 The mosquito can fly up to 400
meters looking for water-filled
containers to lay their eggs but
usually remains close to the human
habitation
 Aedes aegypti is a daytime feeder
 Peak biting periods are early
in the morning and in the
evening before dusk.
Dengue







National Dengue Prevention and Control
Program
Fastest spreading vector-borne disease in the
world endemic in 100 countries
Has four serotypes (DENV1, DENV2, DENV3, and
DENV4)
First infection with one of the four serotypes
usually is non severe or asymptomatic, while
second infection with one or other serotypes
may cause severe dengue.
Dengue has no treatment but the disease can be
early managed
Dengue Awareness Month is observed around
the world every June
In the PH, dengue continues to cause severe
health, social and economic impacts in the
country
 Endemic in all 17 regions, 81 provinces,
1,634 municipalities/cities and 40,086
barangays

Current DOH campaign for dengue:
 CRUSH Dengue, Para hindi mag-Landing on
You!

TRANSMISSION
 Transmitted by day biting Aedes aegypti and
Aedes albopictus mosquitoes
 Aedes aegypti
 Common name is Yelloe fever
mosquito
 Known vector of yellow fever virus,
dengue virus, chikungunya virus,
Zika virus
 Dengue is spread through the bite of
the female Aeddes aegypti
 Mosquito becomes infected
when it takes the blood of
an infected person infected
 After about one week, the
mosquito can then transmit
the virus while biting a
healthy person
 Dengue can not be spread directly
from person to person. However, a
person infected and suffering from
dengue fever can infect other
mosquitoes.
 Humans are known to carry
the infection from one
country to another or from
one area to another during
the stage when the virus
circulates and reproduces in
the blood system.
 Europe and Antarctica: only
continents that do not
experience
dengue
transmission
 Aedes aegypti has evolved into an
intermittent biter and prefers to bite
more than one person during the
feeding period. This mechanism has
made Aedes aegypti a very highly
efficient epidemic vector mosquito.
 Adult mosquitoes "usually" rest
indoors in dark areas (closets, under
beds, behind curtains). Here it is
protected from wind, rain and most
predators, which increases its life
expectancy and the probability that
it will live long enough to pick up a
virus from one person and pass it on
to the next.
o
If you're, asked what the best measure/strategy
is to combat dengue, the answer is to eliminate
the mosquitoes' egg laying sites, called "source
reduction".

Plaque
Reduction
Neutralization Test (PRNT)
DENGUE CASE CLASSIFICATION AND LEVEL OF
SEVERITY
B. Dengue with warning signs
 Dengue illness is categorized according to
level of severity as:
- A previously well person with acute
febrile illness of 1-7 days plus any of the
following:
A. Dengue without warning signs
- Dengue without warning warnings can
be further classified according to signs
and symptoms and laboratory tests as:
 Abdominal pain or tenderness
 Persistent vomiting
 Clinical signs of fluid accumulation
(ascites)
 Mucosal bleeding
 Lethargy or restlessness
 Liver enlargement
 Increase in hematocrit and/or
decreasing platelet count
 Suspect dengue
 previously well individual with acute
febrile illness of 1-7 days duration
plus two of the following:
- Headache
- Myalgia
- Body malaise
- Arthralgia
- Retro-orbital pain
- Anorexia
- Vomiting
- Diarrhea
- Nausea
- Flushed skin
-Rash (petechial, Hermann's
sign)
 Probable dengue
 a suspect dengue case plus
laboratory test:
- Dengue NS1 antigen test
- CBC (leukopenia with or
without thrombocytopenia) or
dengue IgM antibody test
(optional)
 Confirmed dengue
 a suspect or probable dengue case
with positive result of any:
- Viral culture
- Polymerase Chain Reaction
(PCR)
- Nucleic Acid Amplification
Test- Loop Mediated Amplification
Assay (NAAT-LAMP)
C. Severe dengue
- Severe plasma leakage leading to
 Shock (DSS)
 Fluid accumulation with
respiratory distress
- Severe bleeding: as evaluated by
clinician
- Severe organ impairment
 Liver: AST or ALT > 1000
 CNS: e.g. seizures, impaired
consciousness
 Heart and other organs (i.e.
myocarditis, renal failure)

PHASES OF DENGUE
 FEBRILE PHASE
 Usually last 2-7 days
 Mild hemorrhagic manifestations
like petechiae and mucosal
membrane bleeding (e.g. nose and
gums) may be seen.
 Monitoring of warning signs is
crucial to recognize its progression
to critical phase.
 Use to detect dengue antibodies during
acute last stage of dengue infection (lgM)
and to determine previous infection (lgG)
 May give false positive result due to
antibodies induced by dengue vaccine
 May cross react with other arboviral
diseases such as Chikungunya and Zika
 DOH augmentation is limited to selected
government hospitals only
 CRITICAL PHASE
 Phase when patient can either
improve or deteriorate.
 Defervescence occurs between 3 to
7 days of illness.
 Defervescence is known as the period in
which the body temperature (fever) drops
to almost normal (between 37.5 to 38°C).
 Those who will improve after
defervescence will be categorized as
Dengue without Warning Signs,
while those who will deteriorate will
manifest warning signs and will be
categorized as Dengue with
Warning Signs or some may
progress to Severe Dengue.
 When warning signs occurs, severe
dengue may follow near the time of
defervescence
which
usually
happens between 24 to 48 hours.
 RECOVERY PHASE
 Happens in the next 48 to 72 hours
in which the body fluids go back to
normal.
 Patients
general
well-being
improves.
 Some patients may have classical
rash of "isles of white in the sea of
red".
 The White Blood Cell (WBC) usually
starts
to
rise
soon
after
defervescence
but
the
normalization of platelet counts
typically happens later than that of
WBC


DENGUE NS1 RDT
 Requested between 1-5 days of illness
 Use to detect dengue virus antigen during
early phase of acute dengue infection
 Test is for free in all health centers and
selected public hospitals nationwide
DENGUE lgM/lgG
 Requested beyond five days of illness

POLYMERASE CHAIN REACTION (PCR)
 One of the gold standard laboratory tests to
confirm dengue virus
 Molecular based test confirmatory test
 Available only in dengue sub-national and
national reference laboratories

NUCLEIC ACID AMPLIFICATION TEST – LOOP
MEDIATED ISOTHERMAL AMPLIFICATION ASSA
(NAAT-LAMP)
 A novel molecular-based test used to detect
dengue virus
 Work just like PCR but cheaper and simpler
in nature
 In the pipeline to be introduced under the
National Dengue Prevention and Control
Program in district and provincial hospitals

PLAQUE REDUCTION NEUTRALIZATION TEST
(PRINT)
 Gold standard to characterize and quantify
circulating level of anti-DENV neutralizing
antibody (Nab)
 Available only at the dengue national
reference laboratory

OTHER TESTS (TOTAL WHITE BLOOD CELL (WBC)
COUNT, PLATELET, HEMATOCRIT)
 Routinely used in hospitals as standard
dengue platelet and increasing hematocrit

MANAGEMENT
 GROUP A – patients who may be sent home
These are patients who are able to:
 Tolerate adequate volumes of oral
fluids
 Pass urine every 6 hours
 Do not have any of the warning signs
particularly when the fever subsides
 Have stable haematocrit


 GROUP B – patient who should be referred
for in-hospital management
Patients shall be referredd immediately to
in-hospital management if they have the
following conditions:
 Warining signs
 Without warning signs but with coexisting conditions that may make
dengue or its management more
complicated (such as pregnancy,
infancy,
diabetes
mellitus,
hypertension, heart failure, renal
failure, chronic haemolytic diseases
such as sickle-cell disease and autoimmune diseases, etc. )
 Social circumstances such as living
alone or living far from health facility
or without a reliable means of
transportation.
 The referring facility has no
capability to manage dengue with
warning signs and/or severe dengue
 Stategies
 Enhanced 4s strategy
 Aksyon Barangay Kontra Dengue in
communities (4S)
i. S – search and destroy
ii. S
–
eek
early
consultation
iii. S – elf protection
measures
iv. S – ay yes to fogging only
during outbreaks
 Please note that 4S strategy also
covers for other water related insect
vector diseases – Zika and
Chikungunya
 For the sake of completeness other
DOH literature proposes the 5S
strategy which includes SUSTAIN
HYDRATION as the 5th S.
 GROUP C – patient with severe dengue
requiring emergency treatment and urgent
referral
These are patients with severe dengue who
require emergency treatment and urgent
referral because they are in the critical phase
of the disease and have the following:
 Severe plasma leakage leading to
dengue
shock
and/or
fluid
accumulation with respiratory
distress;
 Severe hemorrhages;
 Severe organ impairment (hepatic
damage,
renal
impairment,
cardiomuopathy, encephalopathy,
or encephalitis)
Patients in Group C shall be
immediately
referred
and
admitted in the hospital within
24 hours.
DENG-GET OUT!
 Pangalagaan ang sarili laban sa kagat ng
lamok
 Mag 4S kontra dengue
o Suyurin at sirain ang mga
pinamumugaran ng mga lamok
o Sumagguni agad sa pinakamalapit
na pagamutan
o Sarili ay protektahan laban sa lamok
o Suuporta sa pagpapausok kapag
may banta ng outbreak

NATIONAL DENGUE
CONTROL PROGRAM
PREVENTION
AND
 Vision
 A dengue free Philippines
 Mission
 Ensure healthy lives and promote
well-being for all at all ages

 Goal
 To reduce the burden of dengue
disease
1. To reduce dengue morbidity by
atleast 25% by 2022
 Indicators
total population
(baseline: 198.1 per 100,000
population)
(2015
data:
200,145/100,981,437 x 100,000)
2. To reduce dengue mortality by at
least 50% by 2022
 Indicators
(baseline: 0.59 per 100,000
population)
(2015 data: 598/100,981.437 x
100,100)
3. To maintain Case Fatality Rate (CFR)
to < 1% every year.
 Indicators
CFR = no. of dengue (probable &
confirmed) deaths x 100
no. of probable & confirmed
cases
CONTROL
 Dengue virus has four serotypes
(DENV1, DENV2, DENV3 and
DENV4)
 First infection with one of the
four serotypes usually is nonsevere or asymptomatic, while
second infection with one of
other serotypes may cause
severe dengue.
 Dengue has no treatment but
the disease can be early
managed.
 The five year average cases of
dengue is 185,008; five year
average deaths is 732; and five
year average Case Fatality Rate
is 0.39 (2012-2016 data).
Morbidity rate = No. of suspect,
probable & confirmed cases
x100,000
total population
AND
 BACKGROUND
 Dengue is the fastest spreading
vector-borne disease in the world
endemic in 100 countries.
 Objectives
Mortality rate = No. of dengue
(probable & confirmed) deaths x
100,000
DENGUE
PREVENTION
PROGRAM

PROGRAM COMPONENTS
 Surveillance
 Case Surveillance through Philippine
Integrated Disease Surveillance and
Response (PIDSR)
 Laboratory-based surveillance/ virus
surveillance through Research
Institute for Tropical Medicine
(RITM) Department of Virology, as
national reference laboratory, and
sub-national reference laboratories.
 Vector Surveillance through DOH
Regional
Offices
and
RITM
Department of Entomology
 Case Management and Diagnosis
 Dengue Clinical Management
Guidelines training for hospitals.
 Dengue NS1 RDT as forefont
diagnosis at the health center/
RHU level.
 PCR as dengue confirmatory test
available at the sub-national and
national reference laboratories.
 NAAT-LAMP
as
one
of
confirmatory tests will be
available at district hospitals,
provincial hospitals and DOH
retained hospitals.
 Integrated Vector Management (IVM)
 Training
on
Vector
Management, Training on Basic
Entomology
for
Sanitary
Inspector,
Training
on
Integrated Vector Management
(IVM) for health workers.
 Insecticide Treated Screens (ITS)
as dengue control strategy in
schools.
 Outbreak Response
 Continuous DOH augmentation
of insectides such as adulticides
and larvicides to LGUS for
outbreak response.
 Health Promotion and Advocacy
 Celebration of ASEAN Dengue
Day every June 15
 Quad media advertisement
 IEC materials
 Research
RABIES


National Rabies Prevention and Control Program
Rabies is a viral disease that affects the central
nervous system of mammals, including humans,
that can cause agitation, paralysis, and death.

TRANSMISSION
 The rabies virus mainly spreads through
animal bites, specifically, through the
exposure of broken skin to the saliva,
tears, or nervous tissue of infected
animals. Direct contact of these bodily
fluids with the mucous membrane of the
eyes, nose and mouth is also a common
route of transmission. The rabies virus
cannot be found in blood and feces.
 Can rabies be transmitted from human to
human?
 It is extremely rare, but precautions still
need to be taken to avoid coming into
contact with the saliva and other bodily
fluids of infected persons.
 What are the signs and symptoms of rabies?
 The first symptoms of rabies are similar
to those of the flu such as general
weakness or discomfort, fever, and
headache. As the rabies virus incubates
inside the body, the person may
experience an itching sensation around
the bite area and symptoms of cerebral
dysfunction such as anxiety, confusion,
and agitation. Patients will later
experience delirium, abnormal behavior,
hallucinations,
hydrophobia,
and
insomnia as the disease progresses.
 What are the symptoms of rabies in a dog or
animal?
 Dogs infected with the rabies virus
develop the following symptoms then
die within 10 days.
 Unprovoked
abnormal
aggression
 Restlessness
 Incoordination and paralysis
 Lethargy
 Hoarse barking or inability to do
so
 Hyper salivation, excessive
salivation or foaming at the
edges of the mouth.
 What is the incubation period?
 Incubation takes two to three months as
the rabies virus travels from the bite
area to the central nervous system.
There are exceptional cases where
incubation only lasts 2-3 days or can take
as long as six months.
 What should I do after an animal bite?
 Immediately wash the bite or scratch
area and apply iodine-containing
medication on the wound. Confine the
dog or animal for observation and report
the circumstances of the bite to a
healthcare professional. Not all animal
bites require rabies specific treatment,
but if the dog exhibits symptoms of the
virus or its background is unknown (i.e.
the dog is a stray), the person MUST get
a rabies vaccine or post-exposure
prophylaxis. Should the dog remain
healthy after 10 days, it is still best to
take the rabies vaccine preventively,
known as pre-exposure prophylaxis.
 What is post-exposure prophylaxis?
 PEP is the administration of the rabies
vaccine to a person AFTER being
exposed to the rabies virus. In countries
where rabies is endemic, like the
Philippines, it is necessary for a person to
undergo post-exposure prophylaxis
immediately after an animal bite,
regardless of the health of the animal in
question.
 What is pre-exposure prophylaxis
 PrEP is the administration of the rabies
vaccine BEFORE exposure to the rabies
virus. It is recommended for individuals
whose work puts them at a higher risk of
animal bites or whose circumstances
limit their ability to seek immediate
medical attention.
 Can rabies be treated in humans?
 Once clinical symptoms begin to
develop, rabies is almost always fatal.
There is currently no effective
medication for patients who have
entered this stage of the disease.
 What can be done to prevent the spread of
rabies?
 Dogs cause almost all cases of rabies in
humans. As such, vaccinating at least 70
percent of dogs in places where rabies is
endemic will break the transmission of
the disease. Training dogs to socialize
with people properly will contribute in
minimizing the transmission of rabies by
preventing animal bites altogether.
Avoiding stray dogs will also keep
chances of catching rabies in the
community low.
 RABIES IN THE PHILIPPINES
 Rabies is endemic in the Philippines, and
remains to be a public health concern.
 100% fatality rate but 100% preventable
 One of the measures by which rabies
could be prevented is through the
implementation of the RA 9482, AntiRabies Act of 2007, which mandated the
creation of a National Rabies Prevention
and Control Program (NRPCP)
 Agencies/Organizations involved in
attaining the goals of the National Rabies
Prevention and Control Program:
 Department of Health (DOH)
 Department of Agriculture (DA) chair (Bureau of Animal
Industry)
 Department
of
Education
(DepEd)
 Department of Interior and
Local Government (DILG)
 Department of Environment and
Natural Resources (DENR)
 World Health Organization
(WHO)
 Animal Welfare Coalition (AWC)
 4 R'S IN ANIMAL
ASSESSMENT:
 Recognizing
 Recording
 Reporting
 Referral
RABIES
 Abnormal, exaggerated gait;
ataxia
and
incoordination
Convulsive seizures
 Paralysis,
prostration,
recumbency
 Death
RISK
 RECOGNIZE THE CLINICAL SIGNS OF
RABIES IN DOMESTIC ANIMALS
 Withdrawal from and resistance
to contact; seeking seclusion
 Wide-eyed; reduced frequency
or absence of blinking; dilated
pupils; photophobia
 Exaggerated, often aggressive,
response to tactile, visual, or
auditory stimuli
 Snapping/biting at imaginary
objects
 Pica (eating or mouthing sticks,
stones, soil, clothing, feces, etc.)
Aggressively
attacking
inanimate objects
 Sexual
excitement
with
attempts to mount inanimate
objects • Compulsive running or
circling, often to the point of
exhaustion Obsessive licking,
biting, or scratching at the site of
viral inoculation
 Dropped jaw, inability to
swallow, excessive salivation
 Change in tone, timbre,
frequency, or volume of
vocalizations
 Flaccid or deviated tail/penis
 Tenesmus (due to paralysis of
the anal sphincter)
 Muscular tremors
 Acute onset of mono-para-,or
quadri-paresis; lameness
 MEDICAL MANAGEMENT OF ANIMAL BITES
 There are three main tenets on the
management of animal bite cases based
on the categorization of the bite
 Cleaning of the wound
 Active Immunization
 Passive Immunization
 If signs of infection are present:
 Swab for culture
 Antibiotic therapy
 Empirical therapy should be directed
against those micro- organisms most
likely to be present for dogs and cats
pathogen such as:
 CATEGORIES OF RABIES EXPOSURE WITH
CORRESPONDING MANAGEMENT
 Category I
 EXPOSURE
 Feeding/touching an animal
 Licking of intact skin (with
reliable history and thorough
physical examination)
 Exposure to patient with signs
and symptoms of rabies by
sharing of eating or drinking
utensils
 Casual contact (talking to,
visiting and feeding suspected
rabies cases) and routine
delivery of health care to patient
with signs and symptoms of
rabies
 MANAGEMENT
 Wash exposed skin immediately
with soap and water.
 No vaccine or RIG needed
 Pre-exposure prophylaxis may
be considered for high-risk
persons
 Category II
 EXPOSURE
 Nibbling of uncovered skin with
or without bruising/hematoma
 Minor/superficial
scratches/abrasions
without
bleeding,
including
those
induced to bleed
 All Category II exposures on the
head and neck area are
considered Category III and shall
be managed as such.
 MANAGEMENT
 Wash wound immediately with
soap and water for at least 10
minutes
 Start vaccine immediately

Dog/cat was vaccinated
against rabies for the
past 2 years
 Complete vaccination regimen until
day 7
 No RIG needed
 If the biting animal starts to
show
signs
of
rabies,
immediately give vaccine and
RIG
 Category III
 EXPOSURE
 Transdermal bites (puncture
wounds, lacerations, avulsions)
or scratches / abrasions with
spontaneous bleeding
 Licks on broken skin or mucous
membrane
 Exposure to a rabies patient
through bites, contamination of
mucous membranes (eyes,
oral/nasal mucosa, genital/anal
mucous membrane) or open
skin lesions with body fluids
through splattering and mouthto-mouth resuscitation.
 Unprotected
handling
of
infected carcass
 Ingestion of raw infected meat
 Exposure to bats
 All Category II exposures on
head and neck area
 MANAGEMENT
o
No human rabies vaccine
shall be provided, provided
that ALL of the following
conditions are satisfied:

Dog/cat is healthy and
available
for
observation for 14 days
 Wash wound with soap and
water.
 Start the vaccine regimen.
 Complete vaccination regimen
until Day 7 regardless of the
status of the biting Animal
 Administer RIG immediately
after vaccination against rabies.
 IMMUNIZATION
 ACTIVE IMMUNIZATION
 Administration
 Vaccine is administered to
induce antibody and T-cell
production
in
order
to
neutralize the rabies virus in the
body. It induces an active
immune response in 7-10 days
after vaccination, which may
persist for years provided that
primary
immunization
is
completed
 Types of Rabies Vaccines
 The National Rabies Prevention
and Control Program (NRPCP)
shall provide the following antirabies tissue culture vaccines
(TVC)
 Purified Vero Cell Rabies Vaccine
(PVRV) - 0.5 ml/vial and 1.0
ml/vial
 Purified Chick Embryo Cell
Vaccine (PCECV) - 1.0 ml/vial
 List of TCV Provided by the NRPCP
to Animal Bite Treatment Centers
with Corresponding Preparations
and Dose
 GENERIC NAME
Purified Vero Cell Rabies Vaccine
(PVRV) VerorabR
 PREPARATION
0.5 mL/vial
 DOSE
ID - 0.1mL
IM -0.5mL
 PREPARATION
mL/vial
 DOSE
ID -0.1mL
IM – 1.0 mL
 GENERIC NAME
Purified Chick Embryo Cell
Vaccine (PCECV)
 PREPARATION
mL/vial
 DOSE
ID -0.1mL IM-1.0mL
 Updated 2-Site Intradermal Schedule
 One dose for ID administration is
equivalent to 0.1 ml
 One dose shall be given on each
deltoid on Days 0, 3, and 7
 For WHO pre-qualified vaccines, the
day 28 dose may be omitted
following the IPC Institute Pasteur du
Cambodge
(IPC)
Intradermal
regimen (2-2-2-0-0)
 WHO Pre-qualified vaccines:
 Rabies vaccine Inactivated
(Freeze Dried) (RABIVAX-S)
 Rabipur
 Verorab
 VaxiRab N
 PASSIVE IMMUNIZATION
 Rabies immune globulins or RIG (also
called passive immunization products)
shall be given in combination with
rabies vaccine to provide the immediate
availability of neutralizing antibodies at
the site of the exposure before it is
physiologically possible for the patient
to begin producing his or her own
antibodies after vaccination. This is
especially important for patients with
Category III exposures. RIGs have a halflife of approximately 21 days.
 Passive immunization against Rabies
must be given within 7 days after
initiation of active immunization since
that is the amount of time that the body
needs to create antibodies from the
active immunization. Beyond 7 days,
administration of Passive Immunization
will neutralize antibodies made by your
body from the active immunization.
 GENERIC NAME
 Human Rabies Immune Globulin
(HRIG)
 PREPARATION
 150 IU/mL at 2mL/vial
 DOSE
 20 IU/kg
 GENERIC NAME
 Purified Equine Rabies Immune
Globulin (pERIG)
 PREPARATION
 200 IU/mL at 5mL/vial
 DOSE
 40 IU/kg
 COMPUTATION AND DOSAGE OF
RABIES IMMUNOGLOBULIN
 HRIG at 20 IU/kg. body weight
(150 IU/ml)
50 kg. patient x 20 IU/kg. = 1000
IU
 ERIG/ F(ab')2 at 40 IU/kg. body
weight (200 IU/ml)
50 kg. patient x 40 IU/kg. = 2000
IU
2000 IU +200 IU/ml = 10 ml.
 WOUND TREATMENT
 Local wound treatment
 Wounds shall be immediately and
vigorously washed and flushed with
soap or detergent, and water preferably
for 10 minutes. If soap is not available,
the wound shall be thoroughly and
extensively washed with water.
 Apply alcohol, povidone iodine or any
antiseptic
 Suturing of wounds shall be avoided at
all times since it may inoculate virus
deeper into the wounds. Wounds may
be capitated using sterile adhesive
strips. If suturing is unavoidable, it shall
be delayed for at least 2 hours after
administration of RIG to allow diffusion
of the antibody to occur through the
tissues
 Any ointment, cream or wound dressing
shall not be applied to the bite site
because it will favor the growth of
bacteria and will occlude drainage of the
wound, if any
 Anti-tetanus immunization shall be
given, if indicated. History of tetanus
immunization (TT/DPT/Td) shall be
reviewed. Animal bites are considered
tetanus prone wounds. Completion of
the primary series of tetanus
immunization is recommended
 Routine Wound Management
 The most common organism isolated
from dog and cat bites is Pasteurella
multocida.
 Other organisms include S. aureus,
Bacteroides sp, Fusobacterium and
Capnocytophaga. Antimicrobials shall be
recommended for the following
conditions:
 All frankly infected wounds
 All category III cat bites
 All other category III bites that
are either deep, penetrating,
multiple or extensive or located
on the hand/face/genital area
 EVERY MARCH IS AWARENESS MONTH
 Maging responsableng amo, huwag
hayaang gumala ang alagang pusa't aso
 RABIES PREVENTION AND CONTROL
PROGRAM
 Rabies is an infection that affects
humans usually transmitted by a
bite or scratch of an infected animal.
This is considered a significant public
health problem in the country as it is
one of the most acutely fatal
infections and responsible for the
death of at least 200 Filipinos
annually. Effective and safe vaccines
to prevent the disease in humans
and animals have been available for
decades. However, its elimination is
hampered by poverty and ignorance
about the disease and its
prevention. Hence, this program
aims to prevent and control rabies
infection
by
providing
and
promoting accessible vaccines,
along with rabies education and
awareness, to the public.
 Mission
 To declare Philippines RabiesFree by year 2030
 Vision
 To eliminate human rabies by
the year 2027
 Goal
 To eliminate rabies as a public
health problem, with absence of
indigenous cases for both
human and animal.
 PROGRAM COMPENENTS
 Mass Dog Vaccination
 Most effective measure to
control canine rabies.
 Headed by the Department of
Agriculture in mass dog
vaccination campaigns and
provision of animal rabies
vaccine.
 Post-Exposure
Prophylaxis
(PEP) and Pre-Exposure (PrEP)
 Post Exposure Prophylaxis
(PEP)
–
antirabies
prophylaxis
should
be
administered
after
an
exposure (such as bite,
scratch, lick, etc.)
 Pre-Exposure Prophylaxis
(PrEP) – vaccination should
be given to individuals who
are at high risk of getting
rabies
 Health Education and Advocacy
Campaign
 Celebration
of
Rabies
Awareness Month under
Executive Order No.
 84, March is Rabies
Awareness Month
 September 28 is World
Rabies Day
 Development
of
IEC
materials
 Integration
of
Rabies
Program into the School
Curriculum
 Training/Capability Building
 Training on National Rabies
Information System (NaRIS)
 Establishment of ABTCs by
Inter-Local Health Zone
 DOH-DA joint evaluation and
declaration of Rabies-free
areas/provinces
STI and HIV/AIDS
 National HIV/AIDS and STI Prevention and
Control Program
 Sexually Transmitted Infections
 More than 30 different bacteria, viruses
and parasites are known to be
transmitted through sexual contact,
including vaginal, anal and oral sex.
Some STIs can also be transmitted from
mother-to-child during pregnancy,
childbirth and breastfeeding. Eight
pathogens are linked to the greatest
incidence of STIS. Of these, 4 are
currently curable: syphilis, gonorrhoea,
chlamydia and trichomoniasis. The other
4 are incurable viral infections: hepatitis
B, herpes simplex virus (HSV), HIV and
human papillomavirus (HPV).
 In addition, emerging outbreaks of new
infections that can be acquired by sexual
contact such as monkeypox, Shigella
sonnei, Neisseria meningitidis, Ebola and
Zika, as well as re-emergence of
neglected
STIs
such
as
lymphogranuloma venereum. These
herald increasing challenges in the
provision of adequate services for STIs
prevention and control.
 Sexually transmitted infections (STIs) are
spread predominantly by unprotected
sexual contact. Some STIs can also be
transmitted during pregnancy, childbirth
and breastfeeding and through infected
blood or blood products.
 STIs have a profound impact on health. If
untreated, they can lead to serious
consequences including neurological
and cardiovascular disease, infertility,
ectopic pregnancy, stillbirths, and
increased
risk
of
Human
Immunodeficiency Virus (HIV). They are
also associated with stigma, domestic
violence, and affects quality of life. The
majority of STIs have no symptoms.
When they are present common
symptoms of STIs are vaginal or urethral
discharge, genital ulcer and lower
abdominal pain.
 The most common and curable STIs are
trichomonas, chlamydia, gonorrhea and
syphilis. Rapidly increasing antimicrobial
resistance is a growing threat for
untreatable gonorrhea.
 Viral STIs including HIV, genital herpes
simplex virus (HSV), viral hepatitis B,
human papillomavirus (HPV) and human
T-lymphotropic virus type 1 (HTLV-1)
lack or have limited treatment options.
Vaccines are available for hepatitis B to
prevent infection that can lead to liver
cancer and for HPV to prevent cervical
cancer. HIV, HSV and HTLV-1 are lifelong
infections: for HIV and HSV there are
treatments that can suppress the virus,
but currently there are no cures for any
of these viral STIs.
 Condoms
used
correctly
and
consistently are effective methods to
protect against STIS and HIV. Screening
with early diagnosis of people with STIs
and their sexual partners offers the best
opportunity for effective treatment and
for preventing complications and further
transmission.


Gonorrhoea and chlamydial infection
 These STIs cause cervicitis in women,
urethritis in men and extra-genital
infections,
including
rectal
and
oropharyngeal manifestations. Common
symptoms include vaginal or penile
discharge and burning with urination. Infants
of infected mothers can contract neonatal
conjunctivitis (red eyes) due to exposure to
the STIs during vaginal delivery. Rectal and
pharyngeal infections can be asymptomatic.
Trichomoniasis
 The predominant symptoms include
abnormal vaginal discharge with redness of
the vulva, itching and painful intercourse.

Genital herpes simplex virus (HSV)
 HSV most commonly presents as painful
sores, vesicles or ulcerations on the external
genitalia and mouth. Symptomatic genital
HSV is a lifelong condition that can be
characterized by frequent symptomatic
recurrences.

 Each year there are an estimated 374
million new infections with 1 of 4 curable
STIs: chlamydia, gonorrhoea, syphilis
and trichomoniasis.
 More than 500 million people 15-49
years are estimated to have a genital
infection with herpes simplex virus (HSV
or herpes) (1).
Syphilis
 Syphilis is often asymptomatic, when
symptoms occur, primary syphilis presents
as a solitary, painless ulcer. Secondary
syphilis may manifest as generalized lesions
affecting skin, mucous membranes and
lymph-node including a classic rash on the
palms of the hands and soles of the feet.
Latent syphilis is asymptomatic and
characterized by positive syphilis serology.


worldwide, the majority of which are
asymptomatic.
Human T-lymphotropic virus type 1 (HTLV-1)
 Generally asymptomatic, the chronic form of
HTLV-1 can cause severe disease, including
adult T-cell leukaemia/lymphoma (ATL) and
a progressive nervous system condition
known as HTLV-1-associated myelopathy or
tropical spastic paraparesis (HAM/TSP).
STI Global Situation
 More than 1 million sexually transmitted
infections (STIs) are acquired every day
 Human papillomavirus (HPV) infection is
associated with over 311 000 cervical
cancer deaths each year (2).
 Almost 1 million pregnant women were
estimated to be infected with syphilis in
2016, resulting in over 350 000 adverse
birth outcomes (3).
 STIs have a direct impact on sexual and
reproductive
health
through
stigmatization, infertility, cancers and
pregnancy complications and can
increase the risk of HIV.
 Drug resistance is a major threat to
reducing the burden of STIs worldwide.

Scope of the problem
 STIs have a profound impact on sexual
and reproductive health worldwide.
 More than 1 million STIs are acquired
every day. In 2020, WHO estimated 374
million new infections with 1 of 4 STIS:
chlamydia (129 million), gonorrhoea (82
million), syphilis (7.1 million) and
trichomoniasis (156 million). More than
490 million people were estimated to be
living with genital herpes in 2016, and an
estimated 300 million women have an
HPV infection, the primary cause of
cervical cancer and anal cancer among
men who have sex with men. An
estimated 296 million people are living
with chronic hepatitis B globally.
can also spread from a mother to her
baby.
 HIV can be treated and prevented with
antiretroviral therapy (ART). Untreated
HIV can progress to AIDS, often after
many years.
 STIs can have serious consequences
beyond the immediate impact of the
infection itself.





STIs like herpes, gonorrhoea and
syphilis can increase the risk of
HIV acquisition.
Mother-to-child transmission of
STIs can result in stillbirth,
neonatal
death,
low-birth
weight and prematurity, sepsis,
neonatal conjunctivitis and
congenital deformities.
HPV infection causes cervical
and other cancers.
Hepatitis B resulted in an
estimated 820 000 deaths in
2019, mostly from cirrhosis and
hepatocellular carcinoma. STIs
such as gonorrhoea and
chlamydia are major causes of
pelvic inflammatory disease and
infertility in women.
HIV/AIDS
 Human immunodeficiency virus (HIV) is
an infection that attacks the body's
immune
system.
Acquired
immunodeficiency syndrome (AIDS) is
the most advanced stage of the disease.
 HIV targets the body's white blood cells,
weakening the immune system. This
makes it easier to get sick with diseases
like tuberculosis, infections and some
cancers.
 HIV is spread from the body fluids of an
infected person, including blood, breast
milk, semen and vaginal fluids. It is not
spread by kisses, hugs or sharing food. It
 WHO now defines Advanced HIV Disease
(AHD) as CD4 cell count less than
200cells/mm3 or WHO stage 3 or 4 in
adults and adolescents. All children with
HIV younger than 5 years of age are
considered to have advanced HIV
disease.

Signs and symptoms
 The symptoms of HIV vary depending on
the stage of infection.
 The disease spreads more easily in the
first few months after a person is
infected, but many are unaware of their
status until the later stages. In the first
few weeks after being infected people
may not experience symptoms. Others
may have an influenza-like illness
including:




fever
headache
rash
sore throat
 The
infection
progressively
weakens the immune system. This
can cause other signs and
symptoms:





swollen lymph nodes
weight loss
fever
diarrhoea
cough
 Without treatment, people with
HIV infection can also develop
severe illnesses:




tuberculosis (TB)
cryptococcal meningitis
severe bacterial infections
cancers such as lymphomas
and Kaposi's sarcoma.
 HIV causes other infections to get
worse, such as hepatitis C, hepatitis
B and mpox.

 Kiss, touch
 Clothes, towels
 Toilet, Shower
 Transmission
 Original source: chimpanzees
 Transfer of body fluids
 Transplacental and perinatal
 needlestick

 Preferentially infects and kills helper (CD4+)
T lymphocytes
 Loss of cell-mediated immunity
 High probability of opportunistic
infections
Transmission
 HIV can be transmitted via the exchange
of a variety of body fluids from people
living with HIV, such as blood, breast
milk, semen and vaginal secretions. HIV
can also be transmitted during
pregnancy and delivery to the child.
People cannot become infected through
ordinary day-to-day contact such as
kissing, hugging, shaking hands, or
sharing personal objects, food or water.
 It is important to note that people with
HIV who are taking ART and are virally
suppressed do not transmit HIV to their
sexual partners. Early access to ART and
support to remain on treatment is
therefore critical not only to improve the
health of people with HIV but also to
prevent HIV transmission.
 HIV IS TRANSMITTED





Use of non-sterile syringes and tools
Pregnancy, Breastfeeding
Blood transfusion
Organ transplant
Unprotected sex
 HIV IS NOT TRANSMITTED
 Food, drink, utensils
 Insect Bites
Pathogenesis
 Main immune response consists of cytotoxic
(CD8+) lymphocytes

Stages of Infection
 Phase 0 – Infection
 HIV acquired through sexual
intercource, blood, or perinatally
 Phase 1 – Window Period
 Rapid viral replication but HIV test is
negative
 Phase 2 – Seroconversion
 Peak or viral load, positive HIV test,
mild flu-like illness lasting 1-2 weeks
 Phase 3 – Latent Period
 Asymptomatic, CD4 goes down, lasts
1-15 years
 Phase 4 – Early Symptoms
 CD4 500 to 200, lasts 5 years, mild
mucocutaneous, dermatolofical and
hematologi ilness
 Phase 5 – AIDS
 CD4<200, lasts 2 years, AIDSdefining illness develop

 In 2021, 650 000 [510 000-860 000] people
died from HIV-related causes and 1.5 million
[1.1- 2.0 million] people acquired HIV.
 There is no cure for HIV infection. However,
with access to effective HIV prevention,
diagnosis, treatment and care, including for
opportunistic infections, HIV infection has
become a manageable chronic health
condition, enabling people living with HIV to
lead long and healthy lives.
Risk factors
 Behaviours and conditions that put people
at greater risk of contracting HIV include:
 having condomless anal or
vaginal sex;
 having
another
sexually
transmitted infection (STI) such
as syphilis, herpes, chlamydia,
gonorrhoea
and
bacterial
vaginosis;
 engaging in harmful use of
alcohol and drugs in the context
of sexual behaviour;
 sharing contaminated needles,
syringes and other injecting
equipment and drug solutions
when injecting drugs;
 receiving unsafe injections,
blood transfusions and tissue
transplantation, and medical
procedures
that
involve
unsterile cutting or piercing; and
 experiencing accidental needle
stick injuries, including among
health workers.
 WHO, Global Fund and UNAIDS all have
global HIV strategies that are aligned with
the SDG targets 3.3 of ending the HIV
epidemic by 2030.
 To achieve this, 95% of all people living with
HIV (PLHIV) should have a diagnosis, 95% of
those should be taking lifesaving
antiretroviral treatment (ART) and 95% of
PLHIV on treatment should achieve a
suppressed viral load for the benefit of the
person's health and for reducing onward HIV
transmission.

MAY 16, 2021 INTERNATIONAL
CANDLELIGHT MEMORIAL DAY
AIDS
 "WE REMEMBER, WE TAKE ACTION, WE
LIVE BEYOND HIV"

HIV/AIDS Global Situation
 HIV remains a major global public health
issue, having claimed 40.1 million [33.6-48.6
million] lives so far with ongoing
transmission in all countries globally; with
some countries reporting increasing trends
in new infections when previously on the
decline.
 There were an estimated 38.4 million [33.943.8 million] people living with HIV at the
end of 2021, two thirds of whom (25.6
million) are in the WHO African Region.
 HIV, AIDS AND STI PREVENTION AND
CONTROL PROGRAM The National HIV,
AIDS and STI Prevention and Control
Program (NASPCP) envisions ZERO new
infections, ZERO discrimination, and
ZERO AIDS-related death. Its mission is
to improve access and utilization of
preventive primary health care services
for HIV and STI while its goal is to reverse
the trend of HIV epidemic by reducing
the estimated annual infections to less
than 7,000 cases by 2022.
 Vision: To achieve ZERO new infections,
ZERO discrimination, and ZERO AIDSrelated death.
 Mission: To improve access and
utilization of preventive primary health
care services for HIV and STI.
 Goals: To reverse the trend of HIV
epidemic by reducing the estimated
annual infections to less than 7,000
cases by 2022.

 Accessibility of ART and management of
opportunistic infections;
 Mobilization of communities of PLHIV
for public awareness campaigns and
stigma reduction activities; and
 Establish comprehensive human rights
and evidence-based policies, programs,
and approaches that aim to reduce
transmission of HIV and its harmful
consequences to members of key
affected populations.
HIV/STI PREVENTION PROGRAM
 PROGRAM ACTIVITIES:
 With regard to the prevention and fight
against stigma and discrimination, the
following are the strategies and
interventions: o Availability of free
voluntary HIV Counseling and Testing
Service; o 100% Condom Use Program
(CUP) especially for entertainment
establishments;
 Peer education and outreach;
 Multi-sectoral coordination through
Philippine National AIDS Council (PNAC);
 Empowerment of communities;
 Community assemblies and for a to
reduce stigma;
 Augmentation of resources of social
Hygiene Clinics; and
 Procured male condoms distributed as
education materials during outreach.
 PREVENTIVE MEASURES, SAFE PRACTICES
AND PROCEDURES
 Creation
of
rights-based
and
community-led behavior modification
programs that seek to encourage HIV
risk reduction behavior among PLHIVs;
 Establishment and enforcement of
rights-based mechanisms to strongly
encourage newly tested HIV-positive
individuals
to
conduct
partner
notification and to promote HIV status
disclosure to partners;
 Establishment
of
standard
precautionary measures in public and
private health facilities;
 HIV TESTING
 HIV testing shall be made available
under the following circumstances:
 if the person is fifteen (15) to below
eighteen (18) years of age, consent to
voluntary HIV testing shall be obtained
from the child without the need of
consent from a parent or guardian
 Any young person aged below fifteen
(15) who is pregnant or engaged in highrisk behavior shall be eligible for HIV
testing and counseling, with the
assistance of a licensed social worker or
health worker. Consent to voluntary HIV
testing shall be obtained from the child
without the need of consent from a
parent or guardian
 consent to voluntary HIV testing shall be
obtained from the child's parent or legal
guardian if the person is below fifteen
(15) years of age or is mentally
incapacitated. In cases when the child's
parents or legal guardian cannot be
located despite reasonable efforts, or if
the child's parent or legal guardian
refused to give consent of the minor
shall also be required prior to the testing
 HEALTH AND SUPPORT SERVICES
 The DOH shall establish a program that
will provide free and accessible ART and
medication for opportunistic infections
to all PLHIVS who are enrolled in the
program
symptoms, and then in the first 4-6 days of
illness
in
patients
without
immunosuppression
 Continuous rapid evolution of the SARS-CoV2 may be attributed to the inherent infidelity
of RNA ciruses that generate random
mutations and the millions of daily infections
COVID 19


MICROBIOLOGY
 A zoonotic disease caused by SARS-CoV-2,
previously known as novel coronavirus 2019
(nCoV)
 Positive snese, single-stranded enveloped
RNA virus belonging to the family
Coronaviradae
 Crown-like appearance

 Most common
 Fever
 Cough (dry)
 Fatigue
Transmission
 By
respiratory
droplets,
though
aerosolization is possible (especially
indoor/prolonged exposure, areas with
poor ventilation )
 Less common
 Myalgia
 Pharyngitis (or other respiratory
symptoms)
 Headache
 GI including diarrhea
 Conjunctivitis
 Loss of taste or smell
 Rash
(chilblains,
discoloring
on
fingers/toes)
 Lower risk transmission
 Fomities
 Viral shedding by asymptomatic people
 Some are super-spreaders, which may be
due to inherent characteristics (e.g., their
speech generates aerosol, loud speaking,
etc.)
 Serious/warning symptoms
 Shortness of breath
 Chest pain/pressure
 Confusion
 Lethargy
 Cyanosis
Aerosol- suspension of tiny droplets or particles in the air,
such as dusts, mists, or fumes
 Mass gatherings especially indoors in smaller
spaces or with poor ventilation appear to
enhance transmission
 Stool shedding is also described later in the
disease, but its role in the spread of the
disease is still uncertain
Symptoms
Variants of Concern (VOC) as of December 2022
WHO
label
Alpha

Incubation
 2-14 days; mean is 4-5 days
 Omicron allegedly faster at 1-2 days
 Viral titers are highest in the earliest phases
of infection, 1-2 days before the onset of
Beta
Gamma
Delta
Country first Year
and
detected
Month First
Detected
United
December
Kingdom
2020
South Africa
September
2020
Brazil
December
2020
India
December
2020
Omicron
South africa November
and
2021
Bootswana
Currently, the circulating VOC is Omicron, includes BA.1,
B.A.2, B.A.3, B.A.4, B.A.5, and descendent lineages. It also
includes B.A.1/B.A.2 circulating recombinant forms such
as XE.
COVID-19
The dominant Omicron variant
The more transmissible variant, first detected in
November 2021, has been detected in at least 165
countries and territories worldwide
Alpha

Variant of Interest (VOI)
 A SARS-CoV-2 Variant:
 With genetic changes that are predicted
or known to affect virus characteristics
such as transmissibility, disease severity,
immune
escape,
diagnostic
or
therapeutic escape; and
 Identified
to
cause
significant
community transmission or multiple
COVID-19 clusters, in multiple countries
with increasing relative prevalence
alongside increasing number of cases
over time, or other apparent
epidemiological impacts to suggest an
emerging risk to global public health

Variant of Concern
Beta
Gamma
Delta
Epsilon
Zeta
Eta
Theta
Lota
Kappa
Lamba
Mu
Omicron
 Increase
in
transmissibility
or
detrimental change in COVID-19
epidemiology; OR
 Increase in virulence or change in clinical
disease presentation; OR
 Decrease in effectiveness of public
health and social measures or available
diagnostics, vaccines, therapeutics
September 2020
May 2020
November 2020
October 2020
October 2020
April 2020
December 2020
January
November 2020
October 2020
December 2020
January 2021
November 2021
NU is too easily confounded with “new” and Xi was not
used because it is a common surname.” - WHO
COVID-19 CASE DEFINITIONS

 A SARS-CoV-2 variant that meets the
definition of a VOI and, through a
comparative
assessment, has been
demonstrated to be associated with one or
more of the following changes at a degree of
global public health significance:
United
Kingdom
South Africa
Brazil
India
India
Brazil
Multiple
countries
Philippines
United States
India
Peru
Colombia
Multiple
countries
COVID-19 Suspect
 Meets clinical AND epidemiological criteria
Clinical criteria


Acute onset of fever AND cough OR
Acute onset of ANY THREE OR MORE of the
following signs or symptoms
 Fever
 Cough
 General weakness/fatigue
 Headache
 Myalgia
 Sore throat
 Coryza
 Dyspnea
 Anorexia
 Nausea
 Vomiting
 Diarrhea
 Altered mental status
Epidemiological Criteria
1. Residing / working in an area with high risk of
transmission of the virus (e.g., closed residential
settings and humanitarian settings, such as camp
and camp-like setting for displaced persons), any
time within the 14 days or prior to symotoms
onset OR
2. Residing in or travel to an area with community
transmission anytime w/in the 4 days prior to
symptoms onset; OR
3. Working in health setting, including within the
health facilities and within households, anytime
within the 14 days prior to symptoms onset


A person with recent onset of anosmia (loss of
smell), ageusia (loss of taste) in the absence of
any other identified cause
Death, not otherwise explained, in an adult with
respiratory distress preceding death AND who
was a contact of a probable or confirmed case or
epidemiologically linked to a cluster which has
had at least one confirmed case identifies with
that cluster
COVID-19 CONFIRMED

A person with laboratory confirmation of COVID19 infection, irrespective of clinical signs and
symptoms.
DIAGNOSTIC TESTING
A patient with severe acute respiratoy illness (SARI: acute
respiratory infection with history of fever or measured
fever of greater than or equal to 38 degree celcius; cough
with onset w/in the last 10 days; and who requires
hospitalization)
COVID-19 PROBABLE


A patient who meets the clinical criteria AND is
a contact of a probable or confirmed case, or
epidemiologiically linked to a cluster of cases
which has had at least one confirmed identified
within that cluster
A suspect case with chest imaging showing
findings suggestive of COVID-19 disease. Typical
chest imaging findings include (Manna, 2020):
 Chest radiography: hazy opacities, often
rounded in morphology, with peripheral and
lower lung distribution
 Chest CT: mulitple bilateral ground glass
opacities, often rounded in morphology,
with peripheral and lower lung distribution
 Lung ultrasound: thickened pleural lines, B
lines (multifocal, discrete, or confluent),
consolidative patterns with or without air
bronchograms
NUCLEIC ACID AMPLIFICATION TEST (NAAT)



Commonly used method of NAAT testing is
Reverse Transcription Polymerase Chain
Reaction (RT-PCR)
Remains to be the golden standard in testing for
SARS-COV-2
Nasopharyngeal (NP) swab specimen is the
norm. Other samples used include nasal,
oropharyngeal, saliva, and lower respiratory
samples.
ANTIGEN TESTING



Tests detect viral proteins, e.g., SARS-CoV-2
spike protein.
Sensitivity is lower than in molecular tests
(ranging from 50-90% in studies); however, the
advantage is a quick turnaround time, usually
<15 minutes.
Detects high viral loads, typically occurring with
the onset of symptoms until day 7.
ANTIBODY TESTING

Serologic testing, higher chances of falsepositives




Not recommended as the sole basis for diagnosis
Do not equate with an “immunity passport” if
positive
Unclear at what level they may equate with
protective immunity
May be used to support a clinical diagnosis if a
patient has a high likelihood of infection but
negative viral RNA testing
UPDATED PHILIPPINE TESTING PROTOCOLS




(DOH Department Memorandum 2022-043 September
13, 2022)








Who is being tested
 Those eligible for COVID-19 medications,
especially A2 (senior citizens), A3 (individuals
with
comorbidities
and
immunocompromised), and at high risk for
disease
Why is testing being done?
 For clinical management
 Confirming COVID-19 to know if
investigational drugs can be given
 Recommended repeat testing of severely
immunocompromised upon completion of
isolation
Should you test?
 Yes
Remarks
 Antigen when symptomatic
 RT-PCR as confirmatory if antigen negative
SURVEILLANCE TESTING





Who is being tested?
 Aymptomatic close contact and not high risk
Why is testing being done?
 Confirming COVID-19 after exposure to
positive case
Should you test?
 Optional
Remarks
 Quarantine, except if vaccinated with atleast
primary series; RT-PCR test preferred or for
active surveillance
Who is being tested?
 Mild symptoms / suspect case and not high
risk
Why is testing being done?
 Confirming COVID-19 after onset of
symptoms
Should you be tested?
 Optional
Remarks
 Isolate immediately (prefer home isolation
and teleconsult)
 Antigen when symptomatic; RT-PCR as
confirmatory if antigen negative or if for
active surveillance



Who is being tested?
 A1 or Health Care Workers
Why is testing being done?
 Surveillance to plan for adequate health
system capacity
Should you test?
 Yes
Remarks
 Antigen when symptomatic RT-PCR to
confirm negative test and to send for WGS
Who is being tested?
 CHDs, LHOs / LESUs, Hospitals
Why is testing being done?
 National sampling for genomic surveillance
Should you test?
 Yes
Remarks
 RT-PCR necessary for surveillance
COVID-19 EXPOSURE CLASSIFICATION
Risk category



human resource department) as well as health
offices (DOH Central and Centers for Health
Development, PHO and Cho except for person
has higher exposure)
High
Moderate
Low
High risk category

Risk of exposure to COVID-19 is very likely as in
areas of activities where HCW must directly cater
or interact with a known COVID-19 patents, e.g.,
where HCW is required to:
VACCINATION CATEGORY/ SUBGROUP
Priority Eligible A
A1. Workers in frontline health services
A2. All senior citizens
 Triage and admit patients in emergency
room
 Enter a COVID-19 patient’s room/ward
 Provide care for COVID-19 patient not
involving or involving aerosol-generating
procedures (e.g., intubation, cough,
induction procedures, bronchoscopies,
dialysis, surgeries, emergency procedures,
oral procedures and exams, or invasive
specimen collection), or
 Collect and/or handle specimens, beddings,
food, utensils, and other personal items
from known or suspected COVID-19 patients
 Transport of COVID-19 patients and remains
including transport to, between and within
health facilities
Moderate risk category

Risk of exposure to COVID-19 is increased due to
constant exposure to a large number of people,
providing care to the general public who are not
known or suspected COVID-19 patients, or
working as a staff in areas within a health facility
such as triaging patients in the outpatient
department, social services section, Malasakit
Centers, RHUs/BHS, birthing clinic, and
ambulatory clinic
A3. Persons with Comorbidiyies
A4. Frontline personnel in essential sectors, including
uniformed personnel
A5. Indigen population
Priority Eligible B
B1. Teacher, social workers
B2. Other Government Workers
B3. Other essential workers
B4. Socio-demographic groups at signigficantly higher
risk other than senior citizens and poor population based
on the NHTS-PR
B5. Oversease Filipino workers
B6. Other remaining workforce
Priority Eligible C
C. Rest of the Filipino population not otherwise included
in the above grouos
Why is there a need to prioritize? To decrease mortality
and preserve the health system capacity of the country
(DOH)
Low risk category

Risk of exposure to COVID-19 is not likely, such
as in performing administrative/ supportive
duties in noncrowded or “clean areas” of health
facilities or away COVID-19 patients, e.g.,
records, billing, and accounting, pharmacy,
VACCINES

Multiple vaccines available for promary series
worldwwide. Two doses needed for individual to
be completely immunized (except for Jansen)


Initial high efficacy of 94-95% for the mRNA
vaccine are now lower due to the Delta and
Omicron variants; however, remain effective in
reducing hospitalization or death from COVID19.
Booster doses are recommended for ages older
or at the age of 12 years old, which improves
vaccine efficacy against the Omicron variant
UPDATED MASKING PROTOCOLS
In accordance with Office of the President Executive
Order No. 03 s. 2022 entitled, “Allowing Voluntary
Wearing of Facemasks in Outdoor Settings and
Reiterating the Continued Implementation of Minimum
Public Health Standards during the State of the Public
Health Emergency Relative to the COVID-19 Pandemic
Voluntary Wearing
 Booster doses given 3 months after
completing the primary series (2 months
only for Jansenn)
 FDA has fully approved Pfizer/BioNTech for
two doses and Moderna COVID-19 for two
doses. Booster doses are also approved for
Pfizer ages older or 12 years of age.
 Pfizer now has EUA for children older or at
the age of 6 months in the US.
 In the Philippines, 2nd booster already open
for A1, A2, A3 including the pediatric
population 12 to 17 years old (both
immunocompromised
and
nonimmunocompromised, either homologous
or heterologous as of September 2022). The
following COVID-19 vaccines with approved
EUAs issued by the Philippine FDA are
indicated for use as 2nd booster doses:
 Pfizer
 Moderna
 Sinovac
 Sinopharm
 AstraZeneca


Wearing of well-fitted face masks shall be
voluntary in open spaces and non-crowded
outdoor areas with good ventilation.
Partially and unvaccinated individuals, high-risk
individuals such as senior citizens and
immunocompromised individuals are strongly
encouraged to wear
Mandatory Wearing

Face masks shall continue to be worn for indoor
private and public establishments, including in
public transportation by land, air, or sea, and in
outdoor settings where physical distancing
cannot be maintained.
Tuberculosis




National Tuberculosis Control Program (NTP)
Infectious diseases caused by a type of bacteria
called Mycobacterium tuberculosis
TB is curable and preventable. However,
incomplete or irregular treatment may lead to
drug-resistant TB or even death.
Pulmonary Tuberculosis
 Most commonly affects the lungs
 Symptoms include:
 Chronic cough
 Coughing up blood
 Fever (especially rising in the
evening)
 Night sweats
 Chest pain
 Loss of appetite
 Weight loss

Extra-pulmonary Tuberculosis
 Involves other organ of the body such as
kidney, bones, liver and others.

TB Infection
- When a person breathes in the TB
bacteria, in most cases, the body is able
to get them to stop them from growing.
The bacteria become inactive, but do not
die. They lie latent, and can become
active later. This state is called TB
infection. People who are infected with
TB do not feel sick, do not have any
symptoms, and cannot spread the
disease. But they could develop TB
disease at some time in the future.
TB Disease
- Not all people with TB infection get
active Tb disease. Only when people
infected with the TB bacteria start
showing signs and symptoms associated
with TB are they considered to have
active TB disease. Some people develop
TB disease soon after becoming
infected, before their immune system
can fight back. Other people may get sick
later, when their immune system
becomes weak for some reason.

-
People with weak immune systems are
more vulnerable to TB. This includes
babies and young children, people
infected with HIV and those who have
the following conditions:
 Diabetes mellitus
 Silicosis
 Cancer of the head or neck
 Leukemia
or
Hodgkin’s
disease
 Severe kidney disease
 Low body weight
 Certain medical treatments
such
as:
corticosteroid
treatment
or
organ
transplant

How does a person get TB?
- TB is spread primarily from person to
person through infected air during close
contact. The TB bacteria get into the air
when someone infected with TB of the
lung coughs, sneezes, shouts, or spits. A
person can become infected when they
inhale minute particles of the infected
sputum from the air.
-
It is not possible to get TB by just
touching the clothes or shaking the hand
of someone who is infected. TB germs
spread more easily in crowded
conditions as the bacteria sometimes
stay alive in the air from a few hours,
especially in small closed places with no
fresh air. Fresh air scatters the germs
and sunlight acts as a bactericide, killing
the TB organisms. Exposure to
moderately hot temperatures for
extended period of time is sufficient to
kill these bacteria.
-
Extra-pulmonary TB does not spread
from person to person.
National Tuberculosis Program

Policies in Diagnosis
- Rapid Diagnostic Test (RDT) such as
Xpert MTB/RIF
 Primary diagnostic test for PTB and
EPTB in adults and children
 All presumptive TB patients who are
at risk for MDR-TB shall be referred
for Xpert MTB/RIF testing.
 If not accessible, a SPUTUM
TRANSPORT SYSTEM shall be used or
patient shall be referred to the
nearest health facility with DR-TB
services for screening.
-
Smear
microscopy/SM
(whether
brightfield or fluorescence microscopy)
or
loop
mediated
isothermal
amplification (TB LAMP)
 Alternative diagnostic test if Xpert is
not accessible.
 Unavailability of Xpert MTB/RIF test
shall not be a deterrent to diagnosis
Tb diseases bacteriologically.
 TB Lamp
 May be utilized to process large
sample loads especially in ACF
activities, but not for children,
PLHIV and MDR-TB risk groups
-
If bacteriologic testing is negative or not
available/accessible, patients shall be
evaluated by the health facility physician
who shall decide on clinical diagnosis
based on best clinical judgement.
-
Tuberculin Skin test (TST), aka Purified
Protein Derivative (PPD) test or
Mantoux test
 Shall be used only as an adjuvant when there
is doubt in making a clinical diagnosis of TB
in children. Either 5-TU or 2-TU strength may
be used
 (TU-Tuberculin Units)
 Trained health workers shall do the testing
and reading of TST.
 An induration of atleast 10 mm
regardless of Bacille CalmetteGuerin (BCG) vaccination status or 5
mm
in
immunocompromised
children
(e.g.
severely
malnourished) is considered a
positive TST reaction.

THE END TB STRATEGY (WHO)
- PILLARS
 Bring together critical interventions to
ensure that all people with TB have equitable
access to high-quality diagnosis, treatment,
care and prevention, without facing
catastrophic
expenditure
or
social
repercussions.
 Pillar 1 – Integrated, patientcentered TB care prevention
 Pillar 2 – Bold policies and
supportive systems
 Pillar 3 – Intensified research and
innovation
 Government stewardship and
accountability,
with
no
monitoring and evaluation
 Building a stong coalition with
civil society and communities
 Protecting
and
promoting
human rights, ethics and equity
 Adaptation of the strategy and
targets at country level, with
global collaboration
- PRINCIPLES
 The success of the Strategy in driving down
TB deaths and illness will depend on
countries respecting the key principles as
they implement the interventions outlined in
each pillar.

TB PATIENT CLASSIFICATION (2020)
- NEW
 Has never had treatment for TB or has taken
anti-TB drugs for less than one month
- RETREATMENT
 Has been treated before with anti-TB drugs
for at least one month. This includes the
following:
 RELAPSE
 Previously treated for TB
and declared cured or
treatment completed, but is
presently diagnosed with
active TB disease.
 TREATMENT AFTER FAILURE
 Previously treated for TB but
failed most recent course
based on a positive Sm
follow-up at five months or
later, or a clinically
diagnosed TB patient who
does not show clinical
improvement
anytime
during treatment.
 TREATMENT AFTER LOST TO
FOLLOW UP
 Previously treated for TB but
did not complete treatment
and lost to follow-up for at
least two months in the
most recent course.
 PREVIOUS TREATMENT OUTCOME
UNKNOWN
 Previously treated for TB but
whose outcome in the most
recent course is unknown
 PATIENTS
WITH
UNKNOWN
PREVIOUS TB TREATMENT HISTORY
 Patients who do not fit any
of the categories listed
above
or
previous
treatment
history
is
unknown (this group will be
considered as previously
treated also)
CHN FINALS REVIEWER
Tuberculosis
National Tuberculosis Control Program (NTP)
Q: What is Tuberculosis (TB)?
Tuberculosis (TB) is an infectious disease caused by a
type of bacteria called Mycobacterium tuberculosis. TB
most commonly affects the lungs, when it is called
pulmonary tuberculosis, but also can involve any other
organ of the body in which case it is called extrapulmonary tuberculosis. These FAQs are about
pulmonary TB.
Q: What is TB Infection?
When a person breathes in the TB bacteria, in most
cases, the body is able to get them to stop them from
growing. The bacteria become inactive, but do not die.
They lie latent, and can become active later. This state
is called TB infection. People who are infected with TB
do not feel sick, do not have any symptoms, and cannot
spread the disease. But they could develop TB disease
at some time in the future.
by just touching the clothes or shaking the hand of
someone who is infected. TB germs spread more easily
in crowded conditions as the bacteria sometimes stay
alive in the air for a few hours, especially in small closed
places with no fresh air. Fresh air scatters the germs and
sunlight acts as a bactericide, killing the TB organisms.
Exposure to moderately hot temperatures for extended
periods of time is sufficient to kill these bacteria. Extrapulmonary TB does not spread from person to person.
NATIONAL TUBERCULOSIS PROGRAM
•
•
•
•
•
Q: What is TB Disease?
Not all people with TB infection get active TB disease.
Only when people infected with the TB bacteria start
showing signs and symptoms associated with TB are
they considered to have active TB disease. Some
people develop TB disease soon after becoming
infected, before their immune system can ght back.
Other people may get sick later, when their immune
system becomes weak for some reason.
People with weak immune systems are more
vulnerable to TB. This includes babies and young
children, people infected with HIV and those who have
the following conditions: diabetes mellitus, silicosis,
cancer of the head or neck, leukemia or Hodgkin's
disease, severe kidney disease,low body weight,
certain medical treatments (such as corticosteroid
treatment or organ transplants)
Q: What are the symptoms of Pulmonary TB?
The most common symptoms of TB are chronic cough,
fever, especially rising in the evening, night sweats,
chest pain, weight loss, loss of appetite, coughing up
blood.
POLICIES IN DIAGNOSIS
•
•
•
•
•
Q: How does a person get TB?
TB is spread primarily from person to person through
infected air during close contact. The bacteria get into
the air when someone infected with TB of the lung
coughs, sneezes, shouts, or spits. A person can become
infected when they inhale minute particles of the
infected sputum from the air. It is not possible to get TB
Tuberculosis or TB is an infectious disease
caused by the bacteria called Mycobacterium
tuberculosis
Transmitted from a TB patient to another
person through coughing, sneezing and
spitting.
Thus, close contacts, especially household
members, could be infected with TB.
Lungs are commonly affected but it could also
affect other organs such as the kidney, bones,
liver and others.
TB is curable and preventable. However,
incomplete or irregular treatment may lead to
drug-resistant TB or even death
•
A rapid diagnostic test (RDT), such as Xpert
MTB/RIF, shall be the primary diagnostic test
for PTB and EPTB in adults and children
All presumptive TB patients who are at high risk
for MDR-TB shall be referred for Xpert MTB/RIF
testing. If not accessible, a sputum transport
system shall be used or patient shall be
referred to the nearest health facility with DRTB services for screening
Smear microscopy/SM (whether brightfield or
fluorescence microscopy) or loop mediated
isothermal amplification (TB LAMP) shall be
the alternative diagnostic test if Xpert is not
accessible. Unavailability of Xpert MTB/RIF test
shall not be a deterrent to diagnose TB disease
bacteriologically
TB LAMP may be utilized to process large
sample loads especially in ACF activities, but
not for children, PLHIV and MDR-TB risk
groups
If bacteriologic testing is negative or not
available/accessible, patients shall be
evaluated by the health facility physician who
shall decide on clinical diagnosis based on best
clinical judgment
Tuberculin skin test (TST), also known as
purified protein derivative (PPD) test or
Mantoux test, shall be used only as an adjuvant
when there is doubt in making a clinical
•
diagnosis of TB in children. Either 5-TU or 2-TU
strength may be used (TU-Tuberculin Units)
Trained health workers shall do the testing and
reading of TST. An induration of at least 10 mm
regardless of bacille Calmette-Guerin (BCG)
vaccination
status
or
5
mm
in
immunocompromised children (e.g., severely
malnourished) is considered a positive TST
reaction
TREATMENT REGIMENS FOR DS-TB (2020)
•
•
•
SUPPLEMENT: THE END TB STRATEGY (WHO)
•
•
Patients eligible for Regimen 1 (2HRZE/4HR):
PTB or EPTB (except CNS, bones, joints)
whether new or re- treatment provided there
is an Xpert result with either
o MTB, RIF sensitive, or
o (2) MTB, RIF indeterminate
New PTB or new EPTB (except CNS, bones,
joints) with positive SM/TB LAMP or clinically
diagnosed; when
o Xpert is not done, or
o MTB not detected on Xpert
Patients eligibile for Regimen 2 (2HRZE/10HR)
EPTB of CNS, bones, joints whether new or retreatment provided there is an Xpert result
with either
o MTB, RIF sensitive, or
o (2) MTB, RIF indeterminate
Types of PTB
TB PATIENT CLASSIFICATION (2020)
•
•
•
•
•
•
•
New - has never had treatment for TB or has
taken anti-TB drugs for less than one month
Retreatment - has been treated before with
anti-TB drugs for at least one month. This
includes the following:
Relapse - previously treated for TB and
declared cured or treatment completed, but is
presently diagnosed with active TB disease
Treatment after failure - previously treated for
TB but failed most recent course based on a
positive SM follow-up at five months or later, or
a clinically diagnosed TB patient who does not
show clinical improvement anytime during
treatment
Treatment after lost to follow-up - previously
treated for TB but did not complete treatment
and lost to follow-up for at least two months in
the most recent course
Previous treatment outcome unknown previously treated for TB but whose outcome
in the most recent course is unknown
Patients with unknown previous TB treatment
history - patients who do not fit any of the
categories listed above or previous treatment
history is unknown (this group will be
considered as previously treated also)
DSSM ang test of choice na ginagamit sa ffup testing
since Xpert MTB/RIF cannot differentiate viable vs.
nonviable or dead bacilli
NOMENCLATURE CODE FOR XPERT RESULTS
T - MTB detected, Rifampicin resistance not detected
RR - Rifampicin resistance detected
TI - MTB detected, Rifampicin resistance indeterminate
N - MTB not detected
I - Invalid/no result/error
For patients with MTB but without rifampicin
resistance, they are classified as DS-TB For those with
risk for MDR-TB and found to have rifampicin resistance
on Xpert, another sputum sample is collected for (1)
baseline culture, (2) phenotypic drug susceptibility
testing, and (3) second-line probe assay (LPA) drugsusceptibility test
OLD TB CLASSIFICATION
Department of Health (DOH).
TB Disease classification based on anatomical site and
bacteriological status
Our Vision
A Tuberculosis-Free Philippines Zero deaths, disease,
and suffering due to tuberculosis
Goals
Long-Term Goal (2035)
Reduce TB burden by decreasing TB mortality by 95%
and TB incidence by 90%.
Medium-Term Goals (2022)
Reduce TB burden by:
OLD RECOMMENDED TREATMENT REGIMEN FOR
ADULTS AND CHILDREN
Category of treatments
• Decreasing the number of TB deaths by 50% from
22,000 to 11,000
• Decreasing TB incidence rate by 15% from
554/100,000 to 470/100,000
• Reduce catastrophic costs incurred by TB-affected
households from 35% to 0%.
• At least 90% of patients are satisfied with the services
of the DOTS facilities.
Objectives
Specific Objectives by 2022
• Improve the utilization of TB care and prevention
services by patients and communities.
Guide in Managing adverse Reaction to anti TB drugs
Adverse reactions
• Reduce the catastrophic cost of TB-affected
households accessing DOTS facilities to 0%.
• Ensure adequate and competent human resources
for TB elimination efforts.
• Improve the use of TB data for effective TB
elimination efforts.
• Enhance the quality of all TB care and prevention
services.
• Increase to at least 90% of DOTS facilities that provide
expanded integrated patient-centered TB care and
prevention services.
National Tuberculosis Control Program
About NTP
The National Tuberculosis Control Program, organized
in 1978 and operating within a devolved health care
delivery system, is one of the public health programs
managed and coordinated by the Infectious Diseases
for Prevention and Control Division (IDPCD) of the
Disease Prevention and Control Bureau (DPCB) of the
• Enhance the political stewardship through a highlevel political commitment of national government
agencies and LGUs to implement localized TB
elimination plans in coordination with different sectors.
NTP Mission:
• To reduce TB burden (TB incidence and TB mortality)
• To reduce catastrophic cost of TB-affected households
• To responsively deliver TB service
NTP Mandates:
1. Develop policies, standards, and national strategic
plan
2. Manage program logistics
3. Provide leadership and technical assistance to the
lower health offices/units
4. Manage data and use the information to inform
programmatic activities
5. Conduct monitoring and evaluation
The NTP works closely with various offices of the DOH:
Under the framework of public-private mix (PPM)
collaboration in TB-DOTS, NTP collaborates with
nongovernmental organizations, such as the Philippine
Coalition Against TB (PhilCAT), a consortium of 60
groups, and the 100-year old Philippine TB Society, Inc.
(PTSI), and many others.
Various developmental partners and their projects
provide technical and financial support to NTP, such as
the World Health Organization (WHO), United States
Agency for International Development (USAID), Global
Fund Against AIDS, TB and Malaria (Global Fund),
Research Institute of TB/Japan Anti-TB Association
(RIT/JATA), Korean Foundation for International Health
(KOFIH) and Korean International Cooperation Agency
(KOICA) and KNCV Tuberculosis Foundation.
III. Program Components
•
•
•
•
•
•
•
Health Promotion
Financing and Policy
Human Resource
Information System
Regulation
Service Delivery
Governance
IV. Target Population / Client
Presumptive TB and TB affected households
V. Area of Coverage
The 17 Centers for Health Development (CHD), through
its regional NTP teams, manage the TB program at the
regional level while the PHOs and city health offices
(CHOs), through its provincial/city teams, are
responsible for the TB control efforts in the provinces
and cities.
TB diagnostic and treatment services are part of the
basic integrated health services which are provided by
DOTS (Directly Observed Treatment, Short Course,
current means of delivery of treatment Services)
facilities which could either be the public health
facilities, such as the RHUs, health centers, hospitals;
other public health facilities, such as school clinics,
military hospitals, prison/jail clinics; NTP-engaged
private facilities, such as the private clinics, private
hospitals, private laboratories, drugstores, and others.
Community groups, such as the community health
teams and barangay health workers, participate in
community-level activities
NTP closely works with the 17 government offices and
private organizations incompliance with the
Comprehensive and Unified Policy (CUP) issued by the
Office of the President in 2003.
Nationwide
VI. Partner Institutions
•
•
•
•
Department of Health: Food and Drug
Administration, Bureau of Quarantine
Other Government: DepEd, DSWD, DILG
(BJMP), DOJ (BuCor), PIA, DOLE
Non Government Organizations: PhilCAT, PBSP
International Organizations: WHO, USAID,
GFATM, ICRC, HIVOS-KNCV
Types of Service
PhilHealth Benefit Package
•
•
TB DOTS Outpatient Benefit Package
Konsulta Package (CXR included)
Trainings
•
•
•
•
•
Training on the Revised TB Manual of
Procedures, 6th Edition
Training for Health Workers Providing TB
Services
Training on Xpert MTB/RIF Assay
Training on Direct Sputum Smear Microscopy
Training on Solid TB Culture Processing for
Mycobacterium Tuberculosis
•
•
•
•
•
•
Training on Light Emitting Diode Fluorescence
Microscopy
Training on Quality Assurance for Direct
Sputum Smear Microscopy
TB DOTS Certifiers Training
Training on Infection Control
Training on Provider Initiated Counselling and
Testing (PICT)
Integrated Training on NTP MOP, NAP, and FAST
Plus Strategy
Leprosy
National Leprosy Control Program (NLCP)
LEPROSY
• Leprosy is a chronic, mildly communicable disease
that mainly affects the skin, the peripheral nerves, the
eyes, and mucosa of the upper respiratory tract
CAUSE
• Mycobacterium leprae bacillus
VII. Policies and Laws
MODE OF TRANSMISSION
RA 10767 Comprehensive TB Elimination Plan Act of
2016
• Transmitted via droplets, from the nose and mouth,
during close and frequent contacts with untreated
cases
VIII. Strategies, Action Points and Timeline
SIGNS AND SYMPTOMS
2017-2022 Philippine Strategic TB Elimination Plan
3 CARDINAL SIGNS OF LEPROSY
•
•
•
•
•
•
•
Activate communities and patient groups to
promptly access quality TB services
Collaborate with other government agencies to
reduce out-of-pocket expenses and expand
social protection programs
Harmonize local and national efforts mobilize
adequate and competent human resources
Innovate TB information generation and
utilization for decision making
Enforce standards on TB care and prevention
and use of quality products
Value clients and patients through integrated
patient-centered TB services
Engage national, regional and local
government units/agencies on multi-sectoral
implementation of TB elimination plan
IX. Program Accomplishments and Status
2019 WHO Global TB Report (Cohort of 2018)
•
•
•
•
•
Estimate TB Burden: Mortality 24/100,000
Incidence 554/100,000
Total Notified Cases: 382,543
Treatment Coverage: 63%
Treatment Success Rate, All Forms (2017): 91%
Treatment Success Rate, MDR/RRTB (2016)
58%
•
o The skin lesion can be single or multiple, usually less
pigmented than the surrounding normal skin.
Sometimes the lesion is reddish or copper-colored.
•
March 24 – World TB Day Commemoration
August – Lung Month Celebration
muscles supplied by the affected nerve.
•
-
National Tuberculosis day sa pamamagitan ng
Proclamation No. 840, s. 1996
August 19 is the birth anniversary of Presicent
Manuel Luis Quezon who died of tuberculosis
Positive slit-skin smear
P In a small proportion of cases, rod-shaped, redstained leprosy bacilli, which are diagnostic of the
disease, may be seen in the smears taken from the
affected skin when examined under a microscope after
appropriate staining.
CLASSIFICATION OF LEPROSY
•
•
•
Fidel Ramos of Agosto 19
-
Enlarged peripheral nerve
o A thickened nerve is often accompanied by other
signs as a result of damage to the nerve. These may be
loss of sensation in the skin and weakness of
X. Calendar of Activities
•
•
Skin patch with loss of sensation
•
Leprosy can be classified on the basis of clinical
manifestations and skin smear results.
In the classification based on skin smears,
patients showing negative smears at all sites
are grouped as paucibacillary leprosy (PB),
while those showing positive smears at any site
are grouped as having multibacillary leprosy
(MB)
Patients with tuberculoid leprosy have limited
disease and relatively few bacteria in the skin
and nervescharacterized by a few flat or slightly
raised skin lesions of various sizes that are
typically pale or slightly red, dry, hairless, and
numb to touch
lepromatous patients have widespread disease
and large numbers of bacteria with a much
more generalized disease, diffuse involvement
of the skin, thickening of many peripheral
nerves, and at times involvement of other
organs, such as eyes, nose, testicles, and bone
THE RIDLEY-JOPLING CLASSIFICATION
•
•
•
•
•
•
Tuberculoid (TT)
Borderline tuberculoid (BT)
Mid-borderline (BB)
Borderline lepromatous (BL)
Lepromatous (LL)
Indeterminate (1)
• Avoid direct contact with untreated patients
(especially young children).
• Practice personal hygiene.
• Maintain body resistance by healthful living. Practice
good nutrition.
• Have enough rest and exercise. Keep environment
clean.
National Leprosy Control Program
The National Leprosy Control Program (NLCP) is a multiagency effort to control Leprosy in the country with
private and public partnership in achieving its goals to
lessen the burden of the disease and its mission to have
a leprosy-free country.
Vision: Leprosy-free Philippines by year 2022
Mission: To ensure the provision of comprehensive,
integrated quality leprosy services at all levels of health
care
Goals
• To further reduce the leprosy burden
• By 2022, these targets must be attained:
TT: tuberculoid; BT: borderline tuberculoid; BB: midborderline; BL: borderline lepromatous; LL:
lepromatous; CMI: cell-mediated immunity; AFB: acidfast bacilli; PB: paucibacillary; MB: multibacillary
Diagram representing the different clinical
classifications of leprosy using both the World Health
Organization and the Ridley-Jopling system. The
increase in number of acid-fast bacilli and defects in
cell-mediated immunity are represented in the
continuum from paucibacillary to multibacillary
disease.
TREATMENT
Multidrug therapy (MDT) treatment
•
1. zero G2D rate among pediatric leprosy patients
2. reduction of new leprosy cases to less than one case
per million population
3. no countries with legislation allowing discrimination
on basis of leprosy
Objectives
• To further reduce the disease burden and sustain
provision of high-quality leprosy services for all affected
communities ensuring that the principle of equity and
social justice are followed
• To decrease by 50% the identified hyper endemic
cities and municipalities
Combination of rifampicin, clofazimine, and
dapsone for Multibacillary (MB) leprosy
patients
Rifampicin and dapsone for Paucibacillary (PB)
leprosy patients
The status of leprosy in the Philippines has been
considered to be not a public threat anymore at the
national level, prompting the public health sector to
successfully declare leprosy not a burden in the
majority of our communities.
Treatment of leprosy with only one anti-leprosy drug
will always result in development of drug resistance to
that drug
However, there is still an area of concern at the
subnational level with very low cases in different parts
of the country.
PREVENTION AND CONTROL
As such, the National Leprosy Control Program aims to
sustain the significant progress of eradicating the
disease to achieve zero transmission and disability by
2022.
•
Treat all leprosy cases to prevent spread of infection.
- Dr. Mann
The specific objective of this program is to ensure the
provision of comprehensive, integrated, and quality
leprosy services at all levels of health care in the
country
PROGRAM COMPONENTS
•
•
•
•
•
•
•
•
Early diagnosis and treatment
Integration of leprosy services
Referral system
Case detection and diagnosis
Advocacy and IEC focusing on stigma
discrimination and reduction
Prevention of Deformity, self-care and
rehabilitation
Recording and reporting
Monitoring, supervision and evaluation
PARTNER INSTITUTIONS
•
•
•
•
•
•
•
•
•
World Health Organization
Novartis Foundation
Sasakawa Memorial Health Foundation
Culion Foundation, Inc.
Philippine Leprosy Mission
Cebu Leprosy and TB Research Foundation Inc.
Philippine Dermatological Society
Coalition of Leprosy Advocates and Patients in
the Philippines
International Leprosy Association
POLICIES AND LAWS
• Administrative Order No. 167, s. 1965: Rules and
Regulations of Leprosy Control in the Philippines
• Republic Act No. 4073: An Act further liberalizing the
treatment of leprosy by amending and repealing
certain sections of the revised Administrative Code
• Presidential Decree No. 384 January 30, 1974:
Amending Republic Act No. 4073 entitled An Act
further liberalizing the treatment of leprosy by
amending and repealing certain sections of the revised
Administrative Code
• Proclamation No. 467: Declaring the Last Week of
February of every year as Leprosy Week
• Administrative Order No. 26 - A, s. 1997: Guidelines
on Elimination of Leprosy as Public Health Problem
• Administrative Order No. 5, s. 2000: Guidelines on the
integration of leprosy services in hospitals
• Department memorandum No. 79, s. 2004:
Recommendations to pursue Leprosy Elimination
Activities in all areas in the country
• Department Circular 366-B, s. 2003: First Leprosy
Forum of the Philippine Dermatological Society on
November 12, 2003
• Department Circular 254, s. 2004: Second Leprosy
Forum of the Philippine Dermatological Society on
November 9, 2004
NLCP Strategies and Action Plan
Strengthen local government ownership, coordination
and partnership
• Ensuring political commitment and adequate
resources for leprosy programs at all levels
• Contributing to UHC with a special focus on children,
women and underserved populations including
migrants and displaced people.
• Promoting partnerships with state and non-state
actors and promote intersectoral collaboration and
partnerships at the international, national and subnational level
• Facilitating and conducting basic and operational
research in all aspects of leprosy and maximize the
evidence base to inform policies, strategies and
activities.
• Strengthening surveillance and health information
systems for program monitoring and evaluation
(including geographical information systems)
Stop leprosy and its complications
• Strengthening patient education and community
awareness on leprosy.
• Promoting early case detection through active casefinding in areas of higher endemicity and contact
management.
• Ensuring prompt start and adherence to treatment,
including working towards improved treatment
regimens
• Improving and management of disabilities.
• Strengthening surveillance for antimicrobial
resistance including laboratory network.
• Promoting innovative approaches for training,
referrals and sustaining expertise in leprosy such eHealth (LEARNS)
• Promoting interventions for the prevention of
infection and disease, such as chemoprophylaxis
NLCP Strategies and Action Plan
Stop discrimination and promote inclusion
• Promoting societal inclusion through addressing all
forms of discrimination and
stigma
• Empowering persons affected by leprosy and
strengthen their capacity to participate actively in
leprosy services, such as CLAP
• Involving communities in actions for improvement of
leprosy services.
• Promoting coalition-building among persons affected
by leprosy and encourage the integration of these
coalitions and or their members with other CBOs.
• Promoting access to social and financial support
services, such as to facilitate income generation, for
persons affected by leprosy and their families.
• Supporting community-based rehabilitation for
people with leprosy related disabilities
CALENDAR OF ACTIVITIES
•
•
•
•
World Leprosy Day (Every last Sunday of
January)
Leprosy Control Week (Every 4th week of
February)
National Skin Disease Detection and
Prevention Week (Every 2nd week of
November)
January 31
blood vessels of the body where the females produce
eggs. Some of the eggs travel to the bladder, liver,
intestine, brain, or other organs of the body while the
rest penetrates the wall of the intestine and passes into
the stool.
Q: What are the symptoms of schistosomiasis?
A: Symptoms include:
•
•
•
•
•
•
•
•
•
Bloated stomach
Abdominal pain
Bowel movements may have blood
Swelling of the liver and spleen
Fatigue
Sewing pain
Swimmers itch
Fever cough
Diarrhea
DOH aims to tally eradicate leprosy by 2030
Schistosomiasis
Schistosomiasis Control and Elimination Program
Q: What is schistosomiasis?
A: Schistosomiasis, also known as bilharzia, is a
parasitic disease (fluke) in the blood called Schistosoma
that lives and resides in the bloodstream and in the
human or domestic animal intestines. It can affect the
liver or other organs in the human body. This disease
can be treated.
Q: How does one get schistosomiasis?
A: Infection occurs when your skin comes in contact
with contaminated fresh water in which certain types
of snails that carry schistosomes are living. Freshwater
becomes contaminated by Schistosoma eggs when
infected people openly defecate in fresh bodies of
water or in the environment or surroundings near
these bodies of water. The eggs hatch, and if certain
types of freshwater snails are present in the water, the
parasites develop and multiply inside until it becomes
a "cercaria". The parasite leaves the snail and enters
the water as free-swimming larvae while awaiting the
presence of humans or animals in the water.
Schistosoma parasites can penetrate the skin of
persons who are wading, swimming, bathing, or
washing in contaminated water. Within several weeks,
the parasites mature into adult worms and live in the
DIAGNOSIS
•
•
•
•
Kato-katz technique
Rectal or liver biopsy
Antibody detection
Circumoval precipitin test (ovoid egg with small
hook)
PATHOGENESIS
•
•
•
•
Adult flukes living in the mesenteric or bladder
veins
Evade host defenses by coating themselves
with host antigens
Egg deposition can occur in any organ but most
commonly involves liver, intestines, and lungs.
Main pathology: host granulomatous reaction
to eggs
o Liver granulomas lead to presinusoidal
obstruction, hepatomegaly and portal
hypertension
o Bladder granulomas lead to nodules,
polypoid lesions, and ulcerations in the
lumens of the ureter and bladder,
which in turn causes urinary
frequency, dysuria, and end stream
hematuria
PECTRUM OF DISEASE: Schistosomiasis
• Acute disease
•
•
Itching and dermatitis (swimmer's itch) at
site of cercarial penetration
• Katayama fever/"snail fever"
o Systemic hypersensitivity, resembling
serum sickness
Chronic disease
o Intestinal Schistosomiasis Schistosoma
mansoni Schistosoma japonicum,
o Chronic
liver
disease,
portal
hypertension
→
gastrointestinal
hemorrhage, massive splenomegaly
o Urinary Schistosomiasis – Schistosoma
haematobium
▪ Painless hematuria, fibrosis of
the bladder
▪ Can cause squamous cell
carcinoma of the bladder due
to chronic irritation by the S
haematobium eggs
o Colonic,
pulmonary,
cerebral
schistosomiasis
o Cor pulmonale
LOCAL EPIDEMIOLOGY
Areas of Endemicity
Sorsogon, Samar, Leyte, Oriental Mindoro, Bohol, all of
Mindanao EXCEPT Misamis Oriental
TREATMENT
• Praziquantel
Q: What should you do if you think you have
schistosomiasis?
A: Consult with your healthcare provider in the nearest
health facility within your area when any of the
symptoms mentioned appeared. Also, people living in
endemic areas should regularly participate in the
annual Mass Drug Administration.
Q: How is schistosomiasis diagnosed?
A: Your health care provider may ask you to provide
stool samples to see if you have the parasite. A blood
sample can also be tested for evidence of infection. For
accurate results, you must wait 6-8 weeks after your
last exposure to contaminated water before samples
are taken.
Q: What is the treatment for schistosomiasis?
A: Safe and effective drugs called Praziquantel (PZQ) are
free and available for the treatment of schistosomiasis
provided by a licensed physician or your healthcare
provider. The PZQ drugs are life-saving and are effective
in treating schistosomiasis.
PREVENTION AND CONTROL
▪
•
▪
Schistosomiasis control strategies for endemic
areas include water sanitation programs, mass
treatment, hygiene education, snail control
and vaccine development.
Minimizing contact with fresh water containing
infectious cercarial larvae is an important
control measure.
mass treatment consists of praziquantel
administration (nonpregnant adults, pregnant
women, and children ≥4 years: 40 mg/kg orally
once; children <4 years: contraindicated)
Praziquantel is the recommended treatment against all
forms of schistosomiasis.
Schistosomiasis Control and Elimination Program
Schistosomiasis japonicum is an acute and chronic
disease caused by parasitic worms called trematodes or
blood flukes
It is endemic in the Philippines and is transmitted
through contact with fresh water infested with the
parasite that penetrates human and animal skin
In the Philippines, the total population at risk is
approximately 12.4 million with 2.7 million individuals
directly exposed to the disease
Hence, this program aims to eradicate the transmission
and incidence of Schistosomiasis Infection in all
endemic barangays by 2025
Vision: Schistosomiasis-free Philippines
Mission: Synchronized and harmonized public and
private stakeholders’ efforts in the elimination of
schistosomiasis in the Philippines
Strategies: preventive chemotherapy and infection
control, transmission control, P2P partnerships,
advocacy and social mobilization, and monitoring and
evaluation
Policies
•
•
•
Department Memorandum No. 2020-0260
RA 4539 National Schistosomiasis Control
Commission
Administrative Order No. 2007-0015 Revised
Management and Prevention of SCH
Mosquitos that transmit Filariasis
-
Aedes poecilius
Anopheles flavirostris
Masonia bonnea
Mansonia uniformis
Culex Quinquifaciatus
Breeding sites
-
Abaca plant
Banana plant
Gabi plant
Pandanus plant
Filariasis
National Filariasis Elimination Program
Lymphatic filariasis, considered as a neglected tropical
disease (NTD), is a parasitic disease caused by
microscopic, thread-like worms.
The adult worms only live in the human lymph system.
The lymph system maintains the body’s fluid balance
and fights infections. Lymphatic filariasis is spread from
person to person by mosquitoes.
Wuchereria bancrofti Brugia malayi
-
Most debilitating nematode infection
Salient Features / Presentation
•
•
•
(+) elephantiasis, scrotal hydrocele formation
(+) tropical pulmonary eosinophilia – presence
of Meyers-Kouwenaar bodies (composed of
aggregate of microfilariae surrounded by
acidophilic hyaline material)
(+) Expatriate syndrome - hyperresponsiveness
to maturing worms seen in individuals infected
after migration to endemic regions
SPECTRUM OF DISEASE: Lymphatic filariasis
•
-
-
Management
▪ In individuals infected after migration to
endemic regions
Diagnosis
▪
Clinical
and
immunologic
hyperresponsiveness to the mature or
maturing worms
• THICK blood smear- allows the species identification
lymphatic filarial worms
O BEST TIME TO COLLECT BLOOD SPECIMEN
8PM to 4AM
• Knott's concentration technique - increases the
concentration and detection rate of microfilariae
Treatment
• Diethylcarbamazine (DEC)
Acute disease
Acute
adenolymphangitis/
dermatolymphangioadenitis
Filarial fever
Acute filarial lymphangitis (palpable cord)
Tropical pulmonary eosinophilia
o Small epithelioid granulomas (MeyersKouwenaar bodies), composed of
aggregates of microfilariae surrounded
by acidophilic hyaline material
Expatriate syndrome
•
Chronic disease
o Lymphedema
(most
common
manifestation) which progresses to
elephantiasis
o Hydrocoele: common in Bancroftian
filariasis (scrotum)
o Milky urine (chyluria)
•
•
office and government health facilities in
endemic areas.
Comments: Tablets should be taken after
meals. Total cumulative DEC dose of 72 mg/kg
for W. bancrofti infections.
Precautions:
• Treatment of pregnant women should be
deferred until after delivery.
• Treatment is contraindicated in individuals
with severe cardiac and kidney diseases.
• Individual with asthma, seizure disorders
• or severe malnutrition should be treated
with caution. Do not initiate treatment
when patient has asthma attack. Treat
asthma first before taking antifilarial drugs.
• If patient is less than 2 years of age, refer
to specialist.
• Adverse Reactions
o
o
Localized: Pain, inflammation, and
tenderness of nodules, adenitis,
lymphangitis due to death of adult
filarial worms. Usually begins from 2-4
days after the first dose of DEC.
Systemic: Fever, headache, malaise,
myalgia and hematuria occur due to
death of microfilariae. Usually begin
from few to 48 hours after taking DEC
and are usually self-limited.
Filariasis Elimination Program
Various provinces and areas in the country still
experience an outbreak of Filariasis, which is a disease
caused by parasitic roundworms usually transmitted
through mosquito bites.
LOCAL EPIDEMIOLOGY
•
•
Bancroftian Filariasis
o Sorsogon, Samar, Leyte, Palawan,
Camarines,
Albay,
Mindoro,
Marinduque,
Romblon,
all
of
Mindanao
Malayan Filariasis
o 。 Eastern Samar, Agusan del Sur,
Palawan, Sulu
TREATMENT
Diethylcarbamazine
PREFERRED REGIMEN:
•
•
Day 1: Diethylcarbamazine (DEC) 6mg/kg div 3
doses (after meals) + Albendazole 400mg
Day 2 to Day 12: DEC 6mg/kg div 3 doses DEC
is free and only available at the DOH Central
Consequently, this program aims to eliminate Filariasis
as a public health problem through a comprehensive
approach and universal access to quality health
services that combat the disease such as mass
treatment programs integrated with parasitic control
programs and elimination campaigns.
Policies and Laws
• Administrative Order No. 2021-0003 Guidelines on
the Establishment
of Integrated Elimination Hub for Malaria and
Lymphatic Filariasis
• Administrative Order No. 2021-0001 Guidelines in the
Use of Ivermectin as an Alternative MDA in
Combination with DEC and ALB for the Treatment of LF
• Executive 0369 GMA Establishing the National
Program for Eliminating Lymphatic Filariasis and
Declaring the Month of November of Every Year as
Mass Treatment for Filariasis in Established Endemic
Areas
the P. Falciparum parasite die within 24 hours, if left
untreated.
Vision
Q: Who are most at risk of malaria?
Healthy and productive individuals and families for
filariasis-free Philippines
A: In 2019, the World Health Organization reported 229
million cases of malaria, putting nearly half of the
world's population at risk of the disease. At least 94
percent of the cases were recorded in Africa but people
in Southeast Asia are also among those at risk,
especially those who live near the habitat of
mosquitoes.
Mission
Elimination of Filariasis as public health problem thru a
comprehensive approach and universal access to
quality health services
Malaria
National Malaria Control and Elimination Program
Q: What is malaria?
A: Malaria is a life-threatening disease caused by the
Plasmodium parasite often transmitted to humans
through the bite of the Anopheles mosquito. People
infected with malaria may experience kidney failure,
seizure, coma, and may die, if left untreated.
Q: How is malaria transmitted?
A: Malaria is caused by Plasmodium parasites, mainly:
P. falciparum, P. vivax, P. ovale, and P. malariae. These
parasites are spread through the bites of the female
Anopheles mosquito from an infected person to
another. Specifically, the Anopheles mosquito becomes
a carrier of the parasite when it bites or takes a blood
meal from a person infected with plasmodium
parasites in their bloodstream. The parasites then mix
into the mosquito's saliva which then gets injected into
the next person that gets bitten. Anopheles mosquitoes
often bite between dusk and dawn
Another Plasmodium parasite, P. knowlesi, can also
cause malaria in humans but is transmitted through
macaques rather than mosquitoes. This is called
"zoonotic malaria" and usually occurs in Southeast
Asia.
Malaria cannot be transmitted through close contact,
but mothers who have the disease may pass on the
parasite before and during childbirth. People receiving
blood transfusions and organ transplants, or sharing
needles with infected patients may also contract
malaria.
In the Philippines, only Sultan Kudarat and two towns
in the province of Palawan remain endemic with
malaria. Meanwhile, the following provinces have been
declared malaria-free: Cebu, Bohol, Catanduanes,
Iloilo, Aklan, Capiz, Guimaras, Leyte, Biliran, Camiguin,
Siquijor, Northern Samar, Southern Leyte, Benguet,
Masbate, Cavite, Surigao del Norte, Marinduque,
Western Samar, Eastern Samar, Albay, Sorsogon,
Batangas, Camarines Sur, Batanes Islands, Dinagat
Islands, Romblon, Abra, Quirino, Davao Oriental, Lanao
del Norte, Misamis Occidental, Mountain Province,
Nueva Vizcaya, Misamis Oriental, South Cotabato,
Bataan, La Union, Pangasinan, Ilocos Norte, Surigao del
Sur, Compostela Valley, Ilocos Sur, Kalinga, Bulacan,
Pampanga, Bukidnon, Davao Occidental, Ifugao,
Agusan del Sur, Tarlac, Laguna, Quezon, Antique,
Negros Oriental, Zamboanga del Norte, Zamboanga
Sibugay, Davao del Sur, Sarangani, Agusan del Norte.
MALARIA
• Malaria is a life-threatening disease caused by
plasmodium parasites transmitted by Anopheles
mosquito or rarely through blood transfusion and
sharing of contaminated needles causing acute febrile
illness and symptoms in the form of fever, headache
and chills.
REVISED POLICY AND GUIDELINES ON THE DIAGNOSIS
AND TREATMENT OF MALARIA
•
•
Q: What are the symptoms of malaria?
A: Malaria is an acute febrile disease and symptoms
often occurs within 10-15 days after the infective
mosquito bite. First symptoms usually appear mild like
fever, chills, and headache, but as the disease
progresses, patients may experience anemia, jaundice,
nausea, vomiting, and diarrhea. People infected with
•
Microscopy will continue to be the "gold
standard" for diagnosing malaria
The
Artemether-Lumefantrine
(AL)
combination will be the first line medicine in
the treatment of confirmed uncomplicated and
severe Plasmodium falciparum malaria,
replacing CQ+SP combination If AL is not
available, whether the patient is conscious or
unconscious, and in case of treatment failure,
quinine (QN) in combination with either
tetracycline or doxycycline or clindamycin
(QN+T/D/C x 7 days), will be the second-line
treatment.
In severe malaria cases wherein the patient is
unconscious, and the facility has no capacity to
adequately manage the patient (e.g. naso-
gastric tube or intravenous therapy),
Artesunate (AS) suppository can be introduced
pending transfer of patient to the next level of
care."
Species Differentiation
PREVENTION AND CONTROL
•
•
Strategies to disrupt malaria transmission
include effective deployment of antimalarial
drugs, personal mosquito protection, mosquito
vector control, and research (including vaccine
development)
Personal protection from infection - Potential
tools for personal protection from infection
include use of mosquito repellants and
insecticide
treated
nets,
intermittent
preventive treatment for selected patient
groups
· Insecticide-treated nets
• Pyrethroids are the major
insecticides used routinely for bed
• net treatment
• Long-Lasting Insecticidal Net (LLIN)
insecticide treated nets (ITNs)
RECOMMENDED PROPHYLAXIS
• Atovaquone-proguanil
o take 1 tablet daily (atovaquone 250 mg +
proguanil 100 mg).
o start 1-2 days before entering the malarious
area, continue daily during your stay and
continue for 7 days after leaving.
• Doxycycline
o take 1 tablet daily of 100 mg.
o start 1 day before entering malarious area,
continue daily during your stay and continue
for 4 weeks after leaving.
• Mefloquine
o take 1 tablet of 250 mg (228 mg base) once a
week.
o tart 1-2 weeks before entering the malarious
area, continue weekly during your stay and
continue for 4 weeks after leaving.
Malaria Control and Elimination Program
Malaria is a life-threatening disease caused by
plasmodium parasites transmitted by Anopheles
mosquito or rarely through blood transfusion and
sharing of contaminated needles. Untreated malaria
may progress to severe illness and even death.
The Philippines carried a high burden of malaria
disease in the past but with the unrelenting efforts of
the National Malaria Control and Elimination Program,
cases and deaths have been reduced significantly, and
the country is now inching towards elimination.
Hence, this program aims to eliminate malaria by
adopting a health system focused approach to achieve
universal coverage with quality-assured malaria
diagnosis and treatment, strengthen governance and
human resources, maintain the financial support
needed, and ensure timely and accurate information
management.
Vision
A malaria-free Philippines by 2030
Mission
By 2022, malaria transmission will have been
interrupted in all provinces except Palawan, 75
provinces will have been declared malaria-free, and the
number of indigenous malaria cases will be reduced to
less than 1200, i.e. by at least 75% relative to 2018.
Further accelerate malaria control and transition
towards Elimination
Goal
By 2022, to reduce malaria incidence in the Philippines
by 90% relative to a 2016 baseline and to increase the
number of malaria free provinces from 32 to 74.
Objective 1 (Universal Access) – To ensure universal
access to reliable diagnosis, highly effective and
appropriate treatment and preventive measures
Objective 2 (Governance and Human Resources) - To
strengthen governance and human resources capacity
at all levels to manage and implement malaria
interventions
endemic provinces, cities and municipalities, and must
be sustained in malaria-free areas
Objective 3 (Health Financing) – To secure government
and non-government financing to sustain malaria
control and elimination efforts at all levels
Policy Direction 5
Objective 4 (Health Information and Regulation) - To
ensure quality malaria services, timely detection of
infection and immediate response, and information
and evidence to guide malaria elimination
Overall Policy Direction Efforts will be geared towards
accelerating the program towards elimination,
attainment of malaria -free status and prevention of
reintroduction.
Overall Policy Direction
Efforts will be geared towards accelerating the program
towards elimination, attainment of malaria -free status
and prevention of reintroduction.
Policy Direction 1
Area stratification down to the barangay/sitio level will
be applied on the basis of rate of transmission to guide
the application of appropriate package of interventions
and prioritization of resources. Provinces reaching zero
indigenous malaria will reclassify their barangay
following the elimination framework stratification of
malaria endemic foci with its corresponding
intervention packages.
Policy Direction 2
The program will ensure universal access to early
diagnosis and prompt treatment. Microscopy remains
the gold standard for malaria diagnosis. Rapid
Diagnostic Tests will complement microscopy in
situations where microscopy will not be immediately
available. Treatment must make use of effective antimalarial drugs, with guidance from results of up-todate efficacy studies done in the country.
Policy Direction 3
Universal coverage of vector control measures will also
be ensured. Use of insecticide treated nets (ITN),
particularly the more cost-effective long lasting
insecticidal nets (LLIN) is the main vector control
measure. Indoor residual spraying (IRS) with insecticide
shall be adopted in areas where the use of net is not
culturally acceptable, displaced population and
epidemic situations. IRS will also be done with guidance
from the results of epidemic and foci investigations.
Policy Direction 4
Quality assurance for malaria microscopy, treatment
and vector control measures will be expanded to all
Malaria surveillance will be used as a core intervention
aimed at detecting suspect malaria cases and
confirming every infection for proper classification and
management particularly in areas that have been
assessed to have interrupted transmission and/or
declared malaria-free. Epidemic management and
response will be integrated with the Philippine
Integrated Disease Surveillance and Response (PIDSR)
and established at all levels of administration.
Policy Direction 6
Health Promotion will be enhanced through the
delivery of key messages focused to each group of
stakeholders and according to the stratification
category of areas.
Policy Direction 7
Local capacities of malaria program management will
be strengthened and coordination among and between
levels of administration relative to malaria program
efforts and resources will be streamlined.
Policy Direction 8
Efforts will be exerted for LGU's to design or adopt
financing mechanism to sustain malaria operation
towards elimination and to maintain their malaria-free
status.
Strategy 1.1 Maintain focal malaria interventions in
municipalities and barangays with active foci
Strategy 1.2 Ensure continuous access to malaria
diagnosis, treatment and preventive measures in zeroindigenous malaria and malaria-free provinces
Strategy 1.3 Implement responsive malaria
interventions among identified vulnerable population
groups
Strategy 1.4 Increase demand for and support to
effective anti-malaria interventions and services
Strategy 2.1 Establish functional organizational
structures and malaria work force at all Levels
Strategy 2.2 Strengthen the policy environment,
management systems and coordination mechanism in
support of malaria elimination
Strategy 3.1 Secure adequate government and nongovernment financial resources in support of malaria
control and elimination
Strategy 4.1 Ensure high quality malaria diagnosis and
treatment, through effective quality assurance systems
Strategy 4.2 Maintain high quality and effective vector
control measures
Strategy 4.3 Strengthen malaria case surveillance and
response systems in support of malaria elimination
according to the Malaria Surveillance and Response
Strategy
Strategy 4.4 Maintain effective malaria program
monitoring and evaluation systems
Category List of Provinces