Current Pandemic H1N1 Updates in the Philippines Department of Health, Philippines Juan M. Lopez, MD, PGradDipPH, MPH Aldrin Q. Reyes, RN

Pandemic H1N1 Timeline Late April 2009: First cases of a novel influenza A (H1N1) virus infection reported in Mexico and US May 2009: the Philippines along with other countries in Asia reported their first cases of influenza from travellers who had come from or visited countries from North and Central America. 11 June 2009: with nearly 30,000 cases reported worldwide, a full pandemic alert was declared by the World Health Organization (WHO). July 2009: the Strategic Advisory Group of Experts (SAGE) on Immunization advised WHO and its member countries that since the spread of the pandemic virus is considered unstoppable, vaccines for the pandemic will be needed in all countries. It emphasized importance of striving to achieve equity among countries to access vaccines developed against pandemic (H1N1) 2009 Department of Health, Philippines

*A (H1N1)= 5,885 Laboratory Confirmed

Current Situation Teenagers & young adults continue to account for the majority of cases, with rates of hospitalization highest in very young children. Between 1% to 10% of patients with clinical illness require hospitalization. Of hospitalized patients, from 10% to 25% require admission to an intensive care unit, and from 2% to 9% have a fatal outcome. Overall, from 7% to 10% of all hospitalized patients are pregnant women in their second or third trimester of pregnancy. Pregnant women are ten times more likely to need care in an intensive care unit when compared with the general population. Department of Health, Philippines

Pandemic H1N1 Timeline October 2009: The Philippine government sought to ensure availability of vaccine supplies by requesting donated vaccines from WHO. November 2009: WHO pledged to provide free supplies of at least 9 million doses of the vaccine to the Philippines for the purpose of immunizing persons who have been prioritized in accordance with the Philippines’ outbreak measures and preparedness plans. – To be obtained from actual vaccine donations from countries that have expressed their willingness to share their supplies with the developing world. – To cover about 10% of the population and would be given primarily to health workers and to priority groups in the population who would be at most risk for severe outcomes of H1N1 infection. – Additional vaccines for 2010 are expected to be procured by the DOH to augment the donated vaccines from WHO. Department of Health, Philippines

Prioritization of population groups for vaccinations As available vaccines will not be initially sufficient for each country, a step-wise approach to vaccinate particular groups will be implemented. The following groups are recommended to be prioritized in the vaccine administration: Department of Health, Philippines

Prioritization of Population Group 1.Health Care Personnel / Frontline Responders 2.Pregnant Women 3.Person > 6 months to 60 years of age 4.Persons above > 5 years old & < 60 y/o with underlying chronic medical conditions Department of Health, Philippines

Ethical Dilemmas Definitions: Suspect cases, Case under investigation (CUI), Case under observation (CUO) (EI: Respect for person/autonomy) Contact tracing: Central Office, Centers for Health Development (CHDs), Local Government Units (LGUs) (EI: Health-care worker’s obligation; stigmatization or isolation) Standard of Care: When to give Oseltamivir? Who will be given Oseltamivir? (EI: Equity, Proportionality, Utility) Department of Health, Philippines

Ethical Dilemmas Who releases Oseltamivir to the referral hospitals? To the non-referral government hospitals? To the private hospitals? Who picks up suspected cases from non- referral hospitals and brings them to referral hospitals? When to use N95 mask? When will the community uses masks? (EI: Equity,Proportionality, Utility) Department of Health, Philippines

Ethical Dilemmas Prophylaxis and treatment Laboratory examinations: Payment Referral Hospitals and laboratory centers for AH1N1 Examination Closing schools, hotels; isolation, quarantine of a village If the epidemic will be extended: Issues on the role, obligations and benefits of health care workers Department of Health, Philippines

How will the Ethical Issues be incorporated into the current plan? 1.Clinical Management and the Use of Anti-virals for Influenza A (H1N1) Virus Infection 2.Infection Control and use of Personal Protective Equipment in Influenza A (H1N1) Virus Infection 3.Laboratory Diagnosis of Influenza A (H1N1) 4.On Public Gatherings in Response to Influenza A (H1N1) Virus Threat 5.Likely to be Positive for Influenza A (H1N1) Viral Infection. Department of Health, Philippines

6. For Hotels and Other Similar Establishments in Response to the Influenza A (H1N1) Virus Threat 7. On the Enhanced Surveillance of Influenza A (H1N1) 8. Use of Anti-viral Drugs for Close Contacts of Probable and Confirmed Cases of Influenza A (H1N1) and the Prevention of the Disease at Home 9. Safety Precautions to Avoid Influenza A (H1N1) Virus Infection on the Job for Health Care Workers Department of Health, Philippines

10. Prevention and Control of Influenza A (H1N1) in Schools 11. Risk Communication as a Health Sector Response to the Influenza A (H1N1) Virus Outbreak 12. Response Level Guide for Schools to Control Novel Influenza A (H1N1) 13. Influenza A (H1N1) Prevention and Control at the Workplace 14. Influenza A (H1N1) Contact Tracing Department of Health, Philippines

15. Procedures in Relation to the Influenza A (H1N1) Virus Outbreak 16. Technical Guidelines - Containment to Mitigation 17. On Revised Clinical Case Management of Influenza A (H1N1) Virus Infection 18. Revised Response Level Guide for Schools 19. Mitigation Response to the Influenza A (H1N1) Virus Infection. 20. Control of Influenza A (H1N1) Virus Infection in Residential Institutions Department of Health, Philippines

21. On the Shift of Reporting from Influenza A (H1N1) Enhanced Surveillance to ILI Surveillance 22. Clinical Management Guidelines Department of Health, Philippines

Ongoing activities Close coordination between the Philippine Department of Health, the WHO and donor agencies such as USAID and UNICEF Awaiting the arrival of vaccines from WHO Pandemic vaccination campaign about to commence on April 26, 2010 Department of Health, Philippines

Thank You! Department of Health, Philippines