1. D E P A R T M E N T O F H E A L T H Influenza A(H1N1) Surveillance 13 July 2009

2. D E P A R T M E N T O F H E A L T H The Influenza Virus

3. D E P A R T M E N T O F H E A L T H "Classical Influenza" Complications, Sore throat, Myalgia Headache Cough Malaise, prostration Coryza Onset of illness 37 39 41 Oral Temperature (°C) 0 1 2 3 4 5 012345678910 Time in days (RMKTCID50/ml) LOG10 nasopharyngeal virus titer Incubation period Virus isolation Fever curve Kilbourne E. D., Influenza, New York, plenum 1987:156-218

4. D E P A R T M E N T O F H E A L T H Name of Pandemic DateDeathsSubtype Involved Pandemic Severity Index Asiatic (Russian) Flu 1889- 1890 1 millionH2N2(?)? Spanish Flu 1918- 1920 20-100 million H1N15 Asian Flu1957- 1958 1-1.5 million H2N22 Hongkong Flu 1968- 1969 0.75-1 million H3N22 Known Human Pandemics

5. D E P A R T M E N T O F H E A L T H Genetic Reassortment

6. D E P A R T M E N T O F H E A L T H Genetic Reassortment SIV

7. D E P A R T M E N T O F H E A L T H WHO Pandemic Phases

8. D E P A R T M E N T O F H E A L T H

9. Laboratory-Confirmed A(H1N1) Cases, Philippines, By Morbidity Week, May 17-Jun 27,2009

10. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Philippines, By Age/Gender, as of June 27, 2009 Age Range:5 months to 79 yrs. Mean:18 yrs. Age group (10-19): 831 (49%) Male:89452% Female:81548%

11. D E P A R T M E N T O F H E A L T H Clinical Manifestations, Laboratory Confirmed A(H1N1) Cases, Philippines, as of June 27, 2009

12. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Philippines, By Region, as of June 27, 2009

13. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Philippines, By Travel origin, as of June 27, 2009

14. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, NCR, By City, as of Jun 27, 2009

15. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, NCR, By Hospital, as of June 27, 2009

16. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, NCR, By School Clusters, as of June 27, 2009

17. D E P A R T M E N T O F H E A L T H Case Under Observation, Case Under Observation, Quezon, By Municipality as of July 18, 2009

18. D E P A R T M E N T O F H E A L T H Laboratory confirmed A(H1N1), Laboratory confirmed A(H1N1), Quezon, By Municipality as of July 18, 2009

19. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Quezon, By Age and Gender as of July 18, 2009

20. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Quezon, By Morbidity Week as of July 18, 2009

21. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases, Quezon, By Facility and Gender as of July 18, 2009

22. D E P A R T M E N T O F H E A L T H Laboratory Confirmed A(H1N1) Cases Quezon, By School and Gender as of July 18, 2009

23. D E P A R T M E N T O F H E A L T H Who is considered a Case Under Observation (CUO)? YES to all three questions: Arrived in the Philippines from an Influenza A(H1N1) affected country (list varies daily) in the past 10 days? Or who has close contact of a confirmed A(H1N1) case. Has fever? Has cough or sore throat?

24. D E P A R T M E N T O F H E A L T H Algorithm for A H1N1 Cases in Quezon Referral Hospital (Quezon Medical Center) Collects specimen & sends Viral Transport Media and a copy of Case Investigation Form to RITM; Manages case Case at home or in the community Call Rural Health Unit Fill up Case Under Observation Form Call Prov’l Health Office (042) 727–5322/ 710-3444 CHD 4A – Quezon (042) 373-1514 Collects specimen, sends VTM and a copy of CUO Form to RITM Case in Non Referral Hospital Fill up Case Under Observation Form Hospital ambulance to transfer case to QMC Case in Referral Hospital Fill up CUO Form, Collects specimen, sends VTM and a copy of CUO Form to RITM; Manages case

25. D E P A R T M E N T O F H E A L T H Algorithm for Management of Cases Under Observation (CUO) CUO Manage as out-patient (Home management) Oseltamivir NOT needed Lab Result : Positive A(H1N1)? yesno Manage patient in a Referral Hospital, GIVE oseltamivir. Risk of Severe Illness? yesno Collect data & specimen (swab)

26. D E P A R T M E N T O F H E A L T H DOH/PHO Hotlines and Referral Hospitals DOH Hotline:(02) 711-1001, 711-1002 CHD 4A Quezon Hotline: (042) 373-1514 / 0917-850-5038 PHO Quezon Hotline:(042) 710-3444 Prov’l Epidemiology and Surveillance Unit (PESU) (042) 727-5322 0920-924-4393 Quezon Medical Center, Lucena City (042) 710-3944 (042) 710-2440 (042) 710-4023 (042) 710-4027

27. D E P A R T M E N T O F H E A L T H Cases Under Observation (CUO) Investigation Form

28. D E P A R T M E N T O F H E A L T H Arriving Passenger Submit properly filled-up HEALTH CHECK LIST to Quarantine Medical Officer (QMO) Pass through Thermal Scanning Asymptomatic upon arrival (Absence of signs and symptoms) Case under Investigation (Suspect) *Home confinement for 7-10 days “Voluntary Domestic Quarantine” (Keep at home/ vessel and be on alert if signs and symptoms develop) If signs and symptoms develop within 10 days of arrival (The passenger calls up the health authority) Home confinement lifted Symptomatic upon arrival (Presence of fever, cough, sore throat, difficulty of breathing, etc.) Refer to designated hospital RITM, (632)8072628-232; 8097599. SLH (632) 7323776-78 LCP: (632) 9246101 Not Suspect OPCEN-HEMS, Tel.(632)7111001, 7111002; (63)9157725621; (63)9215922361 NEC- DOH, Tel.(632)7431937 BOQ (632)3019100-17 *Depending on the Incubation Period of the Disease Initial examination by Quarantine Medical Officer Still asymptomatic after 10 days Isolation Area Bureau of Quarantine Protocol on the Management of Cases Under Investigation from Ports of Entry

29. D E P A R T M E N T O F H E A L T H Surveillance Activities May6Enhanced Surveillance Daily ( Passive and Active) Reporting of Influenza like illness (ILI) Zero case reporting May 7 Distribution of Health Advisory (Climate change symposium participant, QMH) May 19Orientation on A(H1N1) Grand Riviera Hotel Lucena City May 22Contract tracing of 2 co-passenger of the 1 st confirmed case from USA May 23Contact identified ( trace the location) by CHO (Problem, Name, Brgy Address ) May 24Contact Identified by RHU (still in Manila) ( same problem)

30. D E P A R T M E N T O F H E A L T H May 22-28Contact Monitoring (10 day) June 3Training on NASO/ORO Pharyngeal SWAB (Quezon Medical Center, Gumaca, Alabat, Catanauan, Tagkawayan and Solcom Hospital) June52 CUO Home Isolation ( Hongkong) June 6 2 CUO MCDGH ( UAE) June91 CUO Home Isolation ( CHINA) June 10Training on NASO/ORO Pharyngeal SWAB (Dist. Hospital & all Private Hospital in Lucena City June11 1 CUO MCDGH (OFW QATAR) June 131 CUO MMG 2 yrs old (Texas, USA) Surveillance Activities

31. D E P A R T M E N T O F H E A L T H June 141 CUO MMG 5 yrs old ( Singapore) June 16Orientation of QMC Personnel including Security Guard June 19 PPDC Meeting ( Updates on AH1N1) June 29-July 1Training on Phil. Integrated Disease Surveillance & Response (PIDSR). (Emphasis on A H1N1 surveillance) June 30Received message from RESU Re: Case monitoring of 2+ cases : Quezonian, FEU Manila student, confined at Manila Doctors Hospital (June 18, recovered) Other case is not a Quezonian, but a resident of Quezon City) Surveillance Activities

32. D E P A R T M E N T O F H E A L T H July 21 CUO Home Isolation ( Chicago) July 3Case Investigation (Sampaloc, Quezon) Influenza like illnesses July 4 1 st Confirm case investigation (contact tracing Hospital base) July56 Probable Cases Hospital Staff Contact Tracing (Community base) July 6Symposium (Lopez, Quezon) Case Investigation (Plaridel, Quezon) Influenza like illnesses July 7Contact Tracing – 9 Probable Cases (Community-School base) Surveillance Activities

33. D E P A R T M E N T O F H E A L T H  Continuous IEC activities  Production/Reproduction and distribution of IEC materials  Radio Interviews  Symposia  Triage area and Holding Rooms in LGU hospitals  Purchase of PPEs among LGU Hospitals  Requisition of PPEs and Anti-Viral drugs  Created a communication network ( Internet, Mobilephones,)  Creation of Prov’l Committee on Emerging and Re-emerging Infectious Diseases. What are being done:

34. D E P A R T M E N T O F H E A L T H Thank You Provincial Epidemiology and Surveillance Unit “We need you to step up to the challenge”