2009 flu pandemic in the Philippines

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Main article: 2009 flu pandemic
Outbreak evolution in the Philippines as confirmed or suspected by different agencies. (11:04, Wednesday August 27, 2014 (UTC))
  Confirmed cases followed by death
  Confirmed community outbreak of H1N1
  Confirmed cases by the Department of Health
  Unconfirmed or suspected cases

The 2009 flu pandemic in the Philippines is a part of larger global flu epidemic that involves new Influenza A virus strain, H1N1. The pandemic reached the Philippines on May 21, 2009 when a young Filipina girl first contracted the A(H1N1) virus while vacationing in Houston, Texas, US. In the following days, several local cases were reported to be caused by contact with two infected Taiwanese women who attended a wedding ceremony in Zambales.

The 10-year-old Filipina girl arrived at the country on May 18 and was hospitalized the day after at the Research Institute for Tropical Medicine in Muntinlupa City. On May 21, Department of Health (DOH) secretary Francisco Duque confirmed the case being the first Philippine swine flu case. On a May 22 press conference at World Health Organization Regional Office in Manila, Secretary Duque announced the first A(H1N1) case in the country:

The DOH confirms today the first case of A(H1N1) in the Philippines. She is a female traveler who arrived in the country on May 18 from the United States, whose throat specimen tested positive based on results from the Research Institute for Tropical Medicine.[4]

—Health Secretary Francisco Duque, Philippine Daily Inquirer

Since the outbreak of A(H1N1) in the Americas, President Gloria Macapagal-Arroyo urged the Department of Health, the Bureau of Immigration, the Bureau of Quarantine and other concerned agencies to control monitor airport and seaport arrivals for possible flu infection. Thermal imaging equipment were installed at major airports to screen passengers coming from infected countries for flu symptoms.[5][6] The Philippines may quarantine travelers arriving from Mexico with fever.[7] Also, the importation of hogs from the U.S. and Mexico was manned, and the restriction of swine influenza vaccine use was retracted. First death was reported on June 19, 2009, a 49 year-old Filipina employee of the Congress, as well as the first death in Asia.[8]

2009 Influenza A(H1N1) cases in the Philippines summary
Number of confirmed cases See table above
Number of provinces and cities with confirmed cases 47[a]
Number of NCR cities with confirmed cases 12[a]
Number of cities/locations with confirmed deaths 9[a]
First confirmed infection in the country May 21, 2009[4]
First confirmed death in the country June 19, 2009[9]
First infection of an OFW/citizen abroad June 1, 2009
Saudi Arabia in Saudi Arabia[10]
First Filipino death abroad July 16, 2009
Hong Kong (China) in Hong Kong[11]
First low-level transmission (community outbreak) June 14, 2009
in Barangay Hilera, Jaen, Nueva Ecija[12][13]
First school to report influenza infection June 23, 2009
De La Salle University, Manila
Fatalities 9 (as of July 29, local reports)
8 (as of July 29, DOH report)

Detection and confirmation of the first case[edit]

Confirmation[edit]

On May 18, 2009, a Filipino family coming from a trip in Houston, Texas arrived in the country. Though infected by the flu, their ten-year-old female child did not exhibit any symptoms except a day after arrival.[14][15] Due to this, her parents decided to inform the local health authorities about it, prompting Department of Health (DOH) representatives to require the girl to undergo laboratory testing at the RITM.[16]

On Thursday, May 21, health authorities and the RITM were able to confirm that the girl was and the first virus "carrier" through throat specimen tests, and the first A(H1N1) infected in the Philippines.

The next day, Health Secretary Duque announced the first flu case at a conference of the World Health Organization (WHO) in Geneva.[16] He then assured members of the media that there is no outbreak so far in the Philippines. However, health authorities did not publicize information regarding the name of the child and her family.[15]

Release from the hospital[edit]

The Director of the National Epidemiology Center, Dr. Eric Tayag, said that the girl's immune system had a positive response to oseltamivir (Tamiflu) and other anti-viral drugs. By May 24, she no longer exhibited fever and cough but still suffered from a sore throat.[17] The 10-year-old was discharged last May 28 by the DOH together with the second A(H1N1) patient, a 50-year-old female from Chicago.[18]

National responses[edit]

Opening of classes[edit]

The day after the confirmation of the first case in the country, the Department of Education (DepEd) indicated that classes will continue to start on June 1 as scheduled.[19] In consulting with Secretary Duque, both he and Education Secretary Jesli Lapus reached a decision to go on with the original scheduled date of the opening of classes. Dr. Tayag also said that there is no reason for class suspension unless there is an actual outbreak in the country.[19]

According to DepEd-National Capital Region director Teresita Domalanta, Secretary Lapus has instructed them to order schools to carry out seminars and launch an information campaign about the symptoms and virus prevention among schools.[17]

In line with this, Secretary Duque issued on May 30 a response alert system on when schools should suspend their classes.[20][21] Based on the response alert system set by the DOH, the Philippines is under response alert level four.[22]

Current Philippine response alert level: Level 4
Alert Level 4
  • Confirmed case(s) and/or death related to Influenza A(H1N1) virus in the Philippines.
  • Confirmed case(s) in school(s).
  • Confirmed human-to-human transmission(s).
  • Declared community outbreak(s).

Response:

  • Be updated on Influenza A(H1N1)-related events.
  • Observing proper hygiene and proper use of sanitation facilities.
  • Listing of students/individuals that have travel histories on countries infected by the disease as well as listing students/individuals with influenza-like symptoms.
  • Isolating individuals with Influenza A(H1N1) symptoms.
  • Establishing health referral stations.
  • Suspension of classes on the affected school(s) and area(s).
Lifting suspension:
  • No more confirmation of cases in the affected school(s) and/or area(s) for seven days.
  • No more cases under observation(s) in the affected school(s) and/or area(s).
  • No more positive confirmed cases in the affected school(s) and/or area(s) for ten days.

Source: Department of Health

Orders of class suspensions[edit]

As of June 6, 2009, because of the said incident, the Commission on Higher Education (CHEd) moved the opening of classes for all colleges and universities nationwide from June 8 to June 15, 2009.[23]

CHED Chairman Emmanuel Angeles said that this postponement of classes will enable the students, especially those coming from abroad vacations, ample time to check their health and go on self-quarantine in case of any virus symptoms will exhibit.[24]

Presidential actions[edit]

In a press conference, Press Secretary Cerge Remonde said that President Arroyo has reiterated her instructions to the DOH, the Bureau of Immigration and all other concerned agencies to be on the top of the situation for regular updates.[25]

The president also ensured that the government is ready to give one million capsules of Tamiflu in case of an epidemic.[16]

Despite the increasing number of cases of A(H1N1) in the country, Press Secretary Remonde said that the Palace is not alarmed with the sudden surge of disease in the Philippines.[26]

Travel bans and advisories[edit]

As of 24 May, Department of Tourism so not issued a travel ban on the country in accordance with the reported flu cases of A(H1N1). Tourism secretary Joseph Ace Durano in his travel advisory said that there are no reported cancellations in any tourism booking so far.[27]

On the other hand, the government issued travel advisories for Mexico, the United States and other mostly-infected areas, advising Filipinos to refrain from making unnecessary travel.[28]

Changes in mass rituals[edit]

On June 5, Manila Archbishop Cardinal Gaudencio Rosales through instructions to Fr. Genaro Diwa of the Ministry of the Liturgical Affairs of the Archdiocese of Manila, issued an advisory ordering priests to temporarily give communion only by the hand, instead of the traditional mouth; and that holding hands during singing of Our Father (Ama Namin) will be discouraged.[29][30] During the Mass for the 5th anniversary of Pondo ng Pinoy at the Xavier School gymnasium in Greenhills, San Juan, the directive was announced before the start of the celebration of the Eucharist.

In line with this, the Manila Archbishop ordered the continuation of earlier commanded Oratio Imperata On H1N1, revisioning the obligatory prayer from its original version-centered on the virus-infected country of Mexico. He added that the Philippines should be included, and other countries in the prayer.[29]

On June 23, the Archbishop of Jaro (in Iloilo) Angel Lagdameo ordered local churches to empty holy water stoups whereas churchgoers are strongly advised to do sign of the cross instead of using holy water.[31]

Around two months after the memorandum ordering extra precautions on the mob regarding catching flu in churches, the Catholic Bishops Conference of the Philippines (CBCP) announced that the new flu strain failed to drag Filipino believers out of churches. According to Msgr. Achilles Dakay of the Roman Catholic Archdiocese of Cebu, church attendance in the archdiocese remained normal despite advisories.[32]

Policy of mitigation[edit]

Tamiflu, influenza antiviral drug

Though the influenza virus is now treated mild, DOH will only then treat it like an ordinary flu, whereas it is no longer an obligation to follow all sick persons.[33] According to Duque, if they shall continue their containment policy, the DOH will lose all their resources. He added, "Ituturing na lamang namin ito na parang [isang] karaniwang trangkaso na lamang. Mahirap namang babantayan mo[/natin] lahat ng [mga] 'yan[g pasyente]." (We shall treat this disease like an ordinary influenza. It is so difficult, as you think, to follow and trace all of them (the patients).[34]

On the other hand, DOH shifted into policy of mitigation where patients with symptoms anomaly exhibiting swine flu will just go see a doctor.[34]

Government action[edit]

Vaccine issues and benefits[edit]

Department of Health's poster about what-to-do and response level system of the government regarding the flu.

Dr. Lyndon Lee Suy, head of the Emerging and Re-emerging Infectious Diseases Program of the Department of Health (DOH), said that the Philippine government, on July 5, still cannot afford to buy mass vaccine, which is estimated to cost PhP 1,000 per dosage.[35] He said that the elderly, among the high-risk group in the Philippines, has a population of around 3.6 million, and vaccination among them requires PhP 3.6 billion (which is a tentative equivalent for the health department's three-year budget).[35] Dr. Lee Suy also added that the stocked 1.5 million anti-viral medicines such as Tamiflu by the DOH is not enough for possible epidemic since most of them are given free to discourage uncontrolled and panic buying.[35] He also said that high-risked group does not only includes elderly, but individuals 5 years and below and with naturally harmful diseases.[35]

On July 7, Roche Philippines announced that it would cut down prices of Tamiflu from PhP 1,000 to PhP 880, to ensure adequate supply of the said anti-viral drug in the Philippines and the rest of the world.[36]

The same day, in a hearing at the Philippine House of Representatives (Congress), Health secretary Francisco Duque requested PhP 19.8 billion fund for H1N1 resistance. He said that the money will be used for buying vaccines (PhP 16 billion), subsidizing poor patients and assistance to the families of poor victims (PhP 3 billion), and implementing rules and rehabilitation of target hospitals for H1N1 patients (PhP 800 million). The Congress questioned the amount of fund largely it is too huge to award and that there are no vaccine yet to buy. On the same hand, Iloilo Representative Ferjenel Biron, also the chairman of the House Committee on Health, asked the secretary to cut its requested budget down to 10% or PhP 2 billion.[37]

On July 27, 2009, the Department of Health announced that the doctors and other health workers such as nurses, aides and volunteers that helped the government to assist H1N1 patients and victims will be among the group that will become the first recipient of 100,000 H1N1 vaccine from the World Health Organization.[38] The vaccine is expected to be out from United States by mid-October.[39]

On August 2, San Juan City officials created a city ordinance seeking PhP 1 million budget seeking for an immediate purchase for health workers in the said city. The resolution will be known as “Battle Against Swine Flu Virus” Ordinance.[40] At the same time, around 3,500 employees of the Caloocan City Hall were given free ant-flu vaccine shots, "to strengthen local government employees' immune system against seasonal flu".[41]

Infected schools[edit]

The first Philippine school to contract A(H1N1) case was in De La Salle University (Manila) presumably on June 3, followed by suspension of classes effective June 4 ending then on June 14.[42] A few days before, on May 30, a mysterious swine flu-like illness was spotted into 29 students of Hilera Elementary School in Jaen, Nueva Ecija[43] which eventually climbed to 40, six days after.[44] The continuous transmission of A(H1N1) in barangay Hilera mystifies health officials, where immediately spread to 19 person, urging DOH to declare community outbreak by June 15 and Nueva Ecija provincial government a state of calamity the following day.[12][13]

Infected schools in the Philippines  (Student cases)[45]#
Note: New events does not reflect on an immediate time in this statistic.
Name of school Location Number of student cases
(as of August 27, 2014)
Date of first
confirmation
References
Adamson University Manila 8 June 19, 2009 [46][47]
Assumption College San Lorenzo Makati City 1 June 22, 2009 [45]
Ateneo de Manila High School Quezon City 3 June 9, 2009 [48][49]
Ateneo de Manila University Quezon City 4 June 17, 2009 [50]
Ateneo de Zamboanga University Zamboanga 1 July 2, 2009 [51]
Bacabac Elementary School Camiling, Tarlac  ? June 22, 2009#### [52]
Bedastos Elementary School Bulacan  ? June 22, 2009#### [52]
Claret School of Quezon City Quezon City 8 June 23, 2009 [50]
De La Salle University Manila 16 June 3, 2009 [48][53]
De La Salle-College of Saint Benilde Manila 2 June 9, 2009 [48][54]
Dominican College San Juan City 1 June 17, 2009 [45][50]
Don Alejandro Roces, Sr. Science and Technology High School Quezon City 3 June 17, 2009 [54][55]
Don Bosco Technical College Mandaluyong City 1 June 21, 2009 [45]
Doña Candelaria Meneses Duque Memorial High School Bulacan, Bulacan 8 June 15, 2009 [48][56]
Far Eastern University - East Asia College Manila 3 June 8, 2009 [48][54]
Hilera Elementary School Jaen, Nueva Ecija
Community outbreak[12] confirmed by DOH##
12 June 11, 2009 [48][54]
Holy Rosary Lucena City 2 July 18, 2009
Karangalan Elementary School Cainta, Rizal 2 June 21, 2009 [45][57]
Lagro Elementary School Quezon City 2 June 16, 2009 [48][58]
La Salle Green Hills Mandaluyong City 1 June 21, 2009 [45]
Lourdes School of Mandaluyong Mandaluyong City 2 June 18, 2009 [59][60]
Mapúa Institute of Technology Makati City 3### June 15, 2009 [48][61][62]
Maryhill College Lucena City 6 July 7, 2009 [63][64][65]
Miriam College Quezon City 3 June 16, 2009 [66]
Our Lady of Perpetual Succor College Marikina City 1 June 17, 2009 [58]
PAREF Southridge School Muntinlupa City 1 June 20, 2009 [45]
Philippine Science High School Palo, Leyte 1 June 16, 2009 [67]
Reedley International School Quezon City 1 June 20, 2009 [68]
Sacdalan Elementary School San Miguel, Bulacan  ? June 22, 2009#### [52]
Sacred Heart College Lucena City 2 July 18, 2009
San Beda College Manila 1 June 20, 2009 [69]
Santa Rosa Central School Santa Rosa, Laguna 2 June 19, 2009 [69][70]
St. Scholastica's College Manila 1 June 21, 2009 [45]
St. Andrew's School Parañaque City 1 June 10, 2009 [48]
St.Louis University , Baguio City Baguio City ? July 11, 2009 [50]
St. Paul College, Pasig Pasig City 1 June 18, 2009 [71]
The British School Manila Taguig City  ? June 22, 2009#### [52]
University of Cebu Lapu-Lapu and Mandaue, Cebu 3 June 20, 2009 [72]
University of Santo Tomas Manila 1 June 22, 2009 [45][73]
University of the Philippines Diliman Quezon City 1 June 17, 2009 [56][74]
Xavier University - Ateneo de Cagayan Cagayan de Oro City 8 July 14, 2009 [75]
# Figures do not include occurrences in respective cities.
## These figures do not reflect the actual number of infections in the whole town of Jaen. The numbers pertaining to Hilera Elementary School solely define the students infected by the virus.
### Some news sources claim to be three, Mapua said it is two. Check the references for more details.
#### No other information provided.[52]

Affected regions[edit]

Currently, there are over 50 infected provinces and cities in the Philippines (excluding Metro Manila component cities):

On the same hand, Metro Manila has the following infected cities:

Provinces/cities with reported H1N1-related deaths.
†† Provinces/cities with H1N1 community outbreaks.

Notes[edit]

  • a Tallies may vary. Please see respective references on the affected regions section.

References[edit]

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  75. ^ "Xavier University Suspends Classes for 10 Days Due to A (H1N1) Virus". Xavier University - Ateneo de Cagayan. 2009-07-15. Retrieved 2009-07-16. 

External links[edit]

Official status reports
Background information