UNCLASSIFIED
FORCE HEALTH PROTECTION BRIEF
Republic of the
Philippines
31 October 2012
UNCLASSIFIED
FORCE HEALTH PROTECTION
Philippines
Historical diseases present in area: Diarrhea, hepatitis A/B, typhoid, dengue,
malaria, JEV, chikungunya, typhus, leptospirosis, hantavirus
Recent Disease Reports: Chikungunya, Hepatitis A, Leptospirosis, Hand, Foot, and
Mouth Disease (EV71), Rabies, Schistosomiasis, Measles, Ciguatera
Force Health Protection Requirements: Up-to-date immunizations, anti-malarial
protocols, JE vaccination required for RON personnel, day and night time insect
precautions, Pre/Post Deployment PPD, and use approved water and food sources.
Medical infrastructure: Private hospitals have better quality of care than public. For
severe illness or injuries utilize Commander 7th Fleet Annex “Q” requirements for
medical treatment.
Environmental Hazards: 15-20 typhoons per year. Untreated water throughout the
country and in resorts. Food contamination risk is high. Rainy season May-October.
Assessment: High risk for infectious diseases.
31 Oct 2012
UNCLASSIFIED
FORCE HEALTH PROTECTION
Points of Contact
•
International SOS/TRICARE Operations Coordinator
– Tel: + (65) 6338 9277 (Medical Assistance)
– Customer Service: 1-877-563-9228
– www.tricare.mil/overseas
•
Fleet Liason USNH Okinawa:
– NHOki-Fleet@med.navy.mil
– Phone: 090-6861-4208
UNCLASSIFIED
FORCE HEALTH PROTECTION
NCMI Definitions
HIGH RISK:
High operational impact due to disease
affecting large percentage or causing severe disease in smaller
percentage of personnel.
INTERMEDIATE RISK:
Disease affects smaller
numbers, causes mild symptoms in larger numbers. Diseases
with unknown impact may fit here as well.
LOW RISK:
Minimal impact on operations due to low
likelihood of cases.
UNCLASSIFIED
FORCE HEALTH PROTECTION
Food & Water
Water is poorly treated even in municipal systems
•Drink only from approved sources
•Treat field water IAW military public health recommendations
Eat only from approved sources
•If necessary, follow these rules
•Eat fully cooked veggies/beans/rice/meats while they are hot (and watch them
being cooked)
•Breads, hard skinned fruits you peel yourself (bananas, oranges), hot tea are
lower risk
•High risk: reef fish (even well cooked), dairy, undercooked/uncooked
meats/vegetables, leftovers, opened beverage containers, ice, frozen dessert,
juice, locally canned/packaged products
•Wash hands before eating!!
UNCLASSIFIED
FORCE HEALTH PROTECTION
Personal Protective Measures
Insect Precautions
•30-35% DEET is adequate
•Reapply DEET every 4-5 hours
•Both day and night biting mosquitoes
•Treat uniforms/outer wear with Permethrin
•Mosquito netting/screens in windows
Blood/Secretion Borne Pathogens
•Avoid sexual contact with local population (HIV, GC,
Chlamydia, Hep B risks)
Respiratory Precautions
•TB risk is intermediate
UNCLASSIFIED
FORCE HEALTH PROTECTION
Hand Washing
Timing:
BEFORE eating
BEFORE smoking
AFTER bathroom
Hand Sanitizer:
70% Alcohol
Not as effective as washing
UNCLASSIFIED
FORCE HEALTH PROTECTION
Dengue and Dengue Hemorrhagic Fever
•
Causative Agent: Virus (Flavivirus).
•
Transmission: Bites of Aedes
mosquitoes--day biters.
Symptoms: Fever, severe headache
(retroorbital), backache, joint pains,
nausea, vomiting, eye pain and rash
(hemorrhagic fever and shock
syndrome are rare without prior
exposure).
Treatment: Supportive (bed rest,
fluids, fever control, NSAIDs, avoid
aspirin and salicylates)
Prevention: No vaccine available;
eliminate artificial containers that hold
water, personal protective measures
(DEET, permethrin, netting).
•
•
•
UNCLASSIFIED
FORCE HEALTH PROTECTION
Dengue Map
UNCLASSIFIED
FORCE HEALTH PROTECTION
Chikungunya Fever
•
Agent - alpha virus of Togaviridae
family
•
Vector - Aedes aegypti and Aedes
albopictus (pictured, right) mosquitoes
(day biters)
•
Signs/Symptoms - fever, severe joint
pains, headaches, muscle aches,
back pain, rash (7-10 days)
•
Prevention - Insect repellent (DEET
on skin, permethrin on clothing/bed
nets), screens for doors and windows,
eliminate standing water
•
Treatment – Support (rest, fluids,
NSAIDs (steroids/narcotics if
unresponsive to NSAIDs)
UNCLASSIFIED
FORCE HEALTH PROTECTION
Malaria
• Agent - Plasmodium falciparum
(60-75%), P. vivax (20-40%)
• Vector – Anopheles flavirostris
(night biters).
• Signs/Symptoms - Cycles of
chills, fever, sweating, vomiting
and yellowing (jaundice) of the
skin/eyes.
• Prevention - Deet, permethrin
treated bed nets/clothing and use
of insecticides.
• Prophylaxis – Doxycycline,
Malarone, Mefloquine
• Treatment – Quinine +
(doxycycline or clindamycin) or
Malarone or Artemesin
UNCLASSIFIED
FORCE HEALTH PROTECTION
Malaria Map
UNCLASSIFIED
FORCE HEALTH PROTECTION
Japanese Encephalitis Virus
•
Agent – Flavivirus, JEV
•
Vector – Culex spp (mosquitoes),
night biters
•
Signs/Symptoms – acute
encephalitis, aseptic meningitis, fever,
headache, vomiting
•
Prevention – Deet, permethrin
treated bed nets/clothing and use of
insecticides.
•
Vaccine – Ixiaro (2 shot series); If
staying >30 days in higher risk area or
shorter stays with significant rice
field/rural exposure
•
Treatment - Supportive
UNCLASSIFIED
FORCE HEALTH PROTECTION
JEV Map
UNCLASSIFIED
FORCE HEALTH PROTECTION
Leptospirosis
•
Causative Agent: Leptospira, a spirochete
•
Transmission: Infection of abrasions, mucus
membranes from contact with infected water,
soil, urine, reproductive fluids
•
Symptoms: May have mild flu-like illness or
as bad as Weil’s syndrome with jaundice,
renal failure, hemorrhage, myocarditis,
arrhythmias, meningitis, pulmonary
hemorrhage.
•
Treatment: Doxycycline, IV PCN (severe
cases); monitor closely
•
Prevention: Avoid contact with potentially
contaminated fresh water; vaccinate animals.
If water contact unavoidable, consider
doxycycline prophylactically.
UNCLASSIFIED
Schistosomiasis
• Moderate risk in Mindanao, Samar, Leyte
Islands, Sorsogon (south Luzon),
eastern Mindoro
• Avoid exposure to freshwater
• No chemoprophylaxis measures
available
• Larvae penetrate intact skin
UNCLASSIFIED
FORCE HEALTH PROTECTION
Local Animals
• Rabies control is poor.
• Do not feed or attempt to
touch animals, including
birds and monkeys.
• Wash bites immediately with
water and soap (preferably
betadine).
• Report bites immediately.
• Consider rabies
preexposure prophylaxis if
working with animals
UNCLASSIFIED
FORCE HEALTH PROTECTION
Travelers’ Diarrhea
•
Transmission: Various; tainted food
and water, poor sanitation.
•
Signs/Symptoms: Abdominal
cramping/pain, fever, and loose
watery stools lasting 3-4 days.
•
Prevention: See previous slide on
food/water preparation.
•
Treatment: Ciprofloxacin for 3 days
and Imodium AD (Loperamide). Do
not take Imodium if you have blood
in your stool.
UNCLASSIFIED
FORCE HEALTH PROTECTION
Tuberculosis (TB)
•
Causative Agent: Bacteria
(Mycobacterium tuberculosis).
•
Transmission: Airborne droplet via
respiration.
•
Symptoms: Cough, fatigue, night
sweats, fever and rapid heart rate.
•
Treatment: Antibiotics and
respiratory isolation.
•
Prevention: No vaccine available,
avoid contact with persons with
active TB, and annual screening for
TB. Avoid prolonged periods in
enclosed public spaces and on
public transportation. Wear N95
mask in contact with known cases.
M. tuberculosis
UNCLASSIFIED
FORCE HEALTH PROTECTION
Sexually Transmitted Disease
HIGH = Hepatitis B
INTERMEDIATE RISK = Gonorrhea, HIV/AIDS,
Chlamydia.
FHP Requirements
• Avoid sexual contact.
• Use latex condoms if
sexually active.
• Use Condom Sense!
UNCLASSIFIED
FORCE HEALTH PROTECTION
Required Health Measures
•
•
•
•
Immunizations (see next slide)
Malaria chemoprophylaxis
Mosquito & insect bite prevention
Pre-mission health assessment
– Include Tuberculosis (TB) screening test
• Obtain personal medication
21
UNCLASSIFIED
FORCE HEALTH PROTECTION
Required Immunizations
• Start vaccinations early to accommodate vaccines
that require several doses within a series
• Routine:
– Tetanus/diphtheria/
pertussis
– Measles (MMR)
– Polio
– Varicella (chicken
pox)
• Mission-specific:
–
–
–
–
–
Hepatitis A
Hepatitis B
Typhoid
Seasonal Influenza
Rabies**
** For high risk groups only – obtain specific guidance
22
UNCLASSIFIED
FORCE HEALTH PROTECTION
Summary
•Philippines is a country with frequent natural
disasters and internal turmoil
•Philippines has a high infectious disease risk
•Personal protective measures go a long way
(hand washing, mosquito precautions, animal
avoidance, food and water safety)
UNCLASSIFIED
FORCE HEALTH PROTECTION
References
•CDC Yellow Book: http://wwwnc.cdc.gov/travel/page/yellowbook2012-home.htm
•NCMI: https://www.intelink.gov/ncmi/index.php
•Vector Control:
http://phc.amedd.army.mil/topics/envirohealth/epm/Pages/MosquitoB
orneDiseaseandControl.aspx
•Shoreland Travax (subscription required): http://www.travax.com
•Travel Alerts (State Department):
http://travel.state.gov/travel/cis_pa_tw/cis/cis_999.html
•Latest Disease Alerts (PROMED Mail): http://www.promedmail.org/
UNCLASSIFIED
Questions?
• Please contact your local health care provider
• Navy Environmental and Preventive Medicine Unit No. 6
Duty Phone: 808-471-0237
NEPMU6-THREATASSESSMENT@med.navy.mil
• Navy Environmental and Preventive Medicine Unit No. 5
Duty Phone: 619-556-7070
nepmu5@med.navy.mil