Philippine Malaria / Mosquito Map / Dengue Fever Map

[Ako Si Jamie]

Several more provinces are close to becoming malaria free like Cam Sur and Cam Norte which will mean the whole of Bicol will be (Albay, Masbate, Sorsogon & Catanduanes already are).

Antique province is at the same stage and when that gets elimination status, the whole of Panay will be free as will the vast majority of The Visayas. The exception being Negros Island.

Dinagat Islands no longer has malaria neither does Misamis Occidental in Mindanao.

Others close to eradication are Pangasinan, Lanao del Norte, La Union and Laguna.

The highest amount of malaria cases occur in the three largest provinces Isabela & Cagayan in North-East Luzon and Palawan, and also Tawi-Tawi and Sulu.

[Doc Alan]

It has proved hard to produce a vaccine against malaria. Now the British pharmaceutical firm, GlaxoSmithKline ( GSK ) has announced a vaccine ( “ RTS,S “ ) which provokes antibodies and “ killer cells “ which attack the parasites before they leave the liver ( where they go after a mosquito’s bite injects them into the bloodstream ).


This was a “ Phase 3 “ trial, in Africa. In children it reduced cases by about half, and infants by a quarter, 18 months after vaccination. But its effects decline after a year. For further ( Phase 4 ) trials there needs to be approval from the European Medicines Agency and World Health Organization ( WHO ). More widespread use depends on approval by donors from all sectors of society. Financing of malaria programmes in 2011 was thought to be only half of the US$ 5 billion required globally.



Malaria occurs in 99 countries and over 3 billion people are at risk of acquiring it.



About 80% of cases and 90% of deaths occur in Africa – especially children. However, since the turn of this century cases have declined by around a fifth and deaths by a quarter. 50 of the 99 countries are on track to reduce cases by 75% by 2015. Elimination of malaria in the European Region appears possible by 2015.


Malaria is linked to poverty – poorer populations living in rural areas ; in housing with less protection ; less access to insecticide treated mosquito nets ( ITNs ) ; longlasting insecticidal nets ( LLINs ) ; indoor residual spraying ( IRS ) ; and they don’t / can’t use health facilities which allow diagnosis and best treatment. Poorer countries do get a higher share of international funding from international sources.



The Philippines is a country described by WHO as in “ Control Phase for malaria “. It has achieved over 75% decrease in cases since the turn of this century. Most financing is “ external “ ( Global Fund to fight AIDS, Tuberculosis, and Malaria ). Coverage is good for ITN / IRS. Annual confirmed cases are less than 10,000 and deaths far below 100. The country is either malaria-free ( at least 27 provinces ), has less than 1 case / 1000 population ( 73 % ), with 1 or more / 1000 in only 7%. It’s mostly a “ rural disease affecting far-flung barangays “.


See http://www.who.int/malaria/publicati...ile_phl_en.pdf





Most visitors to the Philippines rightly choose not to buy anti-malarial tablets ( they are not free in the UK ). If you do decide to buy them, advice is inconsistent. Having carefully reviewed this, I see no reason to change the drugs already recommended here.
EITHER


• Doxocycline ( “Vibramycin” ) 10 mg daily 1-2 days before you go, every day in the malarious area, and for 28 days after you leave.

OR


• Mefloquine ( “ Lariam “ ) 250 mg tablet weekly, starting 1-3 weeks before you go, every week in the malarious area, and for 28 days when you leave the area.


If you are unfortunate enough to acquire malaria, wherever you have been, our NHS WILL treat you for free. Remember that immunity ( whether natural / acquired or from a future vaccine ) is not long-lasting, so it is still possible to get malaria from an infected mosquito.

Personal insect repellents will always be required, but as with antimalarial drug resistance, resistant mosquitoes and individual skin types need to be kept in mind when buying them.

See also :-



http://www.who.int/malaria/publicati...eport_2012/en/

http://www.gsk.com/media/press-relea...s-of-foll.html

http://www.wpro.who.int/philippines/.../en/index.html

http://www.wpro.who.int/philippines/en/

[Doc Alan]

In my judgement this further update on malaria is worth posting here on a permanent thread. As always the information is accurate to the best of my knowledge and I take responsibility for it.


Global malaria death rates have fallen by about half since 2000. There were still over 200 million cases and over 600,000 deaths in 2012. Most are in sub-Saharan Africa ( in November a woman from UK died from malaria after a holiday in The Gambia ). The local population may have some natural immunity, but too many get malaria who might not have done, if they had insecticide-treated bednets and the right drugs. An estimated million lives have been saved in Africa by such measures in the past decade.



Almost ALL drugs have more than one action – either good and / or unwanted “ side effects “. Added to this with antimalarials are :- parasite resistance ; and fake drugs – so if the wrong drugs are used for a given part of the world they may be worse than useless.



Even genuine anti-malarials CAN have side effects, but they are nowhere near as common as many people think.



Five issues may be considered by individuals and their pharmacists / doctors :-


• Risk of exposure to malaria

• Extent of drug resistance

• Efficacy ( how good ? ) of recommended drugs

• Side effects

• Individual factors ( age, pregnancy, other illness such as kidney / liver disease ).



If you decide to take antimalarials, but worry about side effects then you could start a few weeks before your trip, so any problems become obvious before leaving the UK. If you DO develop side-effects while abroad, try to continue prevention by obtaining a reliable alternative from a pharmacist or doctor.



Antimalarial drugs need to be paid for in the UK. However, if malaria is diagnosed on your return ( in most cases it’s a straightforward diagnosis ), then treatment is FREE on the NHS. 30 -50 cases a week may be treated by the NHS ; it reflects well on the success of treatment that only 2 – 16 deaths have occurred in this country each year over the past two decades.


As for the Philippines, reported malaria cases have decreased by ¾ since 2000 ( now less than 10,000 ) ; deaths by almost 100% ( from about 750 to a dozen ) ; and the national goal is to eliminate it by 2020 .



It’s a matter for individual judgement ( and the five issues above ) whether to take antimalarials. The most highly endemic provinces are now Apayao and Quirino in Luzon, Sul and Tawi-Tawi in Mindanao.



If anyone DOES consider they need antimalarials for the Philippines, the recommended drugs are still EITHER doxocycline 10 mg daily ( 1 – 2 days before travelling ; daily in the malarious area ; for 28 days after leaving ) OR mefloquine ( 250 mg weekly ; starting 1 – 3 weeks before trip ; every week in malarious area ; for four weeks after leaving ).



My own choice ? I have never taken antimalarials during work in Malaysia or visits to the Philippines in the past 4 decades .


http://globalhealthsciences.ucsf.edu...pines_2013.pdf

[Doc Alan]

Half the world’s population is now at risk of contracting dengue, although it’s only severe in 1/20 and fatal in 1%. There have been more cases in Brazil this century than any other country. All of the few hundred cases reported each year in the UK are the result of travelling to endemic areas, although numbers of insect bites and stings do seem to be increasing.


• The Philippines continues to have many thousands of cases, and several hundred deaths, each year – it’s a leading cause of childhood hospitalizations.


• No wonder therefore, that a dengue vaccine study involving Filipino children from San Pablo City, Laguna and Cebu City, together with others from Indonesia, Thailand, Malaysia and Vietnam, has attracted much interest.


• This is a " Phase 3 " trial – meaning the vaccine has " passed " the first two smaller phases to test its safety.


• Two cheers for the results ! It’s been shown to have an overall protective efficacy ( effectiveness ) of 56% in over 10,000 children aged 2 – 14 years. The efficacy was best for dengue types 3 and 4 ; less good for type 1 ; and low against type 2. It was better in younger age groups.


• A problem with dengue is that the immune response is not only complex, but also ( unusually ) a response to one type leads to a more severe reaction if infected at some future time with another type.



• More results are awaited. For now, this is the best of several vaccines in the pipeline. But it can’t be a single solution with less than 3/5 efficacy .


• The vaccine – produced by Sanofi-Pasteur, could be available by 2016. It’s unlikely to be cheap. So there is doubt as to whether national dengue vaccination programmes could be justified and cost-effective. Perhaps only high-risk groups or age groups where the vaccine is most effective should be targeted. Ideally the vaccine needs monitoring for a few years to confirm it’s safe and reasonably effective.


• Meantime, for the foreseeable future, prevention will continue to require control of the Aedes mosquitoes with insecticides, checking surroundings for stagnant and clean water, use of insect repellents, nets, protective clothing, and air conditioning. This is easier said than done. The mosquitoes causing dengue are day-time biting ( unlike malaria ), and other factors contribute to the increase in cases ( urbanisation, poor living conditions, climate change, international travel ). There is also still no specific treatment – although at least most cases are self-limiting.


• Dengue should always be considered – by anyone recently returned from the tropics with a fever, as well as their doctor. Successful treatment for most includes bed rest, plenty of oral fluids, and paracetamol ( not aspirin ).


http://www.thelancet.com/journals/la...060-6/fulltext

[Doc Alan]

There have been an estimated 300,000 ( + ) deaths from malaria in Africa since the Ebola epidemic started earlier this year.


Good news from the Philippines – no ebola cases so far, and the country is on course for eliminating malaria by 2020 .


There has been a drastic steady decline in cases and deaths within the past decade. The Asia-Pacific Malaria Elimination Network ( APMEN ) is talking not just of control but elimination of malaria in the Philippines. Reported cases have declined to under 8,000 last year :-





Deaths have gone from 150 in 2005 to 12 last year :-





The " stratification map " for 2013 shows this pattern :-





15 of the country’s 80 provinces contributed to almost all of the reported cases ; half in Palawan, and a third in Tawi-Tawi :-





53 provinces are " malaria-endemic " - the top 5 being Palawan, Tawi-Tawi, Sulu, Maguindanao, and Zambales. " Malaria –free " means no indigenous cases in the last 5 years :-





Early diagnosis and prompt treatment are vital !

( RDT = rapid diagnostic test using a drop of blood on a test strip ; microscopy is " gold standard " = looking for parasites on a slide smeared with blood ) :-







Prevention, should it be considered necessary, is still with doxocycline ( Vibramycin ) or mefloquine ( Lariam ). Of course the world’s first malaria vaccine will hopefully be available in the next two years .


http://apmen.org/philippines/


http://apmen.org/storage/apmen-vi/AP...20Baquilod.pdf

[Terpe]

Nice post Alan, very useful update

[Doc Alan]

Nice post Alan, very useful update

Thank you Terpe

Good news like this deserves noting - I do try to keep members informed especially when they have posted about a health topic. How it would be appreciated if they all responded

[Doc Alan]

Today there are few cases and very few deaths from malaria in the Philippines. If it is considered necessary to take tablets for prevention, " Malarone " ( atovaquone-proguanil ) 1 tablet daily ( from 1-2 days before entering malarious area to 7 days after leaving ) ; " Vibramycin " ( doxocycline ) 1 tablet daily ( from a day before to 4 weeks after leaving ) ; OR " Lariam " ( mefloquine hydrochloride ) 1 tablet once a week ( from 1-2 weeks before to 4 weeks after leaving ) are recommended as guidelines, depending on individual circumstances. Take advice from your doctor or travel health clinic … and be prepared to pay.



The major decline in malaria appears to result from a combination of early detection / treatment ; improved vector ( mosquito ) control ; and health promotion ; external funding outweighs Government expenditure.


Malaria is of course still a very serious infection elsewhere in the world – causing over 600,000 deaths annually, over 90% of these being in Africa ( over 80% children under 5 ). The Ebola epidemic may have resulted in more untreated cases and an additional 10,000 deaths in Guinea, Sierra Leone and Liberia.


The malaria parasite has a complicated lifestyle - which is why it has proved so hard to produce an effective vaccine. Now there is good news – widely reported in the media - about a malaria vaccine which provides " modest protection " against Plasmodium falciparum ( the commonest ) malaria in children for the 12 months after vaccination.


The vaccine has been assessed by European Medicines Agency ( EMA ), although it’s not for marketing in the EU. The hope is to use it for active immunisation of African children. World Health Organization ( WHO ) will add to EMA’s work by looking at other factors such as cost ( the manufacturer claims it sees this vaccine as " humanitarian rather than as a commercial " product ) and effectiveness – then give their recommendation by November this year.


The vaccine is known as " Mosquirix " ( also " RTS,S/AS01 " ). It’s composed of a Plasmodium falciparum protein fused with hepatitis B surface antigen, and combined with hepatitis B surface antigen(s) in the form of non-infectious virus-like particles produced in yeast cells by recombinant DNA technology. So the vaccine does protect against hepatitis B – but there is already an effective hep B vaccine for use where malaria prevention is not needed. Hep B is much commoner in the Philippines than the UK.


The benefits of " Mosquirix " seem to outweigh the risks, but it doesn’t offer complete protection, and an 18 month booster dose is needed after the initial course of 3 vaccines. It would seem to be a milestone but not a magic bullet. If WHO does approve, it will then be up to countries in Africa and other malaria-prone regions to decide whether to adopt the vaccine – in addition to all the other measures needed to beat this dreadful infection.


http://www.ema.europa.eu/docs/en_GB/...C500190447.pdf

[Doc Alan]

About half the world’s population is now at risk of dengue - up to 4 billion people in 128 countries, with actual numbers estimated to be about a tenth of this. There were large outbreaks worldwide last year, including around 170,000 cases reported in the Philippines.


It’s mainly spread by the bites of infected female Aedes aegypti mosquitoes - which also transmit Zika infection, chikungunya and yellow fever.


Local and imported dengue outbreaks could ( again ) occur in Europe - such as affected Madeira and mainland Portugal 4 years ago, transmitted by mosquitoes which can survive lower temperatures.


Recovery from one of the 4 types of dengue gives lifelong immunity to that type - but subsequent infection by another type increases the risk of severe dengue ( " Dengue Haemorrhagic Fever " ).


Severe dengue was first recognized in the 1950s during outbreaks in the Philippines and Thailand. Although there’s still no specific treatment, death rates can be less than 1%, given the right care - especially maintaining patients’ body fluid volume.


The first dengue vaccine has been registered in the Philippines and several other countries since late last year ( " Dengvaxia " by Sanofi-Pasteur ) ; several other vaccines are being developed.


The main method of controlling or preventing transmission MUST still be to target the mosquitoes.


There is controversy about the safety of " Dengvaxia " ( possible side effects including a future rise in cases of severe dengue ), availability, and cost, for all who might benefit from it. The Philippines Department of Health should pay attention to future recommendations from SAGE ( World Health Organization Strategic Advisory Group of Experts ) !


We should be optimistic that it WILL be possible to prevent dengue in the next few years.


http://bit.ly/1W8ci83

[Michael Parnham]

Another interesting update, thank you Alan

[SimonH]

The Philippines is the first country to launch the dengue vaccine

http://edition.cnn.com/2016/04/06/he...e-philippines/

http://www.channelnewsasia.com/news/...e/2664344.html

[ssbib]

Advice needed: I'm in Quezon City waiting for my wedding at the end of the month. For this trip I was advised to get malaria medication (I haven't been in the past) and I am having a bad reaction to it. I'm coming out in a rash and it's getting itchy and spreading. I want to discontinue and checking out that map on the first page it looks like I'm in a low to no risk zone so why was I advised to get this. Do any of you take this medication when travelling to Manila area?

[Longweekend]

No I have never taken any medication even when I lived in Manila....

[Michael Parnham]

No none at all even when I lived in Dumaguete, never had any vaccinations for anything since 2007

[Terpe]

Advice needed: I'm in Quezon City waiting for my wedding at the end of the month. For this trip I was advised to get malaria medication (I haven't been in the past) and I am having a bad reaction to it. I'm coming out in a rash and it's getting itchy and spreading. I want to discontinue and checking out that map on the first page it looks like I'm in a low to no risk zone so why was I advised to get this. Do any of you take this medication when travelling to Manila area?

I'm another one who has never taken malaria tabs in Philippines.
Personally i'd stop them with such a reaction
Some malaria meds can result in some nasty side effects

There a limits on just how long you can continue taking them due to the effects
I'm living here now for nearly 3 years without malaria meds
Like others I'm Just sharing my own experience.

I've lived in a few countries with malaria mozzies and at first was advisedto take the meds
But when you're living there for months on end you're advised not to take them

[Terpe]

Advice needed: I'm in Quezon City waiting for my wedding at the end of the month. For this trip I was advised to get malaria medication (I haven't been in the past) and I am having a bad reaction to it. I'm coming out in a rash and it's getting itchy and spreading. I want to discontinue and checking out that map on the first page it looks like I'm in a low to no risk zone so why was I advised to get this. Do any of you take this medication when travelling to Manila area?

I'm another one who has never taken malaria tabs in Philippines.
Personally i'd stop them with such a reaction
Some malaria meds can result in some nasty side effects

There a limits on just how long you can continue taking them due to the effects
I'm living here now for nearly 3 years without malaria meds
Like others I'm Just sharing my own experience.

I've lived in a few countries with malaria mozzies and at first was advisedto take the meds
But when you're living there for months on end you're advised not to take them

[Steve.r]

Never taken any here either

[ssbib]

Thanks for all the advice guys. I have been in touch with the tropical medicine centre at Liverpool hospital and they have told me to stop taking them and said I shouldn't have been told to get them anyway if I'm only going to be staying in Quezon City. I should be having them now with breakfast but think I will stop.

[fred]

The Philippines have been very lucky that the Covid virus seems not to be compatible with the dreaded Dengue annual death scourge!

Dengue deaths down 80++ %?? Wow. It`s a miracle.

Think the last 2 posts would do better in the conspiracy thread!

[Dave_]

The Philippines have been very lucky that the Covid virus seems not to be compatible with the dreaded Dengue annual death scourge!

Dengue deaths down 80++ %?? Wow. It`s a miracle.

Think the last 2 posts would do better in the conspiracy thread!

Is this the report you are referring to?

WHO - Dengue - Surveillance report 20210923

Quite possibly the number of cases of Dengue is lower because people are shielding from Covid and staying home.

[fred]

Is this the report you are referring to?

WHO - Dengue - Surveillance report 20210923

Quite possibly the number of cases of Dengue is lower because people are shielding from Covid and staying home.

Philippines reports dengue deaths are down dramatically.

One year after the national dengue epidemic was announced in August 2019, reported dengue cases have dropped from 430,282 to 59,675 in 2020. Dengue mortalities have also significantly dropped from 2019 with 1,612 deaths versus 231 in 2020.

https://doh.gov.ph/press-release/DOH...-BY-78-percent

Do you honestly think that people here just stay at home?
Stay at home and do what?
Await their Philippine Government furlough relief schemes in order to buy Rice and Fish?

Must be the masks and plastic face shields that are protecting the people from Mosquito bites!!
Do people really read this shyte and believe it to be so?

If you check the link above you will see that the Government are attempting to take credit for the 80++% reduction in Dengue cases due to their W.I.L.D initiatives during a so called Flu + Pandemic that they claim is out of control.
Quite incredible.
In reality,the Phils GOV. probably report their success in tackling the Dengue death scourge in order to receive more back slapping and financial 3rd world Sponsorship from the renowned CORRUPT Organization, the W.H.O.
Good Job Philippines Health dept.!!

As far as Malaria goes,I have never met a single soul that has suffered with it here in the Philippines in 37 years.
Perhaps I need to get out more.. (better not though as I could get Dengue or the Flu+!!)

I must apologize if my comments mainly based on facts come across as a little "Flippant".
Not my intention.

[fred]

Through these efforts, the DOH will roll out the Nucleic Acid Amplification Test-Loop Mediated Isothermal Amplification Assay (NAAT-LAMP) which offers cheaper and simpler dengue diagnosis

Yes.
It`s called a Covid 19 molecular (PCR) test.

[Doc Alan]

One of the posts you thought "would do better in the conspiracy thread" was actually mine, with good news about malaria.

There were only 3 deaths from malaria in the Philippines last year, and a dramatic decline in reported cases since this thread was started over a decade ago.

Elsewhere in the world malaria is still a deadly disease. Over 260,000 children in sub-Saharan Africa die from malaria annually. My post reported on a long-awaited malaria vaccine ("RTS, S") which acts against P.falciparum, the most deadly malaria parasite globally.

It is far more difficult to produce an effective vaccine against a parasite than bacteria or viruses. Even a reduction of 30% in severe malaria is a significant achievement.

Conspiracy ? Not in my opinion. Thanks for your apology. I'll think twice before posting again.