Government declares national epidemic as dengue cases continue to surge
Dengue cases continue to surge in the Philippines, with over 167,607 dengue cases and more than 720 deaths reported by the Department of Health (DOH) from 1 January to 27 July 2019. On 6 August, the DOH declared a national dengue epidemic, urging its regional offices to step up surveillance, case management and outbreak response. Health officials warn the current number of dengue cases might double by October.
Reported dengue cases are the highest incidence over the past five years, and the deaths mostly children from five to nine years old. Because children do not have immunity to dengue yet and are more prone to infection, they are the most affected by the disease and there is no antiviral treatment available beyond supportive care. In 2017, the Philippines Food and Drug Administration (FDA) suspended the license of the dengue vaccine Dengvaxia in 2017 following a controversy regarding a DOH school-based dengue vaccination campaign. With the rapid rise in dengue cases, there are calls from some health professionals to lift the ban. The health department is considering a ruling on the ban, saying that the vaccine will not stop the ongoing epidemic as it will need to undergo an approval process which may take months.
According to a WHO Philippines situation report, the case fatality rate of 0.43 per cent is significantly higher than the regional average of 0.22 per cent in the Western Pacific, and has placed the risk assessment as high at national level, and low at regional and global level.
Ten regions in the Philippines are at epidemic levels of dengue
As of 13 August, the Department of Health reports that three more regions, including the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), have reached the dengue epidemic threshold, bringing the total to ten regions. Case fatality rates are highest in the Bicol, Davao, BARMM regions, while case incidence is highest in Western Visayas, Calabarzon, Caraga, Zamboanga and Northern Mindanao regions.
Urbanization, climate change contributing to the spread of dengue
Several Asian countries are experiencing unusually high numbers of dengue cases for this time of year. According to the World Health Organization, of out of an estimated 2.5 billion people at risk for dengue globally, about 70 per cent live in Asia Pacific countries. Cambodia, the Lao People’s Democratic Republic, Malaysia, the Philippines, Singapore and Viet Nam have observed early increases in the number of dengue cases reported so far this year. In the Asia Pacific, climate conditions, unclean environments, unplanned urban settlements and rapid urbanization can lead to increased mosquito breeding in communities.
According to Dr. Gawrie Loku Galappaththy, Medical Officer for Malaria and other Vector-borne and Parasitic Diseases of WHO Philippines, a variety of factors can contribute to the increasing dengue cases in the Philippines. “The onset of El Niño has led to drought and water shortages in some provinces in the Philippines. Due to water shortages, people collect water in containers for general use, increasing the likelihood of dengue mosquito breeding places,” said Dr. Galappaththy. “The increased awareness on dengue, and the general population is seeking health care promptly, therefore the reporting has increased,” she said. “Dengue is also a cyclical disease, which means there is an expected increase of cases every three years.”
Multi-sectoral response needed to fight the rise of dengue
According to WHO, one of the most effective measures to prevent dengue is by reducing mosquito breeding sites at the community level. Dengue mosquitoes like to breed in containers that collect water such as tires, bottles, and coconut shells. Communities can clean their surroundings, empty and wash water containers and dispose unused containers that may accumulate water.
“Dengue control is not just up to the health sector. It can only be successful if different sectors work together,” says Dr. Galappaththy. “The local government is extremely crucial in pushing for vector control at the community level, while the education sector can assist in health promotion and vector control at school settings.”