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UNCLASSIFIED Republic of the Philippines 31 October 2012 FORCE HEALTH PROTECTION BRIEF.

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Presentation on theme: "UNCLASSIFIED Republic of the Philippines 31 October 2012 FORCE HEALTH PROTECTION BRIEF."— Presentation transcript:

1 UNCLASSIFIED Republic of the Philippines 31 October 2012 FORCE HEALTH PROTECTION BRIEF

2 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: 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

3 UNCLASSIFIED FORCE HEALTH PROTECTION International SOS/TRICARE Operations Coordinator –Tel: + (65) (Medical Assistance) –Customer Service: –www.tricare.mil/overseaswww.tricare.mil/overseas Fleet Liason USNH Okinawa: –Phone: Points of Contact

4 UNCLASSIFIED 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. FORCE HEALTH PROTECTION NCMI Definitions

5 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!!

6 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

7 UNCLASSIFIED FORCE HEALTH PROTECTION Hand Washing Timing: BEFORE eating BEFORE smoking AFTER bathroom Hand Sanitizer: 70% Alcohol Not as effective as washing

8 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).

9 UNCLASSIFIED Dengue Map FORCE HEALTH PROTECTION

10 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)

11 UNCLASSIFIED FORCE HEALTH PROTECTION 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 Malaria

12 UNCLASSIFIED Malaria Map FORCE HEALTH PROTECTION

13 UNCLASSIFIED FORCE HEALTH PROTECTION 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 Japanese Encephalitis Virus

14 UNCLASSIFIED JEV Map FORCE HEALTH PROTECTION

15 UNCLASSIFIED FORCE HEALTH PROTECTION 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. Leptospirosis

16 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

17 UNCLASSIFIED FORCE HEALTH PROTECTION 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 Local Animals

18 UNCLASSIFIED FORCE HEALTH PROTECTION 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. Travelers’ Diarrhea

19 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

20 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!

21 UNCLASSIFIED 21 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 FORCE HEALTH PROTECTION

22 UNCLASSIFIED 22 Required Immunizations Routine: –Tetanus/diphtheria/ pertussis –Measles (MMR) –Polio –Varicella (chicken pox) Mission-specific: –Hepatitis A –Hepatitis B –Typhoid –Seasonal Influenza –Rabies** Start vaccinations early to accommodate vaccines that require several doses within a series ** For high risk groups only – obtain specific guidance FORCE HEALTH PROTECTION

23 UNCLASSIFIED 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) FORCE HEALTH PROTECTION

24 UNCLASSIFIED References CDC Yellow Book: home.htmhttp://wwwnc.cdc.gov/travel/page/yellowbook home.htm NCMI: https://www.intelink.gov/ncmi/index.phphttps://www.intelink.gov/ncmi/index.php Vector Control: orneDiseaseandControl.aspx orneDiseaseandControl.aspx Shoreland Travax (subscription required): Travel Alerts (State Department): Latest Disease Alerts (PROMED Mail): FORCE HEALTH PROTECTION

25 UNCLASSIFIED Questions? Please contact your local health care provider Navy Environmental and Preventive Medicine Unit No. 6 Duty Phone: Navy Environmental and Preventive Medicine Unit No. 5 Duty Phone:


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