2021 PIDSR Annual Report

PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE
EPIDEMIC-PRONE DISEASE CASE SURVEILLANCE
2021 ANNUAL REPORT

Philippine Integrated Disease Surveillance and Response:
Epidemic-Prone Disease Case Surveillance
2021 Annual Report
Published by
Public Health Surveillance Division

Epidemiology Bureau
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz
Manila 1003, Philippines
The PIDSR-EDCS Annual Report 2021 is published by the Epidemiology Bureau.

The data in this report were obtained from the Regional Epidemiology and Surveillance
Units (RESUs). This report can only provide information on comparative statistics by
sociodemographic category and region of the diseases, syndromes and conditions
included in PIDSR-EDCS.
This report may be reproduced in full or in part for non-profit purposes without
prior permission, provided proper attribution to the Epidemiology Bureau is made.
Furnishing the Epidemiology Bureau, a copy of the reprinted or adapted version will be
appreciated.
By the Staff of the Epidemiology Bureau the Department of Health, Philippines
Editorial Board:
Alethea R. De Guzman, MD, MCHM, PHSAE

Director IV
Epidemiology Bureau Jasmin P. Andoy, RN
Health Program Officer II- Philippine Integrated
Richelle P. Abellera, RN, PHSAE Disease Surveillance and Response Officer-
Officer-In-Charge-Chief, Public Health Surveillance vision
Acute Meningitis and Encephalitis Syndrome
Epidemiology Bureau and Chikungunya
Herdie L. Hizon Jenny Rose Prudente, RN

Officer-In-Charge-Chief, Supervising Health Nurse II, Philippine Integrated Disease
Program Officer Surveillance and Response Officer- Acute
Epidemiology Bureau Bloody Diarrhea, Acute Viral Hepatitis and
Cholera
Kris Pauline D. Martinez, RN
Senior Health Program Officer- Cluster Lead, Non- Jewel P. Rodriguez, RND
VPD Health Program Officer II, Philippine Integrated
Philippine Integrated Disease Surveillance and Disease Surveillance and Response Officer-
Response Officer- Neonatal Tetanus and Non- Typhoid Fever and Influenza-Like-Illness
Neonatal Tetanus
Alfonso C. Sy, RN
Edriz Noelle B. Ruezo, RN Health Program Officer I- National Vaccine
Senior Health Program Officer, Cluster Lead- Preventable Disease Surveillance Officer- Acute
VPD Flaccid Paralysis
Philippine Integrated Disease Surveillance and
Response Officer- Rotavirus Ronalyn G. Valera, RM
Health Program Officer II, Philippine Integrated
Eunice P. Guzman, RN Disease Surveillance and Response Officer-
Nurse III- Cluster Lead, VPD Pertussis and Meningococcal Disease
Philippine Integrated Disease Surveillance and
Response Officer- Leptospirosis Ranzel Luiz S. Raymundo, RPm
Health Program Officer II, Philippine Integrated
Jessa F. Sayson, RMT Disease Surveillance and Response Officer-
Health Program Officer II, National Vaccine Diphtheria and Rabies
Preventable Disease Surveillance Officer-
Measles-Rubella Trixie Marie B. Balmes
Administrative Assistant III, Philippine
Charles Maurice A. Natan, RND Integrated
Health Program Officer II, Philippine Integrated Disease Surveillance and Response
Disease Surveillance and Response Officer-
Dengue
| 2021 PIDSR-EDCS Annual Report
Contents
Preface .......................................................................................................................................................... 1
Acknowledgment .......................................................................................................................................... 1
Message from the Office of the Epidemiology Bureau Director .................................................................. 2
Chapter 1. Introduction ................................................................................................................................ 3
Goal and Objective of PIDSR 3
Epidemic Surveillance Systems Framework 4
How to use this Annual Report 5
Data Interpretation 5
Limitations to the Data 5
Chapter 2. Vaccine Preventable Diseases ..................................................................................................... 7
2.1 Acute Flaccid Paralysis (AFP) 8
2.2 Diphtheria 16
2.3 Measles/Rubella 21
2.4 Neonatal Tetanus 30
2.5 Non-neonatal Tetanus 35
2.6 Pertussis 39
Chapter 3. Food and Water-borne Diseases ............................................................................................... 44
3.1 Acute Bloody Diarrhea 45
3.2 Cholera 50
3.3 Acute Viral Hepatitis 55
3.4 Rotavirus 61
3.5 Typhoid Fever 66
Chapter 4. Zoonotic and Vector-borne Diseases ........................................................................................ 70
4.1 Chikungunya 71
4.2 Dengue 74
4.3 Leptospirosis 79
4.4 Rabies 83
Chapter 5. Other Diseases .......................................................................................................................... 86
5.1 Acute Meningitis-Encephalitis Syndrome (AMES) 86
5.2 Influenza-like Illness 91
5.3 Meningococcal Disease 95

Annex 1. 2021 PIDSR-EDCS Morbidity Week Calendar ............................................................................... 99
The Epidemic-prone Disease Case Surveillance (EDCS) of Philippine Integrated Disease

Surveillance and Response (PIDSR) is the main source of disease surveillance information used by
various stakeholders. Data collected provide key health intelligence that assists public health
authorities in monitoring disease trends, identifying risk populations and implement effective
public health interventions to respond to priority diseases. Other stakeholders include the
academe, researchers, and other government organizations.
This report is one of the yearly publications of morbidity and mortality statistics of
notifiable diseases/syndromes by the Epidemiology Bureau, Department of Health (EB-DOH)
reported by Disease Reporting Units (DRUs) and Epidemiology and Surveillance Units (ESUs)
across all levels of the health system. The diseases/syndromes were identified as those with
epidemic potential. This includes the following:
Vaccine Preventable Diseases Food and Water-borne Diseases

 Acute Flaccid Paralysis  Acute Bloody Diarrhea
 Diphtheria  Cholera
 Measles-Rubella  Hepatitis A
 Neonatal Tetanus  Rotavirus
 Non-Neonatal Tetanus  Typhoid Fever
 Pertussis 
Zoonotic and Vector-borne Diseases Other Diseases/Syndromes
 Chikungunya  Acute Meningitis-Encephalitis
 Dengue Syndrome (AMES)
 Leptospirosis  Influenza-Like Illness (ILI)
 Rabies  Meningococcal Disease
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The Epidemiology Bureau extends its sincerest gratitude to the Centers for Health
Development (CHDs), through its Regional Epidemiology and Surveillance Units (RESUs) and all
Disease Reporting Units (DRUs) participating in the PIDSR National Network for their unwavering
support to generate this PIDSR-EDCS 2021 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 2021.
We would also like to acknowledge the Disease Prevention and Control Bureau (DPCB) for
the commendable partnership in maximizing surveillance data as basis in their policy, decision-
making, and implementation.
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The Epidemiology Bureau of the Department of Health remains committed to deliver and realize
its mandate to provide and promote epidemiologic information for evidence-based decision
making. Hence, it is with great pride and honor to present to you the 2021 Philippine Integrated
Disease Surveillance and Response (PIDSR) - Epidemic-prone Disease Case Surveillance (EDCS)
Annual Report.
The year 2021 starts us to recover from the COVID-19 pandemic and our disease surveillance
officers continues their duty with utmost dedication and perseverance. This report is the product
of resilience and hard work of all Epidemiologist and Disease Surveillance Officers at all levels of
epidemiological surveillance units: national, regional, provincial, city and municipal health
offices.
Along with this report, I would like to acknowledge too our partners in health from the
government and private hospitals, Local Government Units, Non - Government Organizations and
other Government and Civil Societies who are supportive of the thrusts of the Department of
Health.
The teamwork from these various organization and key players in surveillance and in health
enables us to reach excellence and continue exemplary performance to serve the Filipino people
and making this country-a Healthy Philippines.
Congratulations and let’s continue to strive for the best!
ALETHEA R. DE GUZMAN, MD, MCHM, PHSAE

Director IV, Epidemiology Bureau
2
iii
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, reporting, confirmation, data
management, analysis, and feedback, 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.
In supports to the Republic Act (RA) No. 11223 “Universal Health Care Act” and RA No. 11332 “Mandatory
Reporting if Notifiable Diseases and Health Events of Public Health Concern Act, the Administrative Order
(AO) No. 2021-0057 “Revised Guidelines on the Philippine Integrated Disease Surveillance and Response
(PIDSR)” was created. The PIDSR is hereby enhanced, integrating the indicator-based surveillance (IBS)
and event-based surveillance (EBS) functions and activities; hence, the Epidemic-prone Disease Case
Surveillance (EDCS) and Event-based Surveillance and Response (ESR) is under PIDSR. The two
surveillances differ in terms of purpose, source, process, and characteristic of data; however, these two
public health surveillances complements each other and serve as the early warning system for epidemics
and public health threats.
The 2021 PIDSR-EDCS 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-EDCS 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 Objective of PIDSR
Goal
A functional integrated disease surveillance and response system that would result in
considerable reduction in morbidity, disability, and mortality caused by epidemic prone diseases and
other health events with potential for public health risk.
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Objectives
1. To provide complete, timely, and accurate disease surveillance information that will guide
response on interventions for all stakeholders, particularly local government units and national
programs;
2. To improve and strengthen the capacity for an integrated surveillance and response at all levels
of the health system.
3. To capture IHR-relevant health events that may constitute a public health emergency of
international concerns and may pose significant public health threat and notify the WHO within
24 hours of assessment.
Epidemic Surveillance Systems Framework
To strengthen epidemic surveillance and to support to the Universal Health Care law, the
Epidemic Surveillance System Framework was created (Figure 1). Epidemic-prone Disease Case
Surveillance (EDCS) and Event-Based Surveillance (EBS) utilizes PIDSR surveillance systems for the
detection of epidemic-prone diseases and other health events with public health concern. While PIDSR-
EBS focuses on rapid capture of any public health event of acute threat, PIDSR-EDCS uses standard case
definitions to detect priority diseases and focuses on epidemic-prone potential diseases which will be
captured on sentinel and non-sentinel sites.
Figure 1. Epidemic Surveillance Systems Framework
4
How to use this Annual Report
This PIDSR-EDCS 2021 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
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-EDCS Annual 2021 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 2020 surveillance data
Data Interpretation
PIDSR-EDCS 2021 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.
5
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.
These limitations to the data should be considered when comparing counts and rates across
conditions and when comparing counts and rates for any condition by person, place, or time. It should
not be assumed that differences reflect only variation in the true incidence of the conditions.
6
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
immunization. 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 surge of cases that might lead to a possible outbreak.
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2.1 Acute Flaccid Paralysis (AFP)
Poliomyelitis is one of the vaccine-preventable diseases targeted for eradication. It is a highly

contagious disease that mainly affects children less than 5 years of age. The last case of wild 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 (cVDPV1) 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 conducted from 2001 until 2002. In June 2018, there were reported polio outbreaks in
some countries in the Western Pacific Region and subsequently, Philippines reported a Vaccine-derived
poliovirus (VDPV) last September 14, 2019.
AFP Surveillance is an intensive case-based surveillance where a comprehensive set of data is

collected for every case of children under 15 years of age with acute onset of paralysis or any case that
falls under the AFP differential diagnosis or a person of any age in whom poliomyelitis is suspected by a
physician. 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, other differential diagnoses that have numerous etiologies. Hence, any
disease that presents AFP, even if diagnosed as the other disease than polio by the physician should be
reported and collected with stool specimen.
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 was recommended that
the target will be raised from 1 to 3 per 100,000 populations for the outbreak regions (Region 3,
CALABARZON, 7, 9, 10, 11, 12, BARMM, Caraga and NCR) and 2 per 100,000 for non-outbreak regions
(Region 1, 2, MIMAROPA, 5, 6, 8 and CAR). In June 2021, the closure of polio outbreak was announced,
and the target of the regions were decreased to 2 per 100,000 from 3 for the whole country. By end of
2021, the non-polio AFP rate was 2.8 with 917 non-polio AFP cases reported (Table 2.1.3). 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 that 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 to
recommend measures to prevent, control and declare that a polio outbreak is closed.
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TREND IN THE PHILIPPINES
The graph shows a steady notification of AFP cases from 2012 to 2018. However, a significant
surge occurred in 2019 when the Department of Health declared polio outbreak in September of the same
year. The sudden increase was due to the enhanced AFP surveillance across the country and the start of
records review in the hospitals. Case finding activities were sustained in 2021 (Figure 2.1.1).
Figure 2.1.1. Reported Acute Flaccid Paralysis Cases (N=5,860)

Philippines, 2012 – 2021
1200 1,003
900 898
1000
Number of cases
800
501 482 516
600 457 414
368
321
400
200
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 898 AFP cases reported nationwide from January 1 to December 31, 2021. All these
cases (898, 100%) have been discarded as non-polio AFP (Figure 2.1.2). Most AFP cases were reported
during the mid of 2021 with their highest levels from morbidity weeks 24 to 30. Compared to last year’s
data, the number of AFP cases this year (N=898) is lower (0.2% decrease) than the number reported in
2020 (N=900) due to the enhancement of AFP surveillance across the country.
Figure 2.1.2. Acute Flaccid Paralysis Cases

Philippines, 2020 vs 2021
Number of Cases 2021 (N=898) 2020 (N=900)
50
45
40
35
30
25
20
15
10
5
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
In 2021, the country exceeded the target AFP cases with a total of 898 cases reported. Nine (9)
out of 17 regions have reached the target with Region III reporting the highest number of cases for the
said year. However, despite reaching the national target there are eight (8) regions that failed to reach
the target number of cases, these are CALABARZON, Region VII, X, XII, BARMM, CAR, Caraga and NCR
(Table 2.1.1).
9
Figure 2.1.3. Distribution of Acute Flaccid Paralysis Cases by Region (N=898)

Philippines, 2021
Classification
2021 Target Reported
Region Non-Polio
AFP Cases Cases
(Discarded)
PHILIPPINES 661 898 898
I 31 31 31
II 22 30 30
III 92 115 115
CALABARZON 123 109 109
MMAROPA 22 23 23
V 42 78 78
VI 46 48 48
VII 65 61 61
VIII 32 85 85
IX 32 43 43
X 42 36 36
XI 44 54 54
XII 38 32 32
BARMM 48 33 33
CAR 11 10 10
Caraga 25 23 23
NCR 98 87 87
Legend:
Reached the target

Failed to reach the target
Number of Cases
10
PROFILE OF REPORTED AFP CASES AND DEATHS
The age of cases ranged from less than 1 year to 28 years old with a median of 6 years old. The
most affected population belonged to the <5 years (396, 44%) age group. Majority of the AFP cases were
males (526, 59%). There was no significant difference in the distribution of cases by age group.
Figure 2.1.4. Reported AFP Cases by Sex and Age Group

Age Group Male (n=529) Female (n=372)
(Years)
≥15
10 - 14
5-9
≤4
250 200 150 100 50 0 50 100 150 200 250

Number of Cases
In 2021, there were 43 reported deaths accounting for a national CFR of 4.8% while 50 deaths
(5.6% CFR) were noted in 2020. Regions with the highest proportion of deaths among cases (CFR) in 2021
were MIMAROPA (13% CFR), Region XI (13% CFR), CAR (10% CFR) and Caraga (8.7% CFR) [Figure 2.1.5].
Figure 2.1.5. AFP Case Fatality Rates by Region

CFR %
19.4
20.0 2020 (n=50) 2021 (n=43)
18.0 15.8
15.4
16.0
13.0 13.0 2020 National
14.0 CFR=5.6%
12.0 10.0 10.0
10.0 8.7 8.3 2021 National
6.9 7.4
8.0 5.6 6.4 6.6 6.5 6.1 5.9 CFR=4.8%
5.1 5.5 5.6
6.0
4.0 2.6 3.1
1.9 2.0 1.7 2.0 1.8 1.8
2.0 0.0 0.0 0.0 0.0 0.0
0.0
Region
Profile by Vaccination Status
Information on the immunization status of reported cases is essential for the EPI coordinators in
choosing appropriate strategies on targeting specific age groups for immunization. Out of the reported
AFP cases, 679 (76%) have complete oral poliovirus vaccination (OPV), 62 (7%) had incomplete (< 3 doses)
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OPV vaccination, 37 (4%) did not receive any OPV dose while 120 (13%) have unknown data. A total of
301 children in the <5 age group received complete doses of oral poliovirus vaccine while lower
proportions of children with complete doses were noted in higher age groups (Figure 2.1.6).
Figure 2.1.6. Immunization Status of Reported AFP Cases by OPV Dose and Age Group (N=898)
Philippines, 2021
100%
80%
60%
40%
20%
0%
≤4 5-9 10 - 14 ≥15 Total
Unknown 43 37 39 1 120
0 OPV Dose 16 8 13 0 37
<3 OPV Doses 36 17 9 0 62
Complete 301 176 200 2 679
Complete <3 OPV Doses 0 OPV Dose Unknown
LABORATORY RESULTS
Viral Isolation and Genotyping
Table 2.1.2 shows the AFP stool specimen test results from the National Polio Laboratory
(NPL) of the Research Institute of Tropical Medicine (RITM). Each AFP case should have two (2) stool
samples collected within 14 days from onset of paralysis with 24 hours apart for laboratory
confirmation.
A total of 859 (96%) AFP cases have submitted one stool specimen for laboratory
confirmation and 848 (96%) have submitted a second stool. Majority of Stool 1 (817, 91%) and Stool
2 (805, 90%) tested negative for poliovirus. There were 2 (0.2%) that yielded Sabin-like results in
stool 1 submission, while 3 (0.3%) have the same results in stool 2.
Table 2.1.2. Stool Specimen Result among Reported AFP Cases (N=898)
Philippines, 2021
Stool Specimen Result *Stool Specimen 1 *Stool Specimen 2
Total 898 100% 886 99%
Negative for poliovirus 817 91% 805 90%
Sabin-like poliovirus 2 0.2% 3 0.3%
Non-polio enterovirus 38 4% 37 4%
Not tested/insufficient sample 2 0.2% 3 0.3%
No stool 39 4% 38 4%
*Regardless of stool collection date
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Differential Diagnosis of Reported AFP Cases
Figure 2.1.7 shows the top 10 differential diagnosis of reported AFP cases in 2021. Electrolyte
Imbalance / Hypokalemia was the most (30, 3%) common diagnosis among the non-polio AFP cases
reported followed by GBS (8, 1%), Pott’s Disease (5, 1%), Age with moderate DHN (5, 1%), CNS Infection
(5, 1%), Acute Transverse Myelitis (5, 1%), TB Meningitis (4, 0.5%), Brain Tumor (3, 0.2%), Spinal Cord
Compression (2, 0.2%) and Extra-pulmonary TB (2, 0.2%). Among the reported cases, 766 cases or 85%
have no indicated final diagnosis (Figure 2.1.7).
Figure 2.1.7. Top 10 Diagnoses of Non-Polio AFP Cases (N=898)
Philippines, 2021
ELECTROLYTE IMBALANCE / HYPOKALEMIA 30

GUILLAIN BARRÈ SYNDROME 8
POTT'S DISEASE 5
AGE WITH MODERATE DEHYDRATION 5
CENTRAL NERVOUS SYSTEM INFECTION 5
ACUTE TRANSVERSE MYELITIS 5
TUBERCOLOSIS MENINGITIS 4
BRAIN TUMOR 3
SPINAL CORD COMPRESSION 2
EXTRAPULMONARY TUBERCOLOSIS 2
SURVEILLANCE PERFORMANCE INDICATORS
Non-Polio AFP Rate
In 2021, a total of 15 out of 17 regions reached the Non-Polio AFP Rate target of 2 per 100,000
population. These are Regions I, II, III, CALABARZON, MIMAROPA, V, VI, VII, VIII, IX, X, XI, XII, Caraga and
NCR. Good performance in reaching this target was noted in several regions being able to reach the said
target for two consecutive years despite the COVID-19 pandemic. Overall, the country reached the
national target with a 2.72 Non-Polio AFP reporting rate. (Figure 2.1.8).
Figure 2.1.8. Comparison of Non-Polio AFP Reporting Rate by Region

2020 2021 Non-polio AFP rate target
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
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AFP Reporting Rate
The Philippines reached the national AFP reporting rate with a national reporting rate of 2.7 per
100,000 population of children under 15 years old. Most of the regions reached the target such as Regions
I, II, III, CALABARZON, MIMAROPA, V, VI, VII, VIII, IX, X, XI, XII, Caraga and NCR while BARMM and CAR did
not reach the AFP reporting rate (Figure 2.1.9).
Figure 2.1.9. Comparison of AFP Reporting Rate by Region
2020 2021 AFP reporting rate target
6.00
5.00
4.00
3.00
2.00
1.00
0.00
Stool Specimen Adequacy Rate
All AFP cases should have full clinical and virologic investigation with at least 80% of AFP cases
having adequate stool specimens collected. Among the 898 non-polio AFP cases, 697 cases had two stool
specimens collected within 14 days from onset resulting to a national adequacy rate of 78% that is below
the target of 80%. One hundred fifty-two (17%) cases had specimens collected beyond the required
collection period. Thirteen (1%) cases had only one specimen stool submitted, 36 (4%) cases had no
specimen samples (Table 2.1.3).
Table 2.1.3. Stool Specimen Adequacy by Region (n=898)
Philippines, 2021
Stool 1 and 2 With specimen
collected within collected more
Region 14 days (Adequate) than 14 days 1 Stool No Stool Total
PHILIPPINES 697 152 13 36 898
I 26 1 0 4 31
II 30 0 0 0 30
III 101 11 0 3 115
CALABARZON 60 40 2 7 109
MIMAROPA 13 9 0 1 23
V 62 12 3 1 78
VI 26 18 0 4 48
VII 52 5 2 2 61
VIII 67 14 1 3 85
IX 43 0 0 0 43
X 32 4 0 0 36
XI 45 5 1 3 54
XII 23 6 1 2 32
BARMM 27 2 2 2 33
CAR 6 4 0 0 10
Caraga 16 7 0 0 23
NCR 68 14 1 4 87
14
Only Region II, IX, X, III, VII, I, XI and BARMM achieved the target of >80% for Adequacy of Stool
Specimen. Regions V (79%), VII (79%) and NCR (78%) nearly reached the target while Regions XII, Caraga,
CAR, MIMAROPA, CALABARZON and Region VI fell short in reaching the stool adequacy target (Figure
2.1.10).
Figure 2.1.10. Stool Specimen Adequacy Rate among Non-Polio AFP Cases by Region (n=898)
Philippines, 2021
Adequate > 14 days No Stool 1 Stool
100%
80%
Percentage
60%
40%
20%
0%
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2.2 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. The incubation period is usually 2 to 5 days (range 1-10 days).
Together with the other vaccine preventable diseases controlling the occurrence of diphtheria
cases and deaths is the goal in the Philippines. This is in line with the Western Pacific Region’s goal and
target which is to control cases and zero death caused by infection with Corynebacterium diphtheria.
Figure 2.2.1 shows Diphtheria cases reported from 2012 to 2021. The number of reported cases
was shown to be gradually increasing from 2012 to 2013 and have plateaued in years 2014 to 2015. By
the year 2016, the cases started to increase peaking at the year 2019 then subsequently plummeted
during the COVID-19 pandemic years (Figure 2.2.1).
Figure 2.2.1. Reported Diphtheria Cases (N=1,263)

Philippines, 2012-2021
16
Nationally, there were 48 cases of Diphtheria reported in 2021. This is 38% lower compared to
the number of cases last year (N=78). The cases for Diphtheria were irregular with no discernable pattern.
In 18 out of 53 morbidity weeks, only 1 case was reported. The highest peak was noted in MW 44 (Figure
2.2.2).
Figure 2.2.2. Reported Diphtheria Cases by Morbidity Week
Table 2.2.1 shows a comparison of the regional data on cases, deaths and case fatality rate (CFR) in 2021
and 2020. Four out of 17 regions have shown an increase in the number of cases in 2021 compared to
2020. MIMAROPA, Region VII and XI reported the highest increase this year with 100% respectively.
Furthermore, it can be noted that Region X and Caraga have not reported a case in the past two years.
Table 2.2.1. Reported Diphtheria Cases, Deaths, and Case Fatality Rates (CFR) by Region (N=48)
2020 2021 % Change in

Region
Cases Deaths CFR Cases Deaths CFR Cases
PHILIPPINES 78 24 31% 48 17 35% ↓ 38%
I 3 0 0% 2 0 0% ↓ 33%
II 3 1 33% 0 0 - ↓ 100%
III 6 1 17% 6 1 17% → 0%
CALABARZON 10 3 30% 11 4 36% ↑ 10%
MIMAROPA 0 0 - 1 0 0% ↑ 100%
V 3 1 33% 2 0 0% ↓ 33%
VI 7 3 43% 2 1 50% ↓ 71%
VII 0 0 - 1 1 100% ↑ 100%
VIII 1 0 0% 0 0 - ↓ 100%
IX 3 0 0% 0 0 - ↓ 100%
X 0 0 - 0 0 - → 0%
XI 0 0 - 1 0 0% ↑ 100%
XII 3 1 33% 0 0 - ↓ 100%
BARMM 16 8 50% 0 0 - ↓ 100%
CAR 1 0 0% 0 0 - ↓ 100%
Caraga 0 0 - 0 0 - → 0%
NCR 22 6 27% 22 10 45% → 0%
17
Across all regions, NCR (22, 46%) and CALABARZON (11, 23%) reported the highest number of
Diphtheria cases. Together, these two regions account for the majority (69%) of all cases in the country
(Figure 2.2.3). The regions with the least reported cases were MIMAROPA, Regions VII, and XI with one
case each. Whereas, Regions II, VIII, IX, X, XII, BARMM, CAR, and Caraga have no reported diphtheria case.
Figure 2.2.3. Distribution of Diphtheria Cases (N=48)

Philippines, 2021
No. of Cases
PROFILE OF CASES AND DEATHS
Diphtheria cases range from age less than 1 year to 59 years old with median of 6 years old. The
most affected age group was 5 to 9 years old with 18 (38%) cases. Twenty-eight (58%) are females while
twenty (42%) are males. High number of cases was seen within the age range of 1 to 9 years old (Figure
2.2.4).
Figure 2.2.4. Reported Diphtheria Cases by Age Group and Sex (N=48)
Philippines, 2021
18
Seventeen Diphtheria cases died in 2021, accounting to national CFR of 35%. Only five regions
have reported deaths on the said year: Region VII, VI, NCR and CALABARZON. Of these, Region VII reported
a high proportion of deaths among cases with 100% case fatality rate followed by Region VI with 50% CFR.
(Figure 2.2.5).
Figure 2.2.5. Reported Diphtheria Case Fatality Rates (CFR) by Region

%CFR 2020 (N=78) 2021 (N=48)

120.0
100.0
100.0
80.0
60.0 50.0 50.0

42.9 45.5
36.4
40.0 33.3 33.3 33.3
30.0
27.3
16.7 16.7
20.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0
Region
VACCINATION STATUS
The majority (15, 33%) of Diphtheria cases and deaths reported were unvaccinated. Fifteen (31%)
cases received two or more DPT doses, while one (2%) case received only one DPT dose (Figure 2.2.6).
Figure 2.2.6. Vaccination Status among Diphtheria Cases and Deaths (N=48)
Philippines, 2021
30
25
Number of Cases
20
15
10
0
NOTE: Deaths are included in the2total
1 DOSE number
OR MORE of cases
DOSES NOT VACCINATED UNKNOWN
Cases 1 15 16 16
Deaths 1 1 10 5
19
LABORATORY RESULTS OF REPORTED CASES

Sixteen (33%) of the 48 reported cases had specimens for laboratory confirmation. Of these, six
(38%) were laboratory-confirmed Diphtheria (Table 2.2.2).
Table 2.2.2. Laboratory Specimens and Results of Diphtheria Cases (N=48)

Philippines, 2021
Total Reported Cases 48

Laboratory Tested 16 (33%)
Confirmed 6 (38%)
Negative 10 (63%)
Not Tested 32 (67%)
Profile of Laboratory Confirmed Diphtheria Cases (n=6)
Among the 48 reported Diphtheria cases, 6 cases were confirmed. Half of the confirmed cases
belong to the 5-9 years old age group followed by two (33%) cases aged between 10-14 years old and a
three-year-old. Only one of these confirmed cases received two or more Diphtheria vaccine. Moreover,
three (50%) confirmed Diphtheria cases were reported from San Lazaro Hospital, while one (17%) case
each was reported respectively from Dr. Jose N. Rodriguez Memorial Hospital, Region I Medical Center,
and Rizal Provincial Hospital System-Antipolo.
Profile of Laboratory Confirmed Diphtheria Deaths (n=4)
Four (24%) of the 17 reported deaths were laboratory confirmed. These confirmed deaths
included three (3) males and one (1) female; three cases ranged in age from 1 to 9 years, while one case
ranged from 50 to 64 years. Three of these deaths involved unvaccinated individuals, two (50%) of which
were from CALABARZON and one (25%) from Region III. Additionally, one case (25%) were reported from
the NCR whose vaccination status was unknown.
20
2.3 Measles/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 describe 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, this have 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 is observed.
For the past 10 years, measles and rubella remained endemic in the country. In years 2014, 2018
and 2019, outbreaks were declared wherein measles and rubella cases were noted to be the highest. A
significant decrease of reported measles and rubella cases was observed in years 2015, 2016, 2017, 2020
and 2021 (Figure 2.3.1). This may be due to the preventive and control response of Department of Health
during the Supplemental Immunization Activities (SIA) and the effect of COVID-19 pandemic, and
quarantine protocols in year 2020 and 2021.
Figure 2.3.1. Reported Measles and Rubella Cases (N=145,535)

60,000 54,564
49,997
50,000
40,000
Number of Cases
30,000 23,017
20,000 5,868
10,000 1,738 2,189 2,902 4,126
891 243
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Year
21
Cases reported in 2021 (243) was 94% lower compared to cases in 2020 (4,126) [Figure 2.3.2]. A
significant decrease of cases was observed due to the implementation of Enhanced Community
Quarantine (ECQ) nationwide in response to the COVID-19 pandemic nationwide.
Figure 2.3.2. Reported Measles and Rubella Cases by Morbidity Week

Number of Cases 2021 (N=243) 2020 (N=4,126)
450
400
350
300
250
200
150
100
50
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
All regions showed a decrease in reported measles and rubella cases compared to the cases
reported in 2020 (Table 2.3.1). A total of 243 cases were reported in 2021. Among the 17 regions, the
National Capital Region (NCR) has the highest reported cases (50 or 21%). It is followed by CALABARZON
(39 or 16%), and Region X (19 or 8%). No death reported among the measles and rubella cases in 2021.
This is 100% lower compared to 38 deaths in 2020.
Table 2.3.1. Measles and Rubella Cases, Deaths and Case Fatality Rates (CFR) by Region
Region 2020 2021 % Change in

PHILIPPINES 4,126 38 0.9% 243 0 0.0% ↓ 94%
I 159 0 0.0% 18 0 0.0% ↓ 89%
II 45 0 0.0% 2 0 0.0% ↓ 96%
III 326 5 1.5% 14 0 0.0% ↓ 96%
CALABARZON 294 0 0.0% 39 0 0.0% ↓ 87%
MIMAROPA 277 1 0.4% 3 0 0.0% ↓ 99%
V 59 0 0.0% 7 0 0.0% ↓ 88%
VI 197 2 1.0% 3 0 0.0% ↓ 98%
VII 92 0 0.0% 7 0 0.0% ↓ 92%
VIII 170 0 0.0% 18 0 0.0% ↓ 89%
IX 182 1 0.5% 15 0 0.0% ↓ 92%
X 443 4 0.9% 19 0 0.0% ↓ 96%
XI 478 7 1.5% 18 0 0.0% ↓ 96%
XII 391 12 3.1% 5 0 0.0% ↓ 99%
BARMM 276 2 0.7% 9 0 0.0% ↓ 97%
CAR 233 0 0.0% 4 0 0.0% ↓ 98%
Caraga 276 2 0.7% 12 0 0.0% ↓ 96%
NCR 228 2 0.9% 50 0 0.0% ↓ 78%
22
Figure 2.3.3. Distribution of Measles and Rubella Cases (N=243)

Philippines, 2021
Number of Cases
PROFILE OF REPORTED MEASLES AND RUBELLA CASES
Figure 2.3.5 shows the measles and rubella vaccination status by age group. Children of 6 to 59
months old were the most affected comprising 149 (61%) of measles and rubella cases. The majority of
measles and rubella cases were unvaccinated (71 or 29%), most were from the age group of 6 to 59
months old (44 or 62%). Out of 243 reported measles and rubella cases, only 3 (1%) cases received one
dose of measles-containing vaccine. Nine months to four years age group was the target population during
the ORI.
Figure 2.3.5. Reported Measles and Rubella Cases Vaccination Status by Age Group (N=243)
Philippines, 2021
Number of Cases
160
140
120
100
80
60
40
20
0
0 - 6 mos. 6 - 59 mos. 5 - 9 yrs 10 - 14 yrs 15 - 19 yrs ≥20 yrs
Age Group (Years)
2 or more doses 1 dose Unknown no. of doses Unknown vaccination status Not vaccinated
23
Most of the reported measles and rubella cases were from the age group of 1 to 4 years old (79
or 33%), followed by the age group of 9 to 11 months old (47 or 19%) and 6 to 8 months old (23 or 9%).
Out of 243 measles and rubella cases, 128 (47%) were males while 115 (53%) cases were females (Figure
2.3.6).
Figure 2.3.6. Reported Measles and Rubella Cases by Age Group and Sex (N=243)
Philippines, 2021
≥40 yrs
35 - 39 yrs
30 - 34 yrs
25 - 29 yrs
20 - 24 yrs
15 - 19 yrs
10 - 14 yrs
5 - 9 yrs
1 - 4 yrs
9 - 11 mos
6 - 8 mos
<6 mos
50 40 30 20 10 0 10 20 30 40 50
Number of Cases
Among the 243 reported suspect measles and rubella cases, only 52 (21%) had specimens for
laboratory testing. A total of 15 (29%) were positive for measles and 37 (71%) were positive for rubella,
all were tested either by IgM or PCR or both. No epidemiologically-linked confirmed case reported.
Majority (191 or 79%), of the reported measles and rubella cases have no specimen for testing, hence
classified as clinically compatible measles (Table 2.3.2).
Table 2.3.2. Laboratory Results of Reported Measles and Rubella Cases (N=243)
Philippines, 2021
Measles and Rubella Cases 243 (100%)
Specimen collected/tested: 52 (21%)
Measles Positive 15 (29%)
Rubella Positive 37 (71%)
No specimen collected/tested: 191 (79%)
Clinically compatible measles 191 (100%)
CONFIRMED MEASLES CASES IN THE PHILIPPINES
A confirmed measles is a case with a positive result for IgM or PCR or a case confirmed by
epidemiological linkage. The figure below shows that there has been a steep in the number of confirmed
measles cases from 2012 to 2021. Highest reported confirmed measles cases were in the year 2014,
followed by 2019 and 2018 wherein measles outbreaks were declared. Reported cases from 2020 to 2021
were significantly lower in comparison to previous years. Cases continued to decrease due to the effect
of the COVID-19 pandemic.
24
Figure 2.3.7. Reported Confirmed Measles Cases (n=43,908)

23,745
25,000
20,000
Number of Cases
15,000
10,000 8,000
5,285
3,648
5,000
703 696 791 949
76 15
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Year
There were only 15 confirmed measles cases reported from January 1 to December 31, 2021 while
949 cases were confirmed in 2020. The top regions with confirmed measles cases were NCR (6, 40%),
Region V (2, 13%), Region VII (2, 13%), and CAR (2, 13%) [Table 2.3.3].
Table 2.3.3. Confirmed Measles Cases, Deaths, and Case Fatality Rates (CFR) by Region
Region 2020 2021 % Change in

PHILIPPINES 949 10 1.1% 15 0 0.0% ↓ 98%
I 3 0 0.0% 0 0 - ↓ 100%
II 4 0 0.0% 0 0 - ↓ 100%
III 31 2 6.5% 0 0 - ↓ 100%
CALABARZON 26 0 0.0% 1 0 0.0% ↓ 96%
MIMAROPA 11 0 0.0% 0 0 - ↓ 100%
V 10 0 0.0% 2 0 0.0% ↓ 80%
VI 70 1 1.4% 0 0 - ↓ 100%
VII 9 0 0.0% 2 0 0.0% ↓ 78%
VIII 26 0 0.0% 0 0 - ↓ 100%
IX 24 0 0.0% 1 0 0.0% ↓ 96%
X 97 0 0.0% 1 0 0.0% ↓ 99%
XI 305 4 1.3% 0 0 - ↓ 100%
XII 181 2 1.1% 0 0 - ↓ 100%
BARMM 54 1 1.9% 0 0 - ↓ 100%
CAR 6 0 0.0% 2 0 0.0% ↓ 67%
Caraga 46 0 0.0% 0 0 - ↓ 100%
NCR 46 0 0.0% 6 0 0.0% ↓ 87%
25
Figure 2.3.8. Distribution of Confirmed Measles Cases (n=15)

Philippines, 2021
Number of Cases
Profile of Confirmed Measles Cases (n=15)
The age group of 9 to 11 months old (5, 33%) was the most affected among the reported
confirmed measles cases followed by age group of 1 to 4 years (3, 20%) and 5 to 9 years (3, 20%). The
reported confirmed measles cases range from less than 2 months to 30 years, with a median of 1 year old.
The majority (8, 53%) were females. Ten (67%) out of 15 confirmed measles cases received unknown
number of doses of measles-containing vaccine. Three (20%) cases were not vaccinated and two (13%)
have unknown vaccination status.
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. This figure shows the trend of confirmed rubella cases from 2012 to 2021. For
the past 10 years, year 2017 reported the highest confirmed rubella (Figure 2.3.9).
Figure 2.3.9. Reported Confirmed Rubella Cases (n=2,478)
474
500
403
353
400
275
Number of Cases
300 241
202 163 178
152
200
100 37
0
2012 2013 2014 2015 2016 Year 2017 2018 2019 2020 2021
26
There were 37 confirmed rubella cases reported from January 1 to December 31, 2021 while 403
cases were confirmed in 2020. The top regions with confirmed rubella cases were NCR (13, 35%), Region
I (4, 11%), Region XI (4, 11%), Region VIII (3, 8%), and Region X (3, 8%). Of the 17 regions only Region VIII
has reported an increase in the number of confirmed rubella cases [Table 2.3.4].
Table 2.3.4. Confirmed Rubella Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region Cases
Cases Deaths CFR Cases Deaths CFR
PHILIPPINES 403 1 0.2% 37 0 0.0% ↓ 91%
I 49 0 0.0% 4 0 0.0% ↓ 92%
II 23 0 0.0% 2 0 0.0% ↓ 91%
III 75 0 0.0% 2 0 0.0% ↓ 97%
CALABARZON 36 0 0.0% 1 0 0.0% ↓ 97%
MIMAROPA 0 0 - 0 0 - → 0%
V 14 0 0.0% 2 0 0.0% ↓ 86%
VI 27 0 0.0% 1 0 0.0% ↓ 96%
VII 7 0 0.0% 1 0 0.0% ↓ 86%
VIII 1 0 0.0% 3 0 0.0% ↑ 200%
IX 5 0 0.0% 0 0 - ↓ 100%
X 3 0 0.0% 3 0 0.0% → 0%
XI 10 0 0.0% 4 0 0.0% ↓ 60%
XII 3 0 0.0% 0 0 - ↓ 100%
BARMM 2 0 0.0% 0 0 - ↓ 100%
CAR 116 0 0.0% 0 0 - ↓ 100%
Caraga 1 0 0.0% 1 0 0.0% → 0%
NCR 31 1 3.2% 13 0 0.0% ↓ 58%
27
Figure 2.3.10. Distribution of Confirmed Rubella Cases (n=37)

Philippines, 2021
Number of Cases
PROFILE OF CONFIRMED RUBELLA CASES (n=37)
The age group of 9 to 11 months old (18, 49%) was the most affected among the reported
confirmed rubella cases followed by age group of 1 to 4 years of age (12, 32%) and 6 to 8 months (4,
11%). The reported confirmed rubella cases range from 5 months to 18 years, with a median of 11
months old. The majority (24, 65%) were males. Out of 37 confirmed rubella cases, only 3 (8%) cases
received one dose of measles-containing vaccine. Most (27, 73%) of the cases, have an unknown number
of doses, 6 (16%) were not vaccinated and 1 (3%) cases have unknown vaccination status. Among the 37
confirmed rubella cases, no pregnant case was reported.
SURVEILLANCE PERFORMANCE INDICATORS
Surveillance indicators gauge the capacity of the country in gearing towards the measles
elimination goal. The Philippines has reached a countrywide measles incidence rate of 0.14 per
1,000,000 and has reached the target of <1 per 1,000,000 population (Table 2.3.5).
1. Timeliness and Adequacy of Specimen Collection
Adequacy and timeliness rate is defined as the collection of specimens among suspect
measles cases within 0 to 28 days from rash onset. The target is ≥80%. In 2021, the overall
adequacy and timeliness of specimen collection rate was 78%. Ten (59%) out of 17 regions
reached the target of this indicator (Regions II, III, MIMAROPA, V, VII, X, XII, CAR, and NCR
[Table 2.3.5].
28
2. Timeliness and Adequacy of Case Investigation Rate
The overall measles timeliness and adequacy of case investigation rate for 2021 was
65%. Only seven (41%) regions reached the target of ≥80% (Regions II, III, V, VI, VII, X, and XII).
This decreases the specificity of epidemiological surveillance to establish evidences of
transmission or to track sources of infection (Table 2.3.5).
3. Suspect Measles Reporting Rate
The 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. For the past years,
this has been achieved due to increased reported cases from the outbreaks. However, due to
the COVID-19 pandemic wherein decrease of reported cases were noted, the national suspect
measles reporting rate for 2021 was 0.81/100,000 population. None of the regions reached
the target (Table 2.3.5).
4. Non-Measles/ Non-Rubella Reporting Rate
The non-measles or non-rubella rate surveillance target has not been attained by all
regions. With the national rate of 0.58/100,000 population, it is observed to be lower
compared to the 2020 rate (Table 2.3.5).
5. Measles Compatibility
Measles compatibility is the proportion of suspect cases that do not have specimens
collected for laboratory confirmation or suspect cases that were not epidemiologically -
linked to other laboratory-confirmed cases but manifested the clinical signs and symptoms
of measles. The target is <10%. In 2021, 22% of the total cases at the national level were
classified as measles compatible or clinically confirmed (Table 2.3.5).
Table 2.3.5. Measles Surveillance Performance Indicators by Region
TIMELINESS &
TIMELINESS & NON-MEASLES/ NON- PERCENTAGE OF
MEASLES INCIDENCE ADEQUACY OF SUSPECT MEASLES
ADEQUACY OF CASE RUBELLA REPORTING MEASLES
RATE SPECIMEN REPORTING RATE
INVESTIGATION RATE COMPATIBLE
REGION COLLECTION
Target: Target: Target: Target: Target: Target:
<1/1,000,000 Pop. ≥80% ≥80% ≥2/100,000 Pop. ≥2/100,000 Pop. <10%
2020 2021 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021
Philippines 8.79 0.14 51 78 26 65 4.49 0.81 0.67 0.58 57 22
I 0.57 0.00 59 75 32 75 4.18 1.06 1.14 0.72 49 25
II 1.10 0.00 81 100 11 100 2.23 0.60 0.99 0.55 22 0
III 2.56 0.00 64 82 31 81 3.32 0.55 0.63 0.44 55 18
CALABARZON 1.63 0.06 44 36 20 27 2.11 0.37 0.26 0.12 69 63
MIMAROPA 3.50 0.00 5 80 1 67 8.95 0.47 0.13 0.38 95 20
V 1.64 0.33 51 85 14 85 1.07 0.33 0.10 0.21 54 15
VI 8.89 0.00 84 95 44 93 3.58 0.51 1.08 0.47 35 5
VII 1.14 0.25 43 92 17 92 1.28 0.60 0.11 0.52 75 8
VIII 5.52 0.00 21 74 8 72 3.76 1.20 0.15 0.82 81 26
IX 6.31 0.26 42 50 18 50 5.52 0.74 0.74 0.34 73 50
X 19.38 0.20 35 83 22 83 9.53 1.79 0.68 1.42 72 17
XI 58.24 0.00 86 70 61 68 11.21 0.89 2.08 0.55 28 30
XII 36.94 0.00 57 83 26 83 9.29 0.85 1.31 0.75 45 12
BARMM 12.75 0.00 22 27 8 18 6.85 0.26 0.33 0.05 76 82
CAR 3.32 1.11 62 94 19 67 19.16 1.83 6.26 1.60 32 6
Caraga 16.85 0.00 37 48 19 48 10.62 0.76 0.51 0.33 79 52
NCR 3.36 0.43 45 86 26 42 1.83 1.61 0.16 1.25 60 14
LEGEND: <1 ≥1 ≥80% <80% ≥80% <80% ≥2/100,000 <2/100,000 ≥2/100,000 <2/100,000 <10%
Pop. Pop. Pop. Pop. ≤50%
>50%
29
2.4 Neonatal Tetanus
Tetanus 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 is the 44th country to eliminate Maternal and Neonatal Tetanus in November
2017 after the Maternal and Neonatal Tetanus Elimination (MNTE) External Validation. Based on the
World Health Organization (WHO), MNTE is achieved when there is less than one case of neonatal
tetanus per 1000 live births in every province or city every year.
Figure 2.4.1 shows the neonatal tetanus cases reported from 2011 up to 2021. The trend
shows a decrease in the reported cases from 2011 to 2015 and a slight increase in years 2016, 2017
and 2019 followed by a significant decrease in the years 2020 and 2021.
Figure 2.4.1. Reported Neonatal Tetanus Cases (N=1,024)

Philippines, 2011 - 2021
250
200 198
162
Number of cases
150
120
100 95 86
85
84
72 69
50
29
24
0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
30
There were 24 neonatal tetanus cases reported in 2021 nationwide. This is 17% lower when
compared to 2020 (N=29). The trend for neonatal tetanus cases for 2020 and 2021 shows an erratic
pattern. Highest number of neonatal tetanus cases in 2021 was noted in morbidity week 49 and
morbidity week 6 (Figure 2.4.2).
Figure 2.4.2. Reported Neonatal Tetanus Cases by Morbidity Week
2021 (N=24) 2020 (N=29)
5
3
Number of Cases
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
Table 2.4.1 shows a comparison of the regional data on cases and deaths in 2021 vis- à-vis
2020. Only five out of 17 regions, Region X (↑200%), MIMAROPA (↑50%), CALABARZON (↑), Region
VII (↑), and Region IX (↑) had reported a percentage increase in 2021.
Table 2.4.1. Neonatal Tetanus Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region
PHILIPPINES 29 15 51.7% 24 14 58.3% ↓ 17%
I 0 0 - 0 0 - → -
II 3 3 100% 1 1 100% ↓ 67%
III 1 0 - 1 1 100% → 0%
CALABARZON 0 0 - 1 1 100% ↑ -
MIMAROPA 2 0 0% 3 0 0% ↑ 50%
V 2 1 50% 1 1 100% ↓ 50%
VI 1 0 0% 1 1 100% → 0%
VII 0 0 - 2 1 50% ↑ -
VIII 0 0 - 0 0 - → -
IX 0 0 - 2 2 100% ↑ -
X 1 0 - 3 2 67% ↑ 200%
XI 2 2 100% 2 1 50% → 0%
XII 3 1 33% 1 0 0% ↓ 67%
BARMM 6 3 50% 5 3 60% ↓ 17%
CAR 0 0 - 0 0 - → -
Caraga 4 3 75% 0 0 - ↓ 100%
NCR 4 2 50% 1 0 0% ↓ 75%
31
Nationally, BARMM reported the highest number of cases (5, 21%) followed by MIMAROPA
(3, 13%) and Region X (3, 13%). Most of the regions, particularly Regions II, III, CALABARZON, V, VI, VII,
IX, XI, XII, NCR, presented a range of 1-2 cases while Regions I, VIII, CAR and CARAGA have no case
reported this year (Figure 2.4.3).
Figure 2.4.3. Distribution of Neonatal Tetanus Cases (N=24)
Philippines, 2021
Number of Cases
PROFILE OF NEONATAL TETANUS CASES AND DEATHS
Neonatal Tetanus cases ranged from ages 3 to 22 days old with a median of 6 days old. The
most affected age group was 3-7 days old with 17 (71%) cases. Both sexes have an equal number of
reported cases (Figure 2.4.4).
Figure 2.4.4. Reported Neonatal Tetanus Cases by Age Group and Sex
Philippines, 2021
Male Female
Age Group
(Days)
>29
23 to 28
18 to 22
13 to 17
8 to 12
3 to 7
0 to 2
10 8 6 4 2 0 2 4 6 8 10
Number of Cases
32
Of the 24 neonatal tetanus cases reported in 2021, there were 14 deaths having a CFR of
58.3%. Six out of 17 regions, Region II, III, CALABARZON, V, VI, and IX had reported a 100% CFR in 2021
[Figure 2.4.5].
Figure 2.4.5. Reported Neonatal Tetanus Case Fatality Rate by Region

2020 National
CFR=58.3%
2019 National
CFR=51.7%
VACCINATION STATUS AMONG MOTHERS OF NEONATAL TETANUS CASES
Among the mothers of the NT cases, majority (10, 42%) did not receive any Tetanus Toxoid (TT)
dose. There were only 5 (21%) mothers who received doses of tetanus toxoid vaccine (Figure 2.4.6).
Figure 2.4.6. Vaccination Status among Mothers of Neonatal Tetanus Cases (N=24)
Philippines, 2021
12
10
Number of Cases
8
6
4
2
0
No TT Dose Received Unknown vaccination Received 1 TT Dose Received 2 TT Dose
status
Vaccination Status
33
DELIVERY PRACTICES AMONG NEONATAL TETANUS CASES
Majority (23, 96%) of the reported neonatal tetanus cases were home deliveries and attended
by either hilot (4, 17%) and midwife (4, 17%). The most utilized tool for cutting the cord in home
deliveries were bamboo (6, 25%) scissors (6, 25%) and blade (5, 21%). Majority (14, 58%) had unknown
stump treatment used while seven or 29% of the cases have used alcohol to treat the stump (Table
2.4.2).
Table 2.4.2. Delivery Practices of Reported Neonatal Tetanus Cases (N=24)

Philippines, 2021
Place of Delivery Cases %
Home 23 96%
Unknown 1 4%
Delivery Attendant
Hilot 4 17%
*Lay Person 4 17%
Midwife 2 8%
Traditional Birth Attendant 1 4%
Unknown 13 54%
Cord Cutting Tool Used
Bamboo 6 25%
Scissors 6 25%
Blade 5 21%
Bolo Knife 1 4%
Rattan Wood 1 4%
Unknown 5 21%
Stump Treatment Used
Alcohol 7 29%
Baby Oil 1 4%
Sterilized Water 1 4%
Talcum Powder 1 4%
Unknown 14 58%
* Relatives
34
2.5 Non-neonatal Tetanus

An acute disease caused by an exotoxin of the tetanus bacillus, Clostridium tetani, 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” is characterized by a forced grin
and raised eyebrows.
Figure 2.5.1 shows the non-neonatal tetanus cases reported from 2012 to 2021. The figure
shows that there was a continuous dropping of reported cases in 2012 to 2013 followed by an
increasing trend of cases from 2014 to 2016. Cases plateaued starting 2017 to 2019 followed by a
significant decrease of cases during the pandemic years 2020 and 2021.
Figure 2.5.1. Reported Non-Neonatal Tetanus Cases (N=8,836)

1,200 1,105 1,072
983 969 942 925
1,000 850
816
Number of cases
800
616
558
600
400
200
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 558 clinically confirmed non-neonatal tetanus cases reported in 2021 nationwide
(Figure 2.5.2). This is 9% lower when compared to reported cases in 2020 (N=616). In 2021, the highest
peak was marked in week 1 with 19 cases, followed by weeks 16, 17, and 45, while weeks 30 and 36
reported the lowest for the year. Irregular distribution of cases was noticed almost throughout the
morbidity weeks of 2020 and 2021.
Figure 2.5.2. Reported Non-Neonatal Tetanus Cases by Morbidity Week

Number of Cases
30 2021 (N=558)
2020 (N=616)
25
20
15
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
35
Table 2.5.1 shows a comparison of the regional cases and deaths in 2021 vis-à-vis 2020. Seven
out of 17 regions have reported an increase in cases in 2021 compared to 2020. Region VIII reported
the highest increase in cases in 2021 compared to 2020 with 40% followed by CALABARZON (5%) and
MIMAROPA (19%).
Table 2.5.1. Non-Neonatal Tetanus Cases, Deaths, and Case Fatality Rates (CFR) by Region
2021 2020 % Change in

Region
PHILIPPINES 558 123 22.0% 616 117 19.0% ↓ 9%
I 36 3 8.3% 59 9 15.3% ↓ 39%
II 18 6 33.3% 26 5 19.2% ↓ 31%
III 51 7 13.7% 46 4 8.7% ↑ 11%
CALABARZON 74 17 23.0% 59 14 23.7% ↑ 25%
MIMAROPA 19 3 15.8% 16 2 12.5% ↑ 19%
V 64 12 18.8% 55 9 16.4% ↑ 16%
VI 42 9 21.4% 60 13 21.7% ↓ 30%
VII 49 10 20.4% 52 14 26.9% ↓ 6%
VIII 14 4 28.6% 10 0 0.0% ↑ 40%
IX 23 11 47.8% 39 11 28.2% ↓ 41%
X 31 8 25.8% 33 4 12.1% ↓ 6%
XI 34 9 26.5% 39 7 17.9% ↓ 13%
XII 21 6 28.6% 19 4 21.1% ↑ 11%
BARMM 13 3 23.1% 17 3 17.6% ↓ 24%
CAR 8 4 50.0% 7 0 0.0% ↑ 14%
Caraga 13 5 38.5% 18 5 27.8% ↓ 28%
NCR 48 6 12.5% 61 13 21.3% ↓ 21%
Of the 17 regions, CALABARZON reported the highest number of cases (74, 13%) followed by
Region V (64, 11%) and Region III (51, 9%), respectively [Figure 2.5.3].
Figure 2.5.3. Distribution of Non-Neonatal Tetanus Cases (N=558)

Philippines, 2021
No. of Cases
36
The reported Non-Neonatal Tetanus cases range from ages less than 1 month to 91 years old
with median of 42 years. Of the reported cases, 203 (36%) were from the age group of 45-64 years
old. The majority, 462 (83%) of the affected cases were males while 96 (17%) were females (Figure
2.5.4).
Figure 2.5.4. Reported Non-Neonatal Tetanus Cases by Age Group and Sex
Philippines, 2021
Age Group Male (n=462)
(Years)
Unspecified
65 yo and older
45 to 64 yo
15 to 44 yo
5 to 14 yo
29 days to 4 yo
200 150 100 50 0 50 100 150 200

Number of Cases
There were 123 non-neonatal tetanus deaths reported in 2021. The top three regions with a
high proportion of deaths among cases (CFR) were CAR with four (4) reported NNT deaths (50%),
Region IX with 11 deaths (48%), and Caraga with five (5) NNT deaths (38%) [Figure 2.5.5].
Figure 2.5.4. Reported Non-Neonatal Tetanus Case Fatality Rates by Region

2021 National
CFR=22%
2020 National
CFR=19%
37
VACCINATION STATUS OF NON-NEONATAL TETANUS CASES
Figure 2.5.5. shows the vaccination status of non-neonatal tetanus cases by age group. The
most affected age group was 45-64 years old (203 or 36%). Of these cases, 147 (72%) received Tetanus
Toxoid vaccination while there were 31 or 15% who did not receive immunization and 25 (4%) NNT
cases have unknown vaccination status.
Figure 2.5.6. Reported Non-Neonatal Tetanus by Age group and Vaccination Status
Philippines, 2021
160
140
120
100
80
60
40
20
0
29 days to 4 yo 5 to 14 yo 15 to 44 yo 45 to 64 yo ≥65 yo UNSPECIFIED Total
RECEIVED VACCINATION 11 38 129 147 42 0 367
NO VACCINATION 1 19 45 31 11 0 107
UNKNOWN VACCINATION STATUS 2 19 28 25 9 1 84
TOTAL 14 76 202 203 62 1 558
PROFILE OF NON-NEONATAL TETANUS DEATHS (n=123)
There were 123 (CFR=22%) reported NNT deaths in 2021 while 117 deaths in 2020 (CFR=19%).
Deaths ranged from 3 to 91 years old with a median of 45 years. Forty-five (37%) were from age group
of 45 to 64 years old. Majority, 100 (81%) were males and seventy-two (59%) received Tetanus vaccine.
38
2.6 Pertussis
Pertussis or whooping cough is a 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 a repeated violent cough. Each series of paroxysms has many coughs
without intervening inhalation and can be followed by a characteristic crowing or high-pitched
inspiratory whoop. Paroxysms frequently end with the expulsion of clear, tenacious mucus, often
followed by vomiting.
The reported cases of pertussis from 2012 to 2021 are shown in Figure 2.6.1. Increase in cases was
noted in years 2013, 2016, 2017 and 2018 while a significant drop in cases was noted in 2019 which
continuously plummeted during the pandemic years 2020 and 2021.
Figure 2.6.1. Reported Pertussis Cases (N=1,900)

400 366
346
350 316
300
Number of cases
234
250
189
200 164
128
150
86
100
44
50 27
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 27 pertussis cases reported in 2021. This is 39% lower than the reported cases in
2020 (N=44). As the number of cases in 2021 drastically reduced, the disease's occurrence became
sporadic. This year, an average of one to two recorded pertussis cases was noted in every morbidity
week as shown in Figure 2.6.2.
39
Figure 2.6.2. Reported Pertussis Cases by Morbidity Week

Number of Cases 2021 (N=27)

6 2020 (N=44)
5
0
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152
Morbidity Week
The table below compares regional cases, deaths, and CFR between 2021 and 2020. Two out
of 17 regions reported an increase in cases in 2021 while nine (9) regions have reported decrease in
cases. Among the regions with reported increase, CAR has noted the highest with 400% increase in
cases compared to the previous year, while Region VI reported a 100% increase. Furthermore, it can
be noted that some regions like MIMAROPA, Region IX and BARMM have not reported a Pertussis case
for the past two years (Table 2.6.1).
Table 2.6.1. Pertussis Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change
Region
Cases Deaths CFR Cases Deaths CFR in Cases
PHILIPPINES 44 2 5% 27 0 0% ↓ 39%
I 1 0 0% 0 0 - ↓ 100%
II 1 0 0% 0 0 - ↓ 100%
III 4 0 0% 2 0 0% ↓ 50%
CALABARZON 4 0 0% 3 0 0% ↓ 25%
MIMAROPA 0 0 - 0 0 - → 0%
V 1 0 0% 0 0 - ↓ 100%
VI 0 0 - 1 0 0% ↑ 100%
VII 6 0 0% 6 0 0% → 0%
VIII 2 0 0% 0 0 - ↓ 100%
IX 0 0 - 0 0 - → 0%
X 2 0 0% 0 0 - ↓ 100%
XI 3 1 33% 1 0 0% ↓ 67%
XII 1 0 0% 0 0 - ↓ 100%
BARMM 0 0 - 0 0 - → 0%
CAR 1 0 0% 5 0 0% ↑ 400%
Caraga 0 0 - 0 0 - → 0%
NCR 18 1 6% 9 0 0% ↓ 50%
40
Highest number of pertussis cases were reported in NCR (9, 33%) followed by Region VII (6,
22%) and CAR (5, 19%). On the other hand, 10 out of 17 regions reported no pertussis cases as shown
in the figure below.
Figure 2.6.3. Distribution of Pertussis Cases (N=27)

Philippines, 2021
No. of Cases
The median age of reported pertussis cases was ≤4 months, with cases ranging in age from
under 1 month to 67 years old. More than half (15, 56%) belong to the age group of infants younger
than 6 months. Fourteen or 52% were females (Figure 2.6.4).
Figure 2.6.4. Reported Pertussis Cases by Age Group and Sex
Philippines, 2021
(Months to Years)
≥5 years old
1-4 years old
6-11 months old
<6 months old
15 10 5 0 5 10 15
Number of Cases
41
There was no reported pertussis death in 2021 which is lower compared to the 2 (CFR 5%)
reported deaths in 2020.
Figure 2.6.5. Reported Pertussis Case Fatality Rates by Region

2020 (n=2) 2021 (n=0)

%CFR
35.0 33.3
30.0
25.0
20.0
15.0
10.0
5.6
2020 National
5.0
CFR=5%
0.0 0.0 0.0 0.0
0.0 2021 National
XI NCR Other Regions CFR=0%
Region
VACCINATION STATUS
Of the 27 reported pertussis cases, only six or 22% have received two or more doses of DPT
vaccine while five or 19% have received one dose. Eleven or 41% did not receive DPT vaccine and 5 or
19% have reported an unknown vaccination status (Figure 2.6.6)
Figure 2.6.6. Vaccination Status among Reported Pertussis Cases (N=27)

Philippines, 2021
12
10
Number of Cases
0
NOT VACCINATED 2 OR MORE DOSES 1 DOSE UNKNOWN
Cases 11 6 5 5
Deaths 0 0 0 0
42
Nine (33%) of the 27 reported cases had samples for laboratory confirmation. Of these, two
(2) were laboratory confirmed pertussis case (Table 2.6.2).
Table 2.6.2. Laboratory Specimens and Results of Pertussis Cases (N=27)

Philippines, 2021
Total Reported Cases 27

Laboratory Tested 9 (33%)
Positive 2 (22%)
Negative 7 (78%)
Not Tested/Unknown 18 (67%)
Profile of Confirmed Pertussis Cases (n=2)
The two laboratory confirmed pertussis cases were reported from CAR (Baguio General
Hospital and Medical Center) and Region VII (Chong Hua Hospital). One case is a 3-year-old female
while the other one is a 22-year-old male. Both cases are alive and have received 2 or more pertussis-
containing vaccine.
43
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.
44
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.
Figure 3.1.1 shows the ABD cases reported in the Philippines from 2011 to 2021. The trend
shows a gradual decrease of cases from the year 2013 to 2014 but cases started to increase in the year
2015 and peaked in 2018. This was then followed by a significant decrease of cases in 2020 to 2021.
Figure 3.1.1. Reported Acute Bloody Diarrhea Cases (N=147,675)

25,000
19,437 19,626
20,000
Number of cases
16,231
14,991 14,513
15,000 13,316 12,749
12,014
10,812
10,000 8,123
5,863
5,000
0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
45
A total of 5,863 ABD cases were reported to PIDSR nationwide from January 1 to December
31, 2021. This signifies a decrease (28%) when compared to the same period of the previous year
(N=8,123) [Figure 3.1.2]. Highest peaks were noted in morbidity week 1 while the lowest was noted in
MW 36 (Figure 3.1.2).
Figure 3.1.2. Reported Acute Bloody Diarrhea Cases

Number of Cases
600
500
400
300
200
100
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
Table 3.1.1 shows a comparison of the regional data on cases, deaths and percentage change
in 2021 side-by-side 2020. Of the 17 regions, Regions X, XI and NCR reported an increase in percent
change compared last year.
Table 3.1.1. Acute Bloody Diarrhea Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region
PHILIPPINES 8,123 53 0.7% 5,863 97 1.7% ↓ 28%
I 10 0 0.0% 2 0 0.0% ↓ 80%
II 424 0 0.0% 189 0 0.0% ↓ 56%
III 194 0 0.0% 192 0 0.0% ↓ 1%
CALABARZON 177 0 0.0% 125 0 0.0% ↓ 28%
MIMAROPA 76 0 0.0% 45 0 0.0% ↓ 41%
V 192 0 0.0% 101 0 0.0% ↓ 46%
VI 16 0 0.0% 11 0 0.0% ↓ 31%
VII 3,168 49 1.5% 2,276 88 3.9% ↓ 29%
VIII 232 0 0.0% 203 0 0.0% ↓ 14%
IX 989 3 0.3% 587 1 0.2% ↓ 40%
X 600 0 0.0% 662 4 0.6% ↑ 10%
XI 130 0 0.0% 392 1 0.3% ↑ 202%
XII 99 0 0.0% 49 0 0.0% ↓ 51%
BARMM 116 0 0.0% 79 0 0.0% ↓ 32%
CAR 863 0 0.0% 571 0 0.0% ↓ 34%
Caraga 811 1 0.1% 333 2 0.6% ↓ 59%
NCR 26 0 0.0% 46 1 2.2% ↑ 77%
46
Looking at the regional caseload, Region VII, Region X, and Region IX reported the highest
number of ABD cases with 2,276 (39%), 662 (11%) and 587 (10%) respectively. Together, these three
regions account for more than half (3,525 or 60%) of all cases in the country (Figure 3.1.3). The regions
with the least reported number of cases include MIMAROPA (45, 1%), Region VI (11, 0.18%) and Region
I (2, 0.03%). CAR has the highest incidence rate among all regions followed by Region VII and Region
IX, at 30, 28 and 15 per 100,000 population, respectively (Figure 3.1.3).
Figure 3.1.3. Distribution of Acute Bloody Diarrhea Cases and Incidence Rates by Region
Philippines, 2021 (N=5,863)
No. of Cases
47
PROFILE OF REPORTED ABD CASES AND DEATHS
The age of ABD cases ranged from less than 1 month to 97 years old with a median of 11 years
old. The most affected population was 1 to 4 years old (1,586, 27%) age group. Majority (3,050, 52%)
of the ABD cases are males [Figure 3.1.4].
Figure 3.1.4. Reported Acute Bloody Diarrhea Cases by Sex and Age Group
Philippines, 2021
Age Group Male (n=3,050) Female (n=2,813)
(in years)
>60
55-59
50-54
45-49
40-44
35-39
30-34
25-29
220-24
15-19
10-14
5-9
1-4
<1
1000 900 800 700 600 500 400 300 200 100 0 100 200 300 400 500 600 700 800 900 1000
Number of Cases
Note: Twenty-two cases belong to unspecified age group.
A total of 97 deaths was reported for 2021 with CFR of 2%. This is 83% higher compared to the
53 deaths in 2020. Region VII had the highest CFR (3.9%) for 2021 (Figure 3.1.4). Age of ABD deaths
ranged from less than 1 to 89 years old with a median of 20 years old. Majority, 52 (54%) of the ABD
deaths are males.
Figure 3.1.4. Reported Acute Bloody Diarrhea Case Fatality Rate by Region
CFR % 2021 2020

5.0
3.9
4.0
3.0
2.2
2.0 2021 National
CFR=2%
1.0 0.6 0.6
0.3 0.2
0 2020 National
0.0 CFR=0.7%
7 NCR 10 CARAGA 11 9 Other1regions
Region
48
LABORATORY RESULTS OF ACUTE BLOODY DIARRHEA CASES
A total of 3,751 (64%) reported cases have specimen for laboratory testing. Three thousand
seventy-three (82%) cases were positive for pathogens. Out of the positive cases, majority (2,807, 91%) of
the isolated pathogen in the stool culture was Entamoeba histolytica followed by Escherichia coli with 121
(4%) cases (Table 3.1.2).
Table 3.1.2. Laboratory Status of Acute Bloody Diarrhea Cases (N=5,863)

Philippines, 2021
Total Reported Cases 5,863

No. of Tested 3,751 (64%)
Positive 3,073 (82%)
Entamoeba histolytica 2,784 (94%)
Escherichia coli 121 (4%)
Trophozoites 39 (1%)
Shigella 16 (0.5%)
Ascaris lumbricoides 6 (0.2%)
Protozoan cyst 5 (0.2%)
No specified organism 102 (3%)
Negative 678 (18%)
Not Tested 1,574 (27%)
Unknown 538 (9%)
Note: Percentage total may not equal to 100 due to rounding-off figures.
49
3.2 Cholera
Cholera is an acute bacterial intestinal infection caused by the enterotoxin of the bacterium
Vibrio cholera sero-group 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.
Figure 3.2.1 shows that there has been an increase in the number of cholera cases in the
Philippines from 2011 to 2012 followed by a decline in cases in 2013 and 2014. However, cases
continue to rise again in 2015 and peaked the highest in 2016. Cholera cases are relatively low during
the start of COVID-19 pandemic in 2020 and rose a little in 2021.
Figure 3.2.1. Reported Cholera Cases (N=57,482)

Philippines, 2011 - 2021
16,000 14,480
14,000
12,000
Number of cases
10,000 8,082
8,000 6,917
6,000 4,900 4,759

4,284 3,914 3,884
4,000 2,296 2,019
1,947
2,000
0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 2,019 cholera cases reported to PIDSR nationwide from January 1 to December 31, 2021.
This is 4% higher when compared to same period last year (N=1,947). Cases from morbidity weeks 1
to 19 of this year were relatively lower than last year while highest peaks in 2021 were noted in
morbidity weeks 51 and 52. Increase of cases in the last two weeks were observed after Typhoon
Odette in December (Figure 3.2.2).
50
Figure 3.2.2. Reported Cholera Cases by Morbidity Week

Number of Cases
250
200
150
100
50
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
Table 3.2.1 shows a two-year (2021 vs. 2021) comparison of the regional data on cases, deaths
and percentage change by region. The regions with the highest percent change were Region X
(↑18,400%), CALABARZON (↑7,800%) and Region XII (↑7,700%).
Table 3.2.1. Cholera Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021
Region % Change in Cases
PHILIPPINES 1,947 4 0.2% 2,019 13 0.6% ↑ 4%
I 0 0 - 0 0 - → 0%
II 0 0 - 0 0 - → 0%
III 0 0 - 7 0 0.0% ↑ 700%
CALABARZON 0 0 - 78 2 2.6% ↑ 7,800%
MIMAROPA 0 0 - 0 0 - → 0%
V 407 2 0.5% 185 2 1.1% ↓ 55%
VI 0 0 - 0 0 - → 0%
VII 3 0 0.0% 12 0 0.0% ↑ 300%
VIII 981 0 0.0% 619 1 0.2% ↓ 37%
IX 12 1 8.3% 3 0 0.0% ↓ 75%
X 1 0 0.0% 185 3 1.6% ↑ 18,400%
XI 3 0 0.0% 173 1 0.6% ↑ 5,667%
XII 0 0 - 77 4 5.2% ↑ 7,700%
BARMM 2 0 0.0% 57 0 0.0% ↑ 2,750%
CAR 0 0 - 0 0 - → 0%
Caraga 538 1 0.2% 619 0 0.0% ↑ 15%
NCR 0 0 - 4 0 0.0% ↑ 400%
51
PROFILE OF CHOLERA CASES AND DEATHS
Looking at the regional caseload, Region VIII and Caraga, Regions V and X and Region XI reported
the highest number of Cholera cases with 619 (31%), 185 (9%) and 173 (9%), respectively. Together, these
five regions account for the majority (1,781 or 88%) of all cases in the country. Caraga reported the highest
incidence rate for cholera with 222.5 per 100,000 population followed by Region VIII with 128.9 and
Region X with 36.5. The regions with zero incidence rate for cholera include Regions I, II, MIMAROPA, VI,
and CAR (Figure 3.2.3).
Figure 3.2.3. Distribution of Cholera Cases and Incidence Rates by Region

No. of Cases
52
Profile of Reported Cholera Cases
Age of cholera cases ranged from less than 1 year old to 105 years old with median of 27 years
old. The most (328, 16%) affected population belong to 5 to 9 years old age group. Majority (1,040, 52%)
of the cholera cases are females (Figure 3.2.4).
Figure 3.2.4. Reported Cholera Cases by Age Group and Sex

Philippines, 2021
Age Group Male (n=979) Female (n=1,040)
(in years)
>60
55-59
50-54
45-49
40-44
35-39
30-34
25-29
220-24
15-19
10-14
5-9
1-4
<1
250 200 150 100 50 0 50 100 150 200 250
Number of Cases
Of the 2,030 reported cholera cases, there were 13 reported cholera deaths having a CFR of
0.6%. Reported deaths increased by 225% compared to last year. Region XII had the highest CFR (5.2%)
in the country in 2021 (Figure 3.2.5). Age of cholera deaths ranged from 11 to 82 years old, with a median
of 36 years old. Seven (54%) out of the 13 reported deaths were males.
Figure 3.2.5. Reported Cholera Case Fatality Rates by Region

CFR % 2021 2020
9.1 8.3
8.1
7.1
6.1 5.2
5.1
4.1
3.1 2021 National
2.1 1.6 CFR=0.6%
1.1 0.2 0.2 2020 National
0
0.1 CFR=0.2%
12 10 8 9 CARAGA Other
NCRregions
LABORATORY RESULTS OF CHOLERA CASES
Region
53
A total of 465 (23%) out of 2,019 reported cases had specimen for laboratory test. One hundred
thirty-nine (30%) cases were laboratory-confirmed cholera via stool culture (Table 3.2.2).
Table 3.2.2. Laboratory Status of Cholera Cases (N=2,019)

Philippines, 2021
Total Reported Cases 2,019

Tested 465 (23%)
Positive (stool culture) 139 (30%)
Vibrio cholerae 111 (79%)
Vibrio cholera (0139) 25 (18%)
Vibrio cholera (01, Ogawa) 3 (2%)
Negative 326 (70%)
Not Tested 1,047 (52%)
Unknown 507 (25%)
Profile of Confirmed Cholera Cases (n=139)
A total of 139 laboratory confirmed cholera cases was reported for 2021. This is 4,533% higher
compared to three (3) cases reported in 2020. Age of confirmed cholera cases ranged from less than 1
year old to 76 years old with median of 13 years old. The most (39, 28%) affected population belong to 1
to 4 years old age group. Majority (77, 55%) of the confirmed cases are males.
Highest number of confirmed cases were from Cavite (30, 22%) followed by Davao del Norte (18,
13%) and Surigao del Norte (17, 12%).
Profile of Confirmed Cholera Death (n=1)
One confirmed cholera death was reported for this year. The case was a 69 year old male from
Cavite.
54
3.3 Acute Viral Hepatitis
Acute Viral Hepatitis is a liver disease caused by the hepatitis 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.
The graph below shows that there has been a significant decline in the number of acute viral
hepatitis cases in the Philippines for the past five years. Highest cases were reported in 2016 then
gradually declined until 2021 (Figure 3.3.1).
Figure 3.3.1. Reported Acute Viral Hepatitis Cases (N=8,452)

2,500
2,162
1,875
2,000
1,527
Number of cases
1,500 1,235
852 801
1,000
500
0
2016 2017 2018 2019 2020 2021
55
There were 801 acute viral hepatitis cases reported in 2021 nationwide. This is 6% lower
compared to the same period last year (N=852). The reported cases peaked in MW 32 of 2021. Fluctuation
in acute viral hepatitis cases was both observed in 2021 and 2020 (Figure 3.3.2).
Figure 3.3.2. Reported Acute Viral Hepatitis Cases by Morbidity Week

Number of Cases
40
35
30
25
20
15
10
5
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
Table 3.3.1 shows a comparison of the regional data on cases, deaths and percentage change in
2020 compared to 2021. The regions with the highest percent change was CAR (↑250%) followed by
Region XI (↑196%), and Region VI (↑55%).
Table 3.3.1. Acute Viral Hepatitis Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in

Region
PHILIPPINES 852 35 4.1% 801 36 4.5% ↓ 6%
I 32 0 0.0% 15 0 0.0% ↓ 53%
II 8 0 0.0% 6 0 0.0% ↓ 25%
III 68 2 2.9% 79 1 1.3% ↑ 16%
CALABARZON 61 5 8.2% 33 4 12.1% ↓ 46%
MIMAROPA 18 0 0.0% 15 1 6.7% ↓ 17%
V 12 3 25.0% 10 0 0.0% ↓ 17%
VI 22 0 0.0% 34 0 0.0% ↑ 55%
VII 121 20 16.5% 132 26 19.7% ↑ 9%
VIII 10 0 0.0% 3 0 0.0% ↓ 70%
IX 209 0 0.0% 171 0 0.0% ↓ 18%
X 75 0 0.0% 47 0 0.0% ↓ 37%
XI 24 0 0.0% 71 1 1.4% ↑ 196%
XII 3 0 0.0% 4 0 0.0% ↑ 33%
BARMM 96 0 0.0% 75 0 0.0% ↓ 22%
CAR 2 0 0.0% 7 0 0.0% ↑ 250%
Caraga 30 0 0.0% 21 2 9.5% ↓ 30%
NCR 61 5 8.2% 78 1 1.3% ↑ 28%
56
Regions with the highest number of reported acute viral hepatitis were Regions IX (171, 21%), VII
(132, 16%) and Region III (79, 10%). These three regions account for almost half (382) of all cases in the
country. Region IX reported the highest incidence rate among all regions with 44.89 per 100,000
population as seen in Figure 3.3.3.
Figure 3.3.3. Distribution of Acute Viral Hepatitis Cases and Incidence Rate by Region
Philippines, 2021 (N=801)
No. of Cases
PROFILE OF ACUTE VIRAL HEPATITIS CASES AND DEATHS
Age of acute viral hepatitis cases ranged from less than 1 month to 92 years old with a median of
33 years old. The most (310, 39%) affected population belong to the 25 to 39 years old age group.
Majority, 470 (59%) of the acute viral hepatitis cases are females (Fig. 3.3.4).
Figure 3.3.4. Acute Viral Hepatitis Cases by Age Group and Sex
Philippines, 2021
(in years)
>60
40-59
25-39
15-24
5 -14
1-4
<1
150 125 100 75 50 25 0 25 50 75 100 125 150

Number of Cases
57
Of the 801 acute viral hepatitis cases reported in 2021, there were 36 reported deaths having a
CFR of 4%. Deaths have increased by 3% compared to last year. The regions with the highest reported CFR
for this year were Region VII (19.7%) followed by Caraga (9.5%) and NCR (1.3%) [Figure 3.3.5]. Age ranged
from less than 1 year old to 77 years old with a median of 48 years old. Majority (28, 78%) of the reported
deaths were males.
Figure 3.3.5. Reported Acute Viral Hepatitis Case Fatality Rates by Region
2021 2020
CFR %
27.0 25.0
25.0
23.0
21.0 19.7
19.0 16.5
17.0
15.0
13.0 2021 National
11.0 9.5 CFR=4.5%
9.0
7.0 2020 National
5.0 0 CFR=4.1%
3.0 1.3
1.0
7 CARAGA NCR 5 Other6regions
Region
LABORATORY RESULTS OF ACUTE VIRAL HEPATITIS CASES
A total of 433 (54%) of the reported cases had specimen for laboratory testing. Out of these, 52
(12%) cases were laboratory-confirmed Hepatitis A (Table 3.3.2).
Table 3.3.2. Laboratory Status of Acute Viral Hepatitis Cases (N=801)

Philippines, 2021
Acute Viral Hepatitis Cases 801

Tested 433 (54%)
Positive for IgM Anti-HAV 52 (12%)
Negative 381 (88%)
Not Tested 296 (37%)
Unknown 72 (9%)
58
Profile of Laboratory Confirmed Hepatitis A Cases (n=52)
Figure 3.3.6 shows that there has been a significant decline in the number of confirmed hepatitis
A cases in the Philippines for the past five years. Highest cases were reported in 2016 then gradually
declined until 2021.
Figure 3.3.6. Reported Laboratory Confirmed Hepatitis A Cases (N=1,832)

700 662
600
456
Number of cases
500
350
400
300 227
200
85
52
100
0
2016 2017 2018 2019 2020 2021
Table 3.3.3 shows a comparison of the regional data on confirmed hepatitis A cases, deaths and
percentage change in 2020 compared to 2021. Nationally, there was a 39% decrease from 85 cases in
2020 to 52 in 2021. Regions V and XI reported the highest increase in confirmed hepatitis A cases with
100% increase compared to cases reported in 2020. The regions with the most number of laboratory
confirmed cases were Region VII (16, 31%) followed by Region X (9, 17%) and Region IX (7, 13%).
59
Table 3.3.3. Confirmed Hepatitis A Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021
PHILIPPINES 85 0 0.0% 52 3 5.8% ↓ 39%
I 0 0 - 0 0 - → 0%
II 0 0 - 0 0 - → 0%
III 2 0 0.0% 3 0 0.0% ↑ 50%
CALABARZON 4 0 0.0% 1 0 0.0% ↓ 75%
MIMAROPA 1 0 0.0% 1 0 0.0% → 0%
V 0 0 - 1 0 0.0% ↑ 100%
VI 2 0 0.0% 3 0 0.0% ↑ 50%
VII 14 0 0.0% 16 3 18.8% ↑ 14%
VIII 2 0 0.0% 0 0 - ↓ 100%
IX 13 0 0.0% 7 0 0.0% ↓ 46%
X 19 0 0.0% 9 0 0.0% ↓ 53%
XI 1 0 0.0% 2 0 0.0% ↑ 100%
XII 3 0 0.0% 0 0 - ↓ 100%
BARMM 8 0 0.0% 2 0 0.0% ↓ 75%
CAR 1 0 0.0% 0 0 - ↓ 100%
Caraga 9 0 0.0% 5 0 0.0% ↓ 44%
NCR 6 0 0.0% 2 0 0.0% ↓ 67%
PROFILE OF LABORATORY CONFIRMED HEPATITIS A CASES (n=52)
The age range of the laboratory confirmed hepatitis a cases reported ranged from less than 1 year
old to 74 years old with median of 29 years. The most affected age group was 25-39 years old with 20 (38%)
cases. Majority, 32 (62%) of the reported cases are males.
Highest number of confirmed cases were from Cebu City (6, 12%) followed by Bukidnon (5, 10%)
and Cebu (4, 8%).
Profile of Confirmed Hepatitis A Death (n=3)
Three (3) confirmed hepatitis A deaths (CFR: 6%) were reported for this year. The deaths ranged from
16 to 34 years old with median of 30 years. All deaths were males. Two (67%) confirmed deaths were from
Cebu City and one (33%) from Cebu province.
60
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. The rotavirus surveillance in PIDSR
started in the year 2015.
Figure 3.4.1 shows the rotavirus cases reported to PIDSR from 2016 to 2021. A downward trend
is observed in reported rotavirus cases from 2016 to 2018. This was followed by a noticeable increase in
cases in 2019 and a significant decrease in cases 2020 to 2021.
Figure 3.4.1. Rotavirus Cases Reported in the Philippines (N= 19,625)

6,000 5,003
5,000 4,004
4,302
Number of cases
4,000 3,156
3,000
1,900
2,000 1,260
1,000
0
2016 2017 2018 2019 2020 2021
61
There were 1,260 rotavirus cases reported in 2021 nationwide. This is 34% lower compared to the
same period in 2020 (N= 1,900). A noticeable decrease in reported cases in 2021 compared to the same
period in 2020 were noted in morbidity weeks 1 to 14. The highest number of cases in 2021 were noted
in morbidity week 22 while the lowest was noted in morbidity week 45. (Figure 3.4.2)
Figure 3.4.2. Reported Rotavirus Cases by Morbidity Week
Number of Cases
180 2021 2020
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
Table 3.4.1 shows a comparison of the regional data on cases and deaths in 2021 compared to
2020. Eight regions have reported a decrease in rotavirus cases in 2021. These are regions I, V, VI, XII,
BARMM, Caraga, CALABARZON and NCR. In contrast, Regions 8 and MIMAROPA have reported an increase
in cases. Regions with no reported cases for both years were Regions II, III, VII, IX, X, XI and CAR.
Table 3.4.1. Rotavirus Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region
PHILIPPINES 1,900 6 0.3% 1,260 1 0.1% ↓ 34%
I* 202 0 0% 37 0 0% ↓ 82%
II 0 0 - 0 0 - → -
III 0 0 - 0 0 - → -
CALABARZON 1 0 0% 0 0 - ↓ 100%
MIMAROPA* 0 0 - 28 0 0% ↑ -
V* 229 0 0% 126 0 0% ↓ 45%
VI* 60 0 0% 21 0 0% ↓ 65%
VII 0 0 - 0 0 - → -
VIII 953 1 0.1% 970 1 0.1% ↑ 2%
IX 0 0 - 0 0 - → -
X 0 0 - 0 0 - → -
XI 0 0 - 0 0 - → -
XII* 12 3 25.0% 2 0 0% ↓ 83%
BARMM 335 2 0.6% 64 0 0% ↓ 81%
CAR 0 0 - 0 0 - → -
Caraga* 92 0 0% 10 0 0% ↓ 89%
NCR* 16 0 0% 2 0 0% ↓ 88%
*Regions with Rotavirus Sentinel Sites
62
Looking at the regional caseload, Region VIII reported the highest number of rotavirus with 970
(77%) cases followed by Region V (126 or 10%) and BARMM (64 or 5%) [Figure 3.4.2].
PROFILE OF ROTAVIRUS CASES AND DEATHS
Figure 3.4.2. Distribution of Rotavirus Cases and Incidence Rate by Region

PROFILE OF ROTAVIRUS CASES AND DEATHS
Age of the reported rotavirus cases range from less than 1 month old to 59 months old with a
median of 12 months old. Majority (760, 60%) of the reported cases were males (Figure 3.4.4).
Figure 3.4.4. Reported Rotavirus Cases by Age Group and Sex

Philippines, 2021
Age Group
(Months) Male Female
24 to 59 mos
18 to 23 mos
12 to 17 mos
9 to 11 mos
6 to 8 mos
3 to 5 mos
0 to 2 mos
250 200 150 100 50 0 50 100 150 200 250

Number of Cases
63
The national case fatality rate (CFR) in 2021 was at 0.1% with only one death reported. This is
lower compared to the reported CFR in 2020 (0.3%). The reported death in 2021 was from Region VIII
[Figure 3.4.5].
Figure 3.4.5. Reported Rotavirus Case Fatality Rates by Region

CFR %
5.0
2020 (n=6) 2021 (n=1)
4.0
3.0
2.0
1.0 0.6 2020 National

0.25 0 0 0 0 CFR=0.3%
0.1 0.1
-
2021 National
VIII XII BARMM Other Regions CFR= 0.1%
Region
Of the 1, 260 reported rotavirus cases, only one or less than 1% has received one dose of rotavirus
vaccine, 429 or 34% were not vaccinated and 830 or 66% have unknown vaccination status (Figure 3.4.6).
Figure 3.4.6. Reported Rotavirus Vaccination Status (N=1,260)

Philippines, 2021
900 830
800
700
Number of Cases
600
500 429
400
300
200
100
1
0
Unknown Not Vaccinated One Dose
Vaccination Status
64
LABORATORY RESULTS OF ROTAVIRUS CASES
A total of 77 (6%) rotavirus cases had specimens for laboratory confirmation. Of these, 12 (16%)
were positive by ELISA test. (Table 3.4.2)
Table 3.4.2. Laboratory Status of Rotavirus Cases (N=1,260)

Philippines, 2021
Laboratory Confirmation Cases %

Total Reported Cases 1,260 100%
Tested 77 6%
Positive (ELISA Test) 12 16%
Negative 65 84%
Not Tested 1,183 94%
PROFILE OF CONFIRMED ROTAVIRUS CASES (n=12)
More than half (7, 58%) of the confirmed rotavirus cases were males. Age ranged from less than
1 month to 36 months old with a median of 12 months old. Most (5 or 42%) of the confirmed rotavirus
cases belong to the 24 to 59 months old age group. All of the confirmed cases are alive. Majority (11, 92%)
have not received rotavirus vaccine (Figure 3.4.7)
Figure 3.4.7. Confirmed Rotavirus Cases Vaccination Status (n=12)

Philippines, 2021
12 11
10
Number of Cases
2 1
0
Unknown Not Vaccinated
Vaccination Status
65
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.
Figure 3.5.1 shows the typhoid fever cases reported from 2008 up to 2021. The trend shows an
increasing trend of reported cases from 2008 to 2012, followed by a decrease of cases in the following
years. Although a slight increase of cases was seen in 2015 and 2019, fewer cases was noted in the years
that followed. The highest number of cases reported in 2012 (n=38,553) and lowest in 2021 (n=6,058).
Figure 3.5.1. Reported Typhoid Fever Cases (N=346,768)

45,000
38,553
40,000 35,116
35,000 31,764 31,368 31,374 31,116
28,823
30,000 26,772
Number of cases
24,340 24,944
25,000
17,869
20,000
15,000 10,375
8,296
10,000 6,058
5,000
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
66
There were 6,058 suspected typhoid fever cases with 24 deaths reported in 2021 nationwide. This
is 27% lower when compared to reported typhoid fever cases in 2020 (N=8,296). The figure below shows
a significant decrease in the reported typhoid fever cases from the beginning of 2021 till morbidity week
10 in comparison to the number of cases reported in 2020. However, this is followed by a similar trend of
reported cases seen in both years for the rest of the morbidity weeks (Figure 3.5.2).
Figure 3.5.2. Reported Typhoid Fever Cases by Morbidity Week

Number of Cases 2021 (N=6,058) 2020 (N=8,296)
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
Table 3.5.1 shows a comparison of the regional data on cases, deaths, CFR, and percent change in
2021 compared to 2020. The regions that reported the highest percent change in the increase of cases
were Regions XI (327%), and CAR (15%).
Table 3.5.1. Typhoid Fever Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region
PHILIPPINES 8,296 21 0.3% 6,058 24 0.4% ↓ 27%
I 1,101 0 0.0% 532 0 0.0% ↓ 52%
II 275 0 0.0% 157 0 0.0% ↓ 43%
III 327 4 1.2% 286 1 0.3% ↓ 13%
CALABARZON 229 1 0.4% 211 2 0.9% ↓ 8%
MIMAROPA 461 3 0.7% 312 1 0.3% ↓ 32%
V 210 2 1.0% 114 5 4.4% ↓ 46%
VI 570 2 0.4% 348 3 0.9% ↓ 39%
VII 646 3 0.5% 386 4 1.0% ↓ 40%
VIII 99 1 1.0% 74 1 1.4% ↓ 25%
IX 495 1 0.2% 320 4 1.3% ↓ 35%
X 1,344 1 0.1% 884 1 0.1% ↓ 34%
XI 73 1 1.4% 312 0 0.0% ↑ 327%
XII 491 0 0.0% 307 0 0.0% ↓ 37%
BARMM 532 0 0.0% 307 0 0.0% ↓ 42%
CAR 1,210 2 0.2% 1,397 1 0.1% ↑ 15%
Caraga 146 0 0.0% 73 0 0.0% ↓ 50%
NCR 87 0 0.0% 38 1 2.6% ↓ 56%
67
Looking at the regional caseload, CAR (1,397, 23%), Region X (884, 15%), and Region I (532,9%)
reported the highest number of typhoid fever cases. Together, these three regions account for almost
half (47%) of all cases in the country. The regions with the lowest reported number of cases include Region
VIII (74, 1%), Caraga (73, 1%), and NCR (38, or <1%). The region with the highest incidence rate is CAR with
74 per 100,000 population, followed by Region X with 17, and Region I and MIMAROPA with 10 [Figure
3.5.3].
Figure 3.5.3. Distribution of Typhoid Fever Cases and Incidence Rate by Region (N=6,058)
Philippines, 2021
No. of Cases
PROFILE OF TYPHOID FEVER CASES AND DEATHS

The age of typhoid fever cases ranges from less than 1 year old to 99 years old with a median of
19 years old. The most affected population belongs to the 1 to 4 years old age group (1,027, 17%). More
than half of the typhoid fever cases were males (3,102, 51%) [Figure 3.5.4].
Figure 3.5.4. Typhoid Fever Cases by Age Group and Sex

Philippines, 2021
Age Group Male (n=3,102) Female (n=2,956)
(Years)
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
600 500 400 300 200 100 0 100 200 300 400 500 600
Number of Cases
68
There is a 14% increase in the number of deaths in 2021 with 24 deaths reported compared to
21 deaths in 2020. Region V followed by NCR reported the highest CFR for 2021 (Figure 3.5.5). Region V
recorded the highest number of deaths with 5 deaths out of 114 cases and a CFR of 4.4%, while NCR
recorded one (1) death out of 38 cases with CFR of 2.6%, the second highest among all regions.
Figure 3.5.5. Reported Typhoid Fever Case Fatality Rates by Region
CFR 2020 2021
5.0%
4.4%
4.5%
4.0%
3.5%
3.0% 2.6%
2.5%
2.0%
1.4% 1.4%
1.5% 1.3% 1.2%
1.0% 1.0% 1.0% 0.9% 0.9%
1.0% 0.7% 2021 National
0.5% 0.4% 0.4% 0.3%
0.2% 0.3% CFR=0.4%
0.5% 0.1%0.1% 0.2%0.1%
0.0% 0.0% 0.0%0.0% 2020 National
0.0%
CFR=0.3%
Region
There were 24 (0.4% CFR) reported typhoid fever deaths. Age ranged from 1 year old to 79 years
old with a median of 32 years. The majority (14, 58%) of the typhoid fever deaths were males.
LABORATORY RESULTS OF TYPHOID FEVER CASES
A total of 5,287 (87%) cases were subjected to laboratory testing. Out of these, 162 (3%) were
positive via culture (Table 3.5.2).
Table 3.5.2. Laboratory Status of Typhoid Fever Cases (N=6,058)

Philippines, 2021
Laboratory result Cases Percentage
Total 6,058 100%
Tested 5,287 87%
Positive Culture 162 3%
Salmonella Typhi 161 99%
Klebsiella Pnuemoniae 1 1%
Positive Typhi Dot 3,107 59%
Positive Tubex 475 9%
Positive Widal 974 18%
Negative 569 11%
Not Tested/ Unknown 771 13%
PROFILE OF CONFIRMED TYPHOID FEVER CASES (n=162)
BARMM reported the highest number of confirmed typhoid fever cases with 53 (33%) cases.
This was followed by Region XI (24, 15%), and Region I (16, 10%). The age of confirmed cases ranged
from less than 1 year to 83 years old with a median of 16 years and the majority (84, 52%) of the
confirmed cases were females.
69
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.
70
4.1 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 that 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 included in the PIDSR surveillance system.
Figure 4.1.1 shows the chikungunya cases reported from 2017 up to 2021. The figure shows a
decreasing trend except in 2018 where there are 2,903 cases reported.
Figure 4.1.1. Chikungunya Cases Reported in the Philippines (N= 13,227)

7000 6,241
6000
5000
Number of cases
4000
2,903
2,701
3000
2000 1,132
1000 157 93
0
2016 2017 2018 2019 2020 2021
There were 93 Chikungunya cases reported nationwide from January 1 to December 31, 2021.
Cases reported in most of the morbidity weeks in 2021 is 41% lower compared to cases in 2020 (N=157).
The reported cases this year ranges from one to eleven cases per week (Figure 4.1.2).
Figure 4.1.2. Reported Chikungunya Cases by Morbidity Week

Number of Cases 2021 (N=93)
40 2020 (N=157)
35
30
25
20
15
10
5
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 53
Morbidity Week
71
Table 4.1.1 shows a comparison of the regional data on cases and deaths in 2021 compared to
2020. The region with the greatest number of chikungunya cases is MIMAROPA with 48 cases. The regions
with the highest percentage change of cases were MIMAROPA (↑269%), followed by CALABARZON
(↑33%). Furthermore, Regions VI VII, IX, XII, and NCR reported chikungunya cases this year while no case
was reported last 2020.
Table 4.1.1. Chikungunya Cases and Deaths by Region

2020 2021 % Change in
Region
Cases Deaths Cases Deaths Cases
PHILIPPINES 157 0 93 0 ↓ 41%
I 1 0 0 0 ↓ 100%
II 1 0 0 0 ↓ 100%
III 1 0 0 0 ↓ 100%
CALABARZON 6 0 8 0 ↑ 33%
MIMAROPA 13 0 48 0 ↑ 269%
V 1 0 1 0 → 0%
VI 0 0 6 0 ↑ -
VII 0 0 12 0 ↑ -
VIII 72 0 0 0 ↓ 100%
IX 0 0 2 0 ↑ -
X 26 0 1 0 ↓ 96%
XI 1 0 1 0 → 0%
XII 0 0 5 0 ↑ -
BARMM 0 0 0 0 → 0%
CAR 1 0 1 0 → 0%
Caraga 34 0 3 0 ↓ 91%
NCR 0 0 5 0 ↑ -
Most of the reported cases were from MIMAROPA (48, 52%), followed by Region VII (12, 13%),
and CALABARZON (8, 9%). Being the highest reporting region, MIMAROPA (14.7) also reported the highest
incidence rate among all regions per 1,000,000 population respectively (Figure 4.1.3).
Figure 4.1.3. Distribution of Reported Chikungunya Cases (N=93)

Philippines, 2021
No. of Cases
72
PROFILE OF REPORTED CHIKUNGUNYA CASES AND DEATHS
The age of chikungunya cases range from 2 months to 65 years old, with a median of 30 years old.
The most affected age group is 30-34 years old (13, 14%). Majority (56, 60%) were females (Figure 4.1.4).
Figure 4.1.4. Reported Chikungunya Cases by Age Group and Sex

Philippines, 2021
(Years)
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
10 8 6 4 2 0 2 4 6 8 10
Number of Cases
Of the 93 reported chikungunya cases, there were 37 (40%) cases tested for confirmation. Of
these, 22 (59%) were confirmed chikungunya cases; 18 (82%) was positive via IgM test and four (4, 18%)
equivocal result (Table 4.1.2).
Table 4.1.2. Laboratory Result of Reported Chikungunya Cases (N=93)

Philippines, 2021
Laboratory Tested: 37 (40%)

Confirmed Chikungunya 22 (59%)
Positive (IgM test) 18 (82%)
Equivocal (IgM test) 4 (18%)
Negative (IgM test) 15 (41%)
Not Tested: 56 (60%)
Note: Confirmed chikungunya cases include both with Positive and Equivocal laboratory results
Profile of Confirmed Chikungunya Cases (n=22)
There were 22 confirmed chikungunya cases for 2021. The age of the confirmed chikungunya
cases ranges from eight-year-old to 65 years old with median of 32-year-old. Fifty-nine (13) percent of
these cases are females. Seven (7) of the reported confirmed chikungunya cases belong to 30-34 years
age group.
73
4.2 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 79,592 dengue cases reported nationwide from January 1 to December 31, 2021. This
is 10% lower compared to the same period last year (N=88,595).
The seasonal pattern of cases starting from morbidity 11 was almost the same as 2020. However,
there is a significant decline of reported dengue cases from morbidity week 1 to 11 comparing to the same
period of 2020 (Figure 4.2.1).
Figure 4.2.1. Reported Dengue Cases by Morbidity Week

9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
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: Region III (20,692 or 26%), NCR
(10,368 or 13%) and CALABARZON (8,926 or 11%). However, incidence rates were highest in CAR (275),
Region III (165) and Region I (161) per 100,000 populations, respectively (Figure 4.2.2).
74
Figure 4.2.2. Distribution of Reported Dengue Cases and Incidence Rate (N=79,592)
Philippines, 2021
No. of Cases:
75
Almost all (10/17) of the regions reported decreased number of dengue cases from 2020 to 2021.
Top three (3) regions with significant decrease of reported cases for 2021 were Caraga (↓83%), Region
VIII (↓81%), and Region VII (↓77%) [Table. 4.2.1].
Table 4.2.1. Reported Dengue Cases and Deaths by Region

2020 2021 % Change in
Region
PHILIPPINES 88,595 357 0.4% 79,592 286 0.4% ↓ 10%
I 7,323 17 0.2% 8,546 11 0.1% ↑ 17%
II 1,340 8 0.6% 1,490 6 0.4% ↑ 11%
III 16,340 58 0.4% 20,692 41 0.2% ↑ 27%
CALABARZON 8,679 28 0.3% 8,926 33 0.4% ↑ 3%
MIMAROPA 5,117 15 0.3% 1,502 18 1.2% ↓ 71%
V 1,565 21 1.3% 798 6 0.8% ↓ 49%
VI 4,087 16 0.4% 2,467 18 0.7% ↓ 40%
VII 11,165 49 0.4% 2,604 17 0.7% ↓ 77%
VIII 4,697 11 0.2% 889 5 0.6% ↓ 81%
IX 2,506 16 0.6% 1,274 10 0.8% ↓ 49%
X 6,109 35 0.6% 4,921 25 0.5% ↓ 19%
XI 1,972 13 0.7% 4,931 9 0.2% ↑ 150%
XII 4,432 25 0.6% 3,636 19 0.5% ↓ 18%
BARMM 1,200 6 0.5% 716 4 0.6% ↓ 40%
CAR 996 5 0.5% 5,180 23 0.4% ↑ 420%
Caraga 3,729 8 0.2% 652 3 0.5% ↓ 83%
NCR 7,338 26 0.4% 10,368 38 0.4% ↑ 41%
The graph shows that there has been a striking increase of cases from 2018 to 2019 and the
dramatic decrease of cases from 2019 to 2020 due to start of COVID-19 pandemic (Figure 4.2.3).
Figure 4.2.3. Number of Dengue Cases Reported in the Philippines

500,000 437,089
450,000
371,634
400,000
Number of cases
350,000
300,000 249,396
204,330 214,149 220,138
250,000
200,000 152,158
121,305
150,000 126,765 88,595 79,592
100,000
50,000
0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
76
PROFILE OF REPORTED DENGUE CASES AND DEATHS
The age of dengue cases ranged from less than 1 month to 112 years old with a median of 14
years old. The most affected population belonged to the 10 to 14 age group (15,209 or 19%). In terms of
sex distribution, 54% or 43,008 of the reported cases were males (Figure 4.2.4).
Figure 4.2.4. Reported Dengue Cases by Age Group and Sex (N=79,592)
Philippines, 2021
Age Group Male (n=43,008)
(Years)
≥ 60
50-54
40-44
30-34
20-24
10-14
≤4
10000 8000 6000 4000 2000 0 2000 4000 6000 8000 10000
Number of Cases
There were 286 (CFR=0.4%) reported dengue deaths. Dengue deaths ranged from ages less than
1 month to 100 years old with a median of 12 years old. Majority of the dengue deaths were males (146
or 51%).
There is a 20% decrease in the number of deaths in 2021 with 286 deaths reported and 357 deaths
in 2020. MIMAROPA reported the highest CFR (1.2%) for 2021 followed by Region IX and V (0.8%) [Figure
4.2.5].
Figure 4.2.5. Reported Dengue Case Fatality Rate by Region

CFR % 2020 (n=357) 2021 (n=286)
1.6
1.3
1.4
1.2
1.2
1.0
0.8 0.8 2021 and
0.8 0.7
0.6 0.7 0.7 2020 National
0.6 0.6
0.6 0.6 0.6
0.5 CFR = 0.4%
0.6 0.4
0.5 0.5
0.5
0.5
0.4
0.4 0.4 0.4
0.3 0.4 0.4 0.4
0.4 0.3
0.2 0.2 0.2 0.2
0.2
0.2 0.1
0.0
Region
77
Majority (45,975 or 58%) of the cases are with warning signs followed by without warning signs
(27,938 or 35%) and with severe dengue (1,610 or 2%) and the rest with unspecified clinical classification
(4,069 or 5%).
A total of 46,299 (58%) among the 79,592 reported dengue cases had specimens collected for
laboratory testing (NS1, IgG, IgM, or PCR). Of which, 325 (0.7%) were tested for laboratory confirmation.
Two hundred thirty (71%) were positive for dengue through PCR. Most (76 or 33%) of the confirmed cases
were Dengue 2. Dengue serotype data were based on samples systematically collected from twenty
selected sentinel hospitals in all regions of the Philippines (Table 4.2.2).
Table 4.2.2 Laboratory Result of Reported Dengue Cases (N=79,592)

Philippines, 2021
Dengue Cases 79,592 100%
1. Number of cases tested* 46,299 58%
a. PCR test 325 0.7%
Positive (confirmed) 230 71%
Dengue 1 61 27%
Dengue 2 76 33%
Dengue 3 65 28%
Dengue 4 28 12%
b. NS1 test 35,411 76%
Positive 29,602 84%
c. IgM test 6,886 15%
Positive 6,078 88%
d. IgG test 9,019 19%
Positive 8,246 91%
2. Not tested 33,293 42%
* A case may have undergone one or more lab procedures hence the number of cases tested may not be equal to the
number tests done.
Profile of Confirmed Dengue Cases (n=89)
There were 230 or 71% out of 325 tested dengue cases that were positive. The age of confirmed
dengue cases ranged from less than 1 year to 72 years old, with a median of 13 years old. Most of the
confirmed cases are males (133 or 58%).
78
4.3 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.
Table 4.3.1 shows the leptospirosis cases reported from 2012 up to 2021. The trend shows a spike
of cases reported starting from 2012 (n=7,635) and noted the second highest reported cases in 2018
(n=5,527) while the lowest cases reported was in 2015 (n=1,424). A decreasing trend of cases was seen in
the past 3 years.
Figure 4.3.1. Reported Leptospirosis Cases (N=33,178)

10,000
7,635
8,000
Number of Cases
5,527
6,000 4,471
3,113 3,531
4,000
1,796 2,043 2,077
1,561 1,424
2,000
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
In 2021, there were 2,077 leptospirosis cases reported nationwide. This is significantly higher (2%)
when compared to the same time period in 2020 (N= 2,043). Cases in most of the morbidity weeks in 2021
were higher compared to cases in 2020. In addition, there were spike of increase in cases noted in third
quarter of 2021 particularly on morbidity weeks 30, 31 and 32, in comparison to the reported cases last
2020 (Figure 4.3.2).
Figure 4.3.2. Reported Leptospirosis Cases by Morbidity Week
Number
400
of Cases 2021 (N=2,077) 2020 (N=2,043)
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
79
Majority (10/17) of the regions reported higher number of leptospirosis cases from 2020 to 2021.
The top regions with the highest increase in percent change were Caraga, Region XII, and Region VIII with
percent increase of 413%, 200%, and 189% respectively (Table 4.3.3).
Table 4.3.3. Reported Leptospirosis Cases and Deaths by Region (N=2,077)

2021 2020 % Change
Region
Cases Deaths CFR Cases Deaths CFR in Cases
PHILIPPINES 2,077 227 10.9% 2,043 212 10.4% ↑ 2%
I 64 5 7.8% 105 13 12.4% ↓ 39%
II 160 12 7.5% 240 16 6.7% ↓ 33%
III 141 10 7.1% 231 23 10.0% ↓ 39%
CALABARZON 124 16 12.9% 267 30 11.2% ↓ 54%
MIMAROPA 38 5 13.2% 30 5 16.7% ↑ 27%
V 148 15 10.1% 132 13 9.8% ↑ 12%
VI 414 51 12.3% 208 22 10.6% ↑ 99%
VII 140 21 15.0% 62 15 24.2% ↑ 126%
VIII 26 3 11.5% 9 2 22.2% ↑ 189%
IX 34 5 14.7% 17 7 41.2% ↓ 100%
X 21 2 9.5% 24 3 12.5% ↓ 13%
XI 132 10 7.6% 84 8 9.5% ↑ 57%
XII 3 0 0.0% 1 0 0.0% ↑ 200%
BARMM 2 1 50.0% 1 0 0.0% ↑ 100%
CAR 59 7 11.9% 64 5 7.8% ↑ 8%
Caraga 41 4 9.8% 8 0 0.0% ↑ 413%
NCR 530 60 11.3% 560 50 8.9% ↓ 5%
Most of the reported leptospirosis were from the following regions: NCR (530 or 26%), Region VI
(414 or 20%), Region II (160 or 8%), Region V (148 or 7%), and Region III (141 or 7%). However, incidence
rates were highest in Region VI (5), Region II (4), and NCR (4) per 100,000 population.
Figure 4.3.4. Distribution of Leptospirosis Cases by Region (N=2,077)

Philippines, 2021
Number of Cases
80
PROFILE OF REPORTED LEPTOSPIROSIS CASES AND DEATHS
There were 2,077 cases of leptospirosis in 2021 in the Philippines. Age of leptospirosis cases
ranged from less than 1 years old to 83 years old with median of 30 years. The most affected population
belonged to the 20 to 24 age group (294 or 14%). Majority of the leptospirosis cases were males (1,841
or 89%) [Figure 4.3.5.].
Figure 4.3.5. Reported Leptospirosis Cases by Age Group and Sex (N=2,077)
Philippines, 2021
Age Group Male (n=1,841) Female (n=236)

(Years)
≥ 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
300 250 200 150 100 50 0 50 100 150 200 250 300
Number of Cases
Top three (3) regions with highest reported case fatality rate (CRF) for 2021 were BARMM (50%
CFR), Region VII (15% CFR) and Region IX (14.7% CFR) [Figure 4.3.6].
Figure 4.3.6. Reported Leptospirosis Case Fatality Rates by Region

2020 (n=2,043) 2021 (n=2,077)
% CFR
60
50
41
40
30 24 22
20 17 2021 National
11 11 10 13 12 10
8 9 10 7
CFR=11%
10
0 0 0 2020 National
0 CFR=10%
Region
81
There were 227 (CFR=11%) reported leptospirosis deaths. Age of leptospirosis deaths ranged from
1 year old to 78 years old with median of 36 years old. Majority of the leptospirosis deaths were males
(200 or 88%).
Out of the 2,077 reported leptospirosis cases, 532 (26%) among the reported cases had specimen
for laboratory testing. Of these, 208 (39%) were confirmed leptospirosis cases (Table 4.3.7).
Table 4.3.7. Laboratory Results of Leptospirosis Cases (N=2,077)

Philippines, 2021
Leptospirosis Cases Case % Cases
Total 2,077 100%
1. Number of cases tested 532 26%
a. Negative result 306 58%
b. Pending result 13 2%
c. Positive cases 208 39%
Positive MAT 155 75%
Positive Culture 47 23%
Positive PCR 6 3%
d. Probable cases 5 0.9%

Positive IgG 1 20%
Positive IgM 3 60%
Positive IgG & IgM 1 20%
2. Not tested/ unknown laboratory done 1,545 74%
Profile of Laboratory Confirmed Leptospirosis Cases
Of the 208 confirmed leptospirosis cases, the age range was from 1 years old to 83 years
old with a median age of 28 years. Majority of the cases were males (188 or 90%) than females
(20 or 10%).
82
4.4 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.

Figure 2.4.1 shows the rabies cases reported from 2012 up to 2021. Number of cases significantly
increased from 2012 to 2014 and then the trend was observed to be steady from 2015 up to 2017.
Furthermore, the recent 4 years has shown gradual decrease but subsequently rise in 2021.
Figure 2.4.1. Reported Rabies Cases (N=2,597)

There were 282 rabies cases reported from January 1, 2021 to December 31, 2021. This is 20%
higher compared to reported rabies cases in 2020 (N=235). Majority of the reported cases per morbidity
week in 2021 were also higher compared to cases reported in 2020. However, there is also a significant
decrease of cases in several morbidity weeks throughout the year (Figure 2.4.2).
Figure 2.4.2. Reported Rabies Cases by Morbidity Week

Philippines, 2021
Number of Cases
2021 (282)
14
2020 (235)
12
10
0
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950515253
Morbidity Week
83
Regions who reported the highest number of rabies were from Central Luzon (47, 17%), Bicol
Region (33, 12%), CALABARZON (32, 11%), and SOCCSKSARGEN (30, 11%). The highest reported rabies
cases were from Camarines Sur (14, 5%), Bulacan, (13, 5%), Bataan, Iloilo, and North Cotabato (12, 4%),
Nueva Ecija and Rizal (11, 4%), and Negros Oriental (10, 4%) (Figure 2.4.3).
Figure 2.4.3 Distribution of Rabies Cases by Regions (N=282)

Philippines, 2021
No. of Cases
Table 2.4.1 shows the comparison of the regional data on rabies cases from 2020 to 2021. Notably,
9 regions showed an increased number of cases compared to last year, wherein MIMAROPA, BARMM,
and XII reported the highest percent increase of 600%, 300%, and 233%, respectively. Moreover, 6 regions
reported a decrease of cases while 2 regions have no changes in their reported cases.
Table 2.4.1. Reported Rabies Cases by Region (N=282)
2020 2021 % Change

Region
Cases Cases in Cases
PHILIPPINES 235 282 ↑ 20%
I 10 9 ↓ 10%
II 14 9 ↓ 36%
III 38 47 ↑ 24%
CALABARZON 25 32 ↑ 28%
MIMAROPA 1 7 ↑ 600%
V 28 33 ↑ 18%
VI 15 27 ↑ 80%
VII 10 13 ↑ 30%
VIII 4 4 → 0%
IX 13 12 ↓ 8%
X 17 11 ↓ 35%
XI 27 23 ↓ 15%
XII 9 30 ↑ 233%
BARMM 0 3 ↑ 300%
CAR 1 1 → 0%
Caraga 7 8 ↑ 14%
NCR 16 13 ↓ 19%
Note: All rabies cases reported were died.
84
PROFILE OF REPORTED RABIES CASES

Most affected age group was 60 years old and above (44, 15%), followed by 5 to 9 years old (36,
13%), and 10 to 14 years old (33 or 12%). Age ranges from 2 to 81 years old, with a median of 35 years
old. Majority of affected cases were males (214 or 76%) [Figure 2.4.4].
Figure 2.4.4. Reported Rabies Cases by Age Group and Sex (N=282)
Philippines, 2021
Only 1 (0.4%) reported rabies cases were laboratory confirmed, 260 cases were classified as
probable (92%) and 21 (7%) rabies cases were suspect. The 1 laboratory confirmed rabies case was 81
years old, male, reported in Region II (1, 100%) [Figure 2.4.4].
Figure 2.4.5. Reported Human Rabies Cases by Case Classification (N=282)

Philippines, 2021
Case Classification No. of Cases % Cases

Total 282 100
Suspect 21 7
Probable 260 92
Confirmed 1 <1
Interval of days from date of bite (exposure) to vaccination ranges from 0 to 123 days with a
median interval of 34 days, while interval of date of onset to date of admission ranges from 0 to 128 days
with a median of 1 day. From date of admission, an interval of 0 to 21 days, with a median of 1 day, to
date of death was noted.
Dogs (267 or 95%) were the majority of biting animal. Category III was the highest exposure
history among the reported rabies cases comprising 202 (72%) 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).
85
Infectious diseases are disorders caused by organisms such as bacteria, viruses, fungi, or
parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful. But under
certain conditions, some organisms may cause disease. Some infectious diseases can be passed from
person to person. Some infectious diseases are currently being monitored in the umbrella of PIDSR such
as the Acute Meningitis Encephalitis Syndrome, Influenza-like Illness, and Meningococcal disease.
5.1 Acute Meningitis-Encephalitis Syndrome (AMES)
The main objective of AMES surveillance, an integrated system of surveillance for both japanese
encephalitis (JE) and bacterial meningitis (BM), 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
Expanded Program for Immunization schedule and/or promote sustained use. In addition, for purposes of
better disease management. AMES is used as a surrogate for JE cases in surveillance. The AMES
surveillance was introduced in PIDSR in the year 2015 with nine (9) sentinel sites.
The graph below shows the AMES cases reported from 2015 up to 2021. The trend shows a
sudden increase in cases in 2017 while continuous decreasing number of cases from 2018 to 2021. The
year 2018 (4,398 cases) was noted with the highest number of reported AMES cases while year 2015 as
(124) the lowest.
Figure 5.1.1. Reported Acute Meningitis Encephalitis Syndrome Cases (N=17,921)

Philippines, 2017 to 2021
5000 4,398
3,924 4,105
4000
Number of cases
2,758 2,736
3000
2000
1000 347
124
0
2015 2016 2017 2018 2019 2020 2021
There were 2,736 suspected AMES cases reported nationwide from January 1 to December 31,
2021. This is 1% lower when compared to 2020 (N=2,758). Cases in most of the morbidity weeks in 2021
were lower compared to cases in 2020. However, increase in cases was noted in the second quarter of
2020, which peaked on morbidity week 17 with 120 AMES cases. The 2021 AMES cases show almost the
same trend when compared to the same period in 2020
(Figure 5.1.2).
86
Figure 5.1.2. Reported Acute Meningitis Encephalitis Syndrome Cases by Morbidity Week
Number of Cases 2021 (N=2,736)
180
2020 (N=2,758)
160
140
120
100
80
60
40
20
0
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152
Morbidity Week
Most of the reported AMES were from the following regions: Region V (325, 12%), Region I (286,
10%) and NCR (254, 9%). Majority (8/17) of the regions reported decreased number of AMES cases from
2020 to 2021. Region VIII reported only 80 AMES cases this year, however, this region reported the highest
percentage change compared to the other regions (Table 5.1.1).
Table 5.1.1. AMES Cases, Deaths, and Case Fatality Rates (CFR) by Region
2020 2021 % Change in
Region
PHILIPPINES 2,758 139 5% 2,736 172 6% ↓ 1%
I* 341 11 3% 286 8 3% ↓ 16%
II* 347 12 3% 248 10 4% ↓ 29%
III* 333 3 1% 231 10 4% ↓ 31%
CALABARZON 187 16 9% 152 12 8% ↓ 19%
MIMAROPA 62 9 15% 66 9 14% ↑ 6%
V* 260 12 5% 325 16 5% ↑ 25%
VI* 197 5 3% 251 9 4% ↑ 27%
VII* 231 19 8% 181 27 15% ↓ 22%
VIII 20 1 5% 80 0 0% ↑ 300%
IX 73 11 15% 46 4 9% ↓ 37%
X 81 5 6% 82 21 26% ↑ 1%
XI* 224 13 6% 189 9 5% ↓ 16%
XII 38 3 8% 32 1 3% ↓ 16%
BARMM 83 6 7% 198 11 6% ↑ 139%
CAR* 74 3 4% 70 2 3% ↓ 5%
Caraga 43 1 2% 45 3 7% ↑ 5%
NCR* 164 9 5% 254 20 8% ↑ 55%
*Region with AMES Sentinel sites
87
PROFILE OF REPORTED AMES CASES AND DEATHS

AMES cases ranged from ages less than 1 month to 92 years old with a median of 3 years old. The
most affected age group belong to the 1 to 4 years old (793, 29%). Most of the AMES cases were males
(1,600, 58%).
Figure 5.1.3. Reported AMES Cases by Age Group and Sex

Philippines, 2021
Age Group
Male (n=1,600) Female (n=1,136)
(Years)
65 and older
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
less than 1
500 400 300 200 100 0 100 200 300 400 500
Number of Cases
There were 172 (CFR=6%) reported AMES deaths. Top three (3) regions with highest reported case
fatality rate (CRF) for 2021 are as follows Region X (21, CFR=26%), Region VII (27, CFR=15%) and
MIMAROPA (9, CFR=14%) [Figure 5.1.4]. Ages range of reported AMES deaths were from 0 to 84 years old
with a median of 9 years old. Most AMES deaths (38 or 22%) are from 1 to 4 years old.
Figure 5.1.4. AMES Case Fatality Rates by Region

2021 National
CFR=6%
2020 National
CFR=5%
88

Out of the 2,736 reported cases, 433 (16%) specimens have been tested. There were 112 (88%)
positive for Japanese encephalitis (JE) on ELISA. Seven (6%) from the 112 confirmed JE were also tested
for other disease like dengue (Table 5.1.2).
Table 5.1.2. Laboratory Results of Acute Meningitis-Encephalitis Syndrome Cases
Philippines, 2021
AMES Cases %
TOTAL 2,736 100
1. Number of cases tested* 433 16%
Positive 128 30%
Haemophilus Influenza 1 1%
Japanese encephalitis* 112 88%
Streptococcus pneumoniae 9 7%
Neisseria Meningitis 1 1%
Other organism (Dengue)* 12 3%
Pending 39 9%
Negative 266 61%
2. Not tested 2,303 84%
*Multiple responses
PROFILE OF LABORATORY CONFIRMED JE CASES (n=112)

There were 112 laboratory confirmed JE cases with age ranged from less than 1 month to 64 years
old with median of 7 years old. Most of the laboratory confirmed cases were males (67, 60%). There were
four (4) confirmed JE deaths reported. These deaths were from Regions III, V, CAR and NCR (Table 5.1.3).
Table 5.1.3. Laboratory Confirmed Japanese Encephalitis Cases, Deaths, and Case Fatality Rates (CFR)
by Region, Philippines, 2020 vs 2021
2020 2021
PHILIPPINES 126 0 0% 112 4 4% ↓ 11%
I* 14 0 0% 27 0 0% ↑ 93%
II* 65 0 0% 26 0 0% ↓ 60%
III* 24 0 0% 8 1 13% ↓ 67%
CALABARZON 0 0 - 0 0 - → 0%
MIMAROPA 0 0 - 1 0 0% ↑ 100%
V* 10 0 0% 20 1 5% ↑ 100%
VI* 1 0 0% 14 0 0% ↑ 1300%
VII* 3 0 0% 0 0 - ↓ 100%
VIII 0 0 - 2 0 0% ↑ 200%
IX 0 0 - 0 0 - → 0%
X 0 0 - 0 0 - → 0%
XI* 1 0 0% 1 0 0% → 0%
XII 0 0 - 1 0 0% ↑ 100%
BARMM 0 0 - 0 0 - → 0%
CAR* 8 0 0% 7 1 14% ↓ 13%
Caraga 0 0 - 2 0 0% ↑ 200%
NCR* 0 0 - 3 1 33% ↑ 300%
*Region with AMES Sentinel sites
89
Region I (27, 24%), Region II (26, 23%), and Region V (20, 18%) reported the highest number of
confirmed JE cases across all regions. These three regions account for majority (65%) of confirmed JE cases
in the country. The regions with the least reported cases were MIMAROPA, Regions XI, and XII with 1
(<1%) confirmed JE case reported per region respectively. Furthermore, CALABARZON, Regions VII, IX, X,
and BARMM have no confirmed JE case reported. Regions with the highest incidence rate are Region II (7)
followed by Region I (5) [Figure 5.1.5].
Figure 5.1.5. Distribution of Japanese encephalitis Cases (N=112)

Philippines, 2021
No. of Cases
PROFILE OF LABORATORY CONFIRMED BACTERIAL MENINGITIS CASES (n=11)
There were 11 laboratory confirmed bacterial meningitis (BM) cases. Confirmed BM cases
ranged from ages less than 1 month to 37 years old with median of 3 years old. Most of the confirmed
case were females (6, 55%). There was one (1) reported death (CFR: 10%) among the confirmed BM
cases. The reported death was a 22-year-old male from Region VII.
90
5.2 Influenza-like Illness

Influenza-like Illness (ILI), or 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. Surveillance of influenza-like illness in the country started in
2009 with 17 ILI sentinel sites from Regions V, IX, XII, CAR, and NCR for specimen collection and laboratory
confirmation.

The graph below shows a steady increase in the number of reported ILI cases from 2011 to 2017.
The rise of cases can be attributed to the enhancement of ILI sentinel surveillance and increased reporting
compliance of disease reporting units. However, there was a slight decrease in 2018 and 2019. What can
be seen in this figure is the significant decrease of reported ILI cases for 2020 despite the COVID-19
pandemic. However, cases started to increase in 2021 as reporting compliance slowly returns to normal
(Figure 5.2.1).
Figure 5.2.1 Influenza-like Illness Cases in the Philippines (N=1,424,392)

2009 to 2021
200 158
140 151 145
Number of cases (in
150 117
100 103
thousands)
92 93 98
86 82
100 60
50
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 82,122 ILI cases reported nationwide. This is 37% higher when compared to 2020
(N=59,835). The trend of Influenza-like Illness cases for 2021 starting MW 12 is higher than 2020 with
peak noted in the first two weeks of August (MWs 31-32), then slowly decreasing towards the end of the
year. The comparison of trends of Influenza-like Illness for 2021 vs 2020 is shown below (Figure 5.2.2).
Figure 5.2.2 Influenza-like Illness Cases by Morbidity Week

Philippines, 2021 vs. 2020
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
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
91
Region XI has the highest number of reported Influenza-like Illness cases with 18,303 or 22%
followed by Region X (11,309 or 14%), and Region VII (10,025 or 12%). Eight regions reported an increase
in the number of influenza-like illness cases for 2021 as seen in Table 5.2.1.
Table 5.2.1 Reported Influenza-like Illness Cases and Deaths by Region

2021 2020 % Change in

Region
PHILIPPINES 82,122 1,000 1% 59,835 633 1% ↑ 37%
I 2,957 1 0% 4,468 1 0% ↓ 34%
II 738 0 0% 805 0 0% ↓ 8%
III 7,417 38 1% 5,597 70 1% ↑ 33%
CALABARZON 9,966 15 0% 7,166 11 0% ↑ 39%
MIMAROPA 462 1 0% 532 0 0% ↓ 13%
V 502 0 0% 218 0 0% ↑ 130%
VI 4,219 194 5% 955 35 4% ↑ 342%
VII 10,025 233 2% 5,886 72 1% ↑ 70%
VIII 5,136 42 1% 8,020 272 3% ↓ 36%
IX 1,094 74 7% 762 24 3% ↑ 44%
X 11,309 245 2% 5,645 38 1% ↑ 100%
XI 18,303 117 1% 6,724 76 1% ↑ 172%
XII 3,012 0 0% 3,570 8 0% ↓ 16%
BARMM 553 1 0% 1,143 3 0% ↓ 52%
CAR 3,116 1 0% 3,379 0 0% ↓ 8%
Caraga 2,682 36 1% 4,205 23 1% ↓ 36%
NCR 631 2 0% 760 0 0% ↓ 17%
The highest incidence rate among all regions was noted in Region XI with a total of 340 cases per 100,000
population. The distribution of Influenza-like Illness cases and incidence rates by region is shown in Figure
5.2.3.
Figure 5.2.3 Distribution of Influenza-like Illness Cases by Region

92
The age of the reported ILI cases ranged from less than 1 month to 105 years old, with a median of
28 years old. The most affected age groups are 1 to 4 years old (15,394 or 19%), and 60 years old and above
(15,215 or 19%) [Figure 5.2.4].
Figure 5.2.4 Reported Influenza-like Illness Cases by Age Group and Sex (N=82,122)
Philippines, 2021
Age Group (Years) Male (n=41,638) Female (n=40,484)

60 and older
55 to 59
35 to 54
25 to 34
20 to 24
15 to19
10 to 14
5 to 9
1 to 4
less than 1
9,000 7,000 5,000 3,000 1,000 1,000 3,000 5,000 7,000 9,000
Number of Cases
Note: Two hundred and eighty-four cases belong to unspecified age group.
Out of 82,122 Influenza-like Illness cases, 1,000 deaths were reported having a CFR of 1.22%.
Ages range from 0 to 99 years old with a median of 61 years old. Most influenza-like illness deaths are
60 years old and above with 529 or 53%. Out of the 1,000 reported Influenza-like Illness deaths, 537 or
54% were males and 463 or 46% were females. Region IX reported the highest CFR among all regions
with 7%. Figure 5.2.5 shows the case-fatality rates of Influenza-like Illness by region.
Figure 5.2.5 Influenza-like Illness Case Fatality Rate by Region

%CFR 2021 2020
8%
7%
7%
6%
5% 5%
4% 4% 2021
3%
3% National
3% CFR = 1.22
2% 2% 2020
2% National
1% 1% 1% 1% CFR = 1.06
1% 1% 1%
1% 1% 1%
0.3% 0.2% 0.3%
0.2% 0.2% 0.2%0% 0.2% 0.03%
0% 0% 0% 0.03%0% 0% 0% 0%0.02%
0%
Region
93
LABORATORY RESULTS OF REPORTED ILI CASES

Out of 82,122 reported ILI cases, 18,568 or 23% of cases have specimens for laboratory testing.
Out of 18,374 cases tested through RT-PCR, 8,343 or 45% were positive Influenza-like Illness cases, most
of which tested positive for SARS-CoV-2 (8,247 or 99%) [Table 5.2.2]. Top regions with confirmed cases
are CALABARZON (2,061 or 24%), Region VII (2,014 or 24%), and Region X (1,508 or 18%).
Table 5.2.2 Laboratory Status and Results of ILI Cases (N=82,122)

Philippines, 2021
Influenza-like Illness Total Cases % Cases

Total 82,122 100%
Tested 18,568 23%
RT-PCR 18,374 99%
Positive 8,343 45%
Influenza A:
H3 22 0.3%
Perth/16/2009(H3N2)-like 5 0.1%
Unspecified subtype 9 0.1%
Influenza B:
Victoria-lineage 9 0.1%
Unspecified subtype 4 0.05%
Adenovirus 15 0.2%
Enterovirus 3 0.04%
Parainfluenza 1 14 0.2%
Parainfluenza 3 3 0.04%
Rhinovirus 10 0.1%
RSV 2 0.02%
SARS-CoV-2 8,247 99%
Negative 10,011 54%
Invalid 20 0.1%
Antigen: 194 1%
Positive 194 100%
Not Tested/Unknown 63,554 77%
Profile of laboratory confirmed Influenza-like Illness Cases (n=8,537)
There were 8,537 laboratory confirmed Influenza-like Illness cases for 2021. Age range from less
than 1 month to 99 years old with a median of 48 years old. Out of the 8,537 laboratory confirmed
Influenza-like Illness cases, 4,401 or 52% were females and 4,136 or 48% were males. There were 361
deaths reported among the laboratory confirmed Influenza-like Illness cases having a CFR of 4.23%.
94
5.3 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. The meningococcal disease surveillance started in PIDSR in the year 2008.
The graph below shows the meningococcal disease cases reported from 2012 up to 2021. The
trend shows an increasing trend of meningococcal disease cases from 2014 to 2019 followed by a sudden
decrease of cases in 2020. However, cases continue to rise from 2015 to 2019. There is a slight increase
in number of cases noted in the year 2021 with 108 cases.
Figure 5.3.1. Reported Meningococcal Disease Cases (N=1,445)

Philippines, 2012 to 2021
400
350
286
Number of cases
300
231
250 203 211
200 162
144
150 99 108
100
50 0 1
0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
There were 108 suspect cases of meningococcal disease reported in 2021 nationwide. This is 9%
higher when compared to 2020 (N=99). The number of reported meningococcal disease cases peaked on
MWs 17 and 24 with seven (7) cases. The 2021 Meningococcal disease cases show a fluctuating trend, the
same with 2020 disease cases but relatively higher in reported cases (N=108) (Figure 5.3.2).
95
Figure 5.3.2. Meningococcal Disease Cases by Morbidity Week

Most of the reported meningococcal disease cases were from the following regions: NCR (21,
19%), REGION VII (14, 13%), CALABARZON (13, 12%), REGION III (11, 10%). Moreover, the regions with
highest CFR (100%) this year were I, II, CAR and CARAGA. Previously in 2020, CARAGA was the reported
highest CFR at 100%.
Table 5.3.1. Meningococcal Disease Cases, Deaths, and Case Fatality Rates (CFR) by Region
2021 2020
PHILIPPINES 108 60 55.6% 99 48 48.5% ↑ 9%
I 2 2 100.0% 1 0 0.0% ↑ 100%
II 1 1 100.0% 4 1 25.0% ↓ 75%
III 11 5 45.5% 2 1 50.0% ↑ 450%
CALABARZON 13 4 30.8% 14 4 28.6% ↓ 7%
MIMAROPA 3 2 66.7% 3 1 33.3% → 0%
V 6 5 83.3% 11 7 63.6% ↓ 45%
VI 5 2 40.0% 7 6 85.7% ↓ 29%
VII 14 10 71.4% 5 2 40.0% ↑ 180%
VIII 8 5 62.5% 5 3 60.0% ↑ 60%
IX 4 2 50.0% 9 7 77.8% ↓ 56%
X 5 3 60.0% 6 3 50.0% ↓ 17%
XI 6 2 33.3% 15 3 20.0% ↓ 60%
XII 5 3 60.0% 0 0 - ↑ 500%
BARMM 1 0 0.0% 0 0 - ↑ 100%
CAR 1 1 100.0% 2 1 50.0% ↓ 50%
Caraga 2 2 100.0% 2 2 100.0% → 0%
NCR 21 11 52.4% 13 7 53.8% ↑ 62%
96
Regions with the highest incidence rates are Region VII (1.72) followed by Region VIII (1.64) and
NCR (1.49) [Figure 5.3.3].
Figure 5.3.3. Distribution of Meningococcal Disease Cases by Region (N=108)

Philippines, 2021
No. of cases
PROFILE OF REPORTED MENINGOCOCCAL CASES AND DEATHS
The age of meningococcal disease cases ranges from less than 1 month to 75 years old, with a
median of 4 years old. The most affected age group is 1 to 4 years old (33, 31%), 62 or 57% were males
and 46 or 43% were females (Figure 5.3.4).
Figure 5.3.4. Reported Meningococcal Disease Cases by Age Group and Sex
Philippines, 2020
Note: One case belongs to unspecified age group.
97
Out of 108 Meningococcal disease cases, 60 deaths were reported having a CFR of 55.6%. Ages
range from less than 1 year old to 75 years old with a median of 3 years old. Most Meningococcal disease
deaths are from the age group of 1 to 4 years old with 19 cases or 32%. A total of 37 or 62% were males
and 23 or 38% were females. Regions with the highest CFR are Region I (100%), Region II (100%), CAR
(100%), and CARAGA (100%). Figure 5.3.5 shows the case-fatality rates of Meningococcal disease cases by
region.
Figure 5.3.5 Meningococcal disease Case Fatality Rates by Region

2020 National CFR=49%
2021 National CFR=56%
Out of 108 reported meningococcal disease cases, 16 (15%) cases had specimen for laboratory
testing. Six (38%) were positive for Neisseria meningitides via RT-PCR, Culture, or Gram Stain (Table 5.3.2).
Table 5.3.2 Laboratory Status and Results of Meningococcal Disease Cases (N=108)
Philippines, 2021
Meningococcal Disease Cases N=108
Tested 16 (15%)
Positive for Neisseria meningitides 6 (38%)
Negative 10 (63%)
Not tested/ Unknown 92 (85%)
Profile of Positive Meningococcal Disease Cases (n=6)
There were six (6) positive meningococcal disease cases for 2021. Age ranges from less than 1
month to 8 years old with a median of 2 years old. The most common age group was between 1 to 4 years
old (4, 67%). Of the six (6) meningococcal disease cases, three (50%) were males and three (50%) were
females. There were five (5) confirmed meningococcal disease deaths (CFR= 83%).
98
Department Circular No. 2020-0414: Morbidity Week Calendar 2021
99

2021 PIDSR Annual Report

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PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE

EPIDEMIC-PRONE DISEASE CASE SURVEILLANCE

2021 ANNUAL REPORT

Public Health Surveillance Division

The PIDSR-EDCS Annual Report 2021 is published by the Epidemiology Bureau.

Alethea R. De Guzman, MD, MCHM, PHSAE

Herdie L. Hizon Jenny Rose Prudente, RN

5.3 Meningococcal Disease 95

The Epidemic-prone Disease Case Surveillance (EDCS) of Philippine Integrated Disease

Vaccine Preventable Diseases Food and Water-borne Diseases

Congratulations and let’s continue to strive for the best!

ALETHEA R. DE GUZMAN, MD, MCHM, PHSAE

Goal and Objective of PIDSR

Epidemic Surveillance Systems Framework

Figure 1. Epidemic Surveillance Systems Framework

How to use this Annual Report

The PIDSR-EDCS Annual 2021 includes the following data:

Limitations to the Data

2.1 Acute Flaccid Paralysis (AFP)

Poliomyelitis is one of the vaccine-preventable diseases targeted for eradication. It is a highly

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

TREND IN THE PHILIPPINES

Figure 2.1.1. Reported Acute Flaccid Paralysis Cases (N=5,860)

Figure 2.1.2. Acute Flaccid Paralysis Cases

Figure 2.1.3. Distribution of Acute Flaccid Paralysis Cases by Region (N=898)

Reached the target

PROFILE OF REPORTED AFP CASES AND DEATHS

Figure 2.1.4. Reported AFP Cases by Sex and Age Group

250 200 150 100 50 0 50 100 150 200 250

Figure 2.1.5. AFP Case Fatality Rates by Region

Complete <3 OPV Doses 0 OPV Dose Unknown

Viral Isolation and Genotyping

Negative for poliovirus 817 91% 805 90%

Sabin-like poliovirus 2 0.2% 3 0.3%

Not tested/insufficient sample 2 0.2% 3 0.3%

*Regardless of stool collection date

Differential Diagnosis of Reported AFP Cases

ELECTROLYTE IMBALANCE / HYPOKALEMIA 30

SURVEILLANCE PERFORMANCE INDICATORS

Non-Polio AFP Rate

Figure 2.1.8. Comparison of Non-Polio AFP Reporting Rate by Region

AFP Reporting Rate

Stool Specimen Adequacy Rate

TREND IN THE PHILIPPINES

Figure 2.2.1. Reported Diphtheria Cases (N=1,263)

2020 2021 % Change in

Figure 2.2.3. Distribution of Diphtheria Cases (N=48)

PROFILE OF CASES AND DEATHS

Figure 2.2.5. Reported Diphtheria Case Fatality Rates (CFR) by Region

%CFR 2020 (N=78) 2021 (N=48)

60.0 50.0 50.0

LABORATORY RESULTS OF REPORTED CASES

Table 2.2.2. Laboratory Specimens and Results of Diphtheria Cases (N=48)

Total Reported Cases 48

Profile of Laboratory Confirmed Diphtheria Cases (n=6)

Profile of Laboratory Confirmed Diphtheria Deaths (n=4)

TREND IN THE PHILIPPINES

Figure 2.3.1. Reported Measles and Rubella Cases (N=145,535)

Figure 2.3.2. Reported Measles and Rubella Cases by Morbidity Week

Region 2020 2021 % Change in

Figure 2.3.3. Distribution of Measles and Rubella Cases (N=243)

PROFILE OF REPORTED MEASLES AND RUBELLA CASES

CONFIRMED MEASLES CASES IN THE PHILIPPINES

Figure 2.3.7. Reported Confirmed Measles Cases (n=43,908)