BACKGROUND: Three weeks after Typhoon Haiyan, an increasing number of acute gastroenteritis cases were reported in Kananga, Leyte, an area where evacuated residents had returned home two days after the disaster. An outbreak investigation was conducted to identify the source and risk factors associated with the increase of gastroenteritis. METHODS: A case was defined as any person in Kananga who developed acute diarrhoea (≥ 3 times/24 hours) and any of the following symptoms: fever, nausea, vomiting or abdominal pain from 11 November 2013 to 10 December 2013. Active case finding was conducted by reviewing medical records, and a case-control study was conducted. Rectal swabs and water samples were tested for bacteriological examination. RESULTS: One hundred and five cases were identified. Multivariate analysis revealed that consumption of untreated drinking-water was associated with illness (adjusted odds ratio: 18.2). Both rectal swabs and municipal water samples tested positive for Aeromonas hydrophila. On inspection of the municipal water system, breaks in the distribution pipes were found with some submerged in river water. CONCLUSION: This acute gastroenteritis outbreak was most likely caused by Aeromonas hydrophila and transmitted through a contaminated water source. This study highlights that areas less damaged by a disaster that do not require ongoing evacuation centres can still have acute gastroenteritis outbreaks. All affected areas should be monitored during a disaster response, not just those with evacuation centres. Boiling or chlorinating of water should also be recommended for all areas affected by disaster.

Background：On 21 August 2013, the Event-based Surveillance and Response system of the Department of Health, Philippines captured a foodborne illness event among residents of a coastal village in Eastern Samar, Philippines. The suspected cause was the consumption of a sea turtle found near the village. A team from the Department of Health was sent to conduct an outbreak investigation.Methods：A case was defined as any person in Arteche, Eastern Samar, who developed dry mouth and burning sensation in the throat from 15 August to 27 August, 2013. Severity of the disease was classified as mild, moderate or severe. We conducted records review, environmental investigation, interviews of key informants and a retrospective cohort study.Results：Sixty-eight cases were identified; four died (case fatality rate = 6%). All cases had a history of turtle meat consumption. Dose-dependent relationship was noted between amount of turtle meat consumed and the risk of illness. In the cohort study, consumption of turtle meat and turtle meat soup were associated with illness.Conclusion：This study identified turtle meat as the source of this foodborne outbreak and emphasized the dangers of consuming turtle meat. Other reported cases of turtle meat poisoning in the Philippines suggest that turtle consumption is an ongoing practice in the country. By publishing information about sea turtle poisoning outbreaks in the Philippines, we hope to raise awareness of the potential severe health effects from ingesting these endangered sea creatures.

Background：In July 2013, the Philippines’ Event-Based Surveillance & Response Unit received a paralytic shellfish poisoning (PSP) report from Tarangnan, Western Samar. A team from the Department of Health conducted an outbreak investigation to identify the implicated source and risk factors in coastal villages known for green mussel production and exportation.Methods：A case was defined as a previously well individual from Tarangan, Western Samar who developed gastrointestinal symptoms and any motor and/or sensory symptoms after consumption of shellfish from 29 June to 4 July 2013 in the absence of any known cause. The team reviewed medical records, conducted active case finding and a case-control study. Relatives of cases who died were interviewed. Sera and urine specimens, green mussel and seawater samples were tested for saxitoxin levels using high performance liquid chromatography.Results：Thirty-one cases and two deaths were identified. Consumption of > 1 cup of green mussel broth was associated with being a case. Seawater sample was positive for Pyrodinium bahamense var. compressum and green mussel samples were positive for saxitoxin. Inspection revealed villagers practice open defecation and improper garbage disposal.Conclusion：This PSP outbreak was caused by the consumption of the green mussel broth contaminated by saxitoxin. As a result of this outbreak, dinoflagellate and saxitoxin surveillance was established, and since the outbreak, there have been no harmful algal blooms event or PSP case reported since. A “Save Cambatutay Bay” movement, focusing on proper waste disposal practice and clean-up drives has been mobilized.

Background：In July 2012, the Philippines National Epidemiology Center received a report of a suspected chikungunya fever outbreak in San Pablo City, Laguna Province, the first chikungunya cases reported from the city since surveillance started in 2007. We conducted an outbreak investigation to identify risk factors associated with chikungunya.Methods：A case was defined as any resident of Concepcion Village in San Pablo City who had fever of at least two days duration and either joint pains or rash between 23 June and 6 August 2012. Cases were ascertained by conducting house-to-house canvassing and medical records review. An unmatched case-control study was conducted and analysed using a multivariate logistic regression. An environmental investigation was conducted by observing water and sanitation practices, and 100 households were surveyed to determine House and Breteau Indices. Human serum samples were collected for confirmation for chikungunya IgM through enzyme-linked immunosorbent assay.Results：There were 98 cases identified. Multivariate analysis revealed that having a chikungunya case in the household (adjusted odds ratio [aOR]: 6.2; 95% confidence interval [CI]: 3.0–12.9) and disposing of garbage haphazardly (aOR: 2.7; 95% CI: 1.4–5.4) were associated with illness. House and Breteau Indices were 27% and 28%, respectively. Fifty-eight of 84 (69%) serum samples were positive for chikungunya IgM.Conclusion：It was not surprising that having a chikungunya case in a household was associated with illness in this outbreak. However, haphazard garbage disposal is not an established risk factor for the disease, although this could be linked to increased breeding sites for mosquitoes.

Background：In May 2012, there were increasing diarrhoea cases and deaths reported from Nabua, Camarines Sur to the Philippines event-based surveillance system. An investigation was conducted to identify risk factors and determine transmission dynamics.Methods：A suspected case was defined as a resident of Nabua with at least three episodes of watery diarrhoea per day from 16 March to 22 June 2012. A confirmed case was defined as a suspected case positive for Vibrio cholerae. An environmental investigation was conducted and rectal swabs and water samples sent to the national reference laboratory for bacterial isolation. A 1:2 case-control study matching for age and sex was conducted. Data were analysed using Epi Info.Results：There were 309 suspected cases with two deaths, and the most affected age group was children under five years (45%). Eight cases were positive for Vibrio cholerae Ogawa El Tor and one for Non-01. Water samples were positive for faecal coliforms and Aeromonas caviae. The case-control study showed that cases had a higher odds than controls of using unchlorinated water sources (odds ratio [OR] = 3.6; 95% confidence interval [CI]:1.6–8.5) and having toilets located within 20 m of a septic tank (OR = 2.7; 95% CI: 1.4–5.3). In multivariate analysis, the only significant factor was drinking from piped water (OR = 0.21; 95% CI: 0.09–0.49).Discussion：In this cholera outbreak, drinking-water from unchlorinated wells was a significant risk factor. Future cholera control efforts should include not just improving water and sanitation systems but also intensified behaviour change campaigns.

Recently, a chelonitoxism (turtle poisoning) outbreak in Arteche, Eastern Samar, Philippines was featured by the Western Pacific Surveillance and Response Journal (WPSAR) describing the dangers of turtle meat consumption.

Background：Middle East respiratory syndrome (MERS) is an illness caused by a coronavirus in which infected persons develop severe acute respiratory illness. A person can be infected through close contacts. This is an outbreak investigation report of the first confirmed MERS case in the Philippines and the subsequent contact tracing activities.Methods：Review of patient records and interviews with health-care personnel were done. Patient and close contacts were tested for MERS-coronavirus (CoV) by real time-polymerase chain reaction. Close contacts were identified and categorized. All traced contacts were monitored daily for appearance of illness for 14 days starting from the date of last known exposure to the confirmed case. A standard log sheet was used for symptom monitoring.Results：The case was a 31-year-old female who was a health-care worker in Saudi Arabia. She had mild acute respiratory illness five days before travelling to the Philippines. On 1 February, she travelled with her husband to the Philippines while she had a fever. On 2 February, she attended a health facility in the Philippines. On 8 February, respiratory samples were tested for MERS-CoV and yielded positive results. A total of 449 close contacts were identified, and 297 (66%) were traced. Of those traced, 15 developed respiratory symptoms. All of them tested negative for MERS.Discussion：In this outbreak investigation, the participation of health-care personnel in conducting vigorous contact tracing may have reduced the risk of transmission. However, being overly cautious to include more contacts for the outbreak response should be further reconsidered.