Mystery illness hits Albay town

abs-cbnNEWS.com

Posted at 12/15/2010 12:01 AM | Updated as of 12/15/2010 12:01 AM

ALBAY, Philippines – A mysterious illness has struck residents of Oas town in Albay, health officials said.

The illness, which is suspected to be hepatitis-A, already caused 21 people to fall ill, according to municipal health officer Dr. Marie Jane Revereza.

She said blood samples from the patients have been sent to the National Epidemiological Center for analysis.

The disease first struck 3 weeks ago, according to residents.

It has now spread to 10 villages in Oas town.

The symptoms include vomiting, stomach ache, and yellowish eyes and skin.

An initial investigation by the health office hinted that the illness could be caused by dirty water being used by the villagers. – Report from Edgar Salcedo, ABS-CBN News Bicol

Provincial Health Office: Report on Hepa A in Oas, Albay

Posted on December 17, 2010

The PHO has been closely working with RHU Oas since Monday. Last Wed, upon discussion of the situation with PHO, I have ordered (1) the flushing of the source and all other water collection facilities by Oas water authorities (2) use of boiling water by Oas households (c) chlorination at source by Oas water authorities and (4) checking of pipelines like what FPIC did to identify potential intrusion of dirt or waste.

December 16, 2010

For : HON. JOEY SARTE SALCEDA
Governor
Through : Luis Domingo B. Mendoza, MD, MHA
Provincial Health Officer II
From : Marilyn A. Palattao, RN, MSPH
Supervising Public Health Nurse
Annie Rose A. Clarino, RN
CDD Coordinator
Carolyn G. Rojas, RN
Hepo
Subject : Update on Viral Hepatitis Suspects in Oas, Albay
cc: Hon. Gregorio H. Ricarte
Mayor – Oas
Dr. Marie Jane Revereza
RHU-Oas
Nestor F. Santiago, Jr., MD, MPHC, MHSA, CESO IV
Director IV, Center for Health Development 5
Aurora Teresa M. Daluro, MD
Regional Epidemilogist

Findings:

A. Cases

From morbidity 48th to 50th week there were a total of 69 viral hepatitis (Hepatitis A) suspects in Oas, Albay that had been investigated by the joint Oas RHU and PHO-PESU team.
Above total viral hepatitis suspects were identified in 19 barangays, but majority of cases were in barangay Iraya Norte (Table 1).
Age ranges from 4 – 59 years old. Median 23 years old with no fatality.
Majority (68%) of those affected were males (N=47/69).
All cases had sought consultation in government health facility (Oas Rural Health Unit and JBDMDH).
Majority of cases showed signs of jaundice (yellowish discoloration of the sclera}, fever, dark colored urine, abdominal pain, anorexia (decrease appetite), vomiting and body weakness.
An almost equal percentage of the clients had bought food and ice outside the school, working area and ambulant vendors.

Practices/habits showed that majority had no good handwashing habits.

B. Environmental

On ocular investigation of the water sources, it showed that majority of the cases made use of the municipal water district (Level III). Flushing of Oas Water System was done last December 14, 2010 and bacteriological exam was done still awaits result.

C. Laboratory Results

Bacteriological examination of water samples at Balogo was positive for coliform ( E.coli) contamination.

Action Taken:

A. LGU/RHU

1. Informed the MHO on Hepatitis cases.
2. Conducted MTC of BHS/RHM.
3. Conducted epidemiological investigation/masterlisting.
4. Conducted individual/ERP counseling.
5. Informed the Oas Water System/Mayor/PHO.

B. PHO-PESU

1. Close coordination with the RHU-Oas on the surveillance and monitoring of cases found.
2. Together with the RHU staff conducted the epidemiological investigation.
3. Supplied RHU with chlorine granules.
4. Coordination with the following agencies concerned:
- CHD5 for laboratory services
- RESU 5 for other disease containment measures
- Barangay council for identification and implementation of safe water collection from identified water outlets.
5. Assisted the RHU staff in case finding and disease containment measures.

6. Collected blood specimen and submit them to NEC.


Recommendations:

A. LGU/RHU

1. Flushing of Oas Water System.
2. Chlorination of water source.
3. Conduct epidemiological investigation of suspected cases.
4. Mobilize health workers in concerned areas and other adjacent areas.
5. Massive health education activities in the community during barangay assemblies with emphasis on the following:
- Water collection for drinking water from the identified outlets of safe drinking water
- Water from the identified positive sampling points will only be used for activities other than drinking purposes
- Use of household chlorination and boiling for drinking purposes
- Proper handwashing technique
- Preparation of food in the home and avoidance of utilizing peddled foods, juices and other drinks.
- Preparation of chlorine stock solutions for household chlorination
- Proper waste disposal
6. Continue treatment and management of cases found.
7. Close monitoring and surveillance of suspects.
8. Coordinate closely with the municipal engineering office as to the steps to be undertaken in the repair of the service pipelines or other correctives measures instituted by the said office.
9. Meet the food handlers and conduct rectal swabbing.
10. Meet the water refilling station owners.
11.Coordinate with the private clinics and hospitals for suspects who seek consultations for inclusion in the report and for follow-up.
12. Rectal swabbing of ambulant vendors


B. PHO-PESU
1. Continuous surveillance and monitoring of cases.
2. Assistance to Oas RHU in technical support, medicines and chlorine granules and forms needed.
C. CHD 5 and Regional Laboratory
1. Laboratory services for water and food borne disease identification and confirmation.



Table 1. Barangay Identified with Hepatitis Suspects, Oas, Albay
December 3-16, 2010

source:
http://joeyssalceda.files.wordpress.com/2010/12/pesu-imrad-16-10.pdf

http://joeyssalceda.wordpress.com/2010/12/17/provincial-health-office-report-on-hepa-a-in-oas-albay/

Water-related Diseases Hepatitis

Hepatitis, a broad term for inflammation of the liver, has a number of infectious and non-infectious causes. Two of the viruses that cause hepatitis (hepatitis A and E) can be transmitted through water and food; hygiene is therefore important in their control.

The disease and how it affects people

Among the infectious causes, hepatitis A and hepatitis E are associated with inadequate water supplies and poor sanitation and hygiene, leading to infection and inflammation of the liver. The illness starts with an abrupt onset of fever, body weakness, loss of appetite, nausea and abdominal discomfort, followed by jaundice within a few days. The disease may range from mild (lasting 1-2 weeks) to severe disabling disease (lasting several months). In areas highly endemic for hepatitis A, most infections occur during early childhood. The majority of cases may not show any symptoms; fatal cases due to fulminant acute hepatitis are rare. Nearly all patients recover completely with no long-term effects.

The cause

Hepatitis A and E viruses, while unrelated to one another, are both transmitted via the faecal-oral route, most often through contaminated water and from person to person. Hepatitis A could also be transmitted via food contaminated by infected food-handlers, uncooked foods, or foods handled after cooking. Hepatitis A has also caused outbreaks transmitted through injecting or non-injecting drug use.

Distribution

Both hepatitis A and E are found worldwide. Hepatitis A is particularly frequent in countries with poor sanitary and hygienic conditions (in Africa, Asia, and Central and South America). Countries with economies in transition and some regions of industrialized countries where sanitary conditions are sub-standard are also highly affected, e.g.in southern and eastern Europe and some parts of the Middle East. Outbreaks of hepatitis E have occurred in Algeria, Bangladesh, China, Ethiopia, Indonesia, Iran, Libyan Arab Jamahiriya, Mexico, Myanmar, Nepal, Pakistan, Somalia, and the Central Asian republics of the CIS.

Scope of the Problem

The mortality rate is low (0.2% of icteric cases) and the disease ultimately resolves. Occasionally, extensive necrosis of the liver occurs during the first 6-8 weeks of illness. In such cases, high fever, marked abdominal pain, vomiting, jaundice, and hepatic encephalopathy (with coma and seizures) are the signs of fulminant hepatitis, leading to death in 70-90% of the patients. In these cases mortality is highly correlated with increasing age, and survival is uncommon over 50 years of age. Among patients with chronic hepatitis B or C or underlying liver disease, who are super infected with hepatitis A virus, the mortality rate increases considerably.

Improved economic and sanitary conditions may lead to a higher disease incidence in older age groups, with higher reported rates of clinically evident hepatitis A. In countries with very low hepatitis A infection rates, the disease may occur among specific risk groups such as travelers. Hepatitis E is mainly found in young to middle-aged adults. Women in the third trimester of pregnancy are especially susceptible to acute fulminant hepatitis arising from hepatitis E infection.

Interventions

As there are no specific antiviral drugs against hepatitis A and E, prevention of these viral diseases remains the most important weapon for their control, such as:

* Providing education on good sanitation and personal hygiene, especially hand-washing
* Adequate and clean water supplies and proper waste disposal
* Vaccination against hepatitis A for persons at risk, e.g. travelers visiting areas where the disease is common.

Prepared for World Water Day 2001. Reviewed by staff and experts from the cluster on Communicable Diseases (CDS) and the Water, Sanitation and Health unit (WSH), World Health Organization (WHO).

http://www.who.int/water_sanitation_health/diseases/hepatitis/en/