Is your drinking-water safe? A rotavirus outbreak linked to water refilling stations in the Philippines, 2016.

INTRODUCTION: In April 2016, the Department of Health in Zamboanga Peninsula reported an increase in the number of acute gastroenteritis cases reported from Zamboanga City. An epidemiologic investigation was conducted to verify the existence of an outbreak, determine source/mode of transmission and recommend control measures. METHODS: A line list of cases was compiled from the 11 hospitals within Zamboanga City and a case-series study was conducted. Suspected cases were any persons from Zamboanga City who had three or more episodes of acute diarrhoea within 24 hours from 15 March to 29 May 2016. Confirmed cases were suspected cases with active symptoms during the investigation who had a stool sample collected with rotavirus detected. Water samples were also collected for viral detection. RESULTS: There were 2936 suspected cases with 22 deaths (case fatality rate: 0.75%), an age range of 8 days to 89 years (median: 2 years), with those aged less than 5 years the most affected age group (1903/2936, 65%). The majority were males (1549/2936, 53%). From the 138 active case patients included in the case-series study, the majority reported contact with a family member who had diarrhoea (89/138, 64%) and using water refilling stations as their major source of drinking-water (88/134, 64%). Of the 93 stool specimens collected, 56 (60%) were positive for rotavirus. Five samples from water refilling stations where case patients reported collecting drinking-water were all positive for rotavirus. DISCUSSION: Strict regulation of water refilling stations and boiling drinking-water in households were implemented, immediately controlling the outbreak. After complying with all the requirements set by the Department of Health, a water safety certificate was awarded to Zamboanga City in September 2018.

Consumption of barracuda in the Caribbean Sea linked to ciguatera fish poisoning among Filipino seafarers.

INTRODUCTION: Ciguatera fish poisoning (CFP) is common in tropical and subtropical waters. On 13 November 2015, eight Filipino seafarers from a cargo ship sailing in the Caribbean Sea experienced a range of symptoms after consuming a barracuda. Upon their return to the Philippines, an investigation was conducted to describe the cases. METHODS: A case-series was conducted. A CFP case was defined as a previously well individual on the ship who developed at least one gastrointestinal symptom and at least one neurologic manifestation after eating barracuda on 13 November 2015. All cases were admitted to hospital in Manila, Philippines and were interviewed using a standard questionnaire. Urine and serum samples of cases were collected for ciguatoxin (CTX) testing by radiological and receptor-binding assay. RESULTS: Eight of the 25 seafarers on the ship ate the barracuda; all eight met the CFP case definition. The age of cases ranged from 37 to 58 years (median: 47 years) and all were males. Onset of symptoms ranged from 1 to 3 hours (median: 2 hours) from the time of ingestion of the barracuda. All cases experienced gastrointestinal (nausea, vomiting, diarrhoea) and neurologic (temperature allodynia, itchiness) symptoms but no cardiovascular manifestations. Urine and serum specimens of all eight cases showed CTX below the detection limit. DISCUSSION: The Philippines Epidemiology Bureau recommended that the Philippine Maritime Authority include CTX poisoning and its health risks in seafarers' training to prevent future cases of CFP. The Event-based Surveillance and Response system will continue to provide a mechanism for the reporting and appropriate management of CFP cases.

An assessment of the case notification system 16 months after Typhoon Haiyan in Region 8, the Philippines.

INTRODUCTION: The Philippines Department of Health uses the Philippine Integrated Disease Surveillance and Response (PIDSR) system to monitor 25 diseases and syndromes that have the potential to cause outbreaks. The focus of this system is to strengthen the capacity of local government units for early detection and response to outbreaks. After Typhoon Haiyan, routine disease surveillance activities were suspended at the Epidemiology and Surveillance Units (ESUs) at the city and provincial levels, as well as laboratory services; surveillance resumed as soon as local conditions allowed. METHOD: We conducted an assessment of PIDSR in March 2015, 16 months post-Haiyan, in Region 8, the most heavily affected region. We used key informant interviews and a review of data from the system to assess the core surveillance and support functions. RESULTS: All ESUs reported they were performing all surveillance core functions, although laboratory confirmation needed to be strengthened at the regional reference laboratory. Access to working communication equipment also needed improvement as did timeliness and completeness of reporting. DISCUSSION: Assessment of surveillance activities, resources and quality should be conducted post-disaster. The strength and operations of the disease surveillance system usually requires support from the local, regional and national governments, especially if there are legal mandates and legislation that includes the system in disaster planning. Regular monitoring of the system is recommended to ensure stability, system development, increased outbreak detection and fewer morbidities and fatalities.