1. Region 8 - WHO · Hospital 1/15 0/15 0/15 4/15 Hospital run by FMT 0/2 0/2 0/2 0/2 ... Palompon...

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Epiweek 4.

1st to 7th December 2013

1. Region 8

1.1 Reporting status

There continues to be challenges with telecommunications making reporting difficult from many areas within Region 8, particularly for areas surrounding Tacloban City and Eastern Samar. With many medical teams also coming from other areas (country and foreign medical teams), there is also the challenge of initiating reporting amongst untrained and/or unfamiliar health workers. In addition, many health services are not functioning. WHO staff are active in these areas: promoting SPEED; training health workers; and collecting data to enter via the internet.

Table 1.1Summary of SPEED Reporting in Region 8

Week beginning

Provinces (#)

Municipalities (#)

Health Facilities and Reporting Sites (#)

1 Dec 3 35 82

24 Nov 2 27 62

17 Nov 2 12 27

10 Nov 2 3 5

Table1.2.Summary of SPEED reporting in Region 8 by Province and health service type.

Week beginning 10 Nov 17 Nov 24 Nov 1 Dec

PROVINCE

Eastern Samar

BHS 0/142 0/142 2/142 11/142

RHU 3/23 3/23 7/23 15/23

Hospital 1/15 0/15 0/15 4/15

Hospital run by FMT 0/2 0/2 0/2 0/2

Evacuation centre 0/1 0/1 0/1 2/2

Mobile Clinics 0/2 0/2 0/2 0/2

FMT 0/8 0/8 1/8 0/8

Leyte

BHS 1/159 10/159 17/159 11/159

RHU 3/54 9/54 17/54 13/54 Hospital 1/33 8/33 5/33 4/33



Mobile Clinics 0/10 1/10 4/10 11/11

FMT 0/42 0/42 2/42 6/42

The total number of sites is the total number of sites registered for SPEED.

Weekly EWARN report Epiweek4

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1.2 Conditions by province and week Table 1.3 Conditions by province and week

Eastern Samar Leyte Samar (Western)

11 Nov

18 Nov

25 Nov

1 Dec

11 Nov

18 Nov

25 Nov

1 Dec

1 Dec

Suspected Condition

Acute Respiratory Illness

599 1184 992 2007 500 4223 9431 4823 28

Wounds 557 585 220 335 379 1384 3095 1088 14

Acute Diarrhea (AWD)

144 156 123 185 61 301 760 356 4

Fever 128 90 63 124 62 173 2075 762 4

Hypertension 71 161 197 235 48 332 874 537 3

Skin Diseases 56 168 172 287 53 447 1380 755 4

Acute asthma 12 65 38 64 8 229 392 156 0

Conjunctivitis 4 9 23 22 5 61 90 66 0

Known Diabetes

9 20 34 34 11 88 117 82 0

Animal bites 2 6 3 17 3 58 92 51 1

Fractures 2 2 35 8 4 38 54 47 0

Acute bloody diarrhea

0 0 11 11 10 23 63 14 0

Leptospirosis 0 0 0 0 0 48 301 37 0

Fever with rash

0 0 1 2 9 20 72 11 0

Meningitis 0 0 0 0 5 8 14 5 0

Fever other symptoms

0 3 9 50 7 44 173 95 0

Acute flaccid Paralysis

0 0 0 2 0 34 1 1 0

Acute Haemorrhagic Fever

0 0 0 2 16 5 11 0 0

Acute Jaundice

0 0 0 0 0 7 7 6 0

Acute malnutrition

0 0 0 0 1 11 62 34 0

Tetanus 0 0 0 0 1 8 9 24 0

Total consultations

0 41 983 2352 30 507 3614 2779 0

The top five consultations for the week are highlighted in yellow. Note the poor compliance with total consultations.


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Eastern Samar Province Disease by Municipality – Acute Respiratory Infection Table 1.4 – Acute Respiratory Infection by Municipality by week – Eastern Samar Province


Municipality

General MacArthur 4 21 9 95

Guiuan 595 1163 512 413 Hernani - - 47 106

Quinapondan - - 288 152

Salcedo - - 105 290

Balangiga - - - 270

Balangkayan - - - 165

Borongan city - - - 11

Giporlos - - - 67

Lawaan - - - 122

Lorente - - - 53

Maydolong - - - 151

Mercedes - - - 57

San Julian - - - 55

TOTAL 599 1184 992 2007

Leyte Province Disease by Municipality – Suspected Leptospirosis Table 1.5 – Suspected Leptospirosis by Municipality by week – Leyte


Municipality

Albuera - - 0 5

Capoocan - - 0 0

Carigara 0 3 0 0

Isabel - - 29 5 Leyte - 4 0

Merida 0 0 0 0

Ormoc City 0 0 0 0

Palo - 29 6 0

Palompon 0 0 6 0

Tabango - 0 0 0

Tacloban City 0 12 38 14

BayBay City - 0 - -

Dagami - 0 - -

Kananga - 0 0 0

Tolosa - 0 1 -

Villiba - 0 0 0

Buruaen 0 - 204 0

Dulag - - 17 0

Macarthur - - - 0

Mayorga - - 0 0

Tanauan - - - 1

Tunga 0 0 0 0


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Abuyog - - 0 -

La Paz - - 0 -

Tabontabon - - 0 -

None ascribed - - - 11

TOTAL 0 48 301 37

Increased numbers of cases were seen in the week beginning 24

th November, notably in Buruaen. These 204 cases were in a single

report that was reported retrospectively and therefore not followed up. Given that the number of cases the next week decreased to zero, it is likely that this was a spurious finding. In the other municipalities where increased cases of leptospirosis were seen in this week, the numbers decreased in the week beginning 1

st December. It is worthwhile continuing to observe leptospirosis cases

in Tacloban City.

1.3 Alerts

a) Measles There have been no confirmed measles cases in Region 8. There were 13 notifications of fever with rash via SPEED in the week beginning December 1st. It is not known how many of these meet the clinical case definition for measles. Of these, six were over five years of age. Seven cases were from Tacloban city and there was no other geographical clustering of cases. Cases meeting the clinical case definition should have blood samples taken and sent to the Research Institute of Tropical Medicine in a timely fashion. Figure 1.1 Location of SPEED notifications of fever with rash 1st Dec to 7th Dec 2013 – Region 8

The red dots represent validated SPEED notifications. The blue dots (crossed out) represent unvalidated notifications. Note validated notifications do not necessarily meet the clinical case definition for measles.

b) Acute Flaccid Paralysis


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There were three notifications of acute flaccid paralysis via SPEED in the week beginning 1st December, all over five years of age. Two were from Llorente in Eastern Samar and one from Tolosa in Leyte. It is not known if these cases met the clinical case definition for acute flaccid paralysis. If they did two stool samples should be collected for those cases less than 15 years of age.

c) Tetanus There were 24 suspected tetanus notifications via SPEED from Leyte province in the week beginning 1st December. Sixteen of these were notified by a mobile clinic in Tanauen, Leyte, seven were from Tacloban City and one from Ormoc District Hospital. These notifications require verification and further investigation.

d) Leptospirosis The number of notifications of suspected leptospirosis via SPEED is significantly lower than in the previous week. In Tacloban city, there were 38 suspected leptospirosis cases notified via SPEED in the week beginning 24

th November, compared to 14 in the week

beginning 1st

December.

e) Dengue The National Epidemiology Centre’s Event based Surveillance and Response system (ESR) has reported four cases of suspected dengue in Leyte province: one from Palo, one from Pastrana and two from Tacloban city. The WHO is working with the Department of Health to improve detection of any dengue outbreaks through the purchase and provision of Rapid Diagnostic tests. These are for the sole purpose of assisting with early detection of a dengue outbreak and it is not intended that this will be used for diagnostic testing in the long term.

f) Diarrhoea The ESR detected an outbreak of diarrhea in Kananga. The outbreak began on the 30th November and there were 123 cases as at 5th

December 2013. There have been no deaths associated with this outbreak. Two rectal swab samples were negative for Cholera,

and one of two samples was positive for Rotavirus.

The ESR also detected an outbreak of diarrhea in Liberty Barangay in Ormoc City on the 5th December. Twenty cases have been

identified. The outbreak has not yet been investigated as the barangay is not accessible.

Sixty one cases of diarrhea in Ormoc District Hospital have been notified to ESR since 30th November. Rectal swabs from the cases

have been sent to RITM for testing. Rapid diagnostic testing for cholera were negative, and five percent of 61 stool samples were

rotavirus positive by rapid diagnostic testing.


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1.4 Trends The following graphs show trend data for health facilities/municipalities from which data are available over time.

Eastern Samar Province

Figure1.2 Guiuan RHU I SPEED data 10 Nov 13 –7 Dec 13 Estimated population – 48,786

In spite of there being daily reports from this RHU, there has been a significant drop-off of reporting of all conditions

during the last week.

Leyte province

Figure 1.3 Leyte Dr Manuel B Velloso Memorial Hospital Leyte SPEED data 10th Nov 2013 – 7th December 2013.

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Sum of FEV Under 5 Case

Sum of FEV Over 5 Case

Sum of ARI Under 5 Case

Sum of ARI Over 5 Case

Sum of AWD Under 5 Case

Sum of AWD Over 5 Case

Values

Date

Sum of FEV Under... Sum of FEV Over ...Sum of ARI Under... Sum of ARI Over ... Sum of AWD Under...Sum of AWD Over...

Region Province Municipal Health Facility


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Figure 1.4. Ormoc City MHO, Leyte SPEED data 10th Nov 2013 – 7th Dec 2013.

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Figure 1.5. Tacloban Airport Field Hospital

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2. Region 6


Reporting from Region 6 has improved considerably in the last week. Due to problems with the GLOBE network in the affected areas, reporting was facilitated by the provision of SMART SIM cards to local health services. Data are sent to the PHO, who then uploads the data to SPEED. Reporting from Negros Occidental has ceased.

Table 2.1.Summary of SPEED Reporting in Region 6

Week beginning

Provinces (#)

Municipalities (#)


1 Dec 4 58 61

25 Nov 4 37 51

18 Nov 4 19 21

11 Nov 5 18 18

Table 2.2.Summary of SPEED reporting in Region 6 by Province and health service type.


PROVINCE

Aklan

BHS 0/79 0/79 0/79 0/79

RHU 6/16 4/16 10/16 12/16

Hospital 1/8 0/8 3/8 0/8




FMT 0/1 0/1 0/1 0/1

Antique

BHS 0/0 0/0 0/0 0/0

RHU 4/18 5/18 3/18 16/18

Hospital 1/10 0/10 0/10 0/10

Hospital run by FMT 0/0 0/0 0/0 0/0 Evacuation centre 0/0 0/0 0/0 0/0


FMT 0/0 0/0 0/0 0/0

Capiz

BHS 0/177 0/177 1/177 0/177

RHU 2/27 5/27 15/27 14/27

Hospital 1/14 1/14 6/14 6/14




FMT 0/3 0/3 0/3 1/3

Iloilo

BHS 1/305 1/305 2/305 2/305


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RHU 0/42 4/42 9/42 13/42

Hospital 0/24 1/24 2/24 6/24




FMT 0/3 0/3 0/3 0/3

Negros Occidental

BHS 0/2 0/2 0/2 0/2

RHU 1/31 0/31 0/31 0/31

Hospital 0/26 0/26 0/26 0/26 Hospital run by FMT 0/0 0/0 0/0 0/0



FMT 0/0 0/0 0/0 0/0

The total number of sites is the total number of sites registered for SPEED.


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2.2 Conditions by Province and week Table 2.3. Conditions by Province and week

Aklan Antique Capiz

10 Nov

17 Nov 24 Nov 1 Dec 10 Nov

17 Nov

24 Nov

1 Dec

10 Nov

17 Nov

24 Nov

1 Dec

Suspected Condition

Acute Respiratory Illness 279 215 332 250 312 146 52 455 347 368 713 864

Wounds 404 135 175 179 112 50 19 56 569 318 319 350

Acute Diarrhea (AWD) 20 29 47 33 32 18 6 26 32 39 39 48

Fever 64 19 99 99 82 33 4 28 149 130 283 159

Hypertension 42 54 100 42 39 28 22 68 127 109 118 234

Skin Diseases 32 15 26 52 26 15 3 19 40 61 74 95

Acute asthma 29 17 32 10 22 7 5 35 28 47 43 39

Conjunctivitis 1 4 6 12 4 5 0 2 5 6 3 6

Known Diabetes 4 5 8 2 2 11 4 4 6 15 11 27

Animal bites 16 3 8 10 6 1 3 6 37 30 63 99

Fractures 3 0 5 3 1 0 0 2 2 2 16 15

Acute bloody diarrhea 0 5 3 2 9 4 1 2 0 8 19 5

Leptospirosis 0 1 0 1 0 0 0 5 0 7 3 1

Fever with rash 0 0 1 0 0 0 0 1 0 1 7 3

Meningitis 0 0 0 0 0 0 0 0 0 0 0 0

Fever other symptoms 6 3 16 15 17 7 3 3 25 49 26 33

Acute flaccid Paralysis 0 0 0 0 0 0 0 0 0 0 0 0


0 0 0 0 1 0 0 0 0 0 0

Acute Jaundice 0 2 0 0 0 0 1 0 1 0 1 2

Acute malnutrition 0 0 2 0 0 0 0 0 0 0 1 0

Tetanus 2 0 0 0 0 0 0 0 0 0 0 1

Total consultations 930 468 725 746 0 0 10 0 1413 1170 1819 2456

Iloilo Negros Occidental

10 Nov 17 Nov 24 Nov 1 Dec 10 Nov 17 Nov 24 Nov 1 Dec

Suspected Condition

Acute Respiratory Illness 455 360 563 450 74 - -

Wounds 333 181 122 257 35 - -

Acute Diarrhea (AWD) 28 27 53 61 22 - -

Fever 226 188 131 84 22 - -

Hypertension 15 14 32 106 16 - -

Skin Diseases 22 9 67 40 6 - - Acute asthma 15 19 22 21 7 - -

Conjunctivitis 1 0 7 16 0 - -

Known Diabetes 2 1 4 19 1 - -

Animal bites 5 5 14 126 3 - -

Fractures 13 0 26 24 0 - -

Acute bloody diarrhea 2 0 0 0 0 - -

Leptospirosis 3 5 2 6 0 - -

Fever with rash 0 0 0 0 0 - -


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Meningitis 2 0 0 3 0 - -

Fever other symptoms 3 1 24 19 0 - -

Acute flaccid Paralysis 0 0 0 0 0 - -


0 3 3 3 0 - -

Acute Jaundice 0 1 1 0 0 - -

Acute malnutrition 0 0 0 3 0 - -

Tetanus 0 0 0 1 0 - -

Total consultations 0 0 0 637 2 0 0 The top five consultations for the week are highlighted in yellow. Note the poor compliance with total consultations. Aklan Province Disease by Municipality – Fever Table 2.4 – Fever by Municipality by week – Aklan Province


Municipality Altavas 43 13 8 8

Balete - - 2 14

Banga 0 0 3 20

Batan - - 10 -

Kalibo (Capital) 19 - 26 23

Madalag 1 6 6 4

New Washington - - 10 17

Buruanga 0 0 - 0

Ibajay 0 0 6 2

Lezo 1 - 28 -

Makato - - 0 1

Malay - - - 1

Nabas - - - 9

Tangalan - - - 0

TOTAL 64 19 99 99

Antique Province Disease by Municipality – Fever Table 2.5 – Fever by Municipality by week – Antique province


Municipality

Barbaza 4 3 - 2

Laua-An 25 13 4 0

Sebaste 0 0 0 0

Bugasong 45 17 - -

Tibiao - 0 - 0

Culasi 8 - - -

Anini-Y - - - 4

Belison - - - 3 Hamtic - - - 3

Libtertad - - - 0


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Pandan - - - 1

Patnongon - - - 5

San Jose (Capital) - - - 1

San Remigio - - - 7

Tobias Fornier (Dao) - - - 1

Valderrama - - - 0

TOTAL 82 33 4 28

Capiz Province Disease by Municipality – Fever Table 2.6 Fever by Municipality by week – Capiz province


Municipality

Dao 0 13 15 17

Dumalag 3 23 11 6

Ivasan - 0 0 1

Jamindan - - 1 2

Ma-Ayon 1 4 3 0

Mambuaso 0 0 2 7

Panay 6 0 12 1

Pilar 129 75 11 -

Pontevedra - 2 17 8

President Roxas 2 8 17 3

Roxas City - - 56 89

Sapi-An - - 0 12

Tapaz - - 6 -

Panitan 8 - 18 0 Sigma - - - 13

Dumaro - - 0 -

TOTAL 130 169 159

Iloilo Province Disease by Municipality – Animal bites Table 2.7 Animal bites by Municipality by week – Iloilo province


Municipality

Ajuy - - 2 1 Balasan 0 1 0 0

Barotac Viejo - - 1 1

Carles 2 0 4 3

Estancia 0 4 5 4

Lemery 3 - 1 1

San Dionisio - - 0 -

Sara - - 1 26

Concepcion - 0 0 0

Alimodian - - - 0

Cabatuan - - - 0


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Iloilo City (Capital) - - - 86

Janiuay - - - 0

Lambunao - - - 2

Leganes - - - 1

San Joaquin - - - 1

San Miguel - - - 0

TOTAL 5 5 14 126

The increase in animal bites that were reported in the week beginning 1

st December is largely explained by having reporting

from Iloilo City for the first time that week. There was, however, a significant increase in the number of animal bites reported from Sara as well.

2.3 Alerts

a) Measles There have been no confirmed measles cases in Region 6. There were four notifications of fever with rash via SPEED in the week beginning December 1st. It is not known how many of these meet the clinical case definition for measles. Of these, one was over five years of age, and this case was located in Anini Y municipality in Antique. The other three cases were under five: two were from Roxas City and one from Ma-Ayon. Cases meeting the clinical case definition should have blood samples taken and sent to the Research Institute of Tropical Medicine in a timely fashion.

b) Tetanus There were two suspected tetanus notifications via SPEED from region 6 in the week beginning 1st December: one from Mambuaso municipality, Capiz; and the other from Iloilo city. The case from Mambuaso died. These notifications require verification and further investigation.


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2.4 Trends The following graphs show trend data for health facilities/municipalities from which data are available over time

Province Aklan

Figure 2.1 Altavas MHO 10 Nov –7th Dec 2013.Estimated Population: 39,288

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Province Capiz

Figure 2.2 Dao municipality SPEED data 10th Nov – 7th December 2013. Estimated population 32,501

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Province Iloilo

Figure 2.3 Estancia RHU, Iloilo, SPEED data 10th Nov – 7th December 2013. Estimated population – 44,995

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3. Region 7 – Cebu Province


Reporting is reducing from Cebu City and surrounding areas as people leave evacuation centers. Reporting has also dropped off from municipalities in Northern Cebu, which is of concern.

Table 3.1Summary of SPEED Reporting in Region 7

Week beginning

Provinces (#)

Municipalities (#)


1 Dec 1 8 10

25 Nov 1 10 24

18 Nov 1 8 15

11 Nov 1 7 13

Table 3.2 Summary of SPEED reporting in Region 7 (Cebu province) and health service type


BHS 5/582 5/582 7/582 0/582 RHU 8/49 4/49 7/49 4/49

Hospital 0/48 0/48 2/48 1/48


FMT 0/12 0/12 1/12 0/12

The total number of sites is the total number of sites registered with SPEED.

3.2 Conditions by Province and Week Table 3.3 Conditions by week – Cebu province

Cebu

10 Nov 17 Nov 24 Nov 1 Dec

Suspected Condition

Acute Respiratory Illness 3199 1915 1332 1029

Wounds 2522 616 306 340

Acute Diarrhea (AWD) 225 162 53 80

Fever 656 510 301 233

Hypertension 424 373 224 206

Skin Diseases 233 209 188 157

Acute asthma 74 44 9 11

Conjunctivitis 26 19 21 20

Known Diabetes 29 40 20 15

Animal bites 40 15 38 33

Fractures 2 2 5 9

Acute bloody diarrhea 3 5 2 7

Leptospirosis 2 0 0 0

Fever with rash 0 0 0 1


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Meningitis 0 0 1 0

Fever other symptoms 7 13 16 5

Acute flaccid Paralysis 1 0 0 0

Acute Haemorrhagic Fever 1 4 1 2

Acute Jaundice 2 4 3 1

Acute malnutrition 0 1 2 2

Tetanus 0 0 0 0

Total consultations 0 38 74 0

The top five consultations for the week are highlighted in yellow. Note the poor compliance with total consultations. Disease by Municipality – Skin diseases Table 3.4 – Skin Diseases by Municipality by week


Municipality

Bantayan 95 103 67 51

Borbon - - 19 -

Cebu City (Capital) - 17 18 15

Bogo City - - 24 64

Daanbantayan 8 - 28 8

Lapu-Lapu City - 0 10 2

Medellin 28 2 1 9 Pilar 40 - 4 -

San Remigio 31 25 14 -

Tabogon - 48 1 -

Tabuelan - - 2 8

Madridejos 24 14 - 0

Santa Fe 7 - - -

TOTAL 233 209 188 157

There was an increase in skin diseases in the city of Bogo. All reports came from a single health facility – the Severo Verallo Memorial Hospital.

3.3 Alerts

a) Measles There have been no confirmed measles cases in Region 7. There was one notification of fever with rash via SPEED in the week beginning December 1

st. It is not known whether this case met the clinical case definition for measles. The case was under five

years of age and was from Medellin RHU. Cases meeting the clinical case definition should have blood samples taken and sent to the Research Institute of Tropical Medicine in a timely fashion.

3.4 Trends The following graphs show trend data for health facilities/municipalities from which data are available over time


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Northern Cebu

Figure 3.1.Bantayan RHU, SPEED data 10th Nov –7th December 2013. Estimated population 74,250

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Appendix 1.

MAP of affected areas showing provinces

From MapAction (insert weblink).

1. Region 8 - WHO · Hospital 1/15 0/15 0/15 4/15 Hospital run by FMT 0/2 0/2 0/2 0/2 ... Palompon...

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