2019 PIDSR Annual Report

| 2019 PIDSR Annual Report
2019 Annual Report

Philippine Integrated Disease
Surveillance and Response (PIDSR)
EPIDEMIOLOGY BUREAU, DEPARTMENT OF HEALTH

PHILIPPINES
Philippine Integrated Disease Surveillance

and Response (PIDSR)
2019 Annual Report
Published by:
Public Health Surveillance Division

Epidemiology Bureau
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz
Manila 1003, Philippines
This report may be reproduced in full or in part for non-profit purposes without prior permission,
provided proper attribution to the Epidemiology Bureau, Department of Health is made. Furnishing
the Bureau, a copy of the reprinted or adapted version will be appreciated.
An electronic copy of this publication can be secured by sending an email to pidsr2@gmail.com.
Suggested Citation: Epidemiology Bureau, Department of Health. Philippine Integrated Disease

Surveillance and Response 2019 Annual Report.
Manila, Philippines: Department of Health.

MESSAGE FROM THE OFFICE OF THE EPIDEMIOLOGY

BUREAU DIRECTOR
It is with great pride and honor to present to you the 2019 Philippine Integrated Disease Surveillance
and Response (PIDSR) Annual Report.
This report is the ultimate product of a ten-year evolution as defined and discussed through the
various steps of an integrated disease surveillance and response process. From collecting data to
identifying problems, through data analysis and information dissemination leading to appropriate
response; to evaluating and improving the response; and, systems improvement as a whole.
Aligned with the Department’s Formula One Plus Agenda which aims for a better quality of health
services for all life stages and addresses the triple burden of diseases, delivered by a functional
service delivery network, financial protection especially for the poor, this document will serve as one
of the pillars to inform our policies and programs.
This report expresses our sincerest acknowledgment and appreciation to all our frontline health
workers. They remain dedicated and committed in the field of disease detection, control and
prevention.
Also, I would like to extend my heartfelt thanks and congratulations to all the Epidemiologists and
Disease Surveillance Officers at the regional, provincial, city and municipal health offices. Thanks to
our partners in health from the government and private hospitals, Local Government Units, Non-
Government Organization and other Government and Civil Societies who are supportive of the
thrusts of the Department of Health.
Thank you for your unswerving and unwavering commitment in serving the Filipino people through
this health worthy endeavor.
FERCHITO L. AVELINO, MD, MPH, PHSAE

Officer-in-Charge, Epidemiology Bureau
i
Contents
Message from the Office of the Epidemiology Bureau Director ............................................................ 6
By The Staff Of The Epidemiology Bureau The Department Of Health, Philippines.............................. iii
Acknowledgments.................................................................................................................................. iv
Introduction ............................................................................................................................................ v
Goal and Objectives of PIDSR.............................................................................................................. v
Conceptual Framework of PIDSR ....................................................................................................... vi
How to use this Annual Report .......................................................................................................... vi
Data Interpretation ........................................................................................................................... vii
Limitations to the Data ..................................................................................................................... vii
1 | Vaccine Preventable Diseases ........................................................................................................... 1
Introduction ........................................................................................................................................ 1
1.1 Acute Flaccid Paralysis (AFP) ......................................................................................................... 1
1.2 Diphtheria ..................................................................................................................................... 9
1.3 Measles and Rubella ................................................................................................................... 14
1.4 Neonatal Tetanus ........................................................................................................................ 22
1.5 Non-Neonatal Tetanus ................................................................................................................ 26
1.6 Pertussis ...................................................................................................................................... 29
1.7 Acute Meningitis-Encephalitis Syndrome (AMES) ...................................................................... 33
2 | Zoonotic and vector-borne Diseases............................................................................................... 36
Introduction ...................................................................................................................................... 36
2.1 Chikungunya................................................................................................................................ 37
2.2 Dengue ........................................................................................................................................ 39
2.3 Leptospirosis ............................................................................................................................... 44
2.4 Rabies .......................................................................................................................................... 48
3 |Food and Water-Borne Diseases (FWBD) ........................................................................................ 51
Introduction ...................................................................................................................................... 51
3.1 Acute Bloody Diarrhea ................................................................................................................ 52
3.2 Cholera ........................................................................................................................................ 56
3.3 Hepatitis A ................................................................................................................................... 61
3.4 Rotavirus ..................................................................................................................................... 65
3.5 Typhoid Fever.............................................................................................................................. 70
4 | Other Diseases/Syndromes ............................................................................................................. 74
Introduction ...................................................................................................................................... 74
4.1 Influenza-like Illness (ILI) ............................................................................................................. 74
4.2 Meningococcal Disease ............................................................................................................... 78
ii
Annex 1. Cases, Deaths and Incidence Rates of Reported Notifiable Diseases in PIDSR in 2018 and
2019 by Region, Philippines .................................................................................................................. 81
Annex 2. Cases and Alert Classification by Morbidity Week, Philippines, 2014 to 2019 ..................... 81
Annex 3. Distribution of Reported Cases by Region and Morbidity Week, PIDSR Notifiable Diseases,
2019 ...................................................................................................................................................... 81
iv
ACKNOWLEDGMENTS
The Epidemiology Bureau extends its sincerest gratitude to the Centers for Health Development
(CHDs), through its Regional Epidemiology and Surveillance Units (RESUs), for their unwavering
support to generate this PIDSR 2019 Annual Report. The EB appreciates the Research Institute for
Tropical Medicine (RITM) for their generous support in laboratory confirmation of diseases under the
PIDSR system and for sharing their expertise with the PIDSR unit and RESUs during trainings and
workshops held in 2019.
We would like to acknowledge all Disease Reporting Units (DRUs) participating in the PIDSR National
Network.
v
INTRODUCTION
Disease surveillance is recognized as the cornerstone of public health decision-making and practice.
The surveillance system generates data that is helpful to the Public Health Officials in understanding
the existing and emerging infectious and non-infectious diseases. Surveillance data provide
information which can be used for priority setting, policy decisions, planning, implementation,
resource mobilization and allocation, prediction and early detection of epidemics. A surveillance
system can also be used for monitoring, evaluation and improvement of disease prevention and
control programs. Without these quality data, interventions may become misguided and wasteful.
With functional surveillance and proper understanding of health problem, it will not be difficult to
ameliorate the health issue. Core functions of public health surveillance, such as case detection,
registration, confirmation, reporting, and dissemination, carried out by Epidemiology and
Surveillance Units (ESUs) should be ensured to detect and respond to health events that pose
immediate public health risks.
The Philippine Integrated Disease Surveillance and Response (PIDSR) System was established to
serve as the existing indicator-based disease surveillance systems in the Philippines and to comply
with the call of the International Health Regulations (2005), or the IHR, for an urgent need to adopt
an integrated approach for strengthening the epidemiologic surveillance and response system of
each member nation.
The 2019 PIDSR Annual Report is a summary of the case-based disease surveillance system. The data
in this report were obtained from, compiled and validated by the PIDSR Unit of the Epidemiology
Bureau (EB) with the Regional ESUs. This report provides information on disease trends by morbidity
week and comparative statistics by time, place and person of notifiable diseases, syndromes and
conditions.
Goal and Objectives of PIDSR
Goal
To support the health sector in reducing morbidity and mortality from diseases of public
health importance through an institutionalized, functional integrated disease surveillance and
response system.
Objectives
1. To continually improve capacities at the national and regional levels to efficiently and
effectively manage national and sub-national surveillance and response systems.
2. To mobilize and empower local government units (LGUs) in the establishment and
institutionalization of disease surveillance and response system.
3. To support health sector capacity development for sustainable disease surveillance and
response systems.
4. To enhance utilization of disease surveillance data for decision making, policy development,
program management, planning, monitoring and evaluation at all levels.
vi
Conceptual Framework of PIDSR
The PIDSR Framework embodies an integrated functional disease surveillance and response
system institutionalized from the national level down to the community level (Figure 1).
Each level of the health care delivery system interacts with each other while performing their
basic roles and responsibilities. Standard case definitions to detect priority diseases are to be used in
all disease reporting units and a comprehensive flow of reporting is adopted. With the PIDSR
surveillance data, the LGUs take an active role in disease detection and response in their respective
localities, while the regional and national levels provide the necessary support.
Figure 1. Conceptual Framework of the PIDSR
How to use this Annual Report
This PIDSR 2019 Annual Report describes significant epidemiologic information for selected
notifiable diseases and gives additional information to support the interpretation of surveillance and
disease-trend data. It comprises tables showing reported cases for the nationally notifiable infectious
vii
diseases, distributed by time, place and person as well as graphs, maps and other visual displays to
facilitate the analysis of surveillance data.
The PIDSR Annual 2019 includes the following data:

● Time: Trend/Epicurve
● Place: Demographic characteristics of cases
● Person:
o Profile of Cases and Deaths
o Age group and Sex
o Vaccination status of cases with vaccine preventable diseases
o Estimates of case fatality ratios
● Laboratory Specimens and Results
● Percent change from 2018 surveillance data
Data Interpretation
PIDSR 2019 Annual Report must be interpreted with caution. Cases from outbreaks identified
and investigated by Disease Reporting Units (DRUs) are not included in the final count. The diagnostic
capabilities of the hospital laboratories also affect the completeness of reporting. For diseases with
laboratory confirmation, those with positive culture, serology or smear as the case requires, are
included.
Limitations to the Data
Notifiable disease reporting is incomplete for most conditions, and completeness and
timeliness of reporting to the jurisdictions and submission of notifications to EB vary by condition and
location. Detection and reporting of health conditions to jurisdictions may be influenced by the
severity of the illness; patient and public awareness of conditions; patient access to health care; the
availability of diagnostic facilities; interests, resources, and priorities of the clinicians, laboratories,
hospitals and other health facilities that report to the jurisdictions; jurisdiction reporting requirements
and resources; emerging pathogens and conditions; and, priorities of state and local health
departments. Reporting delays also occur due to outbreaks, competing priorities, and for other
various reasons (e.g., technical problems, changes in staff schedules, vacation periods). Moreover,
data may be batched reported during outbreaks and at other times, including at the end-of-year when
surveillance staff are finalizing the data.
Case counts and rates may also vary over time (e.g. from year to year) based on changes in
public and provider awareness; changes in laboratory and diagnostic techniques; and changes in the
definition of conditions.
1
1 | VACCINE PREVENTABLE DISEASES
Introduction
There are six (6) vaccine preventable diseases targeted for eradication, elimination and control in
the Philippines namely: Acute Flaccid Paralysis, Measles, Rubella, Diphtheria, Pertussis and Neonatal
Tetanus. Different strategies were implemented such as surveillance activities, health promotion,
and vaccination. Various programmatic and surveillance indicators were developed to track risks of
transmission and measure quality of case detection and reporting.
A clear picture of the country’s status of diseases for the whole year compared to the previous or
specified period of time will prevent progression or halt unfavorable existing conditions thus,
prompt action and appropriate response will be determined.
To highlight the prevention of occurrence, they only require a complete vaccination. Once neglected
or forgotten, this precipitates the surging of cases that might lead to a possible outbreak.
1
1.1 Acute Flaccid Paralysis (AFP)
Poliomyelitis is one of the vaccine preventable diseases targeted for eradication. It is a highly
contagious disease which mainly affects children less than 5 years of age. The last case of polio in the
Philippines was in 1993 in Cebu. In October of 2000, the Philippines, along with the other members of
the Western Pacific Region, was certified polio-free. However, in September of 2001, a type 1 highly
evolved circulating vaccine-derived poliovirus (cVDPV 1) was isolated from three acute flaccid paralysis
(AFP) cases and one healthy contact from three separate communities in the country. Extensive OPV
immunization campaigns were done from 2001 until 2002. Also starting June 2018, there were
reported polio outbreaks in some countries in the Western Pacific Region and subsequently,
Philippines reported its first Vaccine-derived poliovirus (VDPV) last September 2019.
AFP Surveillance is an intensive case-based surveillance wherein a comprehensive set of data

is collected for every case of children under 15 years of age with acute onset of paralysis or a person
of any age in whom poliomyelitis is suspected by a physician. Before the declaration of polio outbreak
last September 2019, the Non-Polio AFP Rate target is 1 per 100,000 population of children under 15
years old. After the declaration, it is recommended that the target will be raised from 1 to 3 per
100,000 populations for the outbreak regions and 2 per 100,000 for non-outbreak regions. By the end
of 2019, the non-polio AFP rate was 2.53 with 872 non-polio AFP cases reported. The non-polio AFP
rate is one of the core performance indicators to gauge the sensitivity of AFP surveillance in the
country. It aims to provide a timely response if an outbreak occurs. Failure to achieve the target
requirement indicates that the existing surveillance system is not sufficient to detect the possible
transmission of polio.
AFP surveillance is an essential strategy which aims to look for poliovirus circulation in the
community by investigating all possible polio cases. Its role is to identify high risk areas or groups and
certify that the Philippines is still polio-free.
TREND IN THE PHILIPPINES
There were 1,003 AFP cases reported nationwide from January 1 to December 31, 2019. Of
these, 872 (87%) have been discarded as non-polio AFP, 19 (2%) cases were classified as polio
compatible, 15 (1%) were classified as vaccine-derived poliovirus (VDPV), while 97 (10%) reported
cases did not fit the case definition and were classified as not AFP (Figure 1.1.1). Most AFP cases were
reported during the 2nd half of 2019 with its highest levels from morbidity weeks 38 to 48.
Figure 1.1.1. Acute Flaccid Paralysis Cases (N=1,003)

Philippines, 2019 vs 2018
Number of Cases 2019 Polio Compatible 2019 VDPV

2019 Not AFP 2019 Discarded
60 Department of Health officially
declared Polio outbreak in the
50 Philippines last September 19, 2019
40
30
20
10
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
2
Regions NCR, III, and CALABARZON reported the highest number of AFP cases nationwide with
over 100 cases in 2019. The regions with the lowest AFP notifications were Regions MIMAROPA, CAR,
and II with 15, 17, and 24 AFP cases, respectively (Figure. 1.1.2). There was a significant increase of
reported cases from previous years after the Department of Health officially declared a polio
outbreak in the Philippines last September 2019.
Figure 1.1.2. Distribution of Acute Flaccid Paralysis Cases by Region (N=1,003)

Philippines, 2019
No. of Cases
Compared to last year’s data, number of AFP cases this year (N=1,003) is two (2) times higher
(142% increase) than number reported in 2018 (N=414) due to the enhanced AFP surveillance
nationwide (Table 1.1.1).
Table 1.1.1. AFP Cases by Region and Classification (N=1,003)

Philippines, 2019
2019 Target AFP
Cases Classification
Reported Non-Polio Polio
Region 3/100,000 2/100,000 Cases (Discarded) Compatible VDPV Not AFP
PHILIPPINES 1014 676 1,003 872 19 15 97
I 48 31 38 31 5 0 2
II 33 22 24 21 0 0 3
III 108 71 105 85 2 0 18
CALABARZON 141 93 105 86 2 1 16
MIMAROPA 33 22 15 13 0 0 2
V 66 44 31 31 0 0 0
VI 72 48 54 54 0 0 0
VII 75 50 48 44 2 0 2
3
Table 1.1.1. (Continued) AFP Cases by Region and Classification (N=1,003)

Philippines, 2019
2019 Target AFP
Cases Classification
Reported Non-Polio Polio
Region 3/100,000 2/100,000 Cases (Discarded) Compatible VDPV Not AFP
VIII 48 32 22 18 1 0 3
IX 39 26 56 55 0 0 1
X 51 34 56 54 0 0 2
XI 51 33 93 93 0 0 0
XII 48 33 66 47 5 5 9
BARMM 51 35 63 49 2 9 3
CAR 18 11 17 14 0 0 3
Caraga 27 19 35 33 0 0 2
NCR 111 73 175 144 0 0 31
Regions with high number of reported deaths in relation to Case Fatality Rate are Region I
with 6 AFP deaths (16% CFR), Region II with 3 reported deaths (13% CFR), and Region X with 5 reported
deaths (9% CFR) [Figure 1.1.3].
Figure 1.1.3. Reported AFP Case Fatality Rate by Region

Case Fatality Rate 2019 2018
18
16
14
12
10
8
6
4
2
0
Regions
PROFILE OF REPORTED AFP CASES AND DEATHS
Age of cases ranged from less than 1 month to 47 years old (median: 7 years). The most
affected population belonged to the <5 years (344 or 34%) age group. Most of the AFP cases were
males (556 or 55%). There was no significant difference in the distribution of cases by age group.
Figure 1.1.4. Reported AFP Cases by Sex and Age Group (N=1,003)
Philippines, 2019
Age (Years) Male Female
>14
10-14
5-9
<5
250 200 150 100 50 0 50 100 150 200

No. of Cases
4
Profile by Vaccination Status
Information on the immunization status of reported cases are essential for the EPI
coordinators in choosing appropriate strategies on targeting specific age groups for
immunization. Among those who had AFP were 514 (51%) children with complete oral
poliovirus vaccine (OPV). Ninety-one (9%) had incomplete OPV vaccination, 77 (8%) did not
receive any dose and 321 (32%) were unknown.
As to age groups, children 10-14 had the most proportion with complete OPV doses
at 33 percent. A greater percentage of children less than 5 years did not receive any single
dose of OPV (55 %) compared to other age groups. Individuals 10 years and above have higher
proportions who did know the number of OPV doses received. This may be due to poor recall
(Figure 1.1.5).
Figure 1.1.5. Immunization Status of Reported AFP Cases by OPV Dose and Age Group (N=1,003)
Philippines, 2019
Complete OPV Dose < 3 OPV Doses

Percentage 0 OPV Dose Unknown
100%
80%
60%
40%
20%
0%
<5 5-9 10-14 >14
Age Group (Years)
LABORATORY RESULTS
Viral Isolation and Genotyping
Table 1.1.2 shows the AFP stool specimen test results from the National Polio
Laboratory (NPL) of the Research Institute of Tropical Medicine (RITM). There were 14 (1%)
isolated vaccine-derived poliovirus from January 1 to December 31, 2019. Among the 1,003 AFP
cases, 24 (2%) AFP cases yielded Sabin-like result while majority of Stool 1 (610 or 61%) and
Stool 2 (573 or 57%) tested negative for poliovirus.
5
Table 1.1.2. Stool Specimen Result among Reported AFP Cases (N=1,003)
Philippines, 2019
Stool Specimen Result Stool Specimen 1 Stool Specimen 2

Positive for Vaccine-derived
poliovirus 14 1% 14 1%
Negative for poliovirus 610 61% 573 57%
Sabin-like poliovirus 24 2% 20 2%
Non-polio enterovirus 47 5% 49 5%
Not tested/insufficient sample 10 1% 9 1%
No stool 298 30% 338 34%
Total 1003 100% 1003 100%
Differential Diagnosis of Reported AFP Cases
The differential diagnosis of AFP includes but is not limited to, poliomyelitis, Guillain-
Barre Syndrome (GBS), traumatic neuritis, and transverse myelitis. These four diseases
represent the most common causes of AFP; however, there are other differential diagnoses
that have numerous etiologies. Hence, any disease that presents AFP, even if diagnosed as
disease other than polio by the physician should be reported and collected with stool
specimen. In 2019, hypokalemia is the most common diagnosis among the non-polio AFP
cases reported (Figure 1.1.6).
Figure 1.1.6. Top 10 Diagnoses of Non-Polio AFP Cases (n=220*)

Philippines, 2019
Final Diagnosis
Hypokalemia
GBS
CNS Infection
AGE
Pott's Disease
Cerebral Palsy
Bacterial Meningitis
Transverse Myelitis
CNS Infection
Electrolyte imbalance
0 10 20 30 40 50
Number of Cases
Legend: GBS, Guillain-Barre Syndrome; AGE, acute gastroenteritis; CNS, central nervous system
*counts of Non-Polio AFP cases under top 10 diagnoses ONLY
6
SURVEILLANCE PERFORMANCE INDICATORS
AFP Reporting Rate and Non-Polio AFP Rate
As seen in the figure below, the performances of the regions for this year is better
compared to their performances from the past 2 years. Regions IX, X, XI, Caraga, and NCR
reached more than 3.00 rate for the Non-Polio AFP Rate. However, Regions III, VI, XII, BARMM
and CAR reached the target of 2.00 (Figure 1.1.7).
Figure 1.1.7. Three-Year Comparison of Non-Polio AFP Rate by Region

Philippines, 2017 – 2019
Rate
2017 2018 2019
6.00
5.00
4.00
3.00
2.00
1.00
0.00
Region
Non-Polio AFP Rate Target for Outbreak Regions
Non-Polio AFP Rate Target for Non-Outbreak Regions
After the polio outbreak declaration last September 2019, it is recommended that the target
will be raised from 1 to 3 per 100,000 population for the outbreak regions and 2 per 100,000 for non-
outbreak regions. From January 1 to December 31, 2019, there were 1,003 AFP cases reported,
providing the Philippines a reporting rate of 2.91 per 100,000 population of children under 15 years
old. Five out of 17 Regions were unable to reach the target. The incidence of AFP (non-polio AFP rate)
caused by diseases other than poliomyelitis is 0.98 per 100,000 population of children under 15 years
of age. Eight out of 17 Regions were below the target (Table 1.1.3).
Table 1.1.3. AFP Reporting and Non-Polio AFP Rate

Philippines, 2019
Region AFP Reporting Rate Non-Polio AFP Rate
PHILIPPINES 2.91 2.53
I 2.40 1.96
II 2.16 1.89
III 2.90 2.35
CALABARZON 2.20 1.80
MIMAROPA 1.36 1.18
V 1.40 1.40
VI 2.23 2.23
VII 1.89 1.73
VIII 1.36 1.12
IX 4.23 4.15
X 3.28 3.17
7
Table 1.1.3. (Continued) AFP Reporting and Non-Polio AFP Rate

Philippines, 2019
Region AFP Reporting Rate Non-Polio AFP Rate
XI 5.51 5.51
XII 3.94 2.81
BARMM 3.54 2.75
CAR 3.02 2.49
Caraga 3.66 3.45
NCR 4.70 3.87
Stool Specimen Adequacy Rate (n=431)
All AFP cases should have full clinical and virological investigation with at least 80% of
AFP cases having adequate stool specimens collected. Among the 872 non-polio AFP cases, 431
cases had two stool specimens collected within 14 days from onset which gives us an adequacy
rate of 49%. One hundred eighty (21%) cases had specimens collected beyond the required
collection period. Thirty-two (4%) cases had only one specimen stool submitted, 229 (26%)
cases had no specimen samples. Among the 17 regions, only Region VI reached or surpassed
the target rate of 80% (Table 1.1.4).
Table 1.1.4. Stool Specimen Adequacy by Region (n=872)

Philippines, 2019
Stool 1 and 2 With specimen
collected within collected more No
Region 14 days (Adequate) than 14 days 1 Stool Stool Total
PHILIPPINES 431 180 32 229 872
I 11 12 0 8 31
II 16 5 0 0 21
III 35 12 4 34 85
CALABARZON 45 21 6 14 86
MIMAROPA 6 4 1 2 13
V 15 10 1 5 31
VI 43 7 4 0 54
VII 32 7 1 4 44
VIII 8 0 3 7 18
IX 43 10 1 1 55
X 10 5 0 39 54
XI 68 19 2 4 93
XII 20 14 1 12 47
BARMM 12 21 1 15 49
CAR 7 4 1 2 14
Caraga 4 6 1 22 33
NCR 56 23 5 60 144
8
Only Region VI achieved the target for Adequacy of Stool Specimen (Figure 1.1.8).
Regions IX, II, XI and VII reached the 70 percent mark. However, Regions X, BARMM and Caraga
came short with less than 30 percent putting them at the end of the graph.
Figure 1.1.8. Stool Specimen Adequacy Rate among Non-Polio AFP Cases by Region (n=872)
Philippines, 2019
Percentage of Stool
Adequacy
100%
90%
80%
70%
80 78 76 73 73
60%
50% 52
40%
50 48 46 44 43 41
30% 39 35
20% 24
10% 19
12
0%
Stool 1 and 2 collected within 14 days (Adequate)

With specimen collected more than 14 days
1 Stool
No Stool Regions
Polio Infection in the Philippines (n=23)
The first isolation in the Philippines was the case in Marogong, Lanao del Sur classified
as circulating Vaccine-derived poliovirus type 2 (cVDPV type 2). The stools were collected last
July 11 and 12 of 2019 and yielded positive for VDPV type 2. Another cluster was noted when
an immunodeficiency-related VDPV type 2 (iVDPV type 2) case was caught in Calamba,
Laguna. A case from Maluso, Basilan yielded positive for VDPV type 1 and it has noted that
the isolated virus was genetically-linked to the VDPV type 1 in Sabah, Malaysia.
Figure 1.1.9. Polio Infection in the Philippines (n=23)

Philippines, 2019
9
1.2 Diphtheria
Diphtheria is an infectious disease spread (from person to person) by respiratory droplets

through coughing and sneezing. Diphtheria usually affects the tonsils, pharynx and occasionally other
mucus membranes or skin. Incubation period is usually 2 to 5 days (range 1-10 days).
There were 272 cases of diphtheria reported in 2019 nationwide. This is 45% higher compared
to the number of cases last year (N=187) [Figure 1.2.1]. Cases were distributed throughout all the
morbidity weeks of 2019. Moderate peaks were noted in weeks 22, 25, and 43-45.
Figure 1.2.1. Reported Diphtheria Cases by Morbidity Week (N=272)

Number of Cases 2019 2018

20
18
16
14
12
10
8
6
4
2
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Looking at the regional caseload, NCR, CALABARZON, and Region III reported the highest
number of diphtheria cases with 80, 51, and 28, respectively. Together, these three regions account
for more than half (58%) of all cases in the country (Figure 1.2.2). The regions with the least reported
cases include MIMAROPA (2), Region VII (3), and Region X (3). Meanwhile, Region VIII and Caraga have
no reported diphtheria case.
10
Figure 1.2.2. Distribution of Diphtheria Cases (N=272)

Philippines, 2019
No. of Cases
Table 1.2.1 shows a comparison of the regional data on cases, deaths and CFR by region in
2019 vis-à-vis 2018. Nationally, cases in 2019 increased from 187 cases in 2018 to 272 cases in 2019
(45% increase). The regions with the highest percent change were Regions CAR (833%), BARMM
(200%), and Region I (200%).
Table 1.2.1. Diphtheria Cases, Deaths and Case Fatality Rates (CFR) by Region
2019 2018 % Change

Region
Cases Deaths CFR Cases Deaths CFR in Cases
PHILIPPINES 272 55 20% 187 37 20% ↑ 45%
I 9 2 22% 3 1 33% ↑ 200%
II 7 1 14% 0 0 - ↑
III 23 3 13% 19 6 32% ↑ 21%
CALABARZON 51 6 12% 43 6 14% ↑ 19%
MIMAROPA 2 1 50% 0 0 - ↑
V 11 6 55% 8 5 63% ↑ 38%
VI 8 1 13% 5 1 20% ↑ 60%
VII 3 1 33% 2 0 0% ↑ 50%
VIII 0 0 - 2 1 50% ↓ 100%
IX 17 1 6% 6 1 17% ↑ 183%
X 3 2 67% 2 0 0% ↑ 50%
XI 5 2 40% 6 3 50% ↓ 17%
XII 7 4 57% 8 1 13% ↓ 13%
BARMM 18 11 61% 6 0 0% ↑ 200%
CAR 28 2 7% 3 0 0% ↑ 833%
Caraga 0 0 - 8 0 0% ↓ 100%
NCR 80 12 15% 66 12 18% ↑ 21%
11
One fifth (20%) of diphtheria cases died in both 2019 and 2018 nationally. However, more
than half of the cases died in Regions X (CFR=67%), BARMM (CFR=61%), Region XII (CFR=57%), and
Region V (CFR=55%) in 2019. These regions, except Region V, posted sharp increase in CFRs from 2018
to 2019. Reduction in CFRs were observed in Regions V, XI, I, NCR, III, VI, CALABARZON, and IX (Figure
1.2.3).
Figure 1.2.3. Reported Diphtheria Case Fatality Rates (CFR) by Region

CFR (%) 2019 2018

67
61 63
57
55
50 50 50
40
33 33 32
22 20
18 17
15 14
13 13 13 12 14
7 6
0 0 0 0 0 0 0 0 0
Region
PROFILE OF REPORTED DIPHTHERIA CASES AND DEATHS
Diphtheria cases range from ages less than 1 year to 82 years old with median of 7 years. The
most affected age group was 5-9 years old (89 or 33%). One hundred thirty-seven (50%) were males
while 135 (50%) were females. There were more male cases in the 5-9 age group. There was no
significant difference in the distribution of cases by sex in other age groups (Figure 1.2.4).
Figure 1.2.4. Reported Diphtheria Cases by Age Group and Sex (N=272)
Philippines, 2019
Male Female
Age Group
≥40
35-39
30-34
25-29
20-24
15-19
10-14
5-9
1-4
<1
70 50 30 10 10 30 50 70
Number of Cases
12
There were 55 (CFR=20%) reported diphtheria deaths. The reported deaths range from ages
less than 1 month to 77 years old with median of 4 years. Majority of diphtheria deaths were males
(35 or 64%).
VACCINATION STATUS
Most of the reported cases did not receive a single dose of Pentavalent (Penta) vaccine (126
or 46%). 76 (28%) received Penta 3 while 55 (20%) have unknown vaccination status. Only 15 cases
(5%) received either Penta 1 or Penta 2. Most deaths (37 or 67%) had no Penta dose received (Figure
1.2.5).
Figure 1.2.5. Vaccination Status among Diphtheria Cases and Deaths (N=272)
Philippines, 2019
140
Number of Cases
120
100
80
60
40
20
0
Unknown
No Penta
Penta 1 Penta 2 Penta 3 Vaccination
Dose received
Status
Cases 10 3 66 89 49
Deaths 2 0 10 37 6
LABORATORY RESULTS OF REPORTED CASES

Eighty-five (31%) of the 272 reported cases had specimen for laboratory test and 13 (5%)
of the cases were laboratory-confirmed via PCR and culture.
Table 1.2.2. Laboratory Specimens and Results of Diphtheria Cases (N=272)

Philippines, 2019
Total Reported Cases 272

Laboratory Tested 85 (31%)
Confirmed 13 (15%)
-RT-PCR-Electrophoresis 1 (8%)
-Aerobic Culture 12 (92%)
Negative 72 (85%)
Not Tested 187 (69%)
13
Profile of Confirmed Diphtheria Cases (n=13)
Among the 272 reported diphtheria cases, thirteen cases are confirmed. The reported
confirmed cases range from 2 to 15 years old with median of 5 years and were prevalent (9 or
69%) among female population. Nine (69%) did not receive Diphtheria vaccine (Figure 1.2.6).
Figure 1.2.6. Vaccination Status among Confirmed Diphtheria Cases (n=13)

Philippines, 2019
Number of Cases
10
8
6
4
2
0
Unknown
No Penta Dose
Penta 1 Penta 2 Penta 3 Vaccination
received
Status
Cases 1 0 0 4 2
Deaths 1 0 0 5 0
Profile of Diphtheria Deaths among Confirmed Cases (n=6)
Among the 13 confirmed cases, there were six deaths (CFR=46%). The confirmed
deaths range from 2 to 10 years old with median of 4 years old. Majority were reported among
male population (5 or 83%).
14
1.3 Measles and Rubella
Measles (Tigdas) is an acute highly communicable viral illness caused by the measles virus in
the genus Morbillivirus of the Paramyxoviridae family. The clinical progression of measles starts with
a prodrome characterized by fever, cough, coryza (runny nose) and conjunctivitis. Small white or
bluish-white lesions found on the buccal mucosa (Koplik’s spots) may also be visible during the
prodrome. These symptoms intensify several days before the onset of rash which is typically described
to be appearing first on the face and spreads to the trunk and extremities.
On the other hand, Rubella is a contagious viral infection that occurs most often in children
and young adults. It is associated with rash that usually starts at the face and neck, progressing down
to the body, swollen lymph glands, conjunctivitis, cough and coryza. Infected adults may develop
arthritis and painful joints. It is the leading vaccine preventable cause of birth defects known as
congenital rubella syndrome (CRS).
The goal for measles elimination in the Western Pacific Region was set in 2005. In September
2012, the Regional Committee for the Western Pacific Region encouraged its member states to
undertake the challenges for measles elimination. The Philippines continuously reaffirms its
commitment in eliminating measles in the country. Apart from achieving and sustaining high levels of
population immunity, it has been well established that intensive surveillance is a key in identifying
high risk populations to properly guide the Expanded Program on Immunization in conducting an
appropriate immunization response in areas where high incidence of measles are observed.
The cumulative total of reported measles cases from January 1 to December 31, 2019 is
51,926. This is 117% higher compared to 2018 (N=23,960) [Figure 1.3.1]. The highest levels of
reported cases occurred between weeks 6 to 11 (Feb. 3-Mar. 16, 2019) with its peak happening in
week 8 (Feb. 17-23) in 2019. This was a significant increase from the reported cases in previous years
and prompted the Department of Health to officially declare a measles outbreak in NCR in February
20191, and subsequently to the rest of the regions.
Figure 1.3.1. Reported Measles- Rubella Cases by Morbidity Week

Number of Cases Measles Outbreak in

2019 (N=51,926) 2018 (N=23,960)
Luzon, Visayas and some
5,000
parts of Mindanao
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
-
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
1
Department of Health, “DOH declares measles outbreak in NCR”, http://www.doh.gov.ph/node/16645
Note: Measles-Rubella = Measles cases + Confirmed Rubella + Discarded (Negative)
Measles Cases = Laboratory confirmed measles + Epi-linked confirmed measles + Measles Compatible
Confirmed Rubella = Laboratory confirmed rubella + Epi-linked confirmed rubella
15
CALABARZON (9,620 or 19%) reported the highest measles-rubella cases followed by NCR with
8,742 (17%) cases and Region III with 7,104 (14%) measles-rubella cases. However, among the 17
regions, MIMAROPA has the highest incidence rate of 77 per 100,000 populations. It is followed by
Caraga (72 per 100,000 population), and CAR with 64 per 100,000 populations (Figure 1.3.2).
Figure 1.3.2. Distribution of Measles-Rubella Cases (N=51,926)

Philippines, 2019
Incidence Rate per

No. of Cases 100,000 population
Fourteen out of 17 regions, showed an increase of reported measles-rubella cases compared

to the cases reported in 2018. MIMAROPA has the most remarkable change in number of cases, from
2018 (n=180) to 2019 (n=2,425) registered a 1,247% increase (Table 1.3.1).
Table 1.3.1. Cumulative Reported Measles-Rubella Cases by Region (N=51,926)

2019 2018
Region % Change
Cases Deaths % CFR Cases Deaths %CFR
PHILIPPINES 51,926 644 1.2 23,960 341 1.4 ↑ 117%
I 2,074 22 1.1 732 6 0.8 ↑ 183%
II 672 4 0.6 92 0 0.0 ↑ 630%
III 7,104 126 1.8 1,530 42 2.7 ↑ 364%
CALABARZON 9,620 142 1.5 3,276 61 1.9 ↑ 194%
MIMAROPA 2,425 27 1.1 180 4 2.2 ↑ 1,247%
V 1,390 16 1.2 379 13 3.4 ↑ 267%
VI 3,294 13 0.4 1,049 6 0.6 ↑ 214%
VII 2,298 17 0.7 500 2 0.4 ↑ 360%
VIII 2,261 41 1.8 248 5 2.0 ↑ 812%
IX 664 2 0.3 1,432 8 0.6 ↓ 54%
X 2,802 19 0.7 1,720 8 0.5 ↑ 63%
XI 1,816 20 1.1 1,651 41 2.5 ↑ 10%
XII 1,383 7 0.5 1,994 19 1.0 ↓ 31%
BARMM 2,242 15 0.7 4,488 41 0.9 ↓ 50%
CAR 1,162 2 0.2 283 0 0.0 ↑ 311%
Caraga 1,977 24 1.2 350 2 0.6 ↑ 465%
NCR 8,742 147 1.7 4,056 83 2.0 ↑ 116%
16
Regions with high number of reported deaths in relation to Case Fatality Rate are Region III
with 126 reported measles-rubella deaths (1.8% CFR), Region VIII with 41 reported deaths (1.8% CFR),
and NCR with 147 reported deaths (1.7% CFR) [Figure 1.3.3].
Figure 1.3.3. Reported Measles-Rubella Case Fatality Rate by Region

2019 2018
CFR % 3.4
2.7
2.5
2.2 2.2
2.0 2.0
1.8 1.8
1.7
1.5
1.2 1.2 1.1
1.1 1.1 1.0
0.8 0.9
0.7 0.7 0.7
0.6 0.5 0.6 0.5 0.6 0.6
0.4 0.4 0.3
0.2
0.0 0.0
Region
PROFILE OF REPORTED MEASLES-RUBELLA CASES
Figure 1.3.4 shows the measles-rubella vaccination status by age group. Children of 6 months
to 4 years old were the most affected comprising 24,563 (47%) of measles-rubella cases. The majority
of measles-rubella cases were unvaccinated (30,727 or 59%), most were from the age group of 6
months to 4 years old (15,994 or 52%). Out of 51,926 reported measles-rubella cases, only 2,142 (4%)
cases received 1 dose of measles-containing vaccine and 755 cases (1%) received 2 or more doses of
measles-containing vaccine. Nine months to 4 years age group was the target population during the
ORI.
Figure 1.3.4. Reported Measles-Rubella Cases Vaccination Status by Age Group (N=51,926)
Philippines, 2019
Number of Cases
25,000
20,000
15,000
10,000
5,000
0
<6 mos. 6 - 59 mos 5–9 10 – 14 15 - 19 ≥20
Age Group (Years)
2 or more doses Unknown vaccination status Unknown no. of doses 1 dose Not vaccinated
*347 cases have no data on Age

17
Majority of the reported measles-rubella cases were from the age group of 1 to 4 years old
(13,465 or 26%), followed by age group of 6 to 8 months old (7,174 or 14%) and less than 6 months
old (5,972 or 12%). Out of 51,926 measles-rubella cases, 27,312 (53%) were males while 24,614 (47%)
cases were females (Figure 1.3.5).
Figure 1.3.5. Reported Measles-Rubella Cases by Age Group and Sex (N=51,926)
Philippines, 2019
Female Male
Age Group (Years)
35 - 39
25 - 29
15 - 19
5 -- 9
9 - 11 mos
<6 mos
8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000
Number of Cases
Among the 51,926 reported suspect measles-rubella cases, only 6,674 (13%) had specimen
for laboratory testing. A total of 4,510 (68%) were positive for measles either by IgM or PCR and 235
(4%) were positive for rubella. There were 3,496 (7%) measles and rubella cases confirmed by
epidemiological linkage (3,490 epi-linked measles cases and 6 epi-linked rubella cases). Also, 41,756
(80%) were measles compatible cases (Table 1.3.2).
Table 1.3.2. Laboratory Results of Reported Measles Cases (N=51,926)

Philippines, 2019
Measles-Rubella Cases 51,926 (100%)
Specimen collected/tested: 6,674 (13%)
Measles Positive (IgM/PCR) 4,510 (68%)
Rubella Positive (IgM/PCR) 235 (4%)
Negative (Discarded) 1,929 (29%)
Epidemiologically-linked measles/ rubella: 3,496 (7%)
Epidemiologically-linked measles 3,490 (100%)
Epidemiologically-linked rubella 6 (0.1%)
Not tested (measles compatible/clinical): 41,756 (80%)
18
CONFIRMED MEASLES CASES IN THE PHILIPPINES
A confirmed measles case is a case with a positive result for IgM or PCR or a case confirmed
by epidemiological linkage. There were 8,000 confirmed measles cases from January 1 to December
31, 2019 while 5,285 cases were confirmed in 2018. Top regions with confirmed measles cases were
NCR (1,748 or 22%), BARMM (750 or 9%), Region XI (688 or 9%) and CALABARZON (675 or 8%). There
were 94 (CFR=1.2%) deaths reported among confirmed measles cases (Table 1.3.3). However, among
the 17 regions, CAR has the highest incidence rate of 19 per 100,000 population. It is followed by
BARMM (18 per 100,000 population), and Region XI with 13 per 100,000 population (Figure 1.3.6).
Figure 1.3.6. Distribution of Confirmed Measles Cases (n=8,000)

Philippines, 2019
Incidence Rate per

Table 1.3.3. Confirmed Measles Cases by Region (n=8,000)

Philippines, 2019 vs. 2018
2019 2018
Region % Change
Cases Deaths %CFR Cases Deaths %CFR
PHILIPPINES 8,000 94 1.2 5,285 107 2.0 ↑ 51%
I 669 13 1.9 105 3 2.9 ↑ 537%
II 129 1 0.8 9 0 0.0 ↑ 1,333%
III 509 9 1.8 298 17 5.7 ↑ 71%
CALABARZON 675 14 2.1 650 12 1.8 ↑ 4%
MIMAROPA 154 1 0.6 9 0 0.0 ↑ 1,611%
V 215 3 1.4 173 6 3.5 ↑ 24%
VI 665 4 0.6 275 0 0.0 ↑ 142%
VII 321 4 1.2 179 1 0.6 ↑ 79%
VIII 93 1 1.1 24 1 4.2 ↑ 288%
IX 97 1 1.0 331 1 0.3 ↓ 71%
X 415 2 0.5 299 4 1.3 ↑ 39%
XI 688 5 0.7 470 19 4.0 ↑ 46%
XII 265 1 0.4 515 14 2.7 ↓ 49%
BARMM 750 4 0.5 649 5 0.8 ↑ 16%
CAR 344 1 0.3 111 0 0.0 ↑ 210%
Caraga 263 0 0.0 84 0 0.0 ↑ 213%
NCR 1,748 30 1.7 1,104 24 2.2 ↑ 58%
19
Profile of Confirmed Measles Cases (n=8,000)
Age group of 1 to 4 years old (1,946 or 24%) was the most affected among the reported
confirmed measles cases followed by age group of 6 to 8 months (1,226 or 15%) and age group
of less than 6 months (976 or 12%). The reported confirmed measles cases range from less
than 1 month to 82 years, with a median of 3 years old. Majority were males (4,227 or 53%).
Out of 8,000 confirmed measles cases, only 248 (3%) cases received 1 dose of measles-
containing vaccine and 73 cases (1%) received 2 or more doses of measles-containing vaccine.
Most of the cases were unvaccinated (5,472 or 68%), 1,287 (16%) cases have unknown number
of doses and 1,287 (16%) cases have unknown vaccination status.
Profile of Confirmed Measles Deaths (n=94)
There were 94 (CFR=1.2%) reported confirmed measles deaths. Measles deaths

ranged from ages less than 1 month to 34 years old (median: 1 year). Most measles deaths
were males (49 or 52%). Majority of the measles deaths were unvaccinated (80 or 85%).
CONFIRMED RUBELLA CASES IN THE PHILIPPINES
A confirmed rubella case is a case with a positive result for IgM or PCR or a case confirmed by
epidemiological linkage. There were 241 confirmed rubella cases from January 1 to December 31,
2019 while 152 cases were confirmed in 2018. Top regions with confirmed rubella cases were CAR (56
or 23%), Region VI (40 or 17%), Region III (23 or 10%), CALABARZON (21 or 9%), and NCR (16 or 7%).
No death was reported among confirmed rubella cases (Table 1.3.4). Among the 17 regions, CAR has
the highest incidence rate of 3 per 100,000 population (Figure 1.3.7).
Table 1.3.4. Confirmed Rubella Cases by Region (n=241)

2019 2018
Region % Change
Cases Deaths %CFR Cases Deaths %CFR
PHILIPPINES 241 0 0.0 152 1 0.7 ↑ 59%
I 15 0 0.0 13 0 0.0 ↑ 15%
II 7 0 0.0 2 0 0.0 ↑ 250%
III 23 0 0.0 7 1 14.3 ↑ 229%
CALABARZON 21 0 0.0 18 0 0.0 ↑ 17%
MIMAROPA 3 0 0.0 2 0 0.0 ↑ 50%
V 7 0 0.0 2 0 0.0 ↑ 250%
VI 40 0 0.0 13 0 0.0 ↑ 208%
VII 10 0 0.0 7 0 0.0 ↑ 43%
VIII 8 0 0.0 1 0 0.0 ↑ 700%
IX 5 0 0.0 4 0 0.0 ↑ 25%
X 7 0 0.0 22 0 0.0 ↓ 68%
XI 10 0 0.0 25 0 0.0 ↓ 60%
XII 4 0 0.0 14 0 0.0 ↓ 71%
BARMM 0 0 - 2 0 0.0 ↓ 100%
CAR 56 0 0.0 2 0 0.0 ↑ 2,700%
Caraga 9 0 0.0 6 0 0.0 ↑ 50%
NCR 16 0 0.0 12 0 0.0 ↑ 33%
20
Figure 1.3.7. Distribution of Confirmed Rubella Cases (n=241)

Philippines, 2019
No. of Cases Incidence Rate per

100,000 population
Profile of Confirmed Rubella Cases (n=241)
Age group of 20 - 24 years old (61 or 25%) was the most affected among the reported
confirmed rubella cases followed by age group of 15 – 19 years of age (42 or 17%). The reported
confirmed rubella cases range from less than 1 month to 56 years, with a median of 19 years
old. Majority were females (131 or 54%). Out of 241 confirmed rubella cases, only 16 (7%) cases
received 1 dose of measles-containing vaccine and 3 cases (1%) received 2 or more doses of
measles-containing vaccine. Most of the cases, have unknown number of doses (106 or 44%),
while 63 (26%) were not vaccinated and 53 (22%) cases have unknown vaccination status.
Profile of Confirmed Rubella Death (n=0)
There were no reported death among confirmed rubella cases. It is 100% lower
compared to the reported confirmed rubella death in 2018 (n=1).
Profile of Confirmed Rubella Pregnancies (n=3)
There were three pregnancies among the confirmed rubella cases. These cases were
from Regions III, VI and IX. Two of these cases had unknown vaccination status while one
was not vaccinated.
SURVEILLANCE PERFORMANCE INDICATORS
Surveillance indicators gauge the capacity of the country in gearing towards the measles
elimination goal. The Philippines has reached a countrywide incidence rate of 74.06 per 1,000,000
population and is way above the target of <1 per 1,000,000 population (Table 1.3.5).
1. Blood Collection and Timeliness Rate
Blood collection and timeliness rate is defined as the collection of specimens among
suspect cases within 0 to 28 days from rash onset. The target is ≥80%. In 2019, the overall
timeliness of adequate blood collection rate was 36%. None among the regions had timely
blood specimen collection rate (Table 1.3.5).
21
2. Timeliness and Adequacy of Case Investigation Rate
The overall timeliness and adequacy of case investigation rate for 2019 was 19%.
None among the regions have met the target. This decreases the specificity of
epidemiological surveillance to establish evidences of transmission or to track sources of
infection (Table 1.3.5).
3. Suspect Measles Reporting Rate
Suspect measles reporting rate is defined as the reporting rate of all cases detected
using the standard case definition. The target is ≥2/100,000 population and this has been
achieved due to increased reported cases from the outbreaks. The national suspect
measles reporting rate was 48.07/100,000 population. All regions reached the target due
to the on-going transmission of measles cases in the country (Table 1.3.5).
4. Non-Measles/ Non-Rubella Reporting Rate
The non-measles or non-rubella rate surveillance target has not been attained
by most of the regions since most of the cases were either clinically compatible measles
or laboratory confirmed measles or rubella. Only Regions I, VI, CAR, and Caraga, surpassed
the target of ≥2/100,000 population (Table 1.3.5).
5. Measles Compatibility
Measles compatibility is the proportion of suspect cases which do not have

specimens collected for laboratory confirmation or suspect cases which were not
epidemiologically-linked to other laboratory- confirmed cases but manifested the clinical
signs and symptoms of measles. The target is <10%. In 2019, 80% of the total cases at the
national level were classified as measles compatible or clinically confirmed (Table 1.3.5).
Table 1.3.5. Measles Surveillance Performance Indicators by Region
22
1.4 Neonatal Tetanus
Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body's
muscles and nerves. It typically arises from a skin wound that becomes contaminated by a bacterium
called Clostridium tetani, which is often found in soil. Common first signs of tetanus are headache and
muscular stiffness in the jaw, followed by stiffness of the neck, difficulty in swallowing, rigidity of
abdominal muscles, spasms, sweating and fever.
The Philippines achieved the status as the 44th country to eliminate Maternal and Neonatal
Tetanus in November 2017 after the Maternal and Neonatal Tetanus Elimination (MNTE) External
Validation.

There were 84 neonatal tetanus cases reported in 2019 nationwide. This is 18% higher when
compared to 2018 (n=71) [Figure 1.4.1]. Moderate cases were noticeable in morbidity weeks 9, 11,17,
22 with the highest peak in week 23. Across the 52 morbidity weeks, there were 27 weeks (52%) with
zero to one case reported.
Figure 1.4.1. Reported Neonatal Tetanus Cases by Morbidity Week (N=84)

8
7
6
5
4
3
2
1
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Nationally, BARMM reported the highest number of cases (25 or 30%) followed by Region XII
(19 or 23%). Most of the regions particularly Regions II, III, CALABARZON, V, VI, IX, X, XI, CAR, Caraga,
and NCR presented a range of 1-5 cases while Regions I, VII and VIII have zero case reporting this
year (Figure 1.4.2)
Figure 1.4.2. Distribution of Neonatal Tetanus Cases (N=84)
Philippines, 2019
No. of Cases
23
Table 1.4.3 shows a comparison of the regional data on cases, deaths and CFR in 2019 vis- à-
vis 2018. There was a remarkable increase (18%) in the national cases from 71 cases in 2018 to 84
cases in 2019. Regions MIMAROPA (400%) and II (200%) reported the highest percentage change.
Table 1.4.3. Reported Neonatal Tetanus Cases and Deaths by Region (N=84)
2019 2018
Region % Change
Cases Deaths Cases Deaths
PHILIPPINES 84 42 71 35 ↑ 18%
I 0 0 1 0 ↓ 100%
II 3 0 1 0 ↑ 200%
III 1 1 3 2 ↓ 67%
CALABARZON 3 3 4 3 ↓ 25%
MIMAROPA 10 5 2 0 ↑ 400%
V 4 3 0 0 ↑
VI 5 5 4 3 ↑ 25%
VII 0 0 2 2 ↓ 100%
VIII 0 0 2 1 ↓ 100%
IX 3 2 4 2 ↓ 25%
X 2 0 6 3 ↓ 67%
XI 2 0 3 0 ↓ 33%
XII 19 12 14 6 ↑ 36%
BARMM 25 9 20 10 ↑ 25%
CAR 2 0 0 0 ↑
Caraga 3 2 3 2 → 0%
NCR 2 0 2 1 → 0%
There was a marked decrease of neonatal deaths in 2019 compared to 2018 nationally. Only
Regions III, CALABARZON, and VI had CFR of 100%. This year, Region V reported CFR of 75% from no
case and death in 2018 while MIMAROPA reported CFR of 50% from zero death last year. Slight
increase was also noted in Region IX (CFR=67%) and Region XII (CFR=63%) while BARMM presented a
decrease in CFR (36%). The rest of the regions had zero death reported (Figure 1.4.3).
Figure 1.4.3 Reported Neonatal Tetanus Case Fatality Rate by Region

CFR (%) 2019 2018
100 100 100 100
75 75 75
67 67 63 67
50 50 50 50 50 50
43
36
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Region
24
PROFILE OF NEONATAL TETANUS CASES AND DEATHS
Neonatal Tetanus cases ranged from 0 to 26 days old with median of 7 days old. The most
affected age group was 3-7 days old with 53 (63%) cases. Majority of disease occurrence was observed
more in male (50 or 60%) than in female population. More males were also inflicted among the 3-7
age group (36 or 72%) [Figure 1.4.4].
Figure 1.4.4. Reported Neonatal Tetanus Cases by Age Group and Sex (N=84)
Philippines, 2019
Male Female
Age Group in Days
23-28
18-22
13-17
8-12
3-7
0- 2
40 35 30 25 20 15 10 5 0 5 10 15 20 25 30 35 40
Number of Cases
There were 42 reported deaths out of 84 cases. Most deaths (9 or 21%) were observed among
7 days old with more than half (23 or 55%) occurrence on the male population. Majority (24 or 57%) have
unknown vaccination status.
VACCINATION STATUS
Fifty-four (64%) of the reported cases had mothers who did not receive Tetanus Toxoid (TT)
vaccine while 21 (25%) have unknown vaccination status. A handful (8 or 10%) has incomplete dose
and only one (1%) mother with complete vaccination (Figure 1.4.5).
Figure 1.4.5. Vaccination Status among Mothers of Neonatal Tetanus Cases and Deaths (N=84)
Philippines, 2019
Number of Cases
60 54
50
40
30 21
20 8
10 1 0 0
0
TT1 TT2 TT3 TT4 No TT Dose Unknown
received Vaccination
Vaccination Status Status
25
Almost all of the reported cases (77 or 92%) were home deliveries and attended by either a
layperson (36 or 43%) or traditional birth attendants (27 or 32%). The most utilized tool for cutting cord
was blade (27 or 32%) followed by bamboo (23 or 27%) with a majority (45 or 54%) of unknown stump
treatment used (Figure 1.3.4).
Table 1.3.4 Delivery Practices of Reported Neonatal Tetanus Cases (N=84)

Philippines, 2019
Place of Delivery Cases %

Home 77 (92%)
Hospital/Lying-In/Clinic 6 (7%)
Others 1 (1%)
Delivery Attendant
*Lay Person 36 (43%)
Traditional Birth Attendant 27 (32%)
Unknown 14 (17%)
Physician 3 (4%)
Hilot 2 (2%)
Midwife 2 (2%)
Cord Cutting Tool Used
Blade 27 (32%)
Bamboo 23 (27%)
Scissors 18 (21%)
Unknown 12 (14%)
*Others 4 (5%)
Stump Treatment Used
Unknown 45 (54%)
Alcohol 23 (27%)
Others 9 (11%)
Povidone Iodine 7 (8%)
* Fellow Cultural Minority,Mother, Aunt, Grandfather, Husband, Neighbors, Relatives, Self
26
1.5 Non-Neonatal Tetanus
An acute disease caused by an exotoxin of the tetanus bacillus, Clostridium tetani, which
grows anaerobically at the site of an injury. The disease is characterized by painful muscular spasms.
The first sign suggestive of tetanus in older children and adults is generalized trismus. Spasms occur,
opisthotonus and the facial expression known as “risus sardonicus” characterized by a forced grin and
raised eyebrows.
There were 926 clinically confirmed non-neonatal tetanus cases reported in 2019 nationwide
(Figure 1.5.1). This is 4% lower when compared to reported cased in 2018 (N=961). Cases were evenly
distributed throughout all the morbidity weeks of 2019. Highest peaks were marked in weeks 10 and
19 while week 26 reported the lowest for the year.
Figure 1.5.1. Reported Non-Neonatal Tetanus Cases by Morbidity Week (N=926)

35
30
25
20
15
10
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
As presented in Figure 1.5.2, non-neonatal tetanus cases were highest in Region CALABARZON
(114 or 12%) followed by Region III with 105 (11%) cases. Regions NCR (95 or 10%) and Region V (91
or 10%) were observed at the same rate. The four cited regions account for almost half (405 or 44%)
of the total reported cases nationwide.
Figure 1.5.2. Distribution of Non-Neonatal Tetanus Cases (N=926)

Philippines, 2019
No. of Cases
27
Table 1.5.1 shows a comparison of the regional cases, deaths and CFR by region in 2019 vis-à-
vis 2018. Nationally, cases slightly decreased (4%) from 961 cases in 2018 to 926 cases in 2019. The
region with the highest percentage change was Region IX (59%) followed by Regions VII (32%) and
BARMM (31%). Region II reported the lowest percentage at 2% while Region X did not exhibit change
in reported cases this year.
Table 1.5.1. Non-Neonatal Tetanus Cases by Region (N=926)

2019 2018
Region % Change
PHILIPPINES 926 158 961 188 ↓ 4%
I 60 8 77 13 ↓ 22%
II 44 3 43 8 ↑ 2%
III 105 14 91 12 ↑ 15%
CALABARZON 114 16 128 46 ↓ 11%
MIMAROPA 14 0 23 4 ↓ 39%
V 91 15 95 15 ↓ 4%
VI 72 12 122 20 ↓ 41%
VII 75 26 57 17 ↑ 32%
VIII 12 3 15 1 ↓ 20%
IX 35 9 22 5 ↑ 59%
X 35 4 35 8 → 0%
XI 17 3 21 2 ↓ 19%
XII 62 15 65 13 ↓ 5%
BARMM 76 13 58 12 ↑ 31%
CAR 7 2 13 1 ↓ 46%
Caraga 12 2 10 1 ↑ 20%
NCR 95 13 86 10 ↑ 10%
The reported deaths in 2018 (188) decreased in 2019 (158) by 16%. Region XI shows highest
CFR (35%) followed by NCR (CFR=29%), BARMM (CFR=26%), and MIMAROPA (CFR=24%). Lowest CFR
was in Region X at 7% (Figure 1.5.3).
Figure 1.5.3. Reported Non-Neonatal Tetanus Case Fatality Rate by Region

2019 2018
CFR (%)
35 36
29 30
26 24 23 23
21 20
17 18 17 19
17 16 16 17 16
13 14 14 13 13
12 10 11
10
7 7 8
0 0 0
Region
28
PROFILE OF NON-NEONATAL TETANUS CASES AND DEATHS
The reported Non-Neonatal Tetanus cases range from less than 1 month to 92 years old with
median of 42 years. Majority, males (766 or 83%) were affected more than the female population.
Among the 926 cases, 659 (71%) received the Tetanus dose. There were 513 (55%) cases with reported
wound sites in the lower extremity (Figure 1.5.4).
Figure 1.5.4. Reported Non-Neonatal Tetanus Cases by Age Group and Sex (N=926)
Philippines, 2019
Male Female
Age Group
≥60
40 to 64
35 to 39
30 to 34
25 to 29
20 to 24
15 to 19
10 to 14
5 to 9
1 to 4
<1
400 350 300 250 200 150 100 50 0 50 100 150 200 250 300 350 400
Number of Cases
Profile of Non-Neonatal Tetanus Deaths (n=158)
There were 158 (CFR=17%) reported NNT deaths in 2019 compared to 188 deaths in 2018
(CFR=20%). Nationally, deaths ranged from age less than 1 month to 89 years old with median of 45
years. Based on occurrence, 61 (39%) deaths were people aged 40 to 60 years old and among males
(128 or 81%). More than half were given Tetanus vaccine (108 or 68%).
29
1.6 Pertussis
Pertussis or whooping cough is highly communicable disease of the respiratory tract caused
by Bordetella pertussis. The initial stage of the disease has an insidious onset with an irritating cough
that gradually becomes paroxysmal, usually within 1-2 weeks, and lasts from 1-2 months or longer.
Paroxysms are characterized by repeated violent cough. Each series of paroxysms has many coughs
without intervening inhalation and can be followed by characteristic crowing or high-pitched
inspiratory whoop. Paroxysms frequently end with the expulsion of clear, tenacious mucus, often
followed by vomiting.
There were 186 reported pertussis cases in 2019. This is 50% lower than the reported cases in
2018 (N=372) [Figure 1.6.1]. Incidence of the disease became sporadic as cases in the current year
decreased significantly. There was a noticeable almost steady reporting of cases in weeks 5-11 then a
slight decrease was observed in weeks 16-26. The remaining weeks with cases ranging from 1 to 5
with an average of 4 except for weeks 14, 16 & 33 with zero case reporting.
Figure 1.6.1. Reported Pertussis Cases by Morbidity Week (N=186)

Philippines, 2019
16
14
12
10
8
6
4
2
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Figure 1.6.2 shows that Region NCR (47 or 25%), CALABARZON (33 or 18%) and Region II (24
or 13%) have the most number of the disease for the current year. They contributed to more than half
(104 or 56%) of the total cases nationwide, while MIMAROPA and Region V have no reported case this
year.
Figure 1.6.2. Distribution of Pertussis Cases (N=186)

Philippines, 2019
No. of Cases
30
The table below presents a comparison of the regional cases, deaths and CFR by region in
2019 vis-à-vis 2018. Nationally, cases reduced by half from 372 cases in 2018 down to 186 in 2019
(50% decrease). The region with the highest percentage change were Region II (140%) and Region IX
(CFR=100%). MIMAROPA and Region V reported a 100% decrease in caseload while similar cases were
noted in Region I and Region XII this year (Table 1.6.1).
Table 1.6.1. Reported Pertussis Cases by Region (N=186)

2019 2018
Region % Change
PHILIPPINES 186 11 372 12 ↓ 50%
I 6 0 6 1 → 0%
II 24 4 10 2 ↑ 140%
III 10 1 48 1 ↓ 79%
CALABARZON 33 1 52 2 ↓ 37%
MIMAROPA 0 0 2 0 ↓ 100%
V 0 0 5 1 ↓ 100%
VI 2 0 7 0 ↓ 71%
VII 12 0 26 1 ↓ 54%
VIII 1 0 3 0 ↓ 67%
IX 2 0 1 0 ↑ 100%
X 5 1 9 0 ↓ 44%
XI 21 2 45 3 ↓ 53%
XII 4 0 4 0 → 0%
BARMM 1 0 10 0 ↓ 90%
CAR 17 0 37 1 ↓ 54%
Caraga 1 0 9 0 ↓ 89%
NCR 47 2 98 0 ↓ 52%
Deaths due to pertussis decreased in 2019 compared to last year as shown in Figure 1.6.3.
Only three regions namely BARMM (CFR=17%), Region X (CFR=10%), and CALABARZON (CFR=3%)
reported deaths for the current year. There was a marked increase in CFR in Region X from 2018 to
2019 while both BARMM and CALABARZON slightly declined in CFR from last year.
Figure 1.6.3. Reported Pertussis Case Fatality Rate by Region

2019 2018
CFR (%)
20 20
17 17
10
7
4 4
2 3 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Region
31
PROFILE OF REPORTED PERTUSSIS CASES AND DEATHS
The age of reported pertussis cases range from less than 1 month to 60 years old with
median of 3 months. Majority of the cases were observed in males (111 or 60%) and noted to be
common among the less than 1-year-old age group (148 or 80%) [Figure 1.6.4].
Figure 1.6.4. Reported Pertussis Cases by Age Group and Sex (N=186)
Philippines, 2019
Male Female
Number of Cases
≥40
30 to 34
20 to 29
15 to 19
10 to 14
5 to 9
1 to 4
<1
100 90 80 70 60 50 40 30 20 10 0 10 20 30 40 50 60 70 80 90 100
Number of Cases
VACCINATION STATUS
Almost half (90 or 48%) of the reported pertussis cases were presented to have no Pertussis
vaccine followed by an unknown vaccination status at 39 (21%). While incomplete dose was reported
at 35 (19%), only a handful of the cases were fully vaccinated (22 or 12%) [Figure 1.6.5].
Figure 1.6.5. Vaccination Status among Reported Pertussis Cases (N=186)

Philippines, 2019
Number of Cases
100
90
80
70
60
50
40
30
20
10
0
Penta 1 Penta 2 Penta 3 No Penta Dose Unknown
received Vaccination Status
Vaccination Status
32
Among the 186 reported cases, 72 (39%) had specimen for laboratory confirmation. Of those
tested, only 16 (22%) were confirmed pertussis by RT-PCR while the remaining cases (56 or 78%) were
negative but still classified as suspect (Table 1.6.2).
Table 1.6.2. Laboratory Specimens and Results of Pertussis Cases (N=186)

Philippines, 2019
Total Reported Cases 186
Laboratory Tested 72 (39%)
Positive 16 (22%)
-RT-PCR 16 (22%)
Negative 56 (78%)
Not Tested/Unknown 114 (61%)
Profile of Confirmed Pertussis Cases (n=16)
The reported positive cases of pertussis ranged from less than 1 month to 4 years old
with median of 2 months. Eight (50%) were male and 8 (50%) females. As to vaccination status,
more than half of the cases did not receive the pertussis vaccine (10 or 63%) while unknown,
incomplete and complete doses had two (13%) respectively (Figure 1.6.6).
Figure 1.6.6. Vaccination Status among Confirmed Pertussis Cases (n=16)

Philippines, 2019
Number of Cases
12
10
0
Penta 1 Penta 2 Penta 3 No Penta Dose Unknown
received Vaccination Status
Vaccination Status
Profile of Confirmed Pertussis Deaths (n=2)
There were two deaths (CFR=8%) among the 16 confirmed pertussis cases. Deaths
were both two-months old, one male (50%) and one female (50%). No pertussis vaccine was
given to both.
33
1.7 Acute Meningitis-Encephalitis Syndrome (AMES)
The main objective of AMES surveillance, an integrated system of surveillance for both
Japanese Encephalitis and bacterial meningitis, is to collect epidemiological data on disease cases.
Such data will prove useful in making evidence-based decisions, whether to introduce new vaccines in
the EPI schedule and/or promote sustained use. In addition, for purposes of better disease
management. AMES is used as a surrogate for Japanese Encephalitis (JE) cases in surveillance.
There were 4,146 suspected Acute Meningitis Encephalitis Syndrome cases reported
nationwide from January 1 to December 31, 2019. This is 5% lower when compared to 2018 (N=4,361).
Cases in most of the morbidity weeks in 2019 were lower compared to cases in 2018. However, there
were increase in cases noted in the third quarter of 2019 particularly on morbidity week 35 to 45, then
it gradually decreases in the later part of the year 2019, but there was no clear trend or pattern
throughout the morbidity week when compared to the same period in 2018 (Figure 1.7.1).
Figure 1.7.1. Reported AMES Cases by Morbidity Week (N=4,146)

2019 2018
160
140
120
100
80
60
40
20
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Most of the reported AMES were from the following regions: NCR (496 or 12%), Region I (492
or 12%) and Region III (452 or 11%). Majority (11/17) of the regions reported increased number of
AMES cases from 2018 to 2019, except for Regions III, VIII, X, XII, CAR, and Caraga, which reported a
decrease of number of reported cases when compared with the same period in 2018.
34
There were 216 (CFR=5%) reported AMES deaths. Top three (3) regions with highest reported
case fatality rate (CRF) for 2019 were BARMM (16% CFR), Region XII (12% CFR) and CALABARZON (9%
CFR) [Table 1.7.1].
Table 1.7.1. Reported AMES Cases and Deaths by Region (N=4,146)

Region 2019 2018
% Change
PHILIPPINES 4,146 216 4,361 153 ↓5%
I 492 21 473 16 ↑4%
II 358 9 342 17 ↑5%
III 452 11 716 12 ↓37%
CALABARZON 394 37 337 18 ↑17%
MIMAROPA 65 4 35 1 ↑86%
V 268 16 268 14 ↑
VI 362 6 325 10 ↑11%
VII 303 23 262 14 ↑16%
VIII 15 1 48 8 ↓69%
IX 76 4 56 6 ↑36%
X 114 5 286 3 ↓60%
XI 294 8 251 2 ↑17%
XII 111 13 153 4 ↓27%
BARMM 116 18 111 3 ↑5%
CAR 139 4 147 5 ↓5%
Caraga 91 4 92 1 ↓1%
NCR 496 32 459 19 ↑8%
PROFILE OF REPORTED AMES CASES AND DEATHS

AMES cases ranged from ages less than 1 month to 96 years old (median: 5 years). The most
affected population belong to the 0 to 4 years old (1,895 or 46%), most of the AMES cases were males
(2,421 or 58%).
AMES deaths ranged from ages less than 1 month to 88 years old (median: 8 years). Most of
the AMES deaths were males (141 or 65%).
Figure 1.7.2. Reported AMES Cases by Age Group and Sex (N=4,146)
Philippines, 2019
Age Group (Years) Male Female
≥60
50 - 59
40 - 49
30 - 39
20 - 29
15 - 19
10 -14
5-9
≤4
1200 800 400 0 400 800 1200

Number of Cases
35

Out of the 4,146 reported cases, 498 or 12% specimens have been tested. Of these, 140 (28%)
were positive for Japanese Encephalitis (JE) on ELISA (Table 1.7.2).
Table 1.7.2. Laboratory Results of AMES Cases (N=4,146)

Philippines, 2019
Total Reported Cases 4,146
Tested for JE* 498 (12%)
Positive for JE 140 (28%)
Negative for JE 349 (70%)
Other Agent 9 (2%)
Dengue 9 (100%)
Tested for Bacterial Pathogen* 197 (5%)
Positive 15 (8%)
Streptococcus pneumoniae 7 (47%)
Haemophilus influenzae 4 (57%)
Neisseria meningitidis 3 (75%)
Enterococcus Faecium 1 (33%)
Other Findings(Turbid CSF) 1 (1%)
Negative 166 (84%)
No sample sent/Unknown 3,451 (83%)
*Multiple responses
Profile of Confirmed JE Cases (n=140)
There were 140 laboratory confirmed JE cases with age ranged from ages less 1 month
to 66 years old (median: 8 years). Most of the confirmed case were males (80 or 57%). There
were six (6) reported deaths (CFR: 4%) among the confirmed JE cases.
Table 1.7.3. Confirmed Japanese encephalitis Cases and Deaths by Region (n=140)
Region 2019 2018
% Change
PHILIPPINES 140 6 235 6 ↓40%
I 49 5 39 0 ↑26%
II 25 0 49 2 ↓49%
III 19 0 70 2 ↓73%
CALABARZON 7 0 5 1 ↑40%
MIMAROPA 2 0 2 0 0%
V 2 0 10 0 ↓80%
VI 4 0 18 0 ↓78%
VII 3 0 3 0 0%
VIII 0 0 1 0 ↓100%
IX 1 0 1 1 0%
X 3 0 0 0 ↑
XI 6 1 9 0 ↓33%
XII 4 0 4 0 0%
BARMM 1 0 2 0 ↓50%
CAR 10 0 20 0 ↓50%
Caraga 3 0 1 0 ↑200%
NCR 1 0 1 0 0%
36
Looking at the regional cases, Region I, Region II, and Region III reported the highest number
of confirmed JE cases with 49, 25, and 19, respectively. Together, these three regions account for
majority (66%) of all cases in the country. The regions with the least reported cases include IX (1),
BARMM (1), and NCR (1). Meanwhile, Region VIII had no reported JE case (Figure 1.7.3).
Figure 1.7.3. Distribution of Japanese encephalitis Cases (N=140)

Philippines, 2019
No. of Cases
Profile of Confirmed Bacterial Meningitis Cases (n=15)
There were 15 laboratory confirmed bacterial meningitis (BM) cases. Confirmed BM cases
ranged from ages less than 1 month to 66 years old with median of 8 years old. Most of the confirmed
case were males (11 or 73%). There were two (2) reported deaths (CFR: 13%) among the confirmed
BM cases.
2 | ZOONOTIC AND VECTOR-BORNE DISEASES
Introduction
Zoonotic disease is an infection naturally transmissible from vertebrate animals to humans. Zoonotic
pathogens maybe bacterial, viral or parasitic. It may also spread through direct contact or through
food, water or environment. Prevention from zoonotic diseases differ from each pathogen and
modes of transmission. Leptospirosis and Rabies prevention and control include vaccination of
animal agents.
Vector-borne diseases are human illnesses caused by parasites, viruses, and bacteria that are
transmitted by vectors. Vectors are living organisms that can transmit pathogens between animals
to humans and vice versa. Many of these vectors are blood-sucking insects. The insects ingest these
viruses in humans. The virus replicate inside the insect and transmits the virus to humans through
insect bites. Dengue and Chikungunya are vector-borne diseases reportable in PIDSR.
This report includes the current trend of selected vector-borne diseases and zoonotic diseases in the
Philippines, its geographic distribution of cases per region and profile of cases that were reported thru
Philippine Integrated Disease Surveillance and Response.
37
2.1 Chikungunya
Chikungunya is a mosquito-borne viral disease that is transmitted from human to human by

the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti
and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including
dengue. The usual incubation period is from 4 to 8 days but it can also range from 2 to 12 days. In
2016, Chikungunya surveillance was started.
There were 1,138 Chikungunya cases reported nationwide from January 1 to December 31,
2019. Cases reported in most of the morbidity weeks in 2019 were lower compared to cases in 2018.
There was slight increase in the cases during the third quarter of 2019, similar to what was reported
in 2018. The lowest number of cases were reported during the summer weeks of 2019 and starting
October 27, 2019 (MW 44) until the end of the year (Figure 2.1.1).
Figure 2.1.1. Reported Chikungunya Cases by Morbidity Week (N=1,138)

300
250
200
150
100
50
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Most of the reported cases were from CALABARZON (695 or 61%), followed by Region VIII
(257 or 23%). Region VIII has the highest incidence rate among all regions followed by CALABARZON,
at 5.54 and 4.36 per 100,000 population respectively.
Figure 2.1.2. Distribution of Reported Chikungunya Cases and Incidence Rate (N=1,138)
Philippines, 2019
Incidence rate per 100,000 pop.

No. of Cases
38
PROFILE OF REPORTED CHIKUNGUNYA CASES AND DEATHS
The age of chikungunya cases range from less than 1 month to 94 years old, with a median of
29 years old. The most affected age group is 10-14 years old (111 or 10%), 474 or 42% were males and
664 or 58% were females (Figure 2.1.3).
Figure 2.1.3. Reported Chikungunya Cases by Age Group and Sex (N=1,138)
Philippines, 2019
≥60
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
≤4
80 60 40 20 0 20 40 60 80
Number of Cases
Of the 1,138 reported chikungunya cases, there were 121 cases tested for confirmation. Of
these, 102 were confirmed chikungunya cases; 87 were positive via PCR and 15 cases had equivocal
result (Table 2.1.1).
Table 2.1.1. Laboratory Result of Reported Chikungunya Cases (N=1,138)

Philippines, 2019
Laboratory Tested: 121 (11%)

Confirmed Chikungunya 102 (84%)
Positive (PCR/ELISA) 87 (72%)
Equivocal (PCR/ELISA) 15 (12%)
Negative (PCR/ELISA) 19 (16%)
Not Tested: 1,017 (89%)
Note: Confirmed case= positive and equivocal
Profile of Confirmed Chikungunya Cases (n=102)

There were 102 confirmed chikungunya cases for 2019. Age range from less than 1
year to 84 years old with a median of 35 years old. Of the 102 confirmed chikungunya cases,
30 (29%) were males and 72 (71%) were females.
39
2.2 Dengue
Dengue fever and the more severe form, dengue hemorrhagic fever, are caused by any of the
four serotypes of dengue virus (types 1, 2, 3, and 4). An infected day-biting female Aedes mosquito
transmits this viral disease to humans. In the Philippines, Aedes aegypti and Aedes albopictus are the
primary and secondary mosquito vectors, respectively. The mosquito vectors breed in the small
amount of water collected in storages and other breeding sites such as tanks, cisterns, flower vases,
plant axils and backyard litter. The incubation period of dengue is from 3 to 14 days, commonly 4-7
days.
There were 437,563 dengue cases reported nationwide from January 1 to December 31, 2019.
This is 77% higher compared to the same period last year (N=247,834).
From morbidity week two (2) there was a continuous decrease until morbidity week 16. From
morbidity week 17 to, there was influx of cases, which peaks at morbidity week 31. During this time,
Health Secretary Francisco T. Duque III declared an epidemic alert and subsequently on August 6,
2019, a national outbreak of dengue was declared. After morbidity week 36, cases started decreasing
gradually until morbidity week 52. However, the seasonal pattern of cases throughout the year was
almost the same with 2018 (Figure 2.2.1).
Figure 2.2.1. Reported Dengue Cases by Morbidity Week (N=437,563)

Dengue national outbreak
declared.
24,000 2019 2018
22,000
20,000
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Morbidity Week
Most of the reported dengue were from the following regions: CALABARZON (76,815 or 18%),
Region VI (58,523 or 13%) and NCR (40,658 or 9%). However, incidence rates were highest in Region
VI (743), Region IX (646) and Region VIII (557) per 100,000 population respectively (Figure 2.2.2).
40
Figure 2.2.2. Distribution of Reported Dengue Cases and Incidence Rate (N=437,563)
Philippines, 2019
Majority (16/17) of the regions reported increased number of dengue cases from 2018 to
2019, only Region II reported a decrease of 5% compared with the same period in 2018. Top three (3)
regions with highest reported case fatality rate (CRF) for 2019 were Region V (0.8% CFR), Region VII
(0.5% CFR), and Region VI (0.4% CFR) [Table. 2.2.1].
Table 2.2.1. Reported Dengue Cases and Deaths by Region (N=437,563)

2019 2018
Region % Change
Cases Deaths CFR% Cases Deaths CFR%
PHILIPPINES 437,563 1,689 0.4 247,834 1,238 0.5 ↑77%
I 19,300 42 0.2 14,819 53 0.4 ↑30%

II 16,723 78 0.5 17,688 62 0.4 ↓5%
III 36,915 96 0.3 31,747 86 0.3 ↑16%
CALABARZON 76,815 272 0.4 30,515 160 0.5 ↑152%
MIMAROPA 10,621 26 0.2 7,719 51 0.7 ↑38%
V 11,282 88 0.8 3,561 36 1.0 ↑217%
VI 58,523 234 0.4 17,163 109 0.6 ↑241%
VII 31,698 153 0.5 22,356 130 0.6 ↑42%
VIII 26,256 74 0.3 10,922 60 0.5 ↑140%
IX 24,598 108 0.4 6,148 54 0.9 ↑300%
X 28,376 96 0.3 21,243 103 0.5 ↑34%
XI 8,054 44 0.5 6,348 21 0.3 ↑27%
XII 20,904 94 0.4 9,164 42 0.5 ↑128%
BARMM 5,456 34 0.6 2,444 32 1.3 ↑123%
CAR 8,926 27 0.3 7,599 8 0.1 ↑17%
Caraga 12,458 30 0.2 9,079 42 0.5 ↑37%
NCR 40,658 193 0.5 29,319 189 0.6 ↑39%
41
PROFILE OF REPORTED DENGUE CASES AND DEATHS
Age of dengue cases ranged from less than 1 month to 102 years old with median of 12 years
old. The most affected population belonged to the 5 to 9 age group (98,498 or 23%). In terms of sex
distribution, there was no significant difference (Figure 2.2.3).
Figure 2.2.3. Reported Dengue Cases by Age Group and Sex (N=437,563)
Philippines, 2019
Age Group Male Female
≥60
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5--9
≤4
60,000 40,000 20,000 0 20,000 40,000 60,000
Number of Cases
There were 1,689 (CFR=0.40%) reported dengue deaths. Dengue deaths ranged from ages less
than 1 year to 91 years old with median of 8 years old. Most of the dengue deaths were females (912
or 54%).
Most of the cases are with warning signs (235,495 or 54%), followed by without warning signs
(168,823 or 39%) and with severe dengue (7,759 or 2%) and the rest with unspecified clinical
classification (25,486 or 6%).
Almost the entire region in the Philippine reported an increase of dengue cases in 2019
compared with the same period in 2018 except for region II. Regions VI, V, VIII, IX, XII, BARMM and
CALABARZON reported more than double of the cases in 2019 compared with same period in 2018.
Figure 2.2.4. Reported Dengue Cases by Region (N=437,563)

Regional Cases 2019 2018

76,815
58,523
40,658
36,915
31,747
31,698
30,515
29,319
28,376
26,256
24,598
22,356
21,243
20,904
19,300
17,688
17,163
16,723
14,819
12,458
11,282
10,922
10,621
9,164
9,079
8,926
8,054
7,719
7,599
6,348
6,148
5,456
3,561
2,444
Region
42
Almost all year round in 2019, cases were above both the alert and epidemic threshold. Cases
increased in morbidity week two (2), however, there was decrease the following morbidity week up
to morbidity week 16. From this period, increase in dengue cases was noted. It was on morbidity week
37 when another decline in cases started. From morbidity week 43 until the end of the year, reported
cases were also below the epidemic and alert threshold (Figure 2.2.5).
Figure 2.2.5. Reported Dengue Cases with Alert and Epidemic threshold (N=437,563)
Philippines, 2019
2020 Alert threshold Epidemic threshold

No. of Cases
25,000
20,000
15,000
10,000
5,000
Morbidity Week
43
Dengue Virus Serotype Distribution in the Philippines
Dengue serotype data were based on samples systematically collected from 20 selected
sentinel hospitals in all regions of the Philippines. A total of 235,994 (54%) among the 437,563
reported dengue cases had specimens collected for laboratory testing. Of which, 1,478 (1%) yielded
positive for dengue through PCR (Table 2.2.2).
Table 2.2.2 Laboratory Result of Reported Dengue Cases (N=437,563)

Philippines, 2019
Laboratory Tested: 235,994 (54%)
Confirmed Dengue via PCR 1,478 (1%)
Dengue 1 265 (18%)
Dengue 1, Dengue 2 3 (0.2%)
Dengue 2 231 (16%)
Dengue 3 935 (63%)
Dengue 4 42 (3%)
NS1 Positive* 144,941 (61%)
Dengue IgM Positive* 24,621 (10%)
Dengue IgG Positive* 31,736 (13%)
Negative (PCR, NS1,Dengue

IgM or IgG test) 33,218 (14%)
Not Tested: 201,569 (46%)
*Multiple responses
Profile of Confirmed Dengue Cases (n=1,478)
There were 1,478 (1%) confirmed dengue cases tested for PCR. Most of the confirmed
cases were Dengue 3. Age of confirmed dengue cases ranged from less than 1 year to 84 years
old, with median of 13 years old. Most of the confirmed cases are males (54%).
44
2.3 Leptospirosis
Leptospirosis is a bacterial disease affecting both humans and animals. The early stages of the
disease may present with high fever, muscle pain, chills, redness in the eyes, abdominal pain,
hemorrhages in skin and mucous membrane (including pulmonary bleeding) vomiting, diarrhea and
rashes. Severe cases result in liver involvement, kidney failure, or brain involvement (thus some cases
may have yellowish body discoloration, dark-colored urine and light stools, low urine output, severe
headache). Leptospirosis has low case fatality rate, however, it increases with advancing age and may
reach 20% or more in patients with jaundice and kidney damage (Weil’s disease) who have not been
treated with renal dialysis. Incubation period of bacteria is 7-10 days.
In 2019, there were 3,541 leptospirosis cases reported nationwide. This is significantly lower
(36%) when compared to the same time period in 2018 (N= 5,556). Cases in most of the morbidity
weeks in 2019 were lower compared to cases in 2018. However, there were increase in cases noted
in third quarter of 2019, particularly on morbidity week 33 to morbidity week 40. Then gradual
decrease in the later part of the year 2019 was seen, similar to what was reported in 2018 (Figure
2.3.1).
Figure 2.3.1. Reported Leptospirosis by Morbidity Week (N=3,541)

450
400
350
300
250
200
150
100
50
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
45
Most of the reported leptospirosis were from the following regions: NCR (1,203 or 34%),
Region III (455 or 13%), Region VI (327 or 9%), Region II (322 or 9%) and Region I (320 or 9%). However,
incidence rates were highest in Region II (9), NCR (9), Region I (6), CAR (6) and Region VI (4) per 100,000
population (Figure 2.3.2).
Figure 2.3.2. Distribution of Leptospirosis Cases and Incidence Rates by Region (N=3,541)
Philippines, 2019
Majority (13/17) of the regions reported fewer number of leptospirosis cases from 2018 to
2019. However, cases in Region II, CAR, BARMM, and Region V increased by 64%, 41%, 33%, and 24%,
respectively.
Table 2.3.1. Reported Leptospirosis Cases and Deaths by Region (N=3,541)

2019 2018
Region % Change
PHILIPPINES 3,541 366 5,556 533 ↓ 36%
I 320 45 587 75 ↓ 45%
II 322 21 196 23 ↑ 64%
III 455 49 493 36 ↓ 8%
CALABARZON 313 38 457 47 ↓ 32%
MIMAROPA 28 4 58 1 ↓ 52%
V 163 15 131 7 ↑ 24%
VI 327 32 697 74 ↓ 53%
VII 60 10 103 15 ↓ 42%
VIII 34 2 86 9 ↓ 60%
IX 39 6 109 15 ↓ 64%
X 47 3 59 8 ↓ 20%
XI 86 9 128 10 ↓ 33%
XII 9 0 9 1 → 0%
BARMM 8 2 6 0 ↑ 33%
CAR 107 11 76 6 ↑ 41%
Caraga 20 2 198 6 ↓ 90%
NCR 1,203 117 2,163 200 ↓ 44%
46
Top three (3) regions with highest reported case fatality rate (CRF) for 2019 were BARMM
(25% CFR), Region VII (17% CFR) and Region IX (15% CFR) [Figure 2.3.3].
Figure 2.3.3. Reported Leptospirosis Case Fatality Rates by Region

2019 2018
Case Fatality Rate
25
17
15
15 14 14 14
13 14
12 12
11 10 11 10 11
10 10 10 10 10 9 9
7 8 8
7 6 6
5
3
2
0 0
Region
PROFILE OF REPORTED LEPTOSPIROSIS CASES AND DEATHS
There were 3,541 cases of leptospirosis in 2019 in the Philippines. Age of leptospirosis cases
ranged from less than 1 year to 88 years old with median of 31 years old. The most affected population
belonged to the 20 to 24 age group (513 or 14%). Majority of the leptospirosis cases were males (3,045
or 86%) [Figure 2.3.4.].
Figure 2.3.4. Reported Leptospirosis Cases by Age Group and Sex (N=3,541)
Philippines, 2019
Male Female
Age Group
≥ 60
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
1-4
≤1
600 400 200 0 200 400 600
Number of Cases
47
There were 366 (CFR=10%) reported leptospirosis deaths. Age of leptospirosis deaths ranged
from less than 1 year to 77 years old with median of 39 years old. Majority of the leptospirosis deaths
were males (325 or 89%).
Only about one fourth (1,002 or 28%) among the reported cases had specimen for laboratory
testing. Of these, 398 (40%) were confirmed leptospirosis cases (Table 2.3.2).
Table 2.3.2. Laboratory Results of Leptospirosis Cases (N=3,541)

Philippines, 2019
Laboratory Status Number (%)
Number of cases tested 1,002 (28%)
Positive leptospirosis cases 398 (40%)
Probable leptospirosis cases (RDT positive) 2 (0.20%)
Negative leptospirosis cases 602 (60%)
Not tested/ unknown laboratory done 2,539 (72%)
Profile of Confirmed Leptospirosis Cases
Of the 398 confirmed leptospirosis cases, the youngest was 2 years old and the oldest
was 80 years of age, with a median age of 30 years. Majority of the cases were males (354 or
89%) than females (44 or 11%).
48
2.4 Rabies
Rabies is a zoonotic disease transmitted to humans from animals caused by a virus. The
disease affects domestic and wild animals, and is spread to people through close contact with
infectious material, usually saliva, via bites or scratches.
Rabies is a fatal acute viral encephalomyelitis caused by the rabies virus, a rhabdovirus of the
genus Lyssavirus. The incubation period is usually 3-8 weeks, but maybe as short as 9 days and as long
as 7 years. The incubation period depends on the severity of the wound, site of the wound in relation
to richness of nerve supply, distance from the brain, amount and strain of virus.
There were 306 rabies cases reported from January 1, 2019 to December 31, 2019. This is 5%
lower compared to reported rabies cases in 2018 (N=323). Most of the reported cases per morbidity
week in 2019 were lower compared to cases reported in 2018. However, an increase of rabies cases
were observed in several morbidity weeks throughout the year (Figure 2.4.1).
Figure 2.4.1. Reported Rabies Cases by Morbidity Week (N=306)

Philippines, 2019

16
14
12
10
8
6
4
2
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Majority of cases were from the following regions: Region III (41, 13%), CALABARZON (36,
12%), Region V (27, 9%), Region VI (25, 8%), and Region X (25, 8%). However, high incidence rates
were noted in Regions I, IX, and XI (Figure 2.4.2). The highest reported human rabies cases were from
the provinces of Nueva Ecija, Pangasinan, Quezon, Davao City, Camarines Sur, Metro Manila and
Negros Occidental (Figure 2.4.2).
49
Figure 2.4.2 Distribution of Rabies Cases and Incidence Rates by Regions (N=306)
Philippines, 2019
Incidence Rate per

Only 10 (3%) reported rabies cases were laboratory confirmed, most were classified as
probable (279 or 91%) and 17 (6%) rabies cases were suspect. Out of 10 laboratory confirmed rabies
cases, three (30%) were reported in Region VI, followed by two (20%) rabies cases in both Regions II
and Region IX [Figure 2.4.3].
Figure 2.4.3. Reported Human Rabies Cases by Region and Case Classification (N=306)
Philippines, 2019
45
40
35
30
25
20
15
10
5
0
CALAB MIMA BARM
1 2 3 5 6 7 8 9 10 11 12 CAR Caraga NCR
ARZON ROPA M
Suspect 0 3 0 2 0 0 0 1 0 2 4 3 0 1 2 2 0
Probable 24 10 41 34 6 27 22 16 9 16 21 20 4 6 4 6 10
Confirmed 0 2 0 0 1 0 3 0 0 2 0 1 0 0 1 0 0
Interval of days from date of bite (exposure) to vaccination range from 0 to 92 days with a
median interval of 3 days, while interval of date of onset to date of admission range from 0 to 92 days
with a median of 1 day. From date of admission, an interval of 0 to 36 days (median of 1 day) to date
of death was noted.
50
PROFILE OF REPORTED RABIES CASES AND DEATHS
Most affected age group was 60 years old and above (47 of 15%), followed by 5 to 9 years old
(40 or 13%) and 45 to 49 years old (30 or 10%). Age range from 1 to 97 years old, with a median of 36
years old. Majority were males (223 or 73%) [Figure 2.4.4].
Figure 2.4.4. Reported Rabies Cases by Age Group and Sex (N=306)
Philippines, 2019
Age Group (Years) Female Male
≥60
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 -- 24
15 - 19
10 -- 14
5 -- 9
0 -- 4
35 25 15 5 5 15 25 35
Number of Cases
Dogs (285 or 93%) were the majority of biting animal. Category III was the highest exposure
history among the reported rabies cases comprising 231 (75%) cases. (Category III is defined as single
or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane
with saliva, and suspect contacts with bats).
51
3 |FOOD AND WATER-BORNE DISEASES (FWBD)
Introduction
Food and waterborne diseases (FWBD) are mainly transmitted through fecal-oral route or ingestion
of water or food contaminated by human or animal feces or urine containing bacteria, viruses or
parasites. These diseases can develop from shortage of water or poor hygiene or handling of food
and water sources which can also allow person-to-person transmission of food and waterborne
diseases. FWBD typically causes gastrointestinal symptoms such as abdominal pain, nausea,
vomiting, and diarrhea. Acute bloody diarrhea, cholera, rotavirus, hepatitis A, and typhoid fever are
reportable diseases in PIDSR.
It has been reported that climate factors such as temperature, rainfall, extreme weather events, and
sea level rises can influence water-borne diseases trends. Cholera epidemics correspond to influx of
estuarine water, plankton blooms, monsoons, and warm temperatures.
52
3.1 Acute Bloody Diarrhea
Acute Bloody Diarrhea (ABD) is usually a sign of invasive enteric infection that carries a
substantial risk of serious morbidity and death, especially in children in developing countries. Shigella
dysenteriae is most frequently isolated from the stools of affected children and is transmitted from
person-to-person through fecal-oral route. The disease is characterized by acute fever and bloody
diarrhea, and can also present with dehydration especially in young children.
A total of 16,305 ABD cases were reported to PIDSR nationwide from January 1 to December
31, 2019. This signifies a decrease (18%) when compared to the same period of the previous year
(N=19,831). Cases were distributed throughout all the morbidity week of 2019. Moderate peaks were
noted in weeks 2 and 31 [Figure 3.1.1]. .
Figure 3.1.1. Reported Acute Bloody Diarrhea Cases (N=16,305)


600
500
400
300
200
100
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
53
Looking at the regional caseload, Region VII, Region IX, and Caraga reported the highest
number of ABD cases with 5,588, 2,520 and 2,232 respectively. Together, these three regions account
for more than half (63%) of all cases in the country. The regions with the least reported number of
cases include MIMAROPA (89), Region I (490) and Region VI (48) [Figure 3.1.2].
Figure 3.1.2. Distribution of Acute Bloody Diarrhea Cases and Incidence Rates by Region (N=16,305)
Philippines, 2019
No. of Cases Incidence Rate
Table 3.1.1. shows a comparison of the regional data on cases, deaths and CFR by region in
2019 side-by-side 2018. Nationally, there is an 18% decrease in cases from 19,831 cases in 2018 to
just 16,305 cases in 2019. The regions with the highest percent change were Regions V (437%), NCR
(73%), and BARMM (71%).
Table 3.1.1. Reported ABD Cases and Deaths by Region (N=16,305)

2019 2018
Region % Change
PHILIPPINES 16,305 26 19,831 20 ↓ 18%
I 49 3 87 0 ↓ 44%
II 1,128 0 1,544 0 ↓ 27%
III 305 0 679 0 ↓ 55%
CALABARZON 682 0 993 0 ↓ 31%
MIMAROPA 89 0 155 0 ↓ 43%
V 161 0 30 0 ↑ 437%
VI 48 0 111 0 ↓ 57%
VII 5,588 19 6,585 16 ↓ 15%
VIII 330 0 351 0 ↓ 6%
IX 2,520 2 2,617 1 ↓ 4%
X 949 1 1,472 0 ↓ 36%
XI 212 0 159 0 ↑ 33%
XII 181 0 204 0 ↓ 11%
BARMM 302 0 177 1 ↑ 71%
CAR 1,432 1 1,715 0 ↓ 17%
Caraga 2,232 0 2,896 2 ↓ 23%
NCR 97 0 56 0 ↑ 73%
A total of 26 deaths reported for 2019. This is 30% higher compared to the 20 deaths for 2018.
Region I had the highest CFR (6.1) for 2019 (Figure 3.1.3).
54
Figure 3.1.3. Reported ABD Case Fatality Rate by Region

6.1
0.6
0.3 0.2
0 0.1 0 0.1 0 0.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.1 0 0
Region
PROFILE OF REPORTED ABD CASES AND DEATHS
Age of ABD cases ranged from less than 1 month to 102 years old (median: 11 years). The
most affected population belong to the 1 to 4 (4,419 or 27%) age group. Half of the ABD cases were
males (8,210 or 50%) [Figure 3.1.4].
Figure 3.1.4. Reported ABD Cases by Sex and Age Group (N=16,305)
Philippines, 2019
60 ≥
40 - 49
20 - 29
5-9
<1
2500 1500 500 500 1500 2500
Number of Cases
There were 26 (CFR=0.16%) reported ABD deaths. Ages of ABD deaths ranged from less than
1 month to 91 years old (median: 28 years). Most of the ABD deaths are males (17 or 65%).
55
LABORATORY RESULTS OF ABD CASES
A total of 10,850 (67%) reported cases have specimen for laboratory testing. Of which, 9,405
(87%) cases were positive for pathogens.
Table 3.1.2. Laboratory Status of ABD Cases (N=16,305)

Philippines, 2019
Reported Cases 16,305

Tested 10,850 (67%)
Positive for pathogen 9,405 (87%)
Negative 1,445 (13%)
Not Tested 5,455 (33%)
Out of the positive cases (9,405), the most common pathogen was Entamoeba histolytica with
8,347 (89%), followed by Shigella with 373 (4%) [Table 3.1.3].
Table 3.1.3. Positive ABD Cases by Causative Pathogen (n=9,405)

Philippines, 2019
Organism No. of Cases %

Total 9,405 100
Entamoeba histolytica 8,347 89
Shigella 373 4
Escherichia coli 283 3
Trophozoites 183 2
Ascaris lumbricoide 14 0.1
Not specified 155 2
Other Organism 50 1
Note: Percentage Total may not equal to 100 due to rounding-off figures.
56
3.2 Cholera
Cholera is an acute bacterial intestinal infection caused by the enterotoxin of the bacterium
Vibrio cholera serogroup 01 and 0139. It is characterized by sudden onset of profuse, painless, watery
diarrhea, nausea and vomiting. If cholera is not treated, it will lead to rapid dehydration, acidosis,
circulatory collapse, hypoglycemia in children and renal failure. It is transmitted through ingestion of
food or water contaminated with vomitus or feces of infected persons. The incubation period is from
a few hours to five days, with average of 2-3 days.
There were 3,891 cholera cases reported to PIDSR nationwide from January 1 to December
31, 2019. This is 70% higher when compared to same period last year (N=2,283). Cases were
distributed throughout all the morbidity weeks of 2019. Highest peak was noted in week 19 [Figure
3.2.1].
Figure 3.2.1. Reported Cholera Cases by Morbidity Week (N=3,891)


140
120
100
80
60
40
20
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
57
Looking at the regional caseload, Region VIII, Caraga and Region V reported the highest
number of cholera cases with 1,885, 1,410 and 537 respectively. Together, these three regions
account for the majority (98%) of all cases in the country. Region IX and Caraga reported the highest
incidence rates (Figure 3.2.2).
Figure 3.2.2. Distribution of Cholera Cases and Incidence Rates by Region (N=3,891)
Philippines, 2019
Table 3.2.1 shows a comparison of the regional data on cases, deaths and CFR in 2019 side-
by-side 2018. Nationally, there is a 70% increase in cases from 2,283 cases in 2018 to 3,891 cases in
2019. The regions with the highest percent change were Regions VIII (188,400%), Region IX (200%)
and NCR (100%).
Table 3.2.1. Reported Cholera Cases and Deaths by Region (N=3,891)
2019 2018
Region % Change
PHILIPPINES 3,891 3 2,283 6 ↑ 70%
I 0 0 0 0 → 0%
II 0 0 0 0 → 0%
III 0 0 0 0 → 0%
CALABARZON 0 0 16 1 ↓ 100%
MIMAROPA 2 0 6 0 ↓ 67%
V 537 3 778 5 ↓ 31%
VI 0 0 1 0 ↓ 100%
VII 1 0 2 0 ↓ 50%
VIII 1,885 0 1 0 ↑ 188,400%
IX 6 0 2 0 ↑ 200%
X 42 0 169 0 ↓ 75%
XI 1 0 15 0 ↓ 93%
XII 0 0 3 0 ↓ 100%
BARMM 3 0 3 0 → 0%
CAR 0 0 3 0 ↓ 100%
Caraga 1,410 0 1,282 0 ↑ 10%
NCR 4 0 2 0 ↑ 100%
58
A total of 3 deaths were reported for 2019 and 6 deaths for 2018; deaths decreased by 50%.
All deaths were reported from Region V (Figure 3.2.3).
Figure 3.2.3. Reported Cholera Case Fatality Rates by Region

6.3
0.560.64
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Region
PROFILE OF REPORTED CHOLERA CASES AND DEATHS
Age of cholera cases ranged from 5 to 105 years old with median of 28. The most affected
population belong to the 5 to 9 years old (751 or 19%) age group. Majority (2,125 or 55%) of the
Cholera cases are females [Figure 3.2.4].
Figure 3.2.4. Reported Cholera Cases by Age Group and Sex (N=3,891)
Philippines, 2019

Unspecified
60 ≥
50 - 59
40 - 49
30 - 39
20 - 29
10 - 19
5-9
1-4
<1
3500 2500 1500 500 500 1500 2500 3500
Number of Cases
There were three (CFR=0.08%) reported cholera deaths aged 24, 49, and 59 years old. Two
(67%) deaths were females.
59
LABORATORY RESULTS OF CHOLERA CASES
A total of 696 (18%) of 3,891 reported cases had specimen for laboratory test. Out of these 8
(1%) cases among were laboratory-confirmed cholera via stool culture (Table 3.2.2).
Table 3.2.2. Laboratory Status of Cholera Cases (N=3,891)

Philippines, 2019

Tested 696 (18%)
Positive (stool culture) 8 (1%)
Vibrio cholera Ogawa 6 (75%)
Vibrio cholera 0139 2 (25%)
Negative 688 (99%)
Profile of Confirmed Cholera Cases (n=8)
There were eight confirmed cholera cases. Age range from 7 to 73 years old, with
median of 48 years old. The confirmed cases were equally distributed among both sexes.
Majority of the confirmed cases were located in Caraga (6 or 75%) [Figure 3.2.5].
Figure 3.2.5. Distribution of Confirmed Cholera Cases (n=8)

Philippines, January 1 – December 31, 2019
No. of Cases
60
Eight confirmed cholera cases were reported for 2019. This is 53% lower compared to 17
cases reported in 2018. There was no confirmed cholera death reported for both years (Table
3.2.3).
Table 3.2.3. Confirmed Cholera Cases and Deaths by Region (n=8)

2019 2018
Region % Change
PHILIPPINES 8 0 17 0 ↓ 53%
I 0 0 0 0 → 0%
II 0 0 0 0 → 0%
III 0 0 0 0 → 0%
MIMAROPA 0 0 0 0 ↓ 0%
V 0 0 0 0 ↓ 0%
VI 0 0 1 0 ↓ 100%
VII 0 0 1 0 ↓ 100%
VIII 1 0 0 0 ↑ -
IX 0 0 0 0 ↓ 0%
X 0 0 1 0 ↓ 100
XI 0 0 1 0 ↓ 100
XII 0 0 3 0 ↓ 100
BARMM 0 0 1 0 ↓ 100
CAR 0 0 0 0 ↓ 0%
Caraga 6 0 6 0 ↓ 0%
NCR 1 0 0 0 ↑ -
61
3.3 Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when
an uninfected (and unvaccinated) person ingests food or water that is contaminated with the feces of
an infected person. The disease is closely associated with unsafe water, inadequate sanitation and
poor personal hygiene.
There were 1,242 acute viral hepatitis cases reported in 2019 nationwide. This is 20% lower
compared to the same period last year (N=1,560). Cases were distributed throughout all the morbidity
week of 2019 (Figure 3.3.1).
Figure 3.3.1. Reported Acute Viral Hepatitis Cases by Morbidity Week (N=1, 242)
80
70
60
50
40
30
20
10
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
Region IX, CALABARZON and NCR reported the highest number of acute viral hepatitis cases
with 196, 193 and 142, respectively. These three regions account for almost half (43%) of all cases in
the country (Figure 3.3.2).
Figure 3.3.2. Distribution of Acute Viral Hepatitis A Cases and Incidence Rate by Region (N=1,242)
Philippines, 2019

62
Table 3.3.1 shows a comparison of the regional data on cases, deaths and CFR in 2019
compared to 2018. Nationally, there is a 20% decrease in cases from 1,560 cases in 2018 to just 1,242
cases in 2019. The regions with the highest percent change were Regions IX (113%), BARMM (42%),
Region II, and CALABARZON (36%).
Table 3.3.1. Reported Acute Viral Hepatitis Cases and Deaths by Region (N=1,242)
2019 2018
Region % Change
PHILIPPINES 1,242 14 1,560 10 ↓ 20%
I 42 0 40 1 ↑ 5%
II 34 0 25 0 ↑ 36%
III 55 0 81 1 ↓ 32%
CALABARZON 193 2 142 0 ↑ 36%
MIMAROPA 28 0 31 0 ↓ 10%
V 22 0 24 1 ↓ 8%
VI 140 1 284 0 ↓ 51%
VII 115 10 246 6 ↓ 53%
VIII 3 0 6 0 ↓ 50%
IX 196 0 92 0 ↑ 113%
X 95 0 191 0 ↓ 50%
XI 29 0 24 0 ↑ 21%
XII 16 0 29 0 ↓ 45%
BARMM 64 0 45 0 ↑ 42%
CAR 4 0 16 0 ↓ 75%
Caraga 64 0 99 0 ↓ 35%
NCR 142 1 185 1 ↓ 23%
There were 14 deaths for 2019 and 10 deaths for 2018; deaths increased by 40%. Region VII
has the highest CFR for 2019 (Figure 3.3.3).
Figure 3.3.3. Reported Acute Viral Hepatitis Case Fatality Rate by Region
8.7
4.2
2.4 2.5
1.0 1.2
0.7 0.5 0.7
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Region
63
PROFILE OF REPORTED ACUTE VIRAL HEPATITIS CASES AND DEATHS
Age of acute viral hepatitis cases ranged from less than 1 month to 92 years old, with median
of 29 years old. The most affected population belonged to the 25 to 29 years old (174 or 14%). Majority
were males (641 or 52%) [Figure 3.3.4].
Figure 3.3.4. Acute Viral Hepatitis Cases by Age Group and Sex (N=1,242)
Philippines, 2019
Male Female
Age Group
Unspecified
60>
50 - 59
40 - 49
30 - 39
20-29
10 - 19
5-9
1-4
<1
150 100 50 0 50 100 150

Number of Cases
There were 14 (CFR=1.13%) reported acute viral hepatitis deaths. Age of ranged from 32 to
70 years old (median: 52 years). Majority of deaths were males (12 or 86%).
LABORATORY RESULTS OF ACUTE VIRAL HEPATITIS CASES
A total of 610 (49%) of 1,242 reported cases had specimen for laboratory test. Out of these,
228 (37%) cases were laboratory-confirmed Hepatitis A via ELISA (IgM) [Table 3.3.2].
Table 3.3.2. Laboratory Status of Acute Viral Hepatitis Cases (N=1,242)

Philippines, 2019
Acute Viral Hepatitis Cases 1,242
Tested 610 (49%)
Positive (ELISA IgM test for Hepatitis A) 228 (37%)
Negative 382 (63%)
Not Tested 632 (51%)
64
Profile of Confirmed Hepatitis A Cases (n=228)
Of the reported acute viral hepatitis cases, there were 228 (37%) confirmed Hepatitis A,
which ranged from 32 to 70 years old (median: 52 years). Majority of the confirmed Hepatitis A
cases were males (148 or 65%). There were two confirmed Hepatitis A deaths (CFR=0.88%). Forty-
two (18%) confirmed cases were located from Region VII (Figure 3.3.5).
Figure 3.3.5. Distribution of Confirmed Hepatitis A Cases (n=228)

Philippines, 2019
No. of Cases
compared to 2018 of the confirmed Hepatitis A cases. Nationally, there is a 36% decrease in
cases from 354 cases in 2018 to just 228 cases in 2019. The regions with the highest percent
change were Regions I (450%), IX (85%), and BARMM (67%).
Table 3.3.3. Confirmed Hepatitis A Cases and Deaths by Region (n=228)

2019 2018
Region % Change
PHILIPPINES 228 2 354 0 ↓ 36%
I 11 0 2 0 ↑ 450%
II 3 0 9 0 ↓ 67%
III 8 0 5 0 ↑ 60%
CALABARZON 24 0 32 0 ↓ 25%
MIMAROPA 4 0 3 0 ↑ 33%
V 1 0 3 0 ↓ 67%
VI 21 1 122 0 ↓ 83%
VII 42 1 74 0 ↓ 43%
VIII 0 0 1 0 ↓ 100%
IX 37 0 20 0 ↑ 85%
X 23 0 17 0 ↑ 35%
XI 2 0 2 0 → 0%
XII 6 0 8 0 ↓ 25%
BARMM 10 0 6 0 ↑ 67%
CAR 2 0 8 0 ↓ 75%
Caraga 7 0 17 0 ↓ 59%
NCR 27 0 25 0 ↑ 36%
65
3.4 Rotavirus
A genus of viruses of the family Reoviridae, which is one of the leading causes of severe
diarrheal disease among all infants and young children worldwide. Consists of eight species referred
to as A, B, C, D, E, F, G and H; the most common of these is Rotavirus A, causing >90% of rotavirus
infections in humans. Nearly every child in the world is infected at least once by the age of five but
immunity develops with infection so subsequent infections are less severe. Adults are rarely affected
but they may still acquire asymptomatic infections, maintaining transmission in the community.
Transmitted by the fecal-oral route, rotavirus is typically acquired through contact with
contaminated hands, surfaces and objects, and possibly by the respiratory route. Highly contagious;
the feces of an infected person can contain more than 10 trillion infectious particles per gram, fewer
than 100 of which are necessary to transmit infection. Stable in the environment and can survive
between 9 and 19 days so sanitary measures adequate for eliminating bacteria and parasites seem to
be ineffective in rotavirus control.
Once inside the human body, the virus infects and damages cells that line the stomach and
the small intestine, causing gastroenteritis. This causes signs and symptoms beginning with an acute-
onset fever and vomiting, followed by watery diarrhea in 24 to 48 hours. These manifestations persist
for 3-8 days but may last longer among immunocompromised patients.
There were 4,305 reported rotavirus cases reported in 2019 nationwide. This is 35% higher
when compared to the same period in 2018 (N= 3,198). Cases were distributed throughout all the
morbidity week of 2019. Moderate peaks were noted in weeks 23 and 33 (Figure 3.3.1).
Figure 3.4.1. Reported Rotavirus Cases by Morbidity Week (N=4,305)


180
160
140
120
100
80
60
40
20
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
66
Looking at the regional caseload, Region VIII, Region V and Region I reported the highest
number of rotavirus cases with 1,632, 719 and 577 respectively. Together, these three regions
account for more than half (68%) of all cases in the country. The regions with zero reported cases
include Regions II, IX, XI and CAR (Figure 3.4.2).
Figure 3.4.2. Distribution of Rotavirus Cases and Incidence Rate by Region (N=4,305)
Philippines, 2019
No. of Cases
Incidence Rate
67
compared to 2018. Nationally, there is a 35% increase in cases from 3,198 in 2018 to 4,305 in 2019.
The regions with the highest percent change were Regions X (300%), Caraga (200%) and VII (200%).
Region VIII also reported 1,632 cases of rotavirus in 2019 from zero case in 2018.
Table 3.4.1. Reported Rotavirus Cases by Region (N=4,305)

2019 2018
Region % Change
PHILIPPINES 4,305 35 3,198 32 ↑ 35%
I 577 4 666 10 ↓ 13%
II 0 0 0 0 → 0%
III 2 0 4 0 ↓ 50%
MIMAROPA 104 0 281 0 ↓ 63%
V 719 2 404 1 ↑ 78%
VI 154 1 415 0 ↓ 63%
VII 3 0 1 0 ↑ 200%
VIII 1,632 4 0 0 ↑ -
IX 0 0 0 0 → 0%
X 4 0 1 0 ↑ 300%
XI 0 0 0 0 → 0%
XII 339 3 502 7 ↓ 32%
BARMM 414 20 606 14 ↓ 32%
CAR 0 0 0 0 → 0%
Caraga 257 0 85 0 ↑ 202%
NCR 97 1 225 0 ↓ 57%
There were 35 deaths in 2019 and 32 deaths in 2018; deaths increased by 9%. BARMM
has the highest CFR for 2019 (Figure 3.4.3).
Figure 3.4.3. Reported Rotavirus Case Fatality Rate by Region

4.8
2.3
1.4 1.5
1.0 0.9 0.7 0.6
0.3 0.2 0.2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Region
68
PROFILE OF REPORTED ROTAVIRUS CASES AND DEATHS
Age of rotavirus cases ranged from ages less than 1 month to 6 years old (median: 1 year).
Majority of the rotavirus cases were males (2,446 or 57%) [Figure 3.4.5]. There were 35 (CFR=0.81%)
reported rotavirus deaths.
Figure 3.4.5. Reported Rotavirus Cases by Age Group and Sex (N=4,305)
Philippines, 2019
Male Female
Age Group
Unspecified
5≥
4 years
3 years
2 years
1 year
7 to 11 months
≤ 6 months
900 700 500 300 100 100 300 500 700 900
Number of Cases
VACCINATION STATUS
Majority of the reported cases (4,168 or 97%) did not receive a single dose of rotavirus
vaccine. Eleven (0.3%) received 1 dose, seven (0.2%) received 2 doses, while another seven cases
(0.2%) received 3 doses. One hundred twelve (3%) cases have unknown vaccination status (Figure
3.3.4).
Figure 3.4.4 Reported Rotavirus Vaccination Status (n=4,305)

Philippines, 2019
Number of
Cases
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
No Vaccination 1 Dose 2 Doses 3 Doses Unknown
Vaccination Status
69
LABORATORY RESULTS OF ROTAVIRUS CASES
A total of 1,535 (36%) rotavirus cases had specimen for laboratory confirmation. Five hundred
seventy-eight (38%) cases were confirmed by ELISA test.
Table 3.4.2. Laboratory Status of Rotavirus Cases (N=4,305)

Philippines, 2019

Tested 1,535 (36%)
Positive (ELISA Test) 578 (38%)
Negative 957 (62%)
Profile of Confirmed Rotavirus Cases (n=578)
There were 578 (38%) confirmed rotavirus cases. Majority of the confirmed rotavirus
cases were male (346 or 60%). Age of confirmed rotavirus cases ranged from less than 1 month
to 4 years old (median: 1 year).
Of the confirmed rotavirus cases, 560 (97%) did not receive a single dose of rotavirus
vaccine, two (0.4%) received 1 dose, three (0.5%) received 2 doses, and another three cases
(0.5%) received 3 doses. Ten (2%) confirmed cases have unknown vaccination status (Figure
3.4.6).
Figure 3.4.6. Confirmed Rotavirus Cases Vaccination Status (n=578)

Philippines, 2019
Number of
Cases
600
500
400
300
200
100
0
No Vaccination 1 Dose 2 Doses 3 Doses
Vaccination Status
Profile of Deaths among Confirmed Rotavirus Cases (n=4)
There were 4 confirmed rotavirus deaths (CFR=0.69%), all of which were males. All
confirmed rotavirus deaths were not vaccinated.
70
3.5 Typhoid Fever
Typhoid Fever and Paratyphoid Fever are systemic bacterial disease with insidious onset of
sustained fever, severe headache, malaise, anorexia, relative bradycardia, splenomegaly,
nonproductive cough in the early stage of the illness, and constipation more often than diarrhea in
adults. The offending organisms are Salmonella typhi and Salmonella paratyphi bacteria.
The clinical presentation varies from mild illness with low-grade fever to severe clinical disease
with abdominal discomfort and complications. The disease is transmitted via oral-fecal route. Severity
of the disease is influenced by strain virulence, quantity of inoculums ingested, duration of illness
before adequate treatment, age and previous exposure to vaccination influence severity.
The incubation period range from 3 days to over 60 days but usually 8–14 days. For
Paratyphoid Fever, the incubation period is 1–10 days. Even after recovery from Typhoid Fever or
Paratyphoid Fever, a small number of individuals continue to carry the bacteria (called carriers). These
people can be a source of infection to others.
There were 26,878 suspected typhoid fever cases with 39 deaths reported in 2019 nationwide.
This is 8% higher when compared to reported typhoid fever cases in 2018 (N=24,836). Cases were
distributed throughout all the morbidity week of 2019 (Figure 3.5.1).
Figure 3.5.1. Reported Typhoid Fever Cases by Morbidity Week (N=26,878)

2019 2018
1000
800
Number of Cases
600
400
200
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Morbidity Week
71
Looking at the regional caseload, CAR, X and VI reported the highest number of typhoid fever
cases with 4,796, 4,094 and 2,631, respectively. Together, these three regions account for almost half
(43%) of all cases in the country (Figure 3.5.2). The regions with the lowest reported number cases
include Regions VIII (374), V (338), and XI (273).
Figure 3.5.2. Distribution of Typhoid Fever Cases and Incidence Rate by Region (N=26,878)
Philippines, 2019
compared to 2018. Nationally, there is an 8% increase in cases from 24,836 in 2018 to 26,878 in 2019.
The regions with the highest percent change were Regions I (98%), CAR (92%) and IX (39%).
Table 3.5.1. Reported Typhoid Fever Cases and Deaths by Region (N=26,878)
2019 2018
Region % Change
PHILIPPINES 26,878 39 24,836 31 ↑ 8%
I 2,019 2 1,018 0 ↑ 98%
II 1,063 1 976 0 ↑ 9%
III 708 0 660 0 ↑ 7%
CALABARZON 1,727 2 1,978 2 ↓ 13%
MIMAROPA 462 2 406 0 ↑ 14%
V 338 5 396 3 ↓ 15%
VI 2,631 4 2,901 5 ↓ 9%
VII 1,688 5 1,598 6 ↑ 6%
VIII 374 2 745 2 ↓ 50%
IX 1,620 6 1,309 4 ↑ 24%
X 4,094 0 5,038 1 ↓ 19%
XI 273 0 196 0 ↑ 39%
XII 2,157 1 2,134 2 ↑ 1%
BARMM 1,936 6 1,573 1 ↑ 23%
CAR 4,796 2 2,494 0 ↑ 92%
Caraga 524 0 950 0 ↓ 45%
NCR 468 1 464 5 ↑ 1%
72
There were 39 deaths in 2019 and 31 in 2018; deaths increased by 26%. Region V has
the highest CFR for 2019 (Figure 3.5.3).
Figure 3.5.3. Reported Typhoid Fever Case Fatality Rate by Region

1.5
1.1
0.8
0.5
0.4
0.4 0.4
0.3 0.3 0.3 0.3
0.2
0.2 0.2 0.1 0.1
0.1 0.1 0.1 0.1
0.05 0.04 0 0
0 0 0 0 0 0 0 0 0 0
Region
PROFILE OF TYPHOID FEVER CASES AND DEATHS
Age of typhoid fever cases ranged from less than 1 month to 100 years old with median of 16
years old. The most affected population belong to the 5 to 9 years old (4,996 or 19%). Majority of the
typhoid fever cases were males (13,960 or 52%) [Figure 3.5.4].
Figure 3.5.4. Typhoid Fever Cases by Age Group and Sex (N=26,878)
Philippines, 2019
Unspecified
60 ≥
50 - 59
40 - 49
30 - 39
20 - 29
10 - 19
5-9
1-4
<1
3500 2500 1500 500 500 1500 2500 3500
Number of Cases
There were 39 (CFR=0.15%) reported typhoid fever deaths. Age ranged from less than 1
month to 73 years old (median: 35 years). Majority of the typhoid fever deaths were males (26 or
67%).
73
LABORATORY RESULTS OF TYPHOID FEVER CASES
A total of 22,517 (84%) cases were subjected to laboratory testing. Out of these, 586 (3%)
were positive via culture (Table 3.5.2).
Table 3.5.2. Laboratory Status of Typhoid Fever Cases (N=26,878)

Philippines, 2019
Tested 22,517 (84%)
Positive Typhi Dot 10,646 (47%)
Positive Widal 5,474 (24%)
Positive Tubex 2,472 (11%)
Positive Culture 586 (3%)
Profile of Confirmed Typhoid Fever Cases (n=586)
Of the tested typhoid fever cases, 586 (3%) were confirmed typhoid fever cases.
Majority of the confirmed cases were males (304 or 52%). Age of confirmed cases ranged from
1 month to 85 years old (median: 14 years).
74
4 | OTHER DISEASES/SYNDROMES
Introduction
Infectious respiratory diseases are spread through droplets that come from coughing and sneezing. The
respiratory pathogen can spread from person to person through close contacts. Some people may
become infected by touching something with these germs on it and then touching their mouth or nose.
Some respiratory illnesses. such as influenza, can be prevented with vaccination. Influenza-like illness
and Meningococcemia diseases are reportable in PIDSR.
4.1 Influenza-like Illness (ILI)
Influenza-like Illness (ILI), commonly called flu, is an acute viral disease of the respiratory tract
characterized by fever, headache, myalgia, prostration, coryza, sore throat and even cough. The
incubation period is usually 1-3 days. Influenza-like Illness may be clinically indistinguishable from disease
caused by acute respiratory viruses, such as common cold, croup, bronchiolitis, viral pneumonia and
undifferentiated acute respiratory disease.
There were 144,977 ILI cases reported nationwide. This is 4% lower when compared to 2018
(N=150,730). The trend of Influenza-like Illness cases for 2019 is almost the same as 2018 with a gradual
decrease in the number of cases from morbidity weeks 2 to 16 and then increasing from morbidity weeks
23 to 29, another increase in cases is noted from morbidity weeks 36 to 41 then gradually decreasing
towards the end of the year. The comparison of trends of Influenza-like Illness 2019 vs 2018 is shown
below (Figure 4.1.1).
Figure 4.1.1. Influenza-like Illness Cases by Morbidity Week (N=144,977)

5,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Morbidity Week
75
Caraga has the highest number of reported Influenza-like Illness cases with 28,358 cases (20%)
followed by CALABARZON (18,965 or 13%), and Region I (15,809 or 11%). Also, Caraga has the highest
incidence rate among all regions with 1,039 cases per 100,000 population. The distribution of Influenza-
like Illness cases and incidence rates by region is shown below (Figure 4.1.2).
Figure 4.1.2. Distribution of Influenza-like Illness Cases and Incidence Rates by Region (N=144,977)
Philippines, 2019
76
PROFILE OF INFLUENZA-LIKE ILLNESS CASES AND DEATHS
Overall, there were 144,977 cases of Influenza-like Illness in 2019 in the country. Age ranged from
less than 1 month to 104 years old, with a median of 6 years old. The most affected age group was 1 to 4
years old (42,880 or 30%). There were more males (73,723 or 51%) than females (71,254 or 49%) [Figure
4.1.3].
Figure 4.1.3. Reported Influenza-like Illness Cases by Age Group and Sex (N=144,977)
Philippines, 2019

≥60
50 - 59
40 - 49
30 - 39
20 - 29
10- 19
5-9
1-4
≤1
25000 20000 15000 10000 5000 0 5000 10000 15000 20000 25000
Number of Cases
Out of 144,977 Influenza-like Illness cases, 34 deaths were reported having a CFR of 0.02%. Age
range from less than 1 month to 96 years old with a median of 34 years old. The most affected age group
is 60 and above with 12 or 35%. Out of the 34 reported Influenza-like Illness deaths, 18 or 53% were males
and 16 or 47% females. BARMM reported the highest CFR among all regions with 1.72% (Figure 4.1.4).
Figure 4.1.4. Case Fatality Rates (CFR) of Influenza-like Illness Cases by Region
2019 2018
Philippines 0.02% Philippines 0.02%
BARMM 1.72% VI 0.93%
XI 0.07% BARMM 0.19%
NCR 0.04% NCR 0.10%
XII 0.04% XI 0.04%
Caraga 0.04% Caraga 0.02%
X 0.02% X 0.01%
MIMAROPA 0.01% VIII 0.01%
CALABARZON 0.01% CALABARZON 0.01%
I 0.00% XII 0.01%
II 0.00% I 0.01%
III 0.00% II 0.00%
V 0.00% III 0.00%
VI 0.00% MIMAROPA 0.00%
VII 0.00% V 0.00%
VIII 0.00% VII 0.00%
IX 0.00% IX 0.00%
CAR 0.00% CAR 0.00%
77
LABORATORY RESULTS OF REPORTED INFLUENZA-LIKE ILLNESS CASES
Out of 144,977 reported ILI cases, 4,311 or 3% of cases had specimen for laboratory testing. Of
which, 166 cases or 3% were positive Influenza-like Illness cases. Majority were Parainfluenza Type 1 (53
or 32%) followed by 34 cases (20%) of Influenza A(H3) [Table 4.1.1].
Table 4.1.1. Laboratory Status and Results of ILI Cases (N=144,977)

Philippines, 2019

Tested 4,311 (3%)
Positive 166 (3%)
Influenza A:
H3 34 (20%)
H1N1 21 (12%)
Unspecified subtype 25 (15%)
Influenza B:
Victoria-lineage 19 (11%)
Yamagata-lineage 1 (0.6%)
B/Florida/4/2006-like 1 (0.6%)
Unspecified subtype 8 (5%)
Influenza A and B 2 (1%)
Parainfluenza:
Type 1 53 (32%)
Type 3 1 (0.6%)
RSV 1 (0.6%)
Not Tested/Unknown/Pending 140,666 (97%)
Profile of Positive Influenza-like Illness Cases (n=166)
There were 166 positive Influenza-like Illness cases for 2019. Age range from less than 1
month to 90 years old with a median of 4 years old. There were more males (90 or 54%) than
females (76 or 46%).
There was one death (CFR=1%) reported among positive Influenza-like Illness cases from
NCR. The case was 39 years old, male.
78
4.2 Meningococcal Disease
Meningococcal disease is caused by a bacterium known as Neisseria meningitides (also called

meningococcus). Twelve serogroups of N.meningitidis have been identified. The infection is transmitted
from person to person through respiratory droplets or secretions. Closed and prolonged contact (e.g.
kissing, sneezing and coughing on someone, living in close quarters or dormitories, sharing eating or
drinking utensils, etc.) facilitate the spread of the disease. Average incubation period is 4 days, ranging
between 2-10 days.
There were 287 suspect cases of meningococcal disease reported in 2019 nationwide. This is 24%
higher when compared to 2018 (N=231). Morbidity week 40 has the highest number of reported
meningococcal disease cases with 14 and MW 29 has the lowest number of reported case with just one.
The trend of meningococcal disease cases in 2019 vs 2018 is shown below [Figure 4.2.1].
Figure 4.2.1. Meningococcal Disease Cases by Morbidity Week (N=287)

16
14
12
10
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Morbidity Week
CALABARZON has the highest number of reported Meningococcal disease cases with 59 or 21%
followed by NCR (50 or 17%), and Region III (27 or 19%). Region V has the highest incidence rate with
0.38% per 100,000 population followed by CALABARZON and NCR both with 0.37% respectively. The
distribution of Meningococcal disease cases and incidence rates by region is shown below (Figure 4.2.2).
79
Figure 4.2.2. Distribution of Meningococcal Disease Cases and Incidence Rates by Region (N=287)
Philippines, 2019
PROFILE OF REPORTED MENINGOCOCCAL CASES AND DEATHS
The age of meningococcal disease cases range from less than 1 month to 74 years old, with a
median of 6 years old. The most affected age group is 1 to 4 years old (72 or 25%), 167 or 58% were males
and 120 or 42% were females (Figure 4.2.3).
Figure 4.2.3. Reported Meningococcal Disease Cases by Age Group and Sex (N=287)
Philippines, 2019
≥60
50 - 59
40 - 49
30 - 39
20 - 29
10 - 19
5-9
1-4
≤1
50 30 10 10 30 50
Number of Cases
80
Out of 287 meningococcal disease cases, 149 deaths were reported having a CFR of 52%. Age
range from less than 1 month to 74 years old with a median of 5 years old. The most affected age group
is 1 to 4 years old with 42 or 28%. Out of the 149 reported meningococcal disease deaths, 81 or 54% were
males and 68 or 46% were females. All cases died from Region I while 12 out of 16 died from Region VI.
The comparison of case fatality rates by region between 2019 and 2018 is shown below (Figure 4.2.4)
Figure 4.2.4. Case Fatality Rates of Meningococcal Disease Cases by Region

2019 2018
Philippines 51% Philippines 49%
I 100% IX 83%
VI 75% I 75%
XII 75% V 67%
VIII 70% VII 62%
CAR 67% II 60%
Caraga 67% MIMAROPA 60%
BARMM 60% III 57%
CALABARZON 54% VI 53%
VII 54% VIII 50%
V 52% XII 50%
MIMAROPA 50% CAR 50%
IX 50% NCR 47%
III 48% XI 46%
NCR 46% CALABARZON 39%
II 33% X 29%
X 25% Caraga 17%
XI 21% BARMM 0%
Out of 287 reported meningococcal disease cases, 46 or 16% of cases had specimen for laboratory
testing. Twenty-five cases (54%) of those that were tested yielded positive results for Neisseria
Meningitidis via Real-Time PCR, Culture, or Gram Stain (Table 4.2.1).
Table 4.2.1 Laboratory Status and Results of Meningococcal Disease Cases (N=287)
Philippines, 2019
Meningococcal Disease Cases N=287
Tested 46 (16%)
Positive* 25 (54%)
Negative 21 (46%)
Not tested/ Unknown 241 (84%)
*detection of Neisseria meningitides via PCR, culture or gram stain
Profile of Positive Meningococcal Disease Cases (n=25)
There were 25 positive meningococcal disease cases for 2019. Age range from 3 months
to 49 years old with a median of 4 years old. The most common age group was between 1 and 4
years old (9 or 36%). Of the 25 meningococcal disease cases, 16 or 64% were males and 9 or 36%
were females. There were 15 deaths (CFR= 60%) out of the 25 positive cases.
81
Annexes
Annex 1. Cases, Deaths and Incidence Rates of Reported Notifiable

Diseases in PIDSR in 2018 and 2019 by Region, Philippines
Annex 2. Cases and Alert Classification by Morbidity Week, Philippines,

2014 to 2019
Annex 3. Distribution of Reported Cases by Region and Morbidity Week,

PIDSR Notifiable Diseases, 2019

2019 PIDSR Annual Report

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| 2019 PIDSR Annual Report

2019 Annual Report

EPIDEMIOLOGY BUREAU, DEPARTMENT OF HEALTH

Philippine Integrated Disease Surveillance

Public Health Surveillance Division

An electronic copy of this publication can be secured by sending an email to pidsr2@gmail.com.

Suggested Citation: Epidemiology Bureau, Department of Health. Philippine Integrated Disease

Manila, Philippines: Department of Health.

MESSAGE FROM THE OFFICE OF THE EPIDEMIOLOGY

FERCHITO L. AVELINO, MD, MPH, PHSAE

Goal and Objectives of PIDSR

Conceptual Framework of PIDSR

Figure 1. Conceptual Framework of the PIDSR

How to use this Annual Report

The PIDSR Annual 2019 includes the following data:

Limitations to the Data

1 | VACCINE PREVENTABLE DISEASES

1.1 Acute Flaccid Paralysis (AFP)

AFP Surveillance is an intensive case-based surveillance wherein a comprehensive set of data

TREND IN THE PHILIPPINES

Figure 1.1.1. Acute Flaccid Paralysis Cases (N=1,003)

Number of Cases 2019 Polio Compatible 2019 VDPV

Figure 1.1.2. Distribution of Acute Flaccid Paralysis Cases by Region (N=1,003)

Table 1.1.1. AFP Cases by Region and Classification (N=1,003)

Table 1.1.1. (Continued) AFP Cases by Region and Classification (N=1,003)

Figure 1.1.3. Reported AFP Case Fatality Rate by Region

PROFILE OF REPORTED AFP CASES AND DEATHS

250 200 150 100 50 0 50 100 150 200

Profile by Vaccination Status

Complete OPV Dose < 3 OPV Doses

Viral Isolation and Genotyping

Stool Specimen Result Stool Specimen 1 Stool Specimen 2

Negative for poliovirus 610 61% 573 57%

Not tested/insufficient sample 10 1% 9 1%

No stool 298 30% 338 34%

Total 1003 100% 1003 100%

Differential Diagnosis of Reported AFP Cases

Figure 1.1.6. Top 10 Diagnoses of Non-Polio AFP Cases (n=220*)

SURVEILLANCE PERFORMANCE INDICATORS

AFP Reporting Rate and Non-Polio AFP Rate

Figure 1.1.7. Three-Year Comparison of Non-Polio AFP Rate by Region

Table 1.1.3. AFP Reporting and Non-Polio AFP Rate

Table 1.1.3. (Continued) AFP Reporting and Non-Polio AFP Rate

Stool Specimen Adequacy Rate (n=431)

Table 1.1.4. Stool Specimen Adequacy by Region (n=872)

Stool 1 and 2 collected within 14 days (Adequate)

Polio Infection in the Philippines (n=23)

Figure 1.1.9. Polio Infection in the Philippines (n=23)

Diphtheria is an infectious disease spread (from person to person) by respiratory droplets

TREND IN THE PHILIPPINES

Figure 1.2.1. Reported Diphtheria Cases by Morbidity Week (N=272)

Number of Cases 2019 2018

Figure 1.2.2. Distribution of Diphtheria Cases (N=272)

2019 2018 % Change

Figure 1.2.3. Reported Diphtheria Case Fatality Rates (CFR) by Region

CFR (%) 2019 2018

PROFILE OF REPORTED DIPHTHERIA CASES AND DEATHS

LABORATORY RESULTS OF REPORTED CASES

Table 1.2.2. Laboratory Specimens and Results of Diphtheria Cases (N=272)

Total Reported Cases 272

Profile of Confirmed Diphtheria Cases (n=13)

Figure 1.2.6. Vaccination Status among Confirmed Diphtheria Cases (n=13)

Profile of Diphtheria Deaths among Confirmed Cases (n=6)

1.3 Measles and Rubella