A(H1N1) VIRUS UPDATE

**Admin** Sat May 23, 2009 5:35 pm

The Department of Health is tracking down 17 passengers of the plane that carried the 10-year-old girl who tested positive for Influenza A(H1N1) – the first confirmed case in the Philippines.

Taiwan health officials, meanwhile, said yesterday one of their three confirmed cases of A(H1N1) involved a woman returning from the Philippines.

Dr. Mavic Vasquez of the DOH’s Bureau of Quarantine said they have determined the identities of the 17 passengers – all Filipinos – based on the manifest obtained from the airline company.

“We are lucky that the patient was (seated) way back in the plane near the wall. There were 17 possible persons with six-hour exposure (to the patient) and (situated) within six feet,” she said at a press briefing.
Vasquez said the 17 passengers are advised to undergo self-quarantine for up to 10 days, the period during which infected individuals manifest symptoms.

Health Secretary Francisco Duque III on Thursday announced that a 10-year-old Filipino girl from the United States was the first confirmed case of A(H1N1) in the Philippines.
The girl had also traveled to Canada where there are also confirmed cases of A(H1N1).

She arrived in the Philippines with her mother on May 18 and complained of fever, cough and sore throat the following day. The patient was brought to an undisclosed hospital.
The swab throat samples taken from the girl were examined and confirmed at the DOH’s Research Institute for

Tropical Medicine (RITM) Thursday afternoon.
DOH Undersecretary Mario Villaverde noted that throat specimens were also taken from the mother but these tested negative for A(H1N1).

Villaverde added the girl’s father and her other housemates have been notified of the situation and are now undergoing self-quarantine at home.

“It’s a good thing that the patient stayed mostly inside their house after arriving, probably because of the time zone difference, and she developed fever the following day. Her contacts are thus limited,” he said.

“The patient is now recovering well. She no longer has fever and cough but still has sore throat,” he said.
But the DOH will send a team of experts to the patient’s house to conduct a “more thorough assessment of the household contacts” who have already been given prophylactics, an antibiotic.

The doctors, nurses and other health personnel attending to the patient have also been given antibiotics and instructed to put on protective gear like face masks to prevent them from contracting the virus.

It was not clear yet how the girl contracted the virus.

“She traveled to many cities in the US but because there is already an established community level transmission in the US, even if we identify the cities, it becomes immaterial because it is almost in the entire US,” Villaverde added.

Taiwan’s Centers for Disease Control, meanwhile, said a 30-year-old woman who had been traveling in Manila from May 16 to 20 with three relatives tested positive for A(H1N1) influenza.

“She was feeling unwell while in Manila. She went to a clinic on Thursday after she developed a fever. Her daughter was also screened after she too was running a fever,” said CDC spokesman Shih Wen-yi.
Test results for the five-year-old girl were scheduled Friday.

Intensified surveillance

To prevent the virus from spreading, the DOH will intensify its surveillance at international airports and seaports to ensure that incoming passengers are properly screened.

The DOH is still trying to determine if it has the manpower and logistics to screen departing passengers.

Dr. Yolanda Oliveros, DOH director for National Center for Disease Prevention and Control, has warned the public against taking Oseltamivir, the anti-flu drug, without doctor’s guidance, saying that this could lead to resistance to the antibiotic.

Oliveros said the public should not panic because there is still no “community level transmission” of the virus.
“The behavior of the virus is very mild. The case fatality rate is very low. I think it’s less than two percent. It kills if those affected are immuno-compromised, or if they already have long debilitating diseases or late management or screening,” she said.

She added that the virus becomes fatal when an infected individual suffers from respiratory complications.
Oliveros has advised the public to observe precautionary measures like eating healthy food, maintaining personal hygiene, drinking lots of water and fruit juices, taking Vitamin C and avoiding stressful activities.

She warned that there is still no vaccine for A(H1N1). The available vaccines in the country are only for seasonal human influenza, and she recommended getting this vaccine to have some protection against contracting flu.

“You won’t be confused that if you develop flu, you’ll think that it’s H1N1,” she pointed out.
In Santiago City in Isabela, health authorities cleared a woman who had earlier been confined due to flu symptoms.

Dr. Genaro Manalo, the city’s health officer, said the woman whose name was withheld arrived from Canada.
“After days in confinement, the woman came out negative which is why we ordered her release from hospital,” Manalo said.

“As of now, there are no cases here, so if there will be such cases, we will investigate,” he said.

WHO warning

Despite the isolation of the first A(H1N1) case in the country, there is still the possibility that the disease could spread, according to the World Health Organization (WHO).

“There is no guarantee that it will be the first and the last case here although we are tracing all those who she had contact with,” WHO representative to the Philippines Dr. Soe Nyunt U said.

Soe also advised Filipinos returning from overseas trips to closely observe their condition for 10 days upon their return even if they are not manifesting symptoms of the disease.

“She had no symptoms when she returned to the country, but developed fever only two days after her return, prompting her parents to report her condition to the Department of Health,” Soe said of the 10-year-old girl who tested positive for A(H1N1) influenza.

Dr. Julie Hall, WHO expert on emerging infectious diseases, said some persons afflicted with the new influenza virus can be “asymptomatic” and may be spreading the disease without them knowing it.

“Some people are asymptomatic or do not develop symptoms of the infection until after 24 to 48 hours but it is possible that they are spreading the virus to somebody else,” Hall explained.

Compared to bird flu and SARS, Hall said A(H1N1) can be considered “milder” since it has lower death rate.
“In the case of H1N1, fever is not a good indicator. It’s not full proof that an infected person without fever is not transmitting the virus,” she pointed out.

Since the A(H1N1) is still a new virus, Hall said governments worldwide should be vigilant and upgrade their preparedness plans.

“The new virus is very unstable. It can still change into a more severe strain. The lower death rate can just be a tip of the iceberg and it can still bring surprises,” she added.
Hall said a vaccine against the new strain is now being developed, but it might take five to six months before it could be mass-produced.

Hall said a total of 11,127 cases of A(H1N1), including 86 deaths, have been recorded in 40 countries as of May 21. The number is increasing everyday, she said.

Hall said prone to the infection are young people, obese individuals and those suffering from diabetes and other illness as well as pregnant women.

More information

Sen. Loren Legarda said the DOH should step up its information campaign on A(H1N1).

The Catholic Bishops’ Conference of the Philippines, for its part, said the DOH should disclose the city or province of origin of the first positive case of Influenza A(H1N1) so that officials could undertake the proper precautionary measures.

“This is one instance when the people wouldn’t mind being bombarded with information by DOH. There’s no such thing as information overload when it comes to swine flu. But the important thing is that our people are getting the right information,” Legarda said.

“The DOH should announce what is the true score, where is the patient with H1N1 virus and what is the extent of our response so we would act accordingly and not cause panic,” CBCP spokesperson Monsignor Pedro Quitorio III said.

Precautions

Tourism Secretary Joseph Ace Durano assured travelers that it’s safe to travel in the country despite a confirmed case of A(H1N1).

“We have issued travel advisories because it is necessary at this time that people, including tourists, will be getting accurate information,” Durano explained.

“There is no pandemic, what we have is an isolated case, just one case,” Durano said.
“As long as the infection can be contained and will not spread the tourism industry is unlikely to be affected,” Durano said.

The Heath Alliance for Democracy, meanwhile, said the government’s screening system should cover American soldiers involved in the Balikatan exercises.

“The Department of Health should consider these military personnel as public health hazards if they refuse to undergo quarantine procedures as set by the World Health Organization,” HEAD secretary-general Dr. Geneva Rivera said.

Most of the American soldiers participating in the Balikatan are based in Okinawa, Japan where there are confirmed cases of A(H1N1).
Rivera asked the DOH not to rely on the assurances of American doctors that the soldiers are free from the disease.

Makati City Mayor Jejomar Binay, meanwhile, said the city has activated its own inter-agency task force against the A(H1N1) virus.

“We have an established and fully functional multi-sectoral task force that has already drawn up an initial Pandemic Preparedness Plan for Makati, which will continue to be expanded or modified as the situation progresses,” Binay said.

“We have prioritized establishments like hotels because of their high level of risk exposure to the virus arising from the constant arrival of foreign guests or Filipinos coming from countries that have confirmed cases of the A(H1N1) flu,” city health officer Lourdes Salud said.

The Department of Labor and Employment, for its part, ordered all establishments to put in place control measures to prevent the spread of the disease in workplaces.

Under Department Advisory No. 04, Labor Secretary Marianito Roque also urged employers to exercise “flexibility and compassion” in granting leaves with pay.

“Employers must see to it that workers at risk of acquiring the infection should use personal protective equipment and must strictly observe proper hygiene,” Roque said.

“To avoid the spread of the infection, we are encouraging employers to adopt a flexible and enlightened approach in granting time off which may include use of annual leave,” Roque explained.

- With Mayen Jaymalin, Jose Rodel Clapano, Evelyn Macairan, Christina Mendez, Paolo Romero and Charlie Lagasca - By Sheila Crisostomo (Philstar News Service, www.philstar.com)

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