect of insecticide resistance FILARIASIS PREVENTION AND CONTROL PROGRAM Filariasis . and Mansonia .

11) 2. Category 3 – without any report of endemicity and considered as non-endemic for the disease : 33 provinces Recent discoveries of new endemic areas  1992 – 13.000 population (’98 national prevalence survey) Program Goal: Filariasis is eliminated as a public health problem. drug reapplication and program management.Pathophysiology  Microfilariae live for 2 years in the body causing periodic fever attacks  Adult worms live for 10 years and when they die granulomas form around them in the lymphatic channels  It blocks the flow of lymph causing gross and irreversible chronic deformity (Elephantiasis and hydrocoeles)  The disease is considered as a disease of the poor  Primarily affects the working age group living in remote and endemic rural areas.recommended by the Global Elimination Group . Filariasis endemicity 1.6% in Marinduque  1998 – 17.it facilitate program monitoring. 25 – A s.7 / 1.  Health Status Objectives: 1. ( Baseline: 9. Category 1 – provinces with reports within the past 10 years establishing its endemicity : 20 provinces (R 4. long-term disability among infectious diseases. 9.“Mass Treatment Month for Filariasis “ . Category 2 – with no report of endemicity but were reported as endemic in the 1960 prevalence survey : 25 provinces 3.7% in Cagayan de Oro City  National prevalence – 9. 8. drug distribution.O. – DOH A. 5.000 populations in endemic municipalities. 1998 November . WHO has identified it as one of the eradicable diseases and has called for its global elimination as a priority. Although Filariasis is not a killer disease. Reduce the prevalence rate to < 1 case per 1.to improve efficiency and ensure concerted efforts .000 in 1998 ) .7 cases per 1. it is considered the 2nd leading cause of permanent.

(Baseline: 40 mf per + case in 1998.administration to patients will be standardized based on weight for age . Coverage  Individuals from ages 2 and above living in endemic areas Exclusion Criteria and Special Precautions: > Treatment of pregnant women will be deferred until delivery. Cagayan de Oro Survey. .  The rationale for mass treatment is that people in endemic area will sooner or later be infected and become a source of infection for others. Global Rate) Diagnosis  Demonstration of microfilariae in a blood smear examination conducted at night due to nocturnal periodicity of the parasite (NBE – nocturnal blood examination) Prevention and Control Measures  Use of mosquito nets  Residual spraying  Screening of houses  Use of protective clothing among plantation workers  Elimination of mosquito breeding places Strategy to eliminate the disease  Mass Treatment with Diethylcarbamazine (DEC) in endemic localities . Reduce the microfilaria density in endemic municipalities to 4 microfilariae per positive case. in an established endemic area whether infected or non-infected with Filariasis. > Special precautions in treating individuals with cardiac and kidney diseases should be observed.standardized dose  Mass treatment is giving the drug to all population. CDCS) 3.given with Albendazole – 400 mg/single.The presence of at least one endemic barangay in a municipality will make the municipality eligible for Mass treatment Frequency: The combination drugs for Mass Treatment will be given once annually for a minimum of four consecutive years in all established municipalities. Selection of Municipalities for Mass Treatment . (Baseline: 3 – 4 per year in 1994.2. Reduce adenolymphangitis attacks to 1 per year.

> There is also need to build sanitary toilet facilities that can reduce the prevalence of the disease.  The flukes copulate and lay eggs. find their way into the blood circulation.  The disease is transmitted to a man or animal when they come in contact with bodies of freshwater infested with cercariae coming from snails. Health Status Objective 1. the eggs get inside the gut and are passed out in the feces.  Once they reach water. Reduce the national prevalence rate of schistosomiasis to 2.5 percent. a tiny freshwater snail identified as Oncomelania quadrasi. then to the liver and into their final habitat—the mesenteric veins in the wall of the intestines where they become adult male and female flukes.  Farmers and freshwater fishermen make up the occupational groups with the highest prevalence of the disease since they have frequent contact with infested water. > Access to safe water supply is also one of the people’s primary needs in rural areas where schistosomiasis is endemic.  Through minute ulcers or sores in the intestinal walls.SCHISTOSOMIASIS CONTROL PROGRAM Schistosomiasis is a tropical parasitic disease caused by a blood fluke known as Schistosoma japonicum. > Records show that around 25% of households have no access to safe water while around 40% of households have no sanitary toilet facilities in endemic areas. It is transmitted through an intermediary host. .  The significance of schistosomiasis is that its primary victims are the rural poor. thus repeating the cycle. the egg hatch into miracidia which will now seek the snail.  The cercariae penetrate the skin of the host.

47% 0.79% Special Target Areas Maguindanao Agusan del Sur Lanao del Norte Surigao del Norte Oriental Mindoro 1997 Baseline 18.06% 8.0 percent for at least five consecutive years.21% 0.38% 0.76% 2.484 Totals for Aug.43% 0.05% 9.484) (HIV/AIDS Registry. (Schistosomiasis is considered eliminated as a public health problem if the prevalence rate is maintained at less 1.Special Target Population School children (1-6 years old) 1997 Baseline 3.2006 N=2.71% 5.41% 2004 Targets 10.18% 0.99% 0.78% 2004 Targets 1. 1984 – Feb.88% 4.) Special Target Areas Davao Oriental Surigao del Sur Zamboanga del Norte Davao del Sur Bohol 1997 Baseline 0.88% 2.17% 2004 Targets 0.91% 18.95% 5.90% 0. January 1984 – February 2006) Cumulative Totals Jan.44% 0. Eliminate schistosomiasis as a public health problem in five endemic provinces.08% SEXUALLY TRANSMITTED INFECTION/HIV/AIDS PREVENTION AND CONTROL PROGRAM Reported Modes of Transmission (N=2. 2005 N =30 Reported Modes of Transmission .29% 11.

Sexual Transmission Heterosexual contact Homosexual contact Bisexual contact Blood/blood products Injecting drug use Needle prick injuries Perinatal No Exposure Reported TOTAL 1.484 21 7 1 0 0 0 0 0 30 Aims in STI Management 1. Risk of HIV/AIDS Common Sexually Transmitted Infections: Bacterial • Gonorrhea • Syphilis • Chlamydia • Chancroid Viral  Genital herpes  Genital warts  Genital molluscum  HIV  Hepatitis B * Protozoa  Trichomonas Fungal  Candidiasis Skin Parasites  Pubic Lice  Scabies .551 452 135 19 7 3 36 281 2. Development of diseases. complications and its consequences 3. Transmission 2.

- passed on by close body contact and do not require actual penetrative intercourse Syndromes  Vaginal Discharge Gonorrhea. Chlamydia  Neonatal eye infection Gonorrhea Preventive Measures A . Herpes Genitalis  Lower abdominal pain in women  Scrotal Swelling Gonorrhea. Contact tracing 4. Secondary > Risk assessment - . Trichomoniasis  Genital Ulcers Syphilis. Laboratory Support Levels of Care 1. Prevention Activities 3. Chlamydia. Condom 3. STI Case Services 2.Abstinence B – Be faithful C – Correct and Consistent use of Condom D – Don’t use illicit drugs/ share syringes and needles E – Educate you/other Partner Management and Its Importance 4 C’s: 1. Compliance 2. Primary > Risk reduction CONDOM PROMOTION (CONSISTENT AND CORRECT USE OF CONDOM) Prevention of STI from occurring in the first place popularizing active health seeking behavior 2. Trichomoniasis. Bacterial vaginosis  Urethral discharge Gonorrhea. Chlamydia. Counseling Strategies 1. Candidiasis. Specialist Services 4.

The incidence of animal bite cases in the country was estimated to be around 400 cases per 100. then progresses to muscle spasms.  The cost of post-exposure treatment is very high. > Death . Promotion of safer sexual behavior 3. delirium. Counseling 7. (Baseline: 5 per million population in 1997. 15 percent of these require active immunization (vaccine) while 40 percent of those requiring active immunization will also need passive immunization (immunoglobulin). and convulsions. The disease affects the nervous system. Prevention of Complication and Sequela 3. paralysis. Management of complications 2. fever and weakness.is always an outcome and often due to respiratory paralysis. Mobilization Wider Base of Multi-Sectoral Support should be expanded RABIES CONTROL PROGRAM Rabies . Thus. Contact tracing 4. which is transmitted through a bite of an infected animal. > The Philippines ranked fourth worldwide in rabies incidence in 1996. ranging from P4. Reduce the incidence of human rabies cases to no more than three cases per million populations.is a fatal disease caused by the rabies virus.000 populations. Effective treatment and compliance 6. Tertiary > Maintain positive sexual behavior 1. It usually manifests initially as headache. depending on the category of bite exposure.  Approximately 300 to 600 Filipinos die of rabies every year. the most cost-effective measure against rabies is the vaccination of dogs. 000. Treatment of contact/s 5. CDCS and FETP) . Health Status Objectives: 1. > Dogs remain the principal reservoir of rabies in the country. Early detection/Screening 2. 000 to P24.1. Universal Precaution 3.  Rabies remains a public health problem in the Philippines.

IMMUNIZATION 1. 7. Increase the proportion of households practicing responsible dog ownership (immunizing dogs against rabies and leashing dogs within the yard) to 90%. Active Immunization (a) Vaccine is administered to induce antibody and T-cell production in order to neutralize the rabies virus in the body. In view of the 100% case fatality of human rabies. give clean food. 2.0 ml/vial. Eliminate human rabies in Visayas – Region 6. and c.  Take care pet dog: bathe. b. and 8(from 3 – 4 cases per year to 0) Risk Reduction Objectives: 1. Passive Immunization (a) Rabies Immunoglobulin (RIG) is given in combination with anti-rabies vaccine to provide immediate protection to patients with Category III exposure.  Never allow pet dog to roam the streets. 2.2. any of the three vaccines may be administered either intramuscularly or intradermally. (b) The types of anti-rabies vaccine available in the Philippines: a. Purified Chick Embryo Cell Vaccine (PCECV)-1. Reduce the number of rabid dogs to less than 10 per 100. 3.5 ml/vial.000dog population. RIG has a half life of approximately 21 days. and provide clean sleeping quarters. (c) All vaccines are considered to be highly immunogenic and safe. National health authorities should evaluate any new vaccine or RIG prior to use. Purified FreeCell Rabies Vaccine (PVRV)-0. It induces an active immune response (in 7-10 days after vaccination) and may persist for one year or more. Purified Duck Embryo Vaccine (PDEV)-1. (b) Only rabies vaccines and RIG that have been evaluated and recognized by WHO and approved by BFAD should be used. Prevention and Control: Be a responsible Pet Owner!  Have a pet dog immunized against rabies at 3 months old and every year thereafter. For active immunization.0 ml/vial. the prevention of rabies infection after exposure is of utmost importance. (c) RIG is of two types: . Increase the proportion of households practicing immediate washing of animal bite site with soap and water to 90%.

for PVRV and 0.5.2 for PDEV/PCECV. cream or occlusive dressing to the bite site. Anti-tetanus immunization and anti microbial may be given if indicated. Do not applies any ointment.• Human rabies Immunoglobulin (HRIG) derived from plasma of human donors administered at 20 IU per kilogram by body weight. suturing of wounds should be avoided. Local Wound Treatment A.1. Animal bites are considered tetanus prone wounds. A.1. anti-rabies immunoglobulin should be infiltrated around and into the wound before suturing. Treatment Regimen b. If possible.2. and • Equine Rabies Immunoglobulin (ERIG) derived from horse scrum administered at 40 IU per kilogram body weight TREATMENT 1. • A one (1) ml insulin syringe with gauge 25 or 26 needle should be used for intradermal injection. if suturing is necessary. Signs and Symptoms . and 7 and at one site on Day 30 and 90 • Injections should be given on the deltoid area of each upper arm in adults. however. 3. Wounds should be immediately and vigorously washed and flushed with soap and water preferably for 10 minutes. Apply alcohol. 2 –site intradermally Schedule (2-2-2-0-1-1) • One dose for intradermal administration is equivalent to 0. at the anterolateral aspect of the thigh.4. or infants. Post-Exposure Treatment a. b. LEPROSY CONTROL PROGRAM  Hansen’s Disease – is a chronic bacterial infection caused by Mycobacterium leprae Mode of transmission: >Airborne – inhalation of droplet /spray from coughing and sneezing of untreated leprosy patient >Microorganism may also enter the body through the skin by prolonged intimate contact. • One dose should be given at two sites on Days 0. • A vaccine should be stored within 40.0C and 8. A. A.3.1 ml. tincture of iodine or any antiseptic.0C and after reconstitution should be used within 8 hours. A.

the PR went down to 0. WHO has set the goal of eliminating leprosy as a public health problem by year 2000  In 1998 the Phil.000 population at the sub-national level. Long standing skin lesions that do not disappear with ordinary treatment  Loss of feeling/numbness on the skin  Loss of sweating and hair growth over the skin lesions  Thickened and/or painful nerves in the neck.g. Achieved the elimination goal by attaining the Prevalence Rate of 0. near elbow joint and the back of knees Health Status Objective:  To reduce the prevalence of leprosy to less than 1 case per 10. even if some sequelae of leprosy remain (e.00  This was largely due to the nationwide implementation of MDT Diagnosis  Based on clinical signs and symptoms. especially if there is a history of contact with Person with Leprosy (PWL)  Only in rare instances is there really a need to use laboratory and other investigations to confirm a diagnosis.00  At end of 2000. ulcers or deformities) Classification Characteristic Single Lesion Paucibacillary (SLPB) Paucibacillary (PB) Multibacillary (MB) Skin lesions Only one lesion More than 5  2 -5 lesions (Includes macule lesions ØAsymmetrically – flat lesion and distributedDefinite Assymetrically papule – raised distributed loss of sensation lesion and Loss of sensation nodule) .57/10. forearm.  Slit Skin Smear (SSS) examination is an optional procedure.9/10. Important: A leprosy patient who has completed treatment should no longer be regarded as a case of leprosy. It is done only when clinical diagnosis is doubtful.

 The standard regimens are considered safe for both mother and the child and therefore be continued during pregnancy. . MB Regimen: Monthly treatment: Day 1 Rifampicin 600/ 450 mg Clofazimine 300/150 mg Dapsone 100/50mg Daily treatment: Day 2 – 28 Clofazimine 50 mg Dapsone 100/50 mg Duration of treatment: 12 blister packs to be taken monthly within a maximum period of 18 months PB Regimen: Monthly Treatment: Day 1 Rifampicin 600 / 450 mg Dapsone 200 / 50 mg Daily treatment: 2 – 28 Dapsone 100 mg Duration of treatment: 6 blister packs to be taken monthly within a maximum period of 9 months.  Disabilities in leprosy is caused by damage to the peripheral nerves  The best way to prevent disabilities:  Early diagnosis and prompt treatment with MDT and early recognition of signs and symptoms of nerve involvement and prompt treatment with prednisone.Nerve damage No nerve trunk (resulting in loss involvement of sensation or weakness of muscles supplied by the affected nerve  None or one nerve trunk Many nerve trunk Multi Drug Therapy (MDT)  .It is a combination of two or more anti-leprosy drugs that renders the patient non-infectious within one month after starting treatment.is the accepted standard treatment for leprosy and is proven to be safe and effective.  .

Hookworms (Anylostoma duodenale and Necator americanus). .is a zoonotic parasitic disease caused by a group of flukes belonging to genus Paragonimus. such that geofactors like temperature and humidity primarily determine its distribution. 2. > Soil-transmitted helminthiases is the third most prevalent infection worldwide. >It was first reported in Ilocos Norte in 1963.800 cases were documented in the same area in 1967. Trichuris trichiura.SOIL .  Mass deworming of children aged two to 14 years old at least twice a year for three consecutive years is required to immediately halt the impact of the disease on children and the community. but they suffer the greatest impact from the disease when they get infected.  The prevalence of soil-transmitted helminthiases among those two to five years old is lesser. > The infection which often involves the lungs has manifestations similar to pulmonary tuberculosis (PTB). This age group has he highest prevalence rate and the greatest source of transmission for the infection. These parasites are classified as soil-transmitted helminths (STH) because their development happens in the soil.TRANSMITTED HELMINTHIASES The three major cause of intestinal parasitism in the Philippines are: 1. One hundred eight deaths from 1. 3.  In 1998 and investigation of an epidemic of a “mystery disease” in Compostela Valley in Bukidnon revealed capillaria parasite. and s ranked 10th among the world’s top 10 infectious disease killers. >Chronic coughing productive of blood streaked sputum and chest pains are some of the signs and symptoms. Ascaris lumbricoides.  The prevalence of soil-transmitted helminthiases in the Philippines has persisted at high levels above 50% over the years. >It is frequently encountered in places where people eat raw or inadequately cooked crabs or possibly snails which harbor the infective stage of Paragonimus. OTHER PARASITOSES PARAGONIMIASIS . > Soil-transmitted helminthiases are the number one most important disease burden among those five to 14 years old. second only to diarrheal diseases and tuberculosis.

Reduces the prevalence rate of soil-transmitted helminthiases to less than 50%. Increase the percentage of children 2 to 14 years old washing hands before eating and after using toilet to 90%. as the mode of transmission. Most of the males affected are fishermen who usually eat their catch raw. MENINGOCOCCEMIA Situationer • 81 lab-confirmed cases from September 26. • There are more fatalities in the 0 . SERVICES AND PROTECTION OBJECTIVES 1.  Intestinal capillariasis is characterized by intestinal malabsorption.7 year age group. particularly bags it. Ensure 90% utilization of sanitary toilets by all households. There are twice as many males the females affected. Benguet had 29 and Mountain Province had 13. chronic diarrhea and borborygmi. • Presentation can take any one of three syndromes. • There are more in the cases in the 15 to 25 year age bracket. 3. the causative agent for meningococcal infections. 2005. Ensure 80% mass deworming coverage of children 2 to 14 years old two times a year for three years and once a year hereafter. • Baguio had the most fatalities which was followed by Benguet with a CFR of 21% Epidemiological parameters • 90% of cases belong to the lower socio-economic group. RISK REDUCTION OBJECTIVES 1. 2. . 2.  History suggests ingestion of raw or inadequate cooked small fish. 2004 to March 26. Reduce infection rate of other parasitoses in man in endemic areas. HEALTH STATUS OBJECTIVES 1. gram-negative diplococci. • Baguio had the most cases with 38. • Acquisition can result in asymptomatic pharyngeal colonization or invasive disease. Increase children wearing footwear to 100%. • Also 31 probable and 108 suspect cases. • There is no predisposing occupation or profession Background • Neisseria meningitidis is encapsulated.

of cough. pulmonary edema . 3. Peaks during dry season and ceases with onset of rains. . gallops. • Infection is preceded by colonization of the nasopharynx. close to 12.000 pop. • 5% become long-term carriers.hypotension • Moderate to high grade fever • Peticheal rash (80%) becomes rapidly purpuric then ecchymotic • CHF. . • An immunoglobulin A1 protease which cleaves LAMP1 allowing its intra-cellular survival. • Transmission is by direct transfer of respiratory secretions. 5. CFR of 10%.1 case/100.In Africa. Physical Findings • Tachycardia +/. Peaks at winter months. rate is as high as 30% and occurs within 24 hours after onset of the disease. Virulence factors… • A polysaccharide capsule which is resistant to phagocytosis.CFR is 13%. Followed by fever with chills. and CFR of 13%. Frequency • In the US: .000 pop. 2.PATHOPHYSIOLOGY • Humans are the only natural host. • In fulminant infections.In UK. 3 SYNDROMES: Meningitis Meningitis with meningococcemia Meningococcemia with meningitis History presents with a non-specific prodrome headache and/or sore throat. . MORTALITY RATES • Case fatality rate is approximately 10-12% for meningitis and 20% for meningococcemia. close to 4.000 cases/yr. 4. • The first six hours of the disease remains the most critical period.000 cases/yr.Outbreak when there are 3 cases or more in a 3 month period or an AR of 10 cases/100. • Entry into the bloodstream and introduction to the target sites/organs. /year . myalgia and arthralgia 1. • An endotoxin which could be shed in large amounts (blebbing) which accounts for the signs and symptoms.

joint fluid.surgical care when necessary ANTIMICROBIALS Pen G Na Chlramphenicol Ceftriaxone Rifampicin Ciprofloxacin Azithromycin Bacteriostatic Bacteriostatic Bacteriostatic Bactericidal Bacteriostatic Bacteriostatic 250t u IV/4hrs 4M u IV/4hrs 100mg/kg/d. skin lesions • Findings on blood culture are positive in 60-80% of untreated patients.hospitalization is required for severely ill patients with fever.intensive care is necessary for suspected fulminant cases . • PMN leukocytes are usually elevated • Thrombocytopoenia present in 20% of cases.provide supportive care .• • Progression is usually rapid Variations in manifestation dictated by presentation Lab Studies • Definitive diagnosis requires culture from blood.begin antibiotic treatment promptly . • PCR (polymerase chain reaction) is a rapid method for diagnosing CSF infection Management • Medical care : . To 1g daily 600mg BIDx2 500mg SD 500mg SD Case definition for routine surveillance • Clinical Case Definition . 2g IV red. • Gram-negative diplococci may be observed in stains from peticheae or buffy coat preparations or from joint fluids. CSF. headache and rashes .

Gram (-) diplococci in the CSF . purpura) .Stiff neck .Turbid CSF .4 or more cases.Final diagnosis of meningococcal disease by the attending physician .Bulging fontanelle .Non-blanching rash (petechiae.One case in a province/city/municipality within a month Geographic Cluster of Cases .Neck stiffness .Increased cell count in CSF Confirmed Case Definition • A suspect or probable case with one or more of the following: .Altered consciousness . An illness with sudden onset of fever (>38. purpura) • Probable Case Definition • A suspect case plus one or more of the following: .Isolation of N.2 or 3 cases in a provincial/city/municipality within a month Outbreak .Altered consciousness .Bulging fontanelle .o C axillary) and one or more of the following: .0 C axillary) and one or more of the following: .Turbid CSF • Plus one or more of the following: . meningitidis DNA from a sterile site (CSF or blood) .Clinical diagnosis of meningococcal disease by the attending physician . meningitidis from a sterile site (CSF or blood) .Positive latex agglutination test for N. in a provincial/city/municipality within a month Close contacts of a Case . meningitides (CSF) Case definition in an Outbreak Situation • Suspect Case Definition  An illness with sudden onset of fever (38.5 C rectal or > 38.5 C rectal or >38.Positive latex agglutination test for N.Identification of N.Gram (-) diplococci in the CSF . with at least one confirmed case. meningitidis (CSF) Threshold levels for Outbreak Declaration Sporadic / Isolated case .Non-blanching rash (petechiae.

dorm room. Health care worker or other caregivers who had intimate exposure to nasopharyngeal secretions (e. Persons who are in contact with a close contact. 3. prison cells. • 3. THOUGH SOME SPECIES ARE MORE RESISTANT TO INFECTION THAN OTHERS • SOME FORMS OF BIRD FLU INFECTION CAN CAUSE ILLNESS TO HUMANS . Persons who do not have close or prolonged contact with the case (e.• • • 1. meningitidis DNA from a sterile site (CSF or blood) What has been done… • Active immunization of frontline health workers and hospital personnel in areas most antibiotic treatment. barkada). Persons living together and sharing sleeping quarters (e. intubation). mouth to mouth resuscitation. military barracks. evacuation camps) including overnight visitors in the week preceding the onset of the case’s illness. boy/girlfriend. casual encounters) • 2. AVIAN INFLUENZA WHAT IS BIRD FLU? • CONTAGIOUS DISEASE OF BIRDS RANGING FROM MILD TO SEVERE FORM OF ILLNESS • ALL BIRDS ARE SUSCEPTIBLE.g. Persons who have similar level of close prolonged contact (e.g. meningitidis from a sterile site (CSF or blood)  Identification of N. boarding house. Health care workers without direct exposure to patient’s respiratory tract secretions. sharing drinking glasses. NOT a Close Contact of a Case • 1. 2.g. people living in the same house. schoolmates or co-workers.g. Laboratory Confirmed Case • A clinical case with one or more of the following:  Isolation of N. cheek kissing.

discharges and surfaces • Birds excrete the virus in their feces.Economic and Public Health Implications – – – – H5N1 causes severe epidemics and mass death of chickens The poultry industry and food security feared to be greatly affected High mortality to humans Pandemic Potential Transmission to humans: • Close contact with live infected birds through infected aerosols. and is then inhaled • Flapping of wings hastens the transmission WHAT ARE THE SIGNS AND SYMPTOMS OF BIRD FLU IN HUMANS? Following exposure to sick or dead chicken patient develops: • Fever • Body weakness or muscle pain . which dries and becomes pulverized.

Prodromal Stage 0-1 day High fever (above 38 °C. .• • • • Cough Sore throat Dyspnea in severe cases Sore eyes (more than 50% of cases die) Clinical Stages of AI in humans: 1. Ornithologists 6.ARDS . Lower Respiratory Stage 1-7 days . Poultry handlers/workers 2. Cullers involved in destruction Eating chicken is safe • Avian flu is not a food-borne virus • Would have to dry out the chicken meat and sniff the carcass to be at any risk • Virus is easily inactivated by heat. Cough and breathe/pleuritic pain. Sellers/people involved in live chicken sale 4. range 2-8 days 2. Incubation 3 days. rather than infecting people Diagnosis • A laboratory confirmation of the bird flu infection and epidemiologic link with unusual death or epidemics of chickens will support the diagnosis of bird flu. People living near poultry farms 3. one does not get bird flu from thoroughly cooked chicken • Very low risk of importing the virus in meat or meat products is on domestic flock. Aviary workers 5.Early dyspnea .Multi-organ failure shortness of Recovery in 50% of cases Most cases have died in spite of ventilatory support after about 10 days Individuals at risk 1. Watery Diarrhea Abdominal pain Vomiting Bleeding from nose and gums in some 3.Inspiratory crackles .

people living and working on poultry farms . • The vaccine currently available against the circulating strains in humans will not protect against the disease caused by the H5N1 influenza strain. • BIRDS THAT SURVIVE INFECTION EXCRETE VIRUS FOR AT LEAST 10 DAYS ORALLY AND IN FECES. workers and breeders to prevent recombination of A1 virus with the human influenza virus.Virus isolation . should be given within the first 2 days of illness.RT-PCR (Polymerase Chain Reaction) IS THERE A VACCINE EFFECTIVE AGAINST BIRD FLU? • NONE. it is recommended for individuals who are potentially exposed to avian influenza virus like poultry handlers. HIGHLY PATHOGENIC VIRUSES CAN SURVIVE FOR LONG PERIODS IN TISSUES. • Easily inactivated by temp of at least 70 degrees Centigrade Use of antiviral agent in avian influenza: Oseltamivir (Tamiflu) Treatment of avian influenza cases: 1 capsule 2x a day.. However. Selected groups for vaccination: . Usefulness of routine influenza vaccines Confer no protection against infection with the H5N1 avian virus. 10 capsules/ treatment Prophylaxis for exposed persons: 1 capsule once a day for at least 7 days Cullers and transporters should be provided with appropriate PPE: • Coveralls plus an impermeable apron or surgical gowns with long cuffed sleeves plus an impermeable apron • Heavy duty rubber gloves that may be disinfected • N95 respirator masks or standard well-fitted masks . WATER AND THE ENVIRONMENT ESPECIALLY WHEN TEMPERATURES ARE LOW. HOW IS BIRD FLU TRANSMITTED TO HUMANS? • Inhalation or contamination with infected discharges and feces of chickens • It is not a food-borne illness. the seasonal vaccine may be useful to prevent reassortment of human and avian viruses.health care workers involved in the daily care of H5N1 human cases .health care workers in emergency care facilities in areas where there is confirmed occurrence of influenza H5N1 in birds. However.cullers involved in destruction of poultry .

Quarantine Exposed persons for 10 days and monitor for signs and symptoms of illness. Slowing the spread of infection: 1. Social Distancing • Reduction of unnecessary travel • Staying at home when sick • Isolation at home (separate room) and Closure of schools • Suspension of public events • Closure or limitation of people in public places establishments or . cough or difficulty of breathing or any sign and symptoms of illness. hand washing 2. Quarantine of contacts • Stay at home for 10 days • Monitor self for fever.• • Goggles Rubber or polyurethane boots covers or disposable protective foot Prevention: • Hand hygiene • Cleaning and disinfection • Avoiding contact with wild birds • Safe food practices • Practice of proper hand washing and cleaning and disinfection procedures in poultries Stages: • STAGE • STAGE • STAGE • STAGE 1 2 3 4 – BIRD FLU FREE PHILIPPINES AVIAN FLU IN BIRDS AI VIRUS TRANSMITTED TO HUMANS HUMAN TO HUMAN TRANSMISSION Exposure: Contact (within 1 meter) with live or dead domestic fowl or wild birds or with persons suspected to have bird flu during the 10 days before the onset of symptoms. • Refer sick persons to the Referral Hospital for SARS and other severe emerging infections. Personal hygiene – cough etiquette.

nose or mouth. stay at home when you are sick. chronic obstructive pulmonary diseases. cancer. – Before shaking hands with other people. • Put used tissues or plastic bags in the trash bin. IT AIMS TO: 1) Raise the awareness of the Filipinos on the need to practice healthy lifestyles. drinking glasses.  If water is not available. • 7 out of 10 leading causes of death in the Philippines( source PHS. • Wash used handkerchiefs separately from clothing. use an alcohol-based hand sanitizer. cough into your sleeve. 2) Raise the consciousness of policy makers on the need to provide the Filipinos with an environment supportive of healthy lifestyle. Thank the person for the kind act. has taken as one of its priorities for the Promotion of Healthy Lifestyles. • Maintain a safe distance of 1 meter from other people when you are sick. • Don’t be offended if someone offers you tissue. • Do not share eating utensils. If you don’t have tissue.3. • Wash your hands with soap and water. – Before touching your eyes. • As much as possible. towels or other personal items. Spit on a trash bin or on a small plastic bag. non-communicable lifestyle related disease: Cardiovascular diseases. diabetes mellitus and kidney diseases. BACKGROUND: There are five major chronic. cognizant of the increasing prevalence of lifestyle related diseases. • 50% of these diseases accounts global burden. • Don’t spit on the floor or on the road. cough or blow your nose. 2002) . INTEGRATED PREVENTION AND CONTROL OF LIFESTYLE-RELATED DISEASES RATIONALE: The Department of Health. Cough Manners • Cover your nose and mouth with tissue or handkerchief every time you sneeze.

922 9. Chronic obstructive pulmonary disease and allied conditions 8.000 Population & Percent Distribution.6 THE FRAMEWORK OF THE PROGRAM: It calls for a comprehensive. Philippine Cancer Control Program 3. Primary level.209 13.9 24. Tertiary level.507 19. Accidents 6. Renal Disease Control Program .138 49. Diabetes mellitus 10.821 34.8 43. National Cardiovascular Diseases Prevention and Control 2.3 35.3 17. Comprehensive approach means: 1. community based approach that follows the health promotion action areas.218 33. all forms 7. integrated.CAUSE OF DEATH 1.prevention focuses on disease management and rehabilitation.9 17.prevention and control means focusing on risk screening and lifestyle modification prompt diagnosis and treatment 3. Tuberculosis.3 48. Non-Communicable Diseases Program 1. Pneumonia 5. 2. nephritic syndrome and nephritis Mortality: ten (10) leading causes Number.320 14. Nephritis. Diseases of the vascular system 3. Certain conditions originating in the perinatal period 9. Malignant neoplasm 4.2 62.192` RATE 88.519 38.5 11. Rate/100.0 42.preventing the emergence of the risk factors in the first place or reduction of exposure for risk factors. Diseases of the heart 2. Secondary level. 2002 NUMBER 70.617 28.

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