DOH launches D.E.N.G.U.E.

strategy
The Department of Health (DOH) today assured that many dengue cases, if mild, can be managed at home and not all cases require hospitalization even as the number of cases nationwide from January to August 21 now rose to 62,503. This figure is 88.8% higher than last years 33,102 for the same period. There were 465 deaths recorded this year. Last year, there were 350 deaths. Instead of confining patients in a hospital facility, parents and caregivers can practice the D.E.N.G.U.E. strategy. D.E.N.G.U.E. stands for D daily monitoring of patients status, E encourage intake of oral fluids like oresol, water, juices, etc, N note any dengue warning signs like persistent vomiting and bleeding, G give paracetamol for fever and NOT aspirin, because aspirin induces bleeding, U use mosquito nets and E early consultation is advised for any warning signs, Health Secretary Enrique Ona said. The new D.E.N.G.U.E. strategy has been devised by the DOH to educate the public on home treatment of mild dengue cases. This is to also help decongest hospitals by giving an assurance that not all dengue cases require hospital confinement but can be managed at home using the said strategy. Ona also reiterated that the most effective way to prevent and fight dengue is still by practicing the DOHs 4-S strategy consisting of Search and destroy, Self-protective measures, Seek early treatment and Say no to indiscriminate fogging. We are urging all local government units to mobilize barangay dengue brigades in their areas, Ona explained, adding that a once-a-week community-wide clean up drives against dengue will help a lot in reducing cases. Measures include emptying of all exposed containers and vases, old tires, coconut husks, and plants of stagnant waters. Abandoned lots, houses and establishments should also be included in the search-anddestroy operations because these may have possible mosquito breeding sites. Ona revealed that most of the cases came from Western Visayas (16.1%), CaLaBarzon (10.9%), Central Mindanao (10.5%), Eastern Visayas (9.2%), National Capital Region (8.9%), Southern Mindanao (8.1%) and Northern Mindanao (7.4%). Ages of cases ranged from 1 month to 95 years old. Majority (52%) of the cases were male. The most affected age group were the 1-10 years while there were more deaths recorded in the less than one year age group and the 1-10 years age group). Ona disclosed that outbreaks were detected in Roxas City and Iloilo City in Region VI and Zamboanga City in Region IX. The health chief explained that a hotspot is defined as clustering of cases with increasing number in the past four weeks. Hotspots were observed in the several barangays in the

following areas: Lipa City and San Jose in Batangas (Region 4A); Puerto Princesa City in Palawan (Region 4B); Kalibo, Aklan (Region VI); Tagbilaran City, Bohol (Region VII); Pudtol, Apayao (CAR) and ; Kalookan and Valenzuela in NCR. On the other hand, clustering of cases occur when there are three or more cases in a barangay in the past four weeks. Clustering of cases was noted in many areas in different Regions of the country. At the National Capital Region, most of the cases were reported from Quezon City. The increase in dengue cases can be attributed to the presence of four different strains of the dengue virus circulating in the country today, plus the fact that the country is experiencing the El Nio phenomenon, Ona elaborated, adding that continuous rains is also responsible for the upsurge in cases. To more strongly respond to the increasing number of dengue cases, the DOH has ramped up efforts in its public education and information campaign to schools and barangays since July in coordination with its regional health offices and other concerned government agencies such as the Department of Education (DepEd) and the Department of Interior and Local Government (DILG). Secretary Ona has also reiterated the directive to activate all dengue express lanes in DOH and to network with regional and provincial blood centers where patients can access safe and clean blood for transfusion in severe cases. There is still no cure or vaccine for dengue and that is why we must focus on other costeffective interventions, the most important of which is source reduction destroy the dengue-carrying mosquitoes, Ona emphasized. The health department is currently looking into other potential strategies to combat dengue such as the use of vaccines against all four dengue strains, the genetic modification of the Aedes mosquitoes which will render them less active in biting victims and even local alternatives such as the use of Tawa-tawa, a local herb that is being investigated for its curative properties against dengue. We are on the lookout for the emerging science and trends concerning dengue which can help us to more effectively fight the disease in the future, says Ona. Meanwhile, we are doing everything we can to arm the public with information and respond to the medical needs of victims given the tools that are currently available to us, he added. Ona reminded the public that dengue, although an all-year round disease, is more common during rainy days when there are more potential breeding grounds for the Aedes aegypti mosquitoes. To prevent dengue, Ona advised the public to destroy all possible mosquito breeding sites like old tires, softdrink bottles and tin cans, and use mosquito nets or protective clothing. He also stressed that fogging may be done only in outbreak areas.

Question & Answer on Dengue Prevention

Q: Why so many cases? A: The answer there is for the past few years has a curve but in every year there are peaks and valleys if you graph Dengue cases. Also it is El Nino season, people are storing water in containers and the presence of clean but stagnant water provides opportunities for the breeding of mosquitoes. This is happening mostly in populated areas. Q: Why are the victims mostly babies? A: Their immune system is still not mature. Also, it is more difficult to actually detect signs and symptoms. The mosquitoes prefer to feed on children. Q: What time do the mosquitoes usually feed? A: Mosquitoes usually feed two hours after sunrise and two hours before sunset. Q: Does katol work? A: Katol repels the mosquitoes but we dont advise people to use Katol all the time because it might trigger respiratory ailments. Q: What are the areas dengue-carrying mosquitoes are usually located? A: Mosquitoes usually breed on stagnant water. People need to check the following: 1. Balde or containers with water 2. Tansans or bottle caps can breed three larvae 3. Water on rooftops 4. Under the refrigerator 5. Discarded tires Q: If there are new strains, what does this mean for treatment? A: We can actually get infected four times in a lifetime because there are four strains of dengue virus.

Q: Are vaccines effective? A: There is potential but it is still being studied. Q: What is tawa-tawa? A: Its an herbal thing that people say it has helped them. It is still being studied. There are no clinical studies yet and for now it is not being considered medication for dengue. Q: Why anti fogging? A: Mosquitoes will just flee to other areas. If we do fogging, it should be done intensively in outbreak areas, covering entire barangays. Q: Why are there a decreasing number of cases in the National Capital Region?

In the previous 3 years, NCR has been affected by more than other regions and residents have some immunity to the strain due to previous exposure to dengue. Increased Public Consciousness o Better reporting of cases o Public awareness campaigns have been going on for months. o There is no shortage of blood. There are blood centers in public hospitals as well as the Philippine National Red Cross. Crucial is earlier identification of the cases o The game plan is to raise awareness of danger signs Barangay health centers do the screening as to avoid overcrowding in hospitals.

Q: Are mosquito nets effective? A: Mosquito nets are used during home treatment. Children who are sick can be taken cared at home. It should be used for home care. What happens is that when a mosquito has bitten a child with dengue that mosquito may pass it on to other people. So the mosquito net is a prevention method. Q: Kris Aquino is an advocate of dengue prevention? A: She is a volunteer and not a government official. She has had two children suffer from Dengue and so she is in a very good position to help with the public health advocacy of the DOH for Dengue Prevention. She is helping as a Dengue Prevention advocate and we appreciate her civic concern. Q: Whats the good news? A: In past years, 2% of the dengue patients (2 out of 100) die. Right now, it is less than 1% because of awareness and prevention. Given as early as 2 months ago, DOST and

DepED have spoken to pool resources to help in the research. There is also regional effort with ASEAN Countries to raise awareness and to coordinate research and development of new modalities for treatment and prevention. Q: What are the things to deliberate if an area is to be considered a Calamity Area? A: There should be a:

Verified confirmed outbreak. Coping capacity of the local government. Requirements from the budgetary point of view. A Proclamation of a State of Calamity in a local area helps mobilize funds for treatment and other public health efforts, when required.

Q: Is there a continued rise of dengue cases? A: We believe that dengue cases have reached the peak and are now decreasing. Our basis is the historical record. Last year August 2009 was the peak. Also, we have to verify and confirm so as not to cause panic since not all symptoms may be dengue. We should also watch the warning signs as much as we watch the fever. When fever goes down, the platelets go down as well. Q: Is there local government participation? A: It should be the advocacy of Barangay Officials. Actually, Quezon City is a role model. Why? Because it is one of the few local governments that is strict on fogging. Sanitation wise, they remind people for sanitize their areas. There should also an appeal to local officials to raise awareness. Q: What are the measures being taken?

Dengue Express Lane in Metro Manila takes care of people who may have Dengue, to assure patients of prompt diagnosis. o These express lanes are trained to look out on the warning signs. They also remind people what to do while they are waiting for diagnosing. PhilHealth will pay for Dengue hospital expenses for patients admitted I government hospitals. We urge the formation of Barangay Brigades to advocate dengue prevention. We urge local governments to fill their local health positions so that the sanidad vacancies for local communities are filled and can work with residents to inspect barangays.

Q: What is the D.E.N.G.U.E. strategy? A:

D daily monitoring of patients status E encourage intake of oral fluids like oresol, water, juices, etc. N note any dengue warning sings like persistent vomiting and bleeding G give paracetamol for fever and not aspirin because aspirin induces bleeding U use mosquito nets E early consultation is advised for any warning sings