Friday, August 25, 2017

Philippines DOH: Monitoring Additional Poultry Workers With `Flu-Like' Symptoms


With the double caveats that the Philippines' regular flu season typically runs from June through November, and that human infections with H5N6 have only rarely been reported, the morning papers are filled with headlines regarding (up to) 34 poultry workers who are being monitored after developing `flu-like' symptoms.
34 suspected bird flu cases in Philippines - Reuters
Ten days ago we saw reports of the Philippine DOH Monitoring Two `Symptomatic' Farm Workers who were subsequently reported as testing `negative' It appears that since then, a number of additional `suspect' cases have been identified.

The Philippine DOH has published the following statement emphasizing that NO confirmed infections have been detected, and that all have been placed in isolation and put on antivirals.  All reasonable steps, given the circumstances. 


The Department of Health (DOH) announced that as of August 24, 2017, there has been NO confirmed human case due to Influenza A H5N6. Since the Department of Agriculture’s (DA) declaration of the bird flu outbreaks in early August, the DOH was able to identify 34 suspect cases (30 from Pampanga and 4 from Nueva Ecija).  They were promptly placed in isolation as part of precautionary measures to avert any possible human to human transmission of infection. Thus, they were also started on the antiviral Oseltamivir while awaiting the laboratory results from the Research Institute for Tropical Medicine (RITM).  As of yesterday 24 August, all were negative for Influenza A H5N6.

In Region III, the DOH has designated the Dr. Jose B. Lingad Memorial Medical Center in San Fernando City, Pampanga and the Dr. Paulino Garcia Memorial and Research Medical Center in Cabanatuan City as referral hospitals for assessment of suspect cases and collection of specimen for laboratory diagnosis. 

In response to this current health threat we are facing, we are working closely together with the DA to ensure that poultry and poultry by products are safe for consumption. We at the DOH are doing everything to effectively respond to this infection.  With our partners, we are actively disseminating public health advisories on the prevention of the transmission of bird flu virus to the human population.

Likewise, our DOH epidemiologic surveillance and response system is active and in place. Trained disease surveillance officers and health workers have been alerted to investigate and report suspected human cases within 24 to 48 hours.

“I have ordered the formulation of the Interim Guidelines, Standards and other Instructions in the Implementation of Enhanced Human Avian Flu Surveillance Management, and Infection Control in the Health Setting.  Further, I directed the pre-emptive positioning of necessary commodities to protect against bird flu transmission to humans such as Personal Protective Equipment (PPE) and anti-viral medicines to DOH Region Office III,” Secretary Paulyn Jean Rosell-Ubial stated.

RITM, as the national reference laboratory, is prepared to receive samples for detection. While the designated referral hospitals (San Lazaro Hospital, RITM and Lung Center of the Philippines) are on heightened alert status with trained medical and para-medical teams who are ready to attend to bird flu cases should they be referred to these health facilities.    

“On top of these preparations, I call on everyone to be vigilant, follow the advisories issued by concerned government agencies and to be equipped with the right information about the disease. As a precautionary measure for those who had direct contact with infected poultry and had developed any flu symptoms, we urge you and the public to report to the Regional Epidemiology and Surveillance Units (RESUs) of the DOH Regional Offices and seek immediate consultation at the nearest DOH Medical Hospital and Centers,” Secretary Ubial emphasized.

Our range of experience with H5N6 infection is limited, but of those cases identified, nearly all developed severe pneumonia, and the majority proved fatal. A far cry from the `fever, cough and cold' described as the primary symptoms in the Reuters report.
Granted, early administration of antivirals could reduce the severity of infection, and close monitoring of poultry workers might have turned up mild cases that would otherwise have gone unnoticed. 
So it makes absolute sense to isolate and test any `suspect' cases, regardless of how mild their symptoms. A genuine infection is always possible. And it would be of considerable value to run H5 serology tests on these individuals a few weeks down the road, to see if any seroconverted.

Pending some positive tests, however, there appears to be less to this story than the headlines would otherwise suggest. 

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