In 2012, the World Health Organization Regional Committee for the Western Pacific Region (WPR) reaffirmed its commitment to eliminate measles and urged WPR member states to interrupt endemic measles virus transmission as rapidly as possible. In 2013, a large measles outbreak occurred in the Philippines despite implementation of measles elimination strategies including a nationwide supplemental immunization activity (SIA) in 2011 using measles- and rubella-containing vaccine and targeting children aged nine months to seven years. To prevent future measles outbreaks a new tool was developed to assess district-level risk for measles outbreaks, based on the WPR polio risk assessment tool previously applied in the Philippines. Risk was assessed as a function of combined indicator scores from four data input categories: population immunity, surveillance quality, program performance, and threat assessment. On the basis of the overall score, the tool assigned each district a risk category of low, medium, high, or very high. Of the 122 districts and highly urbanized cities in the Philippines, 58 (48%) were classified as high risk or very high risk, including the district of the Metro Manila area and Region 4A where the outbreak began in 2013. Risk assessment results were used to guide the monitoring and supervision during the nationwide SIA conducted in 2014. The initial tool drafted in the Philippines served as a template for development of the global risk assessment tool. Regular annual measles programmatic risk assessments can be used to help plan risk mitigation activities and measure progress toward measles elimination.
Background: Enteroviruses (EVs) are most commonly associated with either mild or asymptomatic infections, however, the presence of silent carriers in the community has been proven to play a crucial role in the spread of diseases such as hand, foot, and mouth disease (HFMD) that records high incidence in Asia Pacific region. In the Philippines, limited information is available on the etiology and prevalence of enterovirus outside the Acute Flaccid Paralysis (AFP) surveillance, thus, a study to determine the baseline prevalence of Non-Polio Enteroviruses (NPEVs) among healthy Filipino children was conducted. Methods: A descriptive, cross-sectional study was performed to determine the prevalence of NPEV among healthy children under 6 years old in the Philippines. Duplicate stool samples were collected from 360 healthy children residing in three major urban cities in the country. Virus isolation and polymerase chain reaction were performed to identify enteroviruses present in the samples. To determine if the results of the study are comparable to the AFP surveillance data, the results of the study were compared to the prevalence and isolation rate among AFP cases of the similar cases collected the same year. Results: Prevalence of enteroviruses among healthy children was found to be at 24.7%. Comparing the NPEV rates from the study and AFP surveillance of similar age and the same year of collection, there was no significant difference in NPEV case prevalence. The study identified a total of 19 different enterovirus serotypes with majority belonging to species Enterovirus B (EV-B). Conclusion: The study was able to establish a baseline NPEV case prevalence of 24.7% among healthy children aged under 6 years old in three major urban sites in the Philippines. The high isolation of NPEV among healthy children signifies continuous fecal-oral transmission of enteroviruses in the community.
Background One of the indicators of a properly functioning Acute Flaccid Paralysis (AFP) surveillance is the proportion of stool samples in which non-polio enteroviruses (NPEV) are detected. Typically, this proportion is expected to be above 10% in tropical countries, however, the Philippines only averages 6.5% NPEV isolation rate. With continued threat of possible importation of wild poliovirus, the current NPEV rate prompted concerns about the quality of the AFP surveillance, in particular, stool sample management and transportation being performed in the field. To know whether the low NPEV rates gathered from AFP cases is a reflection of the true prevalence in the Philippines, a stool survey of healthy children 0-5 years old from three urban communities was conducted in 2015.Methods Two stool samples were collected from three hundred sixty healthy children. Virus isolation and Polymerase Chain Reaction was performed to identify enteroviruses in the samples. The results were compared to the prevalence and isolation rate among AFP cases the same year.Results Results show a prevalence of 24.7% which is higher than 12.4% prevalence rate among AFP cases the similar year. However, analysis of AFP cases between 0-5 years old showed prevalence of 20.8% (p-value 0.33) which is not significantly different when compared to the study.Conclusion This study supports the idea that the observed low NPEV rate in the country may be due to low number of NPEV prevalence. However, further investigations on all possible data sources for NPEV such as among hand, foot, and mouth disease (HFMD), and aseptic meningitis cases, may be necessary to fully understand the occurrence of NPEVs in the country.
Background Enteroviruses are most commonly associated with either mild or asymptomatic infections, however, the presence of silent carriers in the community has been proven to play a crucial role in the spread of diseases such as HFMD that records high incidence in Asia Pacific region. In the Philippines, limited information is available on the etiology and prevalence of enterovirus outside the Acute Flaccid Paralysis (AFP) surveillance. Methods Duplicate stool sampleswere collected from 360 healthy children. Virus isolation and polymerase chain reaction were performed to identify enteroviruses present in the samples. To determine if the results of the study are comparable to the AFP surveillance data, the results of the study were compared to the prevalence and isolation rate among AFP cases of the similar cases collected the same year. Results Prevalence of enteroviruses among healthy children was found to be at 24.7%. Comparing the NPEV rates from the study and AFP surveillance of similar age and the same year of collection, there was no significant difference in NPEV case prevalence.The study identified a total of 19 different enterovirus serotypes with majority belonging to species Enterovirus B (EV-B). Conclusion The study was able to establish a baseline NPEV case prevalence of 24.7% among healthy children aged under 6 years old in three major urban sites in the Philippines. The high isolation of NPEV among healthy children signifies continuous fecal-oral transmission of enteroviruses in the community. Surveillance of other diseases caused by EVs, such as HFMD and meningitis is necessary in order to complete the picture of EV circulation in the Philippines.
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