RITM Responds to MERS-CoV Threat RITM is now
in the Country ISO 9001:2008
certified
An RITM molecular biologist performs MERS-CoV molecular testing of samples from the Etihad
flight EY0 424’s passengers.
A n imported case of MERS-CoV in the plane which carried the male Filipino
the country proved RITM’s nurse.
preparedness for emerging infectious
disease threats. Among the 414 passengers of EY 0424,
As the Department of Health’s (DOH) National
Referral Center for Emerging and Reemerging
Infectious Diseases, the Research Institute
for Tropical Medicine (RITM) responds to
the threat of the Middle East Respiratory
Syndrome-Corona Virus (MERS-CoV) in the
Philippines. On April 15 , 2014, the arrival
of a 45-year-old male Filipino nurse who
initially tested positive for the MERS-CoV in
the United Arab Emirates (UAE) put RITM’s
response to test.
RITM immediately activated its Emergency
Operations Center (EOC) and ensured
efficient hospital containment of suspected
cases and rapid laboratory response. RITM
performed rapid testing of samples obtained
from passengers of the Etihad flight EY 0424,
WHAT’S INSIDE >>
>RITM Labs >Message
Receive WHO from the
Accreditation RITM Director
p2 p2
410 were tracked and tested for MERS-CoV
including the male Filipino nurse who initially
tested positive in UAE. All of them tested
negative for the infectious disease.
“We immediately coordinated the results
to the DOH Central Office, National
Epidemiological Center and Regional
Epidemiology and Surveillance Units as
soon as the laboratory tests were released,”
explained Rowena Capistrano of the RITM
Surveillance Unit.
Meanwhile, all of the four remaining
passengers who were not traced had already
left the country when the surveillance for the
MERS-CoV was activated.
>> continued on page 2
>Infographic: >Feature:
RITM’s Response In the Time of
to MERS-CoV Dengue Mitigation
p3 p4
T he Research Institute for Tropical
Medicine
International
(RITM) received
Organization
its
for
Standardization certificate on Quality
Management System (ISO 9001:2008)
after undergoing a rigid application
process. RITM obtained the certificate on
July 11.
RITM is now an ISO certified institution for
the provision of Administrative, Medical,
and Research and Development Services,
including Knowledge and Technology
Transfer.
RITM met the criteria of an organization
with quality management system including
policies such as strong customer focus,
top management support, organizational
process strategy, and continual improvement.
Furthermore, RITM successfully
complied with and showed evidence for
documentation and implementation of
mandatory ISO 9001:2008 requirements:
control of documents, control of records,
internal audit, control of nonconforming
product, corrective action, and preventive
action.
The first stage of the audit was conducted
on February 7. It was followed by the second
stage audit on April 11, before certification
was granted.
RITM adopted ISO 9001:2008 standards
in compliance with the Executive Order
No. 605 which directs all government
departments and agencies to institutionalize
Quality Management Systems as part of
a government-wide quality management
program.
>RITM Celebrates >Staff Updates
33rd Anniversary
p6 p8
RITM Responds...
(from page 1)
RITM has updated rapid detection
methods, well-equipped laboratory and
hospital facilities, and trained personnel in
responding to the threat of new infectious
disease agents. RITM currently uses
molecular detection methods which ensure
sensitive and rapid diagnosis. RITM can also
detect the virus by electron microscopy and
histopathology. RITM is also part of a global
network of laboratories which provide
mutual support for confirmation and further
characterization of new infectious agents.
“The laboratory procedures that RITM
follows are recommended by the World
Health Organization,” added Edelwisa
Mercado, Head of the RITM Molecular
Biology Laboratory.
RITM Labs Receive WHO Accreditation
A laboratory technologist from RITM’s National Measles Laboratory performs measles IgM
enzyme immunoassay.
Three national reference laboratories of
RITM, namely the National Polio Laboratory,
the National Measles Laboratory, and the
National Japanese Encephalitis Laboratory,
all under the Department of Virology,
were accredited by the World Health
Organization (WHO) in terms of their
capability and capacity to detect, identify,
and promptly report target pathogens.
As part of the WHO Laboratory Network for
Polio, Measles and Japanese Encephalitis,
the laboratories’ performance is evaluated
annually through several mechanisms:
confirmatory testing, proficiency testing
and site visit. Accreditation confirms Finally, WHO sends laboratory experts to
that the laboratories’ operations and NRL for site visits at least once a year to
procedures met the WHO standards. review the performance for the preceding
12 months. Using a comprehensive
“Confirmatory testing is done by regularly checklist –from laboratory requirements
sending clinical samples from the
national reference laboratory (NRL) to the
2 RITM UPDATE APRIL-JUNE 2014
Mercado also stated that the patient who
initially tested positive at UAE tested
negative at RITM, denoting that the virus
probably has been cleared while the patient
was recovering on his way home.
The threat of emerging infectious diseases
like MERS-CoV is no longer new to RITM. In
the past, RITM has successfully responded to
global public health emergencies such as the
Severe Acute Respiratory Syndrome (SARS)
in 2003, the Pandemic Influenza H1N1 (Swine
Flu), and Ebola-Reston Vrus Infection in 2009.
RITM continues to receive specimens referred
for testing by the National Epidemiology
Center and by other institutions. To date,
there has been no new recorded MERS-CoV
case in the country.
designated regional reference laboratory
for re-testing. The regional reference
laboratory sends the result of their re-
testing to NRL. Concordance with the
results of the regional reference laboratory
is monitored,” explained Dr. Amado Tandoc,
head of the Department of Virology .
In proficiency testing, the regional
reference laboratory sends pre-tested
panels to NRL for testing. The results of
the regional reference laboratory is not
revealed to NRL until after the latter has
sent results from its own testing.
>> continued on page 8
MESSAGE
From the RITM Director
Dear RITM Colleagues and Partners,
We are very happy that the first
issue of RITM Update is out. This
quarterly newsletter will serve to
inform RITM staff and partners
on the Institute’s continuing
contribution to the prevention and
control of infectious and tropical
diseases in the Philippines.
For the maiden issue, we are
announcing that RITM is now ISO
certified. We are also featuring
RITM’s significant research and
surveillance activities, including
clinical studies on dengue vaccine
in the country where RITM
researchers are at the forefront. We
are also sharing how the Institute
responded efficiently to the threat
of the Middle East Respiratory
Syndrome-Coronavirus (MERS-
CoV) in the Philippines.
We look forward for RITM Update as
a means for RITM to stay connected
as a community and to engage
externally with our partners. We
are also coming up with an annual
report so this newsletter will serve
as a preview.
With warm regards,
Socorro P. Lupisan, MD
Director IV, RITM
RITM UPDATE APRIL-JUNE 2014 3
In the Time of Dengue Mitigation
RITM’s Contributions to the World’s Fight against the Disease
A clinical trial staff of the Dengue Vaccine Study conducts a group orientation to study
participants and their guardians.
N elia Dinulos, 51, is a mother of one. A few
years ago, she encountered her biggest
challenge as a parent. Her nine-year-old
daughter developed dengue.
At first, Nelia thought it was just an ordinary
fever. The fever though, would go on and off
for a week. She finally decided to bring her
daughter to the hospital. Laboratory tests
confirmed that her daughter was suffering
from dengue fever. Fortunately, the disease
was detected early and proper medical
attention led to her daughter’s recovery.
Dinulos shares this nightmare with the rest
of 500, 000 parents every year - parents of
children hospitalized because of serious
cases of dengue. The World Health
Organization (WHO) further accounts
that around 50 to 100 million people are
afflicted by dengue annually, and over 2.5
billion people (over 40% of the world’s
population) are at risk to be infected. This
makes dengue the world’s fastest-spreading
mosquito-borne disease. Of those afflicted
by the disease, 22,000 die.
Considered by WHO as a ‘neglected
disease’, dengue is primarily transmitted
to humans by two mosquito species—
Aedes aegypti and Aedes albopictus. The
virus can be transferred through the bites
of infected female mosquitoes. Also, a
dengue-afflicted human can indirectly
4 RITM UPDATE APRIL-JUNE 2014
transmit the virus to other persons through the Philippines the country in Southeast
the vector mosquitos. Studies suggest
that female Aedes aegypti mosquitoes, the
most common dengue vector in the world,
tend to permanently stay in or around the
houses where they emerge as adults. This
may imply that people’s mobility could be
more responsible in spreading the virus
rather than the mosquitos.
“ around 50 to 100 million Phase III study only showed moderate
people are afflicted by efficacy,
dengue annually, and but also in Asia. The vaccine also showed
over 2.5 billion people a clinically important reduction of
(over 40% of the world’s dengue
population) are at risk to be is consistent with the result of the previous
infected. Of those afflicted
by the disease, 22,000 die”
A lot of preventive actions and control
measures are being implemented to avoid
the massive burden of the disease. These
include early warning systems; vector
control; environmental, epidemiological
and disease surveillance; laboratory
support; clinical case management;
environmental controls; and social
mobilization. Experts, however, firmly
believe that the availability of an effective
vaccine is still ‘the holy grail’ of dengue
prevention.
CYD-TDV Clinical Trial’s Promising Result
In the Philippines, the clinical development
of the world’s first dengue vaccine to
complete the initial Phase III efficacy trial
is conducted by the Research Institute
for Tropical Medicine, with Dr. Rosario
Capeding as the principal investigator.
This potential vaccine is a live-attenuated
tetravalent vaccine developed by the
French pharmaceutical company Sanofi
Pasteur (CYD-TDV).
The clinical trial included 10,275 children
aged 2 to 14 in Indonesia, Malaysia, the
Philippines, Thailand, and Vietnam. CYD-
TDV yielded a promising result as it showed
a significant reduction of 56.5% of dengue
disease cases in the five countries combined.
A total of 3,500 children from the Philippines
(with San Pablo City, Laguna and Cebu
City as study sites) participated in the
said clinical study of CYD-TDV. This makes
Asian leg of the study with the highest
number of enrollees. Capeding added that
the Philippines, through RITM, is the only
country which has been actively involved in
all three phases of clinical development of
CYD-TDV.
Asked what will be the implication of the
study’s promising results, Capeding stated
that it will have a big impact even if the
considering the high burden of
the disease not only in the Philippines
hemorrhagic fever and the risk of
hospitalization. Above all, its safety profile
clinical studies assessing vaccine’s safety.
The Long Wait for an Effective Vaccine
Against the Dengue Virus
It actually took about 70 years to come up
with a potentially-effective vaccine against
dengue. Capeding cited various reasons
on the slow progress of dengue vaccine
development. One of the primary problems
is the challenge to develop four combined
immunogens since dengue is caused by
four different serotypes. In other words,
the vaccine must be tetravalent to induce
 FEATURE

Dr. Rosario Capeding, principal investigator of the Dengue Vaccine Trial in the Philippines, gives an inspirational talk on the potential impact of
the candidate dengue vaccine to the community of San Pablo City, Laguna.

a protective immune response against all is still waiting for the the Latin American leg Filipino children. The study focuses on
four viruses. of the clinical trial which was conducted association of dengue infection to the
among 9-16 year old children in Colombia, variation of human leukocyte antigens
“Another challenge is the absence of Mexico, Honduras, Puerto Rico and Brazil. It (HLA), a group of genes which are
suitable animal model for dengue. Monkeys is expected to complement the Southeast responsible for regulation of the human
can be susceptible to dengue virus but they Asian study. immune system.
can only demonstrate viraemia (presence
of virus in the blood) and does not actually Continuous monitoring will also be The Department of Medical Entomology
present clinical disease. Thus, you really have implemented even after the commercial is conducting a research to determine
to test the vaccine in humans,” explained release of the vaccine. the insecticide susceptibility profile of
Capeding Aedes aegypti and Aedes albopictus and
“There will be post-marketing surveillance the possible development of resistance
Furthermore, WHO, in their released and this is an SOP for all vaccines and drugs,’” in these dengue vectors to ensure that all
guidelines for dengue diagnosis and control, added Capeding. insecticide-based control strategies remain
inferred that there may have a possibility optimally effective.
that a dengue vaccine could potentially
cause severe disease (including Dengue A descriptive study, headed by Dr. Nelia
Hemorrhagic Fever) in vaccine recipients if “CYD-TDV yielded a Salazar, is also being conducted to describe
the implementation of a Department
solid immunity was not established against
all four serotypes. Therefore, vaccine design
promising result as it of Interior and Local Government
really requires intensive research to ensure showed a significant Memorandum which created an inter-
that the dengue vaccine to be developed is agency cooperation strategy to reduce
safe and efficient.
reduction of 56.5% of dengue cases in the country and to assess
dengue disease cases the outcome of the said dengue control
Also, since there is lack of a validated interventions in six highly urbanized cities.
correlates of protection, clinical efficacy in the five countries
studies are critical to fully understand combined ” RITM’s Commitment to Combat Dengue
In a tropical country like the Philippines
the mechanism of protective immunity
against dengue virus and confirm that the where dengue is endemic, the situation
candidate vaccines induce a protective Other RITM Research Activities on could be worse if no appropriate research
immune response. Dengue Prevention and Control initiatives are conducted to complement
Aside from CYD-TDV efficacy study, RITM the present control measures against the
CYD-TDV Still a Work in Progress performs other research projects on dengue virus. Research activities on dengue are
Despite the positive result of the Phase III control and prevention. expected to inform measures to alleviate,
clinical trial of CYD-TDV, Capeding clarified if not immediately eliminate the burden of
that the candidate vaccine is still a work in Another study headed by Capeding aims to dengue in the country.
progress. identify protective and pathogenic immune
responses against dengue virus (DENV) RITM, as the country’s lead agency for
“There is a very important component in this among infants. Studies show that primary research in infectious diseases, is committed
clinical trial which is the surveillance phase. DENV infection during infancy is more likely to conduct extensive and multidisciplinary
Aside from the active surveillance phase, we to lead to Dengue Hemorrhagic Fever and research with the hope of contributing to
also have the hospital surveillance phase severe illness than during childhood or the world’s fight against dengue.
where we will follow up the hospitalized adulthood.
dengue cases. It will run until 2017,” she As RITM joins the international community
explained. A study headed by Ms. Edelwisa Mercado in the goal of eliminating the disease, the
and Dr. Fe Espino seeks to understand the Institute hopes that the stories like those of
Furthermore, the developer of the vaccine genetic factors among humans that may Nelia’s would be less likely to be heard in the
affect the severity of dengue fever among near future.

RITM UPDATE APRIL-JUNE 2014 5

 RITM Celebrates 33rd
Anniversary
T he Research Institute for Tropical Medicine (RITM) celebrated its anniversary on
April 21, marking its 33rd year as the country’s lead institute for infectious disease
research.

A holy mass commenced the line-up of activities for the institute’s anniversary celebration.
Recognitions for RITM staff were also given, including Loyalty Awards, Achievement Awards
and Service Awards. Afterwhich, Drs. Leilani Senador, Ma. Teresita Gabriel, and Gracia Teodisio
of the Department of Dermatology gave lectures on Leprosy. RITM staff enjoyed free movie
screening of Frozen and Superman Returns and raffle prizes.

RITM was established in 1981 as the research laboratory of the Department of Health through
the Executive Order No. 674, in order to conduct efficient and economical implementation 4
of research programs on diagnosis control and treatment of tropical and infectious diseases.

1
6

2 3
7

1 Dr. Eric Tayag and Dr. Socorro Lupisan awarding plaque of recognition to former RITM Director, Dr. Olveda
2 Dr. Gabriel, Dr. Socorro Lupisan, Dr. Eric Tayag strutting their dance moves for the program finale
3 RITM Staff gamely grooving with Dr. Eric Tayag to the tune of Walk in the Club
4 RITM Staff lining up to satisfy their sweet tooth with the free ice cream
5 RITM Staff showing off their tickets to the free movie screenings
6 Dr. Leilani Senador from the Department of Dermatology giving a lecture on Leprosy
7 RITM staff receiving Loyalty Award to recognize their years of service in the Institute
8 RITM staff receiving Service Award to recognize their efforts during the Post-Yolanda Emergency Response
in the Visayas area 8

6 RITM UPDATE APRIL-JUNE 2014

RITM holds Dengue
Surveillance
Stakeholders’
Meeting
RITM, in collaboration with the National
Center for Disease Prevention and Control
(DOH-NCDPC), the National Epidemiology
Center and the Regional Epidemiology
Surveillance Unit conducted the Dengue
Surveillance Strakeholders’ Meeting at the
Mariott Hotel, Pasay City on April 14-16.
The meeting aimed to develop active and
sentinel-based dengue surveillance in all
regions of the Philippines and to establish
a framework for implementation of future
plans of the National Dengue Control
Program.
Among the topics discussed were
the current dengue situation in the
Philippines, partnership for National
Dengue Surveillance and dengue research
updates. A Regional Microplanning
Session for dengue surveillance was also
conducted. Dr. Lyndon Lee Suy, DOH-
NCDPC’s Program Manager for Emerging
and Re-emerging Diseases facilitated the
session.
RITM Sets up Clinical Trial Unit
Tasked to develop and implement policies
and procedures for the conduct of clinical
trials in the institute, RITM created the
Clinical Trial Unit (CTU) through the Office
Order No. 192, S. 2014. CTU will work in
coordination with RITM’s other divisions
and study groups, the Institutional Review
Board and the newly established Research
and Innovation Office (RIO).
RITM Operationalizes its Communication and
Engagement Office
To optimize RITM’s communication
efforts to its partners and the public, the
Communication and Engagement Office
(CE Office) was created through RITM
Office Order No. 213, S. 2013.
The CE Office, under the Office of the RITM
Director, is tasked to implement RITM’s
communication strategy. The strategy
includes the implementation of campaigns
that will establish and communicate RITM’s
institutional identity, and highlight RITM’s
contribution to public health
RITM Facilitates Workshop on Nat’l Dengue
Vector Surveillance Plan
Mr. Aldrin Reyes, Supervising Health Program Officer of the Department of Health gives the
workshop’s opening remarks
The Medical Entomology Department and
the Communication and Engagement Office
of RITM facilitated the Department of Health’s
workshop on the development of dengue
vector surveillance plan for the National
Dengue Prevention and Control Program.
The workshop was held at Ciudad Christia
Resort, San Mateo Rizal, May 27-29.
This was the first session of the three-series
workshop that aims to come up with a policy
that will support the national implementation
of dengue vector surveillance in the
Philippines. The workshop was attended by
RITM-CTU is further assigned to maintain
a registry of the institute’s clinical trials
and the trials’ personnel; ensure regular
calibration of all clinical trial equipment
maintained by RITM; and serve as liaison
between the administration and clinical
trial proponents. Dr. Mari Rose de los Reyes
and Dr. Cristina Ambas were appointed
as CTU Head and CTU Coordinator,
respectively.
The CE Office is further tasked with
generation of content and execution of
projects for RITM institutional marketing
activities; development and distribution of
RITM official public information materials;
and designing and implementation of
internal communication activities.
the Regional Health Office coordinators.
During the workshop, the participants
identified the gaps and issues on
implementation of dengue vector
surveillance in their regions; proposed
solutions to their identified problems and
developed an action plan to effectively roll
out the dengue vector surveillance activity
across the country.
The drafted action plan will be the basis of
discussion forthe next workshop with LGU
officials and staff on November.
NEWSBITS
RITM Surveillance
Unit Finalizes
Manual of
Procedures
To improve the public health impact of
surveillance activities at RITM, the Institute’s
Surveillance Unit (SU) organized a workshop
for the development of the SU Manual of
Procedures.
The workshop was held at the Bayleaf Hotel,
Intramuros, Manila last June 10-11.
Dr. Eric Tayag, Director of DOH’s National
Epidemiology Center highlighted the role
of the RITM-SU in the surveillance efforts
of DOH especially during the outbreak of
emerging infectious diseases.
The workshop was facilitated by Dr. Beatriz
Quiambao, RITM’s Assistant Director and
Head of SU, and Ms. Rowena Capistrano,
Surveillance Unit Officer.
RITM UPDATE APRIL-JUNE 2014 7
Maria Rosario Capeding, MD, head of the Microbiology Department and
Principal Investigator of the Dengue Vaccine Clinical Trial in the Philippines is this year’s
Dr. Jose P. Rizal Memorial Awardee for Research. The said recognition was awarded by
the Philippine Medical Association. Dr. Capeding received a trophy designed by National
Artist Napoleon V. Abueva, a gold medallion, free trip to the United States to attend
the convention of the American Academy of Family Physicians, and P150, 000 worth of
medicines that she can share with a civic organization of her choice.
Eleonor Fundan Avenido of the Immunology Department is one of the
recipients of the Japanese Government-funded Monbukagakusho Scholarship for 2014.
She is currently taking her Master’s Degree in Pharmaceutical Science at Nagasaki
University, Japan.
Arthur Dessi E. Roman, MD of the Medical Department received a Joint Japan/
World Bank Graduate Scholarship (JJ/WBGSP) for a Master’s Degree in Tropical Medicine
at Nagasaki University, Japan.
Jun Ryan C. Orbina of the Molecular Biology Laboratory and Communication and
Engagement Office is one of the participant-scholars for the Global Leaders for Innovation
and Knowledge Program of the Fujitsu-Japan-America Institute of Management Dr. Rosario Cepeding, head of Microbilogy Dept., receives the
Sciences. The program is a multi-campus course where the participants learn knowledge Dr. Jose P. Rizal Award trophy and gold medallion for research.
management in Japan; Hawaii, United States; Thailand; and Singapore.

Sonia B. Sia, MD, head of the Antimicrobial Resistance Surveillance Laboratory received a full scholarship from the Department of Health for a Master’s
Degree in Public Management at the Ateneo de Manila University.
Wilfredo Aure of the Medical Entomology Department was accepted to pursue his PhD in Entomology at the Universiti Sabah in Malaysia through a
grant from Monkeybar Project, a multidisciplinary collaborative research project on zoonotic malaria, where Aure is also involved. The grant was funded by
the London School of Hygiene & Tropical Medicine, a partner institution of the Monkeybar Project.
Cristino Narciso of the National TB Reference Laboratory and Neil Yabut of the Molecular Biology Laboratory had completed the one-year Training
Program for Advanced Biorisk Officers (ABOT2). The training was organized by the University of the Philippines Manila Institutional Biosafety and Biosecurity
Committee (UPM- IBBC), in partnership with the US Department of State Biosecurity Engagement Programme (BEP) and Philippine Biosafety and Biosecurity
Association (PhBBA) to promote and strengthen laboratory biosafety and biosecurity.

RITM Labs Receive... RITMEA-AHW Elects

RITM Update
(from page 2) New Officers
to equipment standard and personnel
training, the WHO commissioned expert
to 2017.
T
he RITM Employees Association-Alliance of
Health Workers elected new officers for 2014
The election was held on May 28-29. Gar-
RITM Update is a quarterly newsletter published
by the Research Institute for Tropical Medicine
- Department of Health (RITM-DOH). For your
will determine if the laboratory performs
its regular operation according to WHO nering 220 votes, Rodolfo Perez was elected as feedback, e-mail us at ritmupdate@gmail.com.
standard. President while Edgardo Damicog won as Vice
President with 215 votes. Below is the complete Web: www.ritm.gov.ph
list of the association’s new officers: Mail: 9002 Research Drive, Filinvest
WHO conducts laboratory accreditation
Corporate City Alabang,
of the laboratories that test vaccine Muntinlupa City 1781 Philippines
preventable diseases as part of global Tel: (632) 809-7599 / 807-2628 to 32
or regional program efforts to eradicate, RITMEA-AHW Officers for 2014-2016 Fax: (632) 842-2245
eliminate or control disease. This is to
President: Rodolfo Perez
ensure maintenance of standards and Vice President: Edgardo Damicog
reliability of the national reference Secretary: Maria Charmaine Romulo Produced by:
laboratories around the world. Treasurer: Lennie Azores
Auditor: Pacita Pimentel
Tandoc added that “the process further PRO: Ireneo Rayos
provides a mechanism for identifying Romeo Garcia
resource and training needs. Moreover, Edgardo Linsangan
the accreditation process builds a strong Carol Torres
relationship between the participating Sgt. At Arms: Ricardo Prudencio Got a knack for writing? Do you have a story
laboratory and the WHO laboratory Board of Directors:Portia Alday that you want to share with our colleagues and
network, which is composed of Gloria June Quiñones partners? Then be an RITM Update Contributor!
international experts – it is, thus a valuable Ruby Catubig Send your articles and/or photographs to
learning opportunity for the participating Erminia Torio ritmupdate@gmail.com and we will feature
laboratory.” Mila Aligato them in the next issue of RITM UPDATE.
Cristina Bustamante

8 RITM UPDATE APRIL-JUNE 2014