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CARDIOVASCULAR AND CEREBROVASCULAR DISEASES

Cardiovascular Disease
• Cardiovascular: Cardio (heart) and vascular (blood vessels)
• Cardiovascular disease- is a disease that affects the heart and blood vessels. It could be heart or blood vessel
issues
• Symptomatic or Asymptomatic
• Types (heart or blood vessels): Arrhythmia, Valve disease, Coronary Artery Disease, Heart Failure, Peripheral
Artery Disease, Aortic Disease, Congenital Heart Disease, Pericardial Disease, Cerebrovascular Disease, Deep
Vein Thrombosis (DVT)
Philippine Statistics
According to the latest WHO data published in 2020 Coronary Heart Disease Deaths in Philippines reached 129,955 or
19.27% of total deaths. The age adjusted Death Rate is 192.11 per 100,000 of population ranks Philippines #32 in the
world
CVDs are part of the larger group of noncommunicable diseases (NCDs), which account for 72% of deaths in the country
in 2021
Global Statistics
Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated 17.9 million lives each year.
CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular
disease, rheumatic heart disease, and other conditions. More than four out of five CVD deaths are due to heart attacks
and strokes, and one-third of these deaths occur prematurely in people under 70 years of age
Common Risk Factors of Cardiovascular Diseases
Smoking
Smoking tobacco significantly increases the chance of developing cardiovascular disease. Smoking damages and narrows
the arteries, making angina pectoris and heart attack more likely
Lack of Exercise
an important risk factor for cardiovascular disease. Not exercising regularly increases a person’s chances of being
overweight, of having high blood pressure and of developing other conditions that make cardiovascular disease more
likely
Diet
Eating an unhealthy diet is a significant risk factor for cardiovascular disease. To lower the risk, a balanced diet made up
of plenty of fruits and vegetables, complex carbohydrates and protein should be aimed at and excess fats, salts and
sugars avoided
Obesity
Being overweight is another leading risk factor for cardiovascular disease. Eating an unhealthy diet and being physically
inactive are both contributing factors to being overweight, which is generally defined as having a body mass index (BMI)
outside the normal range
High Blood Pressure
High blood pressure, known as hypertension, is another contributing factor to cardiovascular disease, including heart
failure, stroke and heart attack. High blood pressure is often symptomless, but can be easily diagnosed by a doctor,
using a routine test
High LDL or Low HDL Cholesterol Levels
High levels of low-density lipoprotein (LDL) cholesterol – also known as “bad cholesterol” – are linked to a range of
cardiovascular diseases. Cholesterol is a fatty substance that is carried around the body by proteins. If too much LDL
cholesterol is present, it can cause fatty substances to build up in the artery walls and lead to complications
Family History of Heart Disease or Other Cardiovascular Disease
There is a genetic element to cardiovascular disease, meaning a family history of the condition is considered to be a risk
factor. Generally, this applies if a person’s first-degree relative developed CVD at what may be considered a relatively
young age. This is the case if the person’s father or brother developed cardiovascular disease before the age of 55, or
their mother or sister developed it before the age of 65
Age
Older people are at greater risk of developing cardiovascular disease. Although the process of aging cannot be changed,
leading a generally healthy lifestyle is recommended to help reduce the likelihood of developing heart and circulatory
conditions
DOH Program
DOH established a CVD prevention and control program and assigned CVD Coordinator to every province to ensure the
correct and efficient implementation of the program
Goals and Objectives
The main objectives of the program were the following
• To reduce the morbidity and mortality from CVD
• To reduce the economic burden of CVD to the individual, the family and the community, and
• To improve the productivity and quality of life of CVD
Memorandum Order 416 – Providing for the nationwide implementation of the CardioVascular Disease prevention and
control program
Department of Health
• Provide direction in the nationwide implementation of the National cardiovascular Disease Prevention and
control
• Coordinate the activities of the program through the CardioVascular Disease (CVD) Advisory Council, technical
working group and task forces;
• Develop and produce Information, Education, Communication (IEC) and other minerals Solicit the participation
and support of pertinent non-government organizations, professional associations and private individuals and
health practitioners
• Conduct orientation and training for in collaboration with the participating departments and agencies on the
National Cardiovascular Disease Prevention and control program particularly on the strategies of prevention and
control
• Monitor the nationwide implementation of the program, evaluate, its effectiveness, and submit periodic reports
thereon to the office of the president
Cerebrovascular Disease
• Cerebrovascular - refers to blood flow in the brain
• Cerebrovascular Disease - refers to a group of conditions that affect blood flow and the blood vessels in the
brain
• Cause: Atherosclerosis is a primary cause of cerebrovascular disease
• Stroke: The most common type of cerebrovascular disease
 • Other Types:
→ Stroke → Vertebral stenosis → Aneurysms
→ Carotid stenosis and intracranial → Vascular
stenosis malformations
• Diagnostic Process: Cerebral Angiography
• Treatment: Endovascular neurosurgery and microsurgery
Philippine Statistics

• According to the latest WHO data published in 2020 Stroke Deaths in Philippines reached 74,167 or 11.00% of
total deaths
• The age adjusted Death Rate is 104.08 per 100,000 of population ranks Philippines #66 in the world
• From 2009 to 2019, stroke remains the second leading cause of death and one of the top five leading causes of
disability in the Philippines
• The true stroke prevalence is uncertain, but reported estimates vary between 0.9% (2005) to 2.6% (2017) of the
population
• Based on types of strokes, seven out of 10 cases are diagnosed as ischemic while the other three are considered
hemorrhagic
• Thirty six percent (36%) of the total stroke deaths are not attended by any medical personnel
Global Statistics
• Annually, 15 million people worldwide suffer a stroke
• Of these, 5 million die, and another 5 million are left permanently disabled, placing a burden on family and
community
• Stroke is uncommon in people under 40 years; when it does occur, the main cause is high blood pressure
• However, stroke also occurs in about 8% of children with sickle cell disease
• For every 10 people who die of stroke, four could have been saved if their blood pressure had been regulated
• Among those aged under 65, two-fifths of deaths from stroke are linked to smoking
Common Risk Factors of Cerebrovascular Diseases
Smoking
Decreased risk by quitting smoking. Risk may be increased further with the use of some forms of oral contraceptives and
are a smoker
High blood pressure
Blood pressure of 140/90 mm Hg or higher is the most important risk factor for stroke
Carotid or other artery disease
The carotid arteries in the neck supply blood to the brain. A carotid artery narrowed by fatty deposits from
atherosclerosis (plaque build ups in artery walls) may become blocked by a blood clot
Diabetes
It is crucial to control blood sugar levels, blood pressure and cholesterol levels
High blood cholesterol
A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease, which raises
the risk of stroke
Physical inactivity and obesity
Being inactive, obese or both can increase the risk of high blood pressure, high blood cholesterol, diabetes, heart disease
and stroke
Age
People of all ages, including children can be at risk to have cerebrovascular diseases. Gender - Stroke is more common in
men than in women
Heredity and race
There is a greater risk of stroke if a parent, grandparent, sister or brother has had a stroke. Blacks have a much higher
risk of death from a stroke than Caucasians do, partly because they are more prone to having high blood pressure,
diabetes and obesity
Prior stroke or heart attack
Those who have had a stroke are at much higher risk of having another one. Those who have had a heart attack are also
at higher risk of having a stroke
DOH Programs
Stroke Medicine Access Program (MAP)
Free medical assistance program for stroke patients. This move by the Health Department is partnered with the Stroke
Society of the Philippines that helps hospitals in establishing acute stroke units
• Select government hospitals nationwide
• Alteplase, a plasminogen activator, every stroke patient eligible to receive it should have access to it
• Despite the free medication, the Health Department reminded the public that strokes can be prevented by
engaging in a healthy lifestyle. Do not smoke. Do not drink alcohol excessively. Engage in regular aerobic activity.
Hypertensive and diabetic patients should take their medications regularly. Maintain your ideal body weight
• DOH discontinued the program due to the lack of neuroimaging machines and organized system of care to
support the provision of the said medicine
National Stroke Policy
Administrative Order No 2020-0059 to improve stroke care in the country. It sets the directions and national policy
framework on the Prevention, Control and Management of Acute Stroke in the Philippines

• It applies to all government and private health facilities, Department of Health offices, Center for Health
Development, Local Government Units and the Bangsamoro Autonomous Region in Muslim Mindanao
• Build capacity and train health workers on acute stroke management
• Identify and establish Acute Stroke Ready Hospitals (ASRH) in the different areas of the country. A certification
program shall be created to ensure the delivery of timely and quality acute stroke care
• Strengthen health promotion and communication in disease prevention and management and ensure public
awareness of Acute Stroke Ready Hospitals
• Facilitate formation of referral pathways and utilize health care provider networks to ensure timely referral of
patients to ASRH
• Strengthen the National Stroke Registry that is integrated in the Unified Disease Registry System
• Provide adequate coverage and access to essential medicine and services in ASRH by strengthening medicine
access programs and enhancement of benefit packages and other payment mechanisms for acute stroke
• Ensure active involvement of civil societies, professional societies, non-government organizations, private and
public hospitals and private sectors in the implementation of the stroke policy.
 CANCER
Philippine and Global Statistics
Number of New Cases in 2020
Both Sexes, All Ages
Other Cancers 46.3%
Breast 17.7%
Lung 12.5%
Colorectum 11.3%
Liver 6.9%
Prostate 5.4%
Total 153, 751
Males, All Ages
Other Cancers 37.9%
Lung 19.9%
Colorectum 14.3%
Prostate 12.3%
Liver 11.1%
Leukemia 4.6%
Total 67, 267
Females, All Ages
Other Cancers 37.6%
Breast 31.4%
Cervix Uteri 9.1%
Colorectum 9%
Lung 6.7%
Ovary 6.2%
Total 86, 484
Common Type of Cancer Worldwide
Breast 22.4%
Lung 21.9%
Colon and Rectum 19.1%
Prostate 14%
Skin 11.9%
Stomach 10.8%
Common Causes of Death Cancer
Lung 35.8%
Colon and Rectum 18.2%
Liver 16.6%
Stomach 15.8%
Breast 13.6%
Common Risk Factors of Cancer
Family Health History
CDC, 2022 A history of the illnesses and ailments that run in your family is your family health history
Your chance of developing cancer may be affected by the conditions, behaviors, and genes that
your family members may share
Acquired Sporadic cancer is the term for cancer that develops as a result of acquired mutations
Mutations Not all of the body's cells contain acquired mutations, and parents cannot pass them on to
their children
Germline Inherited cancer is cancer brought on by germline mutations
Mutations It causes between 5% and 20% of all cancers (ASCO, 2018)
Genetic Testing Genetic testing looks for alterations in your DNA, often known as mutations or variations
Genetic testing is useful in many areas of medicine and can change the medical care you or
your family member receives
Genetic testing can diagnose a genetic disorder like fragile X or reveal your risk of contracting
cancer
Using More than 85% of lung cancer deaths are caused by smoking
Cigarettes Smokers are more likely than nonsmokers to develop lung cancer
Tobacco use has been linked to cancers of the mouth, larynx, pharynx, esophagus, pancreas,
and bladder in general
Excessive Heavy drinkers are more likely to develop cancers of the mouth, throat, esophagus, larynx, and
Alcohol liver
Consumption According to some studies, even moderate drinking may increase the risk of breast cancer
Unhealthy Many cancers are influenced by diet, particularly those affecting the digestive and
Eating Habits reproductive systems
Cancer incidence has been linked to a long-term habit of not eating a healthy diet. Similarly,
being significantly overweight has been
Environmental Pollutants present in the air or water can put us at risk for developing cancer
Factors One example is asbestos in the air which may cause lung cancer and pleura cancer, otherwise
known as mesothelioma
Pesticides also raise the risk for cancers like leukemia and non-Hodgkin lymphoma
Gas radiation also serves as an issue, as radioactive gas radon from the soil increases the risk
for lung cancer
Lung cancer may also arise in people who smoke
Radiation Radiation also is a big risk factor in cancer development
Extended exposure to sunlight exposes us to ultraviolet radiation, leading to skin cancer
Ionizing radiation is also present in the use of x-ray tests, thus causing a risk of cancer with the
frequency of x-ray testing
Medications Certain medications also bring a person at risk of developing cancers through various routes
Several examples are due to the presence of estrogen, such as in oral contraceptives and
hormone therapy
Other hormones in drugs like testosterone may also lead to liver cancer
Treatment medications like Tamoxifen, Chemotherapy, and Radiation therapy may lead to
breast cancer and second cancer

DOH Programs
Philippine Cancer Control Program
DOH National Cancer Control Beginnings Prior 1987

• As cancer rose to become the country's fifth leading cause of death, the Department of Health initiated cancer
control efforts by establishing an autonomous unit known as the National Cancer Control Center (NCCC)
 • Other notable achievements in the past include the creation of a population-based cancer registry that collects
cancer incidence data and the establishment of a Community Cancer Control Program in the province of Rizal in
1973, under the auspices of the Rizal Medical Center
Executive Order 119 in 1987

• The National Cancer Control Center (NCCC) was abolished by virtue of Executive Order 119 in 1987
• The NCCC Manila building and Quezon City office went to Jose R. Reyes Memorial Medical Center and East
Avenue Medical Center
• Its function is related to the planning of the cancer control program, which was transferred to the newly-created
Non-Communicable Disease Control Service
Administrative Order No. 89-As. 1990
• AO No. 89-As 1990 provided the guidelines of the Philippine Cancer Control Program (PCCP)
• It specified the program policy, components, implementing guidelines, and timetable
• The first phase of the program implementation was the orientation training in 1988 of Regional PCCP Core
Trainers
• In 1992, the program's coverage of implementation gradually expanded to include the other regions
Objectives of PCCP
Cancer Epidemiology and Research
• It assesses the impact of cancer in the community, factors, identifying groups, effects, and studies therapeutic
programs
• It also conducts relevant research on the prevention, diagnosis, treatment, and support for patients
Public Information and Health Education
• Public information campaign is conducted for the prevention and early detection of cancer
• The National Cancer Consciousness Campaign is a year-round primary strategy which includes the development
and maintenance of e-campaigns against cancer
Cancer Prevention and Early Detection
• It aims to promote relevant cancer prevention programs, as well as the detection of specific cancer types
• This includes screening programs
Cancer Treatment and Training
• It strengthens cancer treatment capabilities of regional medical centers
• Designing and implementing training courses related to cancer control is also included for personnel of the DOH
and other institutions
Hospital Tumor Board and Tumor Pregnancies

• There is a mandate for development of hospital tumor registries of DOH hospitals

• It is currently ongoing for Manila, Rizal, Davao, and Cebu population-based cancer registries
• It is a must in surgery-training accredited hospitals in the Philippines.
Cancer Pain Relief and Palliative Care
• DOH provides free morphine for indigent patients of its hospitals
• Palliative and rehabilitation care beds are also provided within the medical wards of hospitals
Specific Cancer Programs of the DOH – PCCP
Lung Cancer Control Program
• To inform/ educate school children and adults on the hazards of smoking and its known risk of developing
cancer
• To prevent the onset of smoking and decrease the number of smokers
• To identify among Filipinos those at high risk of developing lung cancer (40 years old and above smokers)
Anti-Smoking Campaign
• Administrative Order No. 8 s. 1993
• Administrative Order No. 10 s. 1993
• Article 94 of Chapter IV of RA 7394
→ Filipino - ‘Warning: Cigarette Smoking is Dangerous to your Health
Breast Cancer Control Program

• To inform or educate all women 30-60 years old on breast self-examination

• To detect the maximum number of early-stage breast cancer
• To treat and rehabilitate all detected cases
Cervix Uteri Cancer Program
• To educate people about cervical cancer
• To screen at least 85% of women 25-55 years of age every 3 years using acetic acid wash
• To identify early lesions of cervical cancer. To establish a practical/ applicable referral system
• To implement appropriate treatment protocol
Program Activities
• Public Information & Health Education
• Professional Education
• Primary prevention
• Case-finding with use of acetic acid wash
• Diagnosis with use of Pap smear and colposcopy
• Treatment
• Research
Liver Cancer Program
Several Governmental Legislations and Department of Health Circulars have been passed towards the fight against
hepatitis B
DOH Circ No. 242s 10 Dec 190 Implementing Guidelines on the Integration of Hepatitis B into the Expanded
Program on Immunization
RA No. 7846-2006 Compulsory Hepatitis B Immunization among Infants and Children less than 8
years old
DOH AO N 0015-2006 Implementing Guidelines on Hepatitis B Immunization for Infants –
Implementation of RA 7846
RA No. 10152 (June 2011) Mandatory Infant and Children Health Immunization Act
RA No. 10526 (April 2013) Liver Cancer and Viral Hepatitis Awareness and Prevention Month Act
Colon/Rectal cancer Control Program
• Focus on digital rectal exam/ FOBT and healthy diet lifestyle, in collaboration with Nutrition Program of the DOH
Healthy Lifestyle
Smoking to some unknown risky lifestyle) can lead to degenerative or late onset diseases on a background of vulnerable
genes self of the individual
Health Care Intervention Strategies in the Diseases Associated with Risky Lifestyles are
• Information dissemination & Education campaign - avoidance of lifestyle
• Counseling
• Screening
• Case-finding and Treatment
• Disease-specific clinical management
• Rehabilitation
• Supportive care
Cancer Pain Relief Programs
The main analgesic concepts implemented are

• Use of oral drugs, allowing hospital discharge and home care

• Analgesics are given on a regular basis - 'by the clock'
• Choice of analgesic agent given is 'by the ladder
The Dangerous Drugs Board on October 19, 1989 through Board regulations No. 6, 6-A, 7, 8 have changed the
regulations on the use of morphine exclusively for cancer patients, effectively achieving the following
• Facilitated the process of obtaining an official prescription (DDB Form No. 1-72) and a local purchase form (DDB
Form No. 8-72)
• Assigned dispensing to duly-licensed Hospital Pharmacies
• Increased the number that can be obtained at one time to – I) for official prescription = 840 mg morphine oral,
448 mg morphine iv, ii) for local purchase = 1.68 gm morphine oral, 896 mg morphine iv
• The Philippine quota for the annual importation of morphine has been increased by the International narcotics
Control Board from 1 kilogram to 25 kilograms
• The Bureau of Foods & Drugs had approved new formulations of morphine sulfate tablets that now include 10,
20, 30, and 50-mg tablets
• Regular budget for the purchase of morphine sulfate tablets was identified in 1990 The National Drug Council in
1992 approved the inclusion of morphine tablet sustained release in the National Drug Formulary
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Philippine and Global Statistics
Prevalence and Demographics of Asthma – COPD
• ACO has a 26.8% prevalence rate (31/194 patients)
• Patients with COPD have a higher ACO rate (31.5%) compared to Asthma (24.1%)
• Asthma-COPD overlap in the Philippines has a statistically higher prevalence rate (27.7%, p = 0.000) compared to
the worldwide prevalence rate (19.9%) as indicated in the study done by Amir et al in 2015 which has the
highest ACO prevalence rate published to date
• Asthmatic patients are predominantly female (72.7%), nonsmokers (84.1%), and are younger (mean age = 57.3
+/- 10.4 years) compared to the COPD and ACO population
• COPD patients are predominantly male (83.8%). A history of tuberculosis (TB) is more common in the COPD
population (64.9%) compared to the Asthmatic ad ACO population with 27.3% and 38.7% respectively
• Although most ACO population have a smoking history of 23 +/- 47 pack-years, cigarette smoking had the
highest median in this group with a value of 46 +/- 48.5 pack-year
The Burden of Obstructive Lung Diseases (BOLD)
• The Burden of Obstructive Lung Diseases (BOLD) program used a standardized methodology comprising
questionnaires and pre- and post-bronchodilator spirometry to assess the prevalence and risk factors for COPD
in people aged 40 and over around the world
• The surveys have been completed in 29 countries and studies are on-going in a further nine. BOLD reported
worse lung function than earlier studies, with a prevalence of COPD grade 2 or higher of 10.1% overall, 11.8% for
men, and 8.5% for women and a substantial prevalence of COPD of 3-11% among never-smokers
• BOLD examined the prevalence of COPD in north and sub-Saharan Africa and Saudi Arabia and found similar
results
• Based on BOLD and other large scale epidemiological studies, it is estimated that the number of COPD cases was
384. 6 million in 2010, with a global prevalence of 11.7% (95% confidence interval (CI) 8.4%–15.0%)
• Globally, there are around three million deaths annually
• With the increasing prevalence of smoking in developing countries, and aging populations in high-income
countries, the prevalence of COPD is expected to rise over the next 40 years and by 2060 there may be over 5.4
million deaths annually from COPD and related conditions
PHILIPPINE STATISTICS GLOBAL STATISTICS
Chronic Obstructive Pulmonary Disease is one of the Chronic obstructive pulmonary disease (COPD) is the
top ten diseases in our country third leading cause of death worldwide, causing 3.23
Using the Burden of Obstructive Lung Disease (BOLD) million deaths in 2019
protocol and study design, non-hospitalized men or Nearly 90% of COPD deaths in those under 70 years
women, aged 40 years or older, were recruited by of age occur in low- and middle-income countries
multi-stage random sampling procedures (LMIC)
Participants completed questionnaires on respiratory Early diagnosis and treatment, including smoking
symptoms and exposure to potential risk factors for cessation support, is needed to slow the progression
COPD, including smoking, occupation and exposure of symptoms and reduce flare-ups
to burning of biomass fuel Environmental exposure to tobacco smoke, indoor air
In 1,188 individuals selected for recruitment, 722 had pollution and occupational dust, fumes and chemicals
acceptable post-bronchodilator spirometry and were are important risk factors for COPD
classified according to the Global Initiative for COPD results from long-term exposure to harmful
Chronic Obstructive Lung Disease (GOLD) stage gasses and particles combined with individual factors,
The overall prevalence of COPD for all stages was including events which influence lung growth in
20.8% childhood and genetics
The prevalence of COPD at GOLD Stage I or higher COPD causes persistent and progressive respiratory
was greater in men compared with women (26.5% vs symptoms, including difficulty in breathing, cough
and phlegm production
 15.3%), and increased between the ages of 40 to >70
years
The prevalence of COPD in a rural community in
Nueva Ecija, Philippines was 20.8% for GOLD Stage I
or higher, and 16.7% for GOLD Stage II or higher

COPD Common Risk Factors

Exposure to Tobacco Smoke
• The most significant risk factor for COPD is longterm cigarette smoking. The more years you smoke and the
more packs you smoke, the greater your risk
People with Asthma
• Asthma, a chronic inflammatory airway disease, may be a risk factor for developing COPD
Genetics
• The uncommon genetic disorder alpha-1- antitrypsin deficiency is the cause of some cases of COPD
Air Pollution
• Indoor and outdoor pollutants can cause the condition when exposure is intense or prolonged
Age
• COPD is most common in people at least 40 years of age who have a history of smoking
Occupational Dusts and Chemicals
• Long-term exposure to industrial dust, chemicals, and gases can irritate and inflame the airways and lungs
DOH Program
Smoking Cessation Program

• The Tobacco Control component of the Lifestyle Related Diseases Prevention and Control Program primarily
aims to reduce non-communicable diseases caused by cigarette smoking
• It implements the World Health Organization (WHO) MPOWER measures which monitors tobacco use and
policies, protects people from exposure to second-hand smoke, offers help to quit tobacco use, warns people of
its dangers, enforces bans on tobacco advertising, and reduces the affordability of tobacco products.
Goal
• Reduce morbidity rates and premature mortality rates due to 4 major chronic diseases
→ Cardiovascular
→ Diabetes
→ Cancer
→ COPD attributed to tobacco use
Specific Objectives
• To reduce the prevalence of tobacco, use among youths and adults
• To increase the protection level of the public from secondhand tobacco smoke
Situational Analysis and Priority Setting Non-Communicable Disease Prevention and Control Program
Goal for 2016
• Smoking Cessation Training for Health Workers
• Increase awareness on NCD’s
→ Cardiovascular
→ Diabetes
→ Cancer
→ Chronic Obstructive Pulmonary Diseases
Specific Objectives
• Decrease high incidence of NCD’s
• Reduction in morbidity and mortality
• Early detection and screening
• Prevalence of risk factors

The DOH Cordillera Regional Office Implements the ‘Go 4 Health’ on Healthy Lifestyle
Go smoke-free, Go Sustansya, Go Sigla, Go Slow sa Tagay

Cancer Control Program

• It serves as the foundation for all government initiatives connected to cancer that seek to reduce the prevalence
of curable cancer, stop and manage its recurrence, and ensure that people have access to high-quality
healthcare for its treatment
• To reduce the impact of cancer and improve the wellbeing of Filipino people with cancer and their families
Goal
• To reduce premature mortality from cancer by 25% in 2025
• To ensure relative reduction of the following risk factors for cancer
→ 10% harmful use of alcohol
→ 10% physical inactivity
→ 30% tobacco use
• To guarantee the availability of the following services for selected population
→ Selected cancer screening
→ Human Papilloma Virus and Hepatitis B vaccination
→ Access to palliative care
→ Drug therapy and counseling
 DIABETES MELLITUS (GROUP 4)
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important
source of energy for the cells that make up the muscles and tissues. It’s also the brain’s main source of fuel.

Philippine Statistics of Diabetes Mellitus

• According to the International Diabetes Federation (IDF), the Philippines have 3.9 million total cases of diabetes,
with a 6.3 percent prevalence of diabetes in adults as of May 2020 which is very alarming.
• Most common in adult and obese peole. Common in males rather than females.
• 1 out of 14 Filipino adults is diagnosed with diabetes
• Pre diabetes: Around 14.2% of the population already have pre diabetes.
• In the Western Pacific, the Philippines ranks fifth behind China, Indonesia, Japan, and Thailand in the number of
diabetics.
• According to the Philippine Statistics Authority, from January to May 2022. Deaths due to diabetes mellitus
recorded 13,437 cases or 6.5 percent and ranked fourth in 2022
• According to the IDF (International Diabetes Federation) , they projected that by 2030, the number of adults with
diabetes in the Philippines will further rise to 5,289,700 and an estimated 7,267,400 by 2045.

Global Statistics of Diabetes Mellitus

2019 Overall Numbers
Prevalence
• 37.3 million Americans, or 11.3% of the population, had diabetes.
• Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents
• Diagnosed and undiagnosed: Of the 37.3 million adults with diabetes, 28.7 million were diagnosed, and 8.5 million
were undiagnosed.

Prevalence in Seniors
• The percentage of Americans age 65 and older remains high, at 29.2%, or 15.9 million seniors (diagnosed and
undiagnosed).

New Cases
• 1.4 million Americans are diagnosed with diabetes every year.

Prediabetes
• In 2019, 96 million Americans age 18 and older had prediabetes.

Diabetes in Youth
• About 283,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.35% of that
population.
• In 2014–2015, the annual incidence of diagnosed diabetes in youth was estimated at 18,200 with type 1 diabetes,
5,800 with type 2 diabetes.

Diabetes in Race/Ethnicity
The rates of diagnosed diabetes in adults by race/ethnic background are:
• 14.5% of American Indians/Alaskan Natives
• 12.1% of non-Hispanic blacks
• 11.8% of Hispanics
• 9.5% of Asian Americans
• 7.4% of non-Hispanic whites
The Breakdown among Asian Americans
• 5.6% of Chinese
• 10.4% of Filipinos
• 12.6% of Asian Indians
• 9.9% of other Asian Americans

The Breakdown among Hispanic Adults

• 8.3% of Central and South Americans
• 6.5% of Cubans
• 14.4% of Mexican Americans
• 12.4% of Puerto Ricans

Deaths
• Diabetes was the seventh leading cause of death in the United States in 2019 based on the 87,647 death
certificates in which diabetes was listed as the underlying cause of death. In 2019, diabetes was mentioned as a
cause of death in a total of 282,801 certificates.

2021 Overall Result

• Approximately 537 million adults (20-79 years) are living with diabetes.
• The total number of people living with diabetes is projected to rise to 643 million by 2030 and 783 million by 2045.
• 3 in 4 adults with diabetes live in low- and middle-income countries
• Almost 1 in 2 (240 million) adults living with diabetes are undiagnosed
• Diabetes caused 6.7 million deaths
• Diabetes caused at least USD 966 billion dollars in health expenditure – 9% of total spending on adults
• More than 1.2 million children and adolescents (0-19 years) are living with type 1 diabetes
• 1 in 6 live births (21 million) are affected by diabetes during pregnancy
• 541 million adults are at increased risk of developing type 2 diabetes
• Around 10% of all people with diabetes have type 1 diabetes.
• Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases.

Common Risks Factors

With type 1 diabetes, your body produces very little or no insulin, necessitating daily insulin injections to maintain blood
glucose levels.

Common risk factors include

• Family History
• Genetics
• Injury to pancreas
• Age
• Exposure to illness caused by viruses

When you’re healthy, your pancreas releases insulin to help your body store and use sugar from the food you eat.
Diabetes happens when one or more of the following occurs:

1. Your pancreas doesn’t make any insulin.

2. Your pancreas makes very little insulin.
3. Your body doesn’t respond the way it should to insulin

Unlike people with type 1 diabetes, people with type 2 diabetes make insulin. But the insulin their pancreas releases
isn’t enough, or their body can’t recognize the insulin and use it properly.

• High blood pressure

 • High blood triglyceride levels
• Low “good” cholesterol level
• Gestational diabetes or giving birth to a baby weighing more than 9 pounds
• Prediabetes.
• Heart disease
• High-fat and carbohydrate diet
• High alcohol intake
• Sedentary lifestyle
• Obesity or being overweight
• Polycystic Ovary Syndrome (PCOS)
• Being of an ethnicity that’s at higher risk
• Over 45 years of age. Older age is significant risk factor for type 2 diabetes
• Had an organ transplant

DOH Programs
DOH Insulin Access Program
A program under the Medicine Access Program (MAP) of the Department of Health (DOH) through the National Center
for Pharmaceutical Access and Management (NCPAM) provides access to medicines for diabetic patients and is in line with
Millennium Development Goal No.

Blood Donation Program

Republic Act No. 7719, also known as the National Blood Services Act of 1994, promotes voluntary blood donation to
provide sufficient supply of safe blood and to regulate blood banks. This act aims to inculcate public awareness that blood
donation is a humanitarian act.

Blood Donation Program Mission

• Blood Safety
• Blood Adequacy
• Rational Blood Use
• Efficiency of Blood Services

Philippine Organ Donation and Transplant Program

This program aims to facilitate and oversee all organ donation and transplantation activities in the country with a goal of
National Self-Sufficiency in Organ Donation and Transplantation and Prevention of Organ Trafficking.

Adolescent Health and Development Program

The adolescent health and development program (AHDP) targets adolescents aged 10-19 years. It is mainly guided by the
Convention on the Rights of Children which states that the program must be in the best interests of the child.

Lifestyle Related Disease

Non-communicable diseases (NCDs) include cardiovascular conditions, diabetes mellitus, lung/chronic respiratory
diseases, range of cancers which are the top causes of deaths globally and locally. These diseases are considered as lifestyle
related and are mostly the result of unhealthy habits. Behavioral and modifiable risk factors like smoking, alcohol abuse,
consuming too much fat, salt and sugar and physical inactivity have sparked an epidemic disease of these NCDs which
pose a public threat and economic burden.

Food and Waterborne Diseases Prevention and Control Program

Refer to the limited group of illnesses characterized by diarrhea, nausea, vomiting with or without fever, abdominal pain,
headache, and body malaise. These are spread or acquired through the ingestion of food or water contaminated by
disease-causing microorganisms which can be bacterial, parasitic, or viral. Hence, this program aims to reduce the
morbidity and mortality due to FWBDs and outbreaks through case management, lab diagnosis, health promotion, policy
development, logistics management, research and M&E, and surveillance and interagency collaboration
MENTAL HEALTH AND STRESS MANAGEMENT
Philippines Statistics
• The ratio of mental health workers per population in the Philippines is low, at 2–3 per 100 000 population
• This ratio is lower than in other Western Pacific Rim countries with similar economic status
• These numbers indicate that the Philippines has a serious deficit of mental health professionals
Philippine and Global Statistics
• The Philippine Mental Health Act went into effect in 2019
• There are only 46 outpatient facilities, 84 general hospitals with psychiatric units, five government hospitals with
pediatric psychiatric facilities, and only 2.0 mental health experts per 100,000 people
• The National Center for Global Health and Medicine (NCGM) in Japan provides the Japanese expertise in
advancing medical technology and public health practices in developing nations
• Continuing its focus on enhancing child and adolescent mental health, Kohnodai Hospital organized another
training program in collaboration with the Philippine Society for Child and Adolescent Psychiatry
• In 2017, Kohnodai Hospital co-created a training program for children ' s mental health in disaster-affected areas
of the Philippines
Global Statistics

• More than half of all mental health issues in children and adolescents begin before the age of 14, affecting an
estimated 10 to 20% of children and adolescents worldwide. Mental illnesses are the third-leading cause of
disability-adjusted life years (DALY) among children in the Western Pacific Region
Risk Factors
Children
• Being a refugee, homeless, receiving care away from home, screen time and sedentary behavior, chronic illness,
obesity, and maternal sickness
Teenagers
• High screen usage, cyberbullying, dysfunctional families, obesity and chronic illness, outside-the-home care,
aspects of refugee status, and demanding academic contexts
Young Adults
• Homelessness, being a member of a sexual minority, migration, and cyberbullying
Adults and General Population

• Being a member of a sexual minority, being socially isolated and lonely, experiencing unstable employment or
unemployment, unwelcoming working conditions, economic inequality, migration, homelessness, caregiving,
physical health issues, and economic disparity
DOH Health Programs
Mental Health and Stress Management
• Addressing concerns related to MNS contributes to the attainment of the SDGs
• Wide range of promotive, preventive, treatment and rehabilitative services
→ For all individuals across the life course especially those at risk of and suffering from MNS disorders
→ Integrated in various treatment settings from community to facility
• Hope to attain the highest possible level of health

Vision
A society that promotes the well-being of all Filipinos, supported by transformative multi-sectoral partnerships,
comprehensive mental health policies and programs, and a responsive service delivery network
Mission
To promote over-all wellness of all Filipinos, prevent mental, psychosocial, and neurologic disorders, substance abuse
and other forms of addiction, and reduce burden of disease by improving access to quality care and recovery in order to
attain the highest possible level of health to participate fully in society
Objectives
1. To promote participatory governance and leadership in mental health
2. To strengthen coverage of mental health services through multi-sectoral partnership to provide high quality
service aiming at best patient experience in a responsive service delivery network
3. To harness capacities of LGUs and organized groups to implement promotive and preventive interventions on
mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services
Program Components
• Wellness of Daily Living
• Extreme Life Experience
• Mental Disorder
• Neurologic Disorders
• Substance Abuse and other Forms of Addiction
Partner Institutions
NGAs
• DOLE • DepEd • CHED
• DSWD • Tesda • DILG
NGOs

• WHO • PNA • WAPR

• PPA • PLAE • NGF
• PAP • AWIT Foundation
Policies and Laws

• DOH Administrative Order No. 8 Series of 2001 – The National Mental Health Policy
• DOH Administrative Order No. 2016- 0039 Revised Operational Framework for a Comprehensive National
Mental Health Program
• Republic Act No. 11036 Mental Health Act
Strategies, Action Points and Timeline
• Governance • Advocacy • Regulation
• Service Coverage • Evidence

Program Accomplishments/Status
1. Passage of the Republic Act No. 11036 dated June 20, 2018 "An Act Establishing a National Mental Health Policy
for the Purpose of Enhancing the Delivery of Integrated Mental Health Services, Promoting and Protecting the
Rights of Persons Utilizing Psychiatric, Neurologic and Psychosocial Health Services, Appropriating Funds
Therefore and for Other Purposes "
 2. DOH Administrative Order No. 2016-0039 dated October 28, 2016 "Revised Operational Framework for a
Comprehensive National Mental Health Program "
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation of the RA No. 11036 also known as The Mental Health
Act
6. Conduct of the Advocacy Activities such as 2nd Public Health Convention on Mental Health, Observance of the
World Health Day, World Suicide Prevention Day, National Mental Health Week and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental Health
9. Establishment of the Medicine Access Program for Mental Health
Calendar of Activities
• September 10 - World Suicide Prevention Day
• October 10 -World Mental Health Day
• 2nd Week of October - National Mental Week
Statistics
• The World Health Organization (WHO) estimates that 154 million people suffer from depression million from
schizophrenia
• 877,000 people die by suicide every year
• 50 million people suffer from epilepsy
• 24 million from Alzheimer’s disease and other dementias
• 15.3 million persons with drug use disorders
In the Philippines
1. 2004 WHO study, up to 60% of people attending primary care clinics daily in the country are estimated to have
one or more MNS disorders
2. 2000 Census of Population and Housing showed that mental illness and mental retardation rank 3rd and 4th
respectively among the types of disabilities in the country (88/100,000)
3. Data from the Philippine General Hospital in 2014 show that epilepsy accounts for 33.44% of adult and 66.20%
of pediatric neurologic out-patient visits per year
4. Drug use prevalence among Filipinos aged 10 to 69 years old is at 2.3%, or an estimated 1.8 million users
according to the DDB 2015 Nationwide Survey on the Nature and Extent of Drug Abuse in the Philippines
5. 2011 WHO Global School-Based Health Survey has shown that in the Philippines, 16% of students between 13-
15 years old have ever seriously considered attempting suicide while 13% have actually attempted suicide one
or more times during the past year
6. The incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005 while rates
rose from 0.12 to 1.09 per 100,000 in females (Redaniel, Dalida and Gunnell, 2011)
7. Intentional self-harm is the 9th leading cause of death among the 20-24 years old (DOH, 2003)
8. A study conducted among government employees in Metro Manila revealed that 32% out of 327 respondents
have experienced a mental health problem in their lifetime (DOH 2006)
9. Based on Global Epidemiology on Kaplan and Sadock’ s Synopsis of Psychiatry, 2015 and Kaufman’s Clinical
Neurology for Psychiatrists, 7th edition, 2013
→ Schizophrenia – 1% - 1 million
→ Bipolar – 1% - 1 million
→ Major Depressive Disorder – 17% - 17 M
→ Dementia – 5% (of older than 65)
→ Epilepsy – 0.06% - 600,000
STRATEGIES TO PREVENT NON-COMMUNICABLE DISEASES (NCDS)
Diet and Nutrition
The key for healthy eating is constructing a balanced diet based on the Food Pyramid. Taking the correct number of
servings of all food categories every day is essential to fulfill your daily needs of nutrients.
• The base of the food pyramid is water. Drinking 8–10 glasses of water every day to hydrate your body and
ensure optimal functions of the organs
• Eating carbohydrates such as bread, cake, biscuits, cereals, rice or pasta is important to provide energy to the
body
• Eat a colorful salad dish every day and eat a fruit after every meal. Milk and dairy products have numerous
benefits. Rich with proteins, vitamins and minerals specifically calcium: necessary for bones health
• Meat, poultry, fish, eggs and beans are the main source of protein. Fats and added sugars also contribute in the
healthy diet
Physical Activity
Promoting Physical Activity to Prevent and Control Noncommunicable Diseases
Physical Activity
• Any bodily movement produced by skeletal muscles that require energy expenditure
• Includes exercises and activities done as part of playing, working, active transportation, household chores, and
recreational activities
Intensity
• The magnitude of the effort required to perform an activity or exercise
• Moderate intensity - requires a moderate amount of effort (brisk walking, dancing, gardening, housework, etc.)
• Vigorous intensity - requires a large amount of effort (fast cycling, running, aerobics, climbing up a hill, etc.)

What are WHO recommended levels of Physical Activity to Prevent and Control Non-communicable diseases?
Children and Youth aged 5 – 17 At least 60 minutes of moderate-to-vigorous-intensity physical activity daily like
sports, transportation, chores, recreation, physical education, or planned exercise
Adults aged 18 – 64 At least 150 minutes of moderateintensity aerobic physical activity throughout the
week like walking, dancing, gardening, hiking, swimming, cycling, household
chores, sports, or planned exercise
Older Adults aged 65 and At least 150 minutes of moderate-intensity aerobic physical activity throughout the
above week or do at least 75 minutes of vigorous-intensity aerobic physical activity
throughout the week or an equivalent combination of moderate- and
vigorousintensity activity

What are the Benefits of Daily Physical Activity?

• Reduce the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression,
and risk of falls
• Improve bones and functional health
• Fundamental to energy balance and weight control

Smoking Cessation
The decision to quit smoking is one of the most important choices you ’ll ever make. It literally can save your life. But it’ s
also the beginning of a long process.
1. Eat a healthy snack or chew gum
2. Find something to do with your hands
3. Connect with the people you love
4. Find a healthy new habit
5. Minimize stress if you can
 6. Think about why you quit
7. Don’t give up if you have a setback
Vision
Tobacco Free Philippines: Healthier People, Communities and Environment
Mission
Guarantee the design and Implementation of an Integrated Comprehensive and Whole System of Government - Society
Response
• Republic Act 10351 An Act Restructuring the Excise Tax on Alcohol & Tobacco
• Republic Act No. 10643 An act to effectively instill health consciousness through graphic health warnings on
tobacco products
• Executive Order No. 26 Providing for the Establishment of Smoke-Free Environments in Public and Enclosed
Places
• Republic Act No. 11467
• Executive Order No. 106
Goal
Reduce morbidity rates and premature mortality rates due to 4 major chronic disease:
• Cardiovascular • Cancer
• Diabetes • COPD attributable to tobacco use
Specific Objectives
• To reduce the prevalence of tobacco, use among youths and adults
• To increase the protection level of the public from secondhand tobacco smoke
Other Strategies: Medication and Early Screening
Why is it important to focus on medication as an avenue for the management of noncommunicable diseases?
• Prevention is preferable to treatment
→ However, for other NCDs, the disease is frequently discovered when the first signs and symptoms
appear. To treat the disease before it gets worse, medication or early treatment is thought to be crucial.
• By not working overtime to support the organs responsible for controlling such sickness, it will also help the
other organs continue to function as they currently do
→ However, in order to have good results, the drug must be taken exactly as prescribed
• Prevention plays a big role in NCDs. So early detection and preventive health screening is an undeniable
requirement and every healthy individual should have an annual Non-Communicable Diseases (NCDs) checkup
NCD Risk Factors
• Tobacco use
• Physical inactivity
• Unhealthy diet, and the harmful use of alcohol
Nurse’s Role and Responsibility in Health Promotion Activities
1. Assessing health needs
2. Building capacity in health promotion
3. Participating as a proactive key player in inter-sectoral collaborations
4. Tackling multiple health determinants
5. Evaluating health promotion activities
6. Generating new knowledge and understanding on health promotion by research
7. Advocating for the individual and community at political and social levels
 NATIONAL IMMUNIZATION PROGRAM

The National Immunization Program, which was then known as Expanded Program for Immunization, was launched by
the Philippine government on July 12, 1967 with the assistance of World Health Organization (WHO) and the United
Nations Children’s Fund (UNICEF) to ensure that infants/children and mothers have access to routinely recommended
infant/childhood vaccines

Vision

Enabled and strong immunization system for everyone, everywhere at every age to attain a vaccine-preventable
disease-free and a healthier Philippines

Mission

Guided by the Universal Health Care Law, the program commits to ensure that every Filipino is fully immunized from
vaccine-preventable diseases by building a strong and well-supported immunization system that is equipped for routine
immunization service delivery and backed with contingencies for and response to public health crises related to VPDs,
vaccines and immunization programs

Specific Goals

• Strengthen immunization services within the primary health care and eventually contribute to universal health
coverage and sustainable development
• Leave no one behind by expanding equitable protection with vaccination for all ages
• Reduce mortality and morbidity by proactively preventing outbreaks of VPDs and providing timely response to
outbreak and other potential health crises related to immunization
• Effectively communicate and address hesitancies and misinformation regarding immunization

Philippine immunization Strategic Plan, 2016 – 2022

Roadmap for Scaling Up the Current Expanded Program of Immunization into a National Immunization program over the
Next 5 years

PhilHealth

Provision of birth dose of BCG and hepatitis B immunization to the newborn is one of the services under the PhilHealth
Newborn Service Package. Provision of Tetanus Toxoid (at least 2 doses) is also part of the maternity care package
reimbursed by PhilHealth

Vaccine Preventable Diseases

Disease Agent Spread

Tuberculosis Bacterium (Myobacterium Airborne/Droplets

tuberculosis)
Hepatitis B Virus Mother to newborn, child to child,
blood, sexual intercourse
Polio Poliomyelitis virus (serotypes 1, 2, 3) Fecal-Oral
Diptheria Corynebacterium diptheriae Close respiratory contact or contact
with infectious material
 Pertussis Bordetella pertussis Close respiratory contact
Tetanus Clostridium tetani Spores enter the body through
wounds
Maternal-Neonatal Tetanus Clostridium tetanu Infection through the umbilical cord
of newborns
Meningitis and pneumonia caused by Haemophilus influenzae type B, Closer respiratory contact
Haemophilus influenza type B bacterium
Rotavirus Virus Fecal-Oral
Measles Virus Close respiratory contact and
aerosolized droplets
Mumps Virus Close respiratory contact and
airborne droplets
Rubella Virus Close respiratory contact and
airborne droplets
Japanese Encephalitis Virus Bite by infected mosquito
Human Papilloma Virus Virus Sexual intercourse
Influenza Virus Close respiratory contact and
airborne droplets
Pnemococcal disease Bacteria Close respiratory contact and
airborne droplets

Surveillance Activity

1. Case Detection and Notification 5. Case Reporting

2. Case Investigation 6. Feedback
3. Case Confirmation 7. Response
4. Data Management and Utilization
Case Classification

• Suspected case
• Probable case
• Confirmed case

The Vaccines

Immunity

• Passive Immunity
→ Natural → Artificial
• Active Immunity
→ Natural → Artificial
Types of Vaccine

• Live attenuated
→ Derived from wild viruses or bacteria which are modified or weakened in laboratories
 • Inactivated
→ Produced by growing the bacteria or virus in culture media which are then subjected to heat or chemical
agents
→ Examples are:
x Whole viruses (e.g., influenza, IPV, rabies)
x Whole bacteria (e.g., pertussis, typhoid, cholera)
x Subunit or fractional vaccines (e.g., influenza, hepB, etc.)
x Pure polysaccharides and conjugates (e.g., Hib, PPV, PCV, etc.)
x Toxoids: diphtheria, tetanus
Basic Principles
Timing and spacing of vaccines
• Multiple vaccines can be administered at the recommended schedule and time using different injection sites
• Multiple vaccines can be administered at the recommended schedule and time using different injection sites
→ 2 live vaccines
→ 2 live parenteral vaccines with 2nd dose of vaccines, with the 2nd dose of the same vaccines usually
administered after 4 weeks
→ Longer interval between doses does not reduce the effectiveness of the vaccine
→ Longer interval between doses does not reduce the effectiveness of the vaccine
Administration of Vaccines
• Client preparation and care
→ IMPORTANT: Always screen clients for possible contra-indications every time you administer a vaccine
→ Explain to the client how the vaccines work, including safety and risk
• Infection control
→ Handwashing
→ Wearing of gloves as necessary
→ Proper disposal of used needles and syringes
Site, Route and Administration
• Oral (Per Oral – PO)
→ Oral vaccines should be administered first before giving injectable vaccines or performing other
procedures that might cause discomfort especially in children
x Administer slowly down one side of the cheek
x Do not trigger gag reflex
x Do not administer or spray directly into the throat
 • Subcutaneous (SC/SQ)
→ Injections are administered into the fatty tissue underneath the dermis and above the muscle tissue
→ Recommended sites are the upper outer triceps of the arm
• Intramuscular (IM)
→ Mostly inactivated vaccines
→ The anterolateral thigh (vastus lateralis muscle) and upper arm (deltoid muscle) are the two routinely
recommended sites
• Intradermal (ID)
→ BCG or post-exposure rabies vaccines
Administering Multiple Vaccines at the Same Time
• Do NOT use the same syringe for more than one vaccine
• As much as possible, do NOT inject the same arm or leg more than once. However, if it is necessary to
administer at least 2 vaccines on the same site, ensure that the injection sites are at least 2 fingers breadths
apart (e.g., PCV, IPV). Do NOT give more than one dose of the same vaccine in one session
• Give doses of the same vaccine at the correct intervals
• Wait at least 4 weeks between subsequent doses of OPV, DEPT-HepB-Hib (PENTA), and PCV
Contraindications and Precautions
• Contraindications are conditions in the recipient that greatly increase the chance of a serious adverse reaction
→ Absolute
→ Temporary
• Precautions are conditions in the recipient that may increase the chance of an adverse reaction or may impair
the ability of the vaccine to produce immunity. Study and remember the appropriate restrictions for each
vaccine
• Never
→ Anaphylaxis or severe hypersensitivity
• Delay
→ If a mother/parent strongly objects
→ Child is suffering from some chronic condition and is under medication
VACCINE TYPE AND FORMULATION ROUTE
BCG Bacillus Calmette – Guerin (BCG): live ID
attenuated mycobacterium bovis
Freeze-dried
Hepatitis B/Hepa B Vaccine Liquid IM
Monovalent
 Oral polio Vaccine (OPV) Live attenuated OPV contains 2 types Oral (drops)
of polio virus
Liquid
Inactivated Polio Vaccine (IPV) Inactivated, whole-cell IPV contains 3 IM
types of polio virus
Liquid
PENTA DPT – Hepa B, Hib Inactivated: conjugate polysaccharide IM
vaccine
Liquid lyophilized
PCV Inactivated conjugated IM
Liquid
PPV Inactivated polysaccharide IM
Liquid
MMR Live attenuated SQ
Freeze-dried Monovalent, measles-
rubella (MR), and measles-mumps-
rubella (MMR)
Rotavirus Vaccine Live Attenuated Oral
Liquid oral suspension
JE Vaccine Live attenuated SQ
Lyophilized powder
TD Vaccine Inactivated toxoid IM
Liquid multivalent form: Td vaccine
HPV Vaccine Recombinant IM
Liquid
Influenza Vaccine Inactivated IM
Schedule ng Pagbibigay ng Bakuna para sa mga Batang Isang Taon Pababa
BAKUNA SAKIT NA MAIIWASAN NIREREKOMENDANG EDAD NG BATA

PAGKAPANGANAK 1½ 2½ 3½ 9 1
BUWAN BUWAN BUWAN BUWAN TAON
BCG Tuberkulosis ✓

Hepatitis B Hepatitis B ✓

Pentavalent Depterya, tetano, ✓ ✓ ✓

Vaccine (DPT-Hep Hepa B, Pertussis,
B-HIB) Pulmonya, Meningitis
Oral Polio Polio ✓ ✓ ✓
Vaccine (OPV)
Inactivated Polio Polio ✓
Vaccine (IPV)
Pneumococcal Pulmonya, Meningitis ✓ ✓ ✓
Conjugate
Vaccine (PCV)
Measles, Mumps, Tigas, Beke, German ✓ ✓
Rubella (MMR) Measles

BCG (Tuberculosis)
PRECAUTION FOR HIV
If the mother is HIV positive, the newborn must be tested for HIV. However, if the HIV
test is not available, BCG vaccine is not given
Contraindications If the baby is positive with HIV infection, BCG vaccine is NOT given
If the baby is negative for HIV infection, BCG vaccine is given
PRECAUTION FOR TB
Treatment with Isoniazid for 6 months first is smear positive
Dosage 0.05ml

Hepa B (Hepatitis B)
Special Precautions Birth dose must be given if there is a risk of perinatal transmission
Dosage 0.5ml
OPV/IVP (Polio)
Contains live, attenuated (weakened) virus
Administered by drops
Inexpensive
OPV Easy to administer
Provides mucosal/gut immunity
Protects close contacts who are unvaccinated
Contains killed virus
Administered by injection
Highly effective
Used commonly
IPV More expensive than OPV
Requires trained health workers
Provides immunity through blood
Carries no risk of vaccine-associated polio paralysis (VAPP) or vaccine-derived
poliovirus (VDPV)
Booster Supplementary doses given during polio eradication
Dosage OPV: two (2) drops into the mouth
IPV: 0.5ml

DPT-HepB+HIB Combination Vaccine (PENTA)

Diphtheria, Tetanus, and Pertussis, Hepatitis B, and Haemophilus Influenzae Type B
Booster For Tetanus Vaccine
→ Total childhood schedule of five (5) doses (3 in infancy), another (Td) in
early childhood (1-6 years), and another (Td) during adolescence (12-15
years) is required. A further dose in adulthood is likely to provide lifelong
protection
For Diphtheria vaccine
→ Total childhood schedule of 6 doses is recently recommended by WHO.
Three (3) doses in infancy, 4th dose at two years old and two other doses
with Td vaccine at school age
Dosage 0.5ml
Pneumonococcal (Streptococcus Pneumoniae)
Forms Pneumonococcal Conjugate Vaccine (PCV13)
→ Contains serotypes 1, 3, 4V, 5, 6A, 6B, 7, 9F, 14, 18, 18C, 19A, 19F and 23F
Pneumonococcal polysaccharide Vaccine (PPV)
→ Contains serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B,
17F, 18C, 19A, 19F, 20, 22F, 23F and 33F
Doses and Schedule PCV – three doses for infants (6, 10, 14 weeks old)
PPV – one dose for adults (60 and 65 yo)
Special Precautions Postpone vaccination if the child has moderate to severe illness (temp: ≥39°C)
Dosage 0.5ml

MMR/MR (Measles, Rubella, Mumps)

Booster In Philippines, booster dose is given at age children at grade 1 and grade 7
Contraindications For measles Containing Vaccine (MCV)
→ Known allergy to vaccine components (including neomycin and gelatin)
→ Pregnancy
→ Severe congenital or acquired immune disorders, including advanced HIV
infection/AIDS
Adverse Reactions Mild – fever, rash 5-12 days following administration
Serious – thrombocytopenia (decreased platelets), anaphylaxis, encephalitis
Joint pain when rubella containing vaccine (RCV) is given to adult women; parotitis
with mumps component
Dosage 0.5ml

Rotavirus (Rotavirus)
Forms Rotarix – monovalent, live attenuated
RotaTeq – live, oral Pentavalent
Doses Two (2) doses (RotarixTM); Three (3) doses (Rotateq TM)
Contraindications Severe allergic reaction to previous dose
Severe immunodeficiency (but not HIV infection)
History of uncorrected congenital malformation of gastro-intestinal (GI) tract
Special Precautions Should be postponed for acute gastroenteritis and/or fever with moderate to
severe illness
Not routinely recommended if with a history of intussusception or intestinal
malformations that possible predispose to intussusception
JE (Japanese Encephalitis)
Booster WHO states that the need for a booster in endemic settings has not been clearly
established. However, most of the countries have adopted the one (1) dose
schedule
Contraindications Known allergy to the vaccine or any of its components
Pregnancy
Any condition that results in a decreased or abnormal immune system response,
including due to any infection (such as HIV), medication and/or congenital
problems (since birth)
Acute diseases, severe chronic diseases, and chronic diseases with acute
symptoms and/or fever)
Encephalopathy (brain disease), uncontrolled epilepsy (seizures) or other diseases
of the nervous system
Adverse Reactions High fever (in 5% - 7% of those vaccinated); injection site reactions (redness,
swelling; in less than 1% with some types of vaccine); low-grade fever, irritability,
nausea and dizziness (rare)
Special Precautions Medical history: caution needed for family or individual history of seizures or
other chronic diseases, allergies and for women who are lactating
Postpone vaccination for at least three (3) months if the person has been given
immunoglobulin
Dosage 0.5ml

TD (Tetanus and Diphtheria)

Doses and Schedule 5 doses (3 doses = infancy as Pentavalent and 2 doses = school-age, Gr. 1 and 7, as
Td)
Pregnant women with childhood DPT/PENTA should be given 3 doses of Td,
otherwise, 5 doses are given
Contraindications PENTA< DT, and Td should not be given to individuals who have suffered a severe
reaction to a previous dose
Dosage 0.5ml
HPV (Human Papilloma Virus Cervical Cancer)
Forms Bivalent HPV vaccine
Quadrivalent HPV vaccine
Nonavalent HPV vaccine
Doses and Schedule 2 doses, 6 months apart, and routinely given to females 9 to 12 years old
Dosage 0.5ml

Seasonal Influenza (Influenza A and B)

Forms Trivalent – 2 influenza A viruses (H1N1 and H3N2) and an influenza B virus
Quadrivalent – protects against 2 influenza A and 2 influenza B viruses
Doses and Schedule Once a year for adults 60 years
Dosage 0.5ml
 INTEGRATED MANAGEMENT OF CHILDHOOD DISEASES (IMCI)
History
YEAR SIGNIFICANT EVENTS
MID-1990s WHO and UNICEF developed INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)
1999 1999 WORLD HEALTH REPORT said that “Children in developing countries are TEN TIMES more likely
to die BEFORE REACHING THE AGE OF 5 than children living in the industrial world”

Leading Causes of Death of Children Below 5 years old (World Health Report, 2019)
1. Preterm birth 3. Pneumonia 6. Malaria
complications 4. Congenital anomalies
2. Birth asphyxia/trauma 5. Diarrhea
Three Components of IMCI
1. UPGRADING the case management and counseling skills of health care providers
2. STRENGTHENING the health system of for effective management of childhood illness
3. IMPROVING family and community practices related to child health and nutrition
Elements of IMCI Case Management Process
• Assess
• Classify
• Identify
• Treat
• Counsel
• Follow Up Care
Principles of Integrated Care
• All sick must be examined for “GENERAL DANGER SIGNS”
→ Unable to drink or breastfeed?
→ Vomits everything?
→ Convulsions?
→ Abnormally sleepy/difficult to awaken?
• All sick children must be assessed for “MAJOR SYMPTOMS”
2 Months to 5 Years 1 week to 2 Months
Cough Bacterial infection
Difficulty of breathing Diarrhea
Diarrhea
Fever
Ear problem
 • Assessment should include
→ Nutrition
→ Immunization
→ Feeding problems, and other potential problems
• Only limited number of clinical signs are used
• Combination of signs lead to a CLASSIFICATION rather than a diagnosis
• IMCI address most but NOT ALL reasons why sick child is brought to clinic
• IMCI used limited number of drugs and NECOURAGE PARTICIPATION of caretakers
• An essential component of IMCI is COUNSELLING of caretakers
Assess and Classify the Sick Child Aged 2 Months up to 5 Years
Ask the Mother what the Child’s Problems are:
• Greet the mother appropriately
• Use good communication and reassure the mother that the child will receive good care
→ Listen carefully to what the mother tells you
→ Use words that the mother understands
→ Give the mother time to answer the questions
→ Ask additional questions when the mother is not sure about her answer
Management of the Sick Child Aged 2 months to 5 Years

Checking for Inability to Drink/Breastfeed

1. Ask if unable to suck or swallow when offered a drink
2. Offer the child a drink and observe
3. Check nose if blocked
Other Terms for Convulsion
• Fits
• Spasms
• Jerky movements
Child is Abnormally Sleepy if
• Drowsy
• Does not show interest
• Does not look or watch face
• Stares blankly
• Does not respond to touch, shake or speech
2 months to 12 months Fast breathing if: RR ≥ 50 bpm
12 months to 5 years Fast breathing if: RR ≥ 40 bpm
Check for Chest Indrawing
• Lift the child’s shirt
• Observe the lower ribs go in when child breaths in
• If not sure, position child to flat lying
• Chest indrawing should always be visible and present all the time
• It is different from intercostal retractions
Listening for Stridor
• Put ear near child’s mouth
• Hear for stridor as the child breathes in
• Be sure to listen to stridor only when the child is calm
• If the child is heard when child breathes out, it is wheezing not stridor
Classifying Cough or Difficult Breathing
COUGH OR DIFFICULTY BREATHING
SIGNS CLASSIFICATION
Home Care No signs of pneumonia No pneumonia; cough or cold
Antibiotic, Antimalarial, Other Fast breathing Pneumonia
Treatment
Urgent Attention and Referral Any general danger signs Severe pneumonia or very severe disease
Chest indrawing
Stridor in calm child

Golden Rule
• The child is classified only once
• Presence of just one sign put the child in that classification
• If the child has signs in more than one row: always select the more serious classification
 Diarrhea lasting for 14 days and more is PERSISTENT DIARRHEA
Blood in the stool is considered DYSENTERY

Not able to drink Unable to take fluid to mouth and swallow it

Drinking Poorly Weak and cannot drink without help
Swallows’ fluid only if fluid is put in his/her mouth
Drinking eagerly If it is clear that the child wants to drink, and could be reaching out for the cup or
spoon when you offer water

Proper Pinching of the Abdomen

• Put the child in his back with arms at sides
• Locate the area HALFWAY BETWEEN UMBILICUS AND SIDE OF ABDOMEN
• Using the thumb and index finger in LINE UP AND DOWN the child’s body and not across, firmly pick up all the
layers of the skin and tissue under it
• Pinch it for ONE SECOND and release
• Check if it goes back
Classifying Dehydration
CLASSIFYING DEHYDRATION
No Dehydration Not enough signs
Some Dehydration 2 of the following signs:
Restless and irritable
Sunken eyes
Drinks eagerly
Skin pinch goes back slowly
Severe Dehydration 2 of the following signs:
Abnormally sleepy or difficult to awaken
Sunken eyes
Not able to drink or drinking poorly
Skin pink goes back slowly

Golden Rule
• A child with diarrhea may have one or more classification for diarrhea
• Example
A child with no dehydration and dysentery should be recorded as: NO DEHYDRATION
Look for signs of Measles
• Generalized rash and one of these:
→ Cough
→ Runny nose
→ Red eyes
If the child has measles now or within the last 3 months
• Look for mouth ulcers
→ If yes, are they deep and extensive?
• Look for pus draining from the eye
• Look for clouding of the cornea (Vitamin A deficiency)
Assess Dengue Hemorrhagic Fever
Ask
• Has the child had any bleeding from nose or gums or in the vomitus or stool
• Has the child had black vomitus or black stool
• Has the child had persistent abdominal pain
• Has the child had persistent vomiting
Look and Feel
• Look for bleeding from nose or gums
• Look for skin petechiae
• Feel cold and clammy extremities
• Check capillary refill if 5 seconds
• Perform TOURNIQUET TEST IF:
→ Child is 6 months or older, and has no other signs, and has fever for more than 3 days
Deciding Malaria Risk
AO No. 129-S (June 12, 2002)
• “All provinces in the country are categorized according to the malaria situation”
• The malaria situation in the Philippines has rapidly evolved over the years. Since 2005, the country has reduced
the malaria cases by 92% and the deaths by 98%. In 2018, a total of 50 out of 82 provinces were officially declared
malaria-free. The remaining cases are concentrated in hard-to-reach areas of the Philippines, mostly in Palawan
• To further drive down this number and reach the global target of reducing the malaria case incidence by 90% by
2030, the Department of Health is strengthening the systems of surveillance, reporting and recording through an
online malaria information system. This initiative is supported by the World Health Organization (WHO)
• Though a number of systems are currently running, what we needed was a more robust and comprehensive
technology with the ability to provide real-time recording and reporting of data,”
 • The Online Malaria Information System (OLMIS) is a web-based system which serves as a tool for data collection,
processing, reporting and the use of information complementing the Philippines’ malaria elimination strategy.
OLMIS has been developed to ensure the ease of access for users since it has an application for Android-based
mobile phones and the web
Category A
a. Provinces with NO IMPROVEMENT in last 10 years
b. Province where situations WORSENED in the last 5 years
c. DEATH is more than 1,000 in last 10 years
Agusan del Sur Davao del Norte Quirino
Agusan del Norte Ifugao Saranggani
Apayao Isabela Sulu
Basilan Kalinga Surigao del Sur
Bukidnon Misamis Oriental Tawi-Tawi
Cagayan Mindoro Occidental Zambales
Compostela Valley Palawan Zamboanga del Sur
Davao del Sur Quezon
Category B
a. Provinces where situation HAS IMPROVED in the last 5 years
b. Average cases 100 – 1,000 per year
Abra Laguna Pangasinan
Aurora Lanao del Sur Rizal
Bataan Maguindanao Romblon
Bulacan Mindoro Oriental South Cotabato
Camarines Norte North Cotabato Sultan Kudarat
Camarines Sur Nueva Ecija Tarlac
Ilocos Norte Nueva Viscaya Zamboanga del Norte
Category C
a. Provinces with SIGNIFICANT REDUCTION in cases in the last 5 years
Albay Ilocos Sur Misamis Occidental
Antique La Union Pampanga
Batanes Marinduque Samar (East and West)
Batangas Masbate Benguet
Negros Oriental Sorsogon Cavite
Negros Occidental Surigao Del Norte
Category D
a. Provinces that are malaria-free, although some are still potentially malarious due to vectors
Aklan Cebu Biliran
Guimaras Camiguin Leyte
Capiz Northern Samar Catanduanes
Siquijor

Persons at Risk for Malaria

• Endemic area resident
• Visited endemic area in the past 4 weeks
• Stayed overnight in endemic area in the past 4 weeks
• Blood transfusion during the past 6 months
• If no information: ALL CHILDREN UNDE R5 YEARS OLD WHO HAVE FEVER ARE AT RISK FOR MALARIA
Classifying Fever
CLASSIFYING FEVER
Fever: Malaria Unlikely No signs of very severe febrile disease and malaria
Runny nose, measles or other causes of fever
Malaria Risk of malaria
Fever but no runny nose
No measles
No other cause of fever
Positive blood smear
Very Severe Febrile Disease Any general danger sign
or Malaria Stiff neck

Classifying Measles
CLASSIFYING FEVER
Measles Signs of measles now or within the last 3 months with no complications
Measles with Eye or Mouth Signs of measles
Complications Pus draining from the eyes
Mouth ulcers which are not deep or extensive
Very Severe Febrile Disease Signs of measles
or Malaria Clouding of cornea
Deep extensive mouth ulcers
Classifying Dengue
CLASSIFYING DENGUE
Fever: Dengue Hemorrhagic None of the signs of severe dengue hemorrhagic fever
Fever Unlikely
Severe Dengue Hemorrhagic Any of the Following Signs
Fever Bleeding from nose or gums
Vomitus in the stool
Skin petechiae
Shock-cold
Clammy extremities with or without slow capillary refill
Persistent abdominal pain and vomiting
Positive torniquet test

Classifying Ear Problems

CLASSIFYING EAR PROBLEMS
No Ear Infection No ear pain
No pus draining from ear
Chronic Ear Infection Pus draining from the ear for TWO WEEKS OR MORE
Acute Ear Infection Pus draining from the ear for LESS THAN TWO WEEKS
Ear pain
Mastoiditis Tender swelling behind the ear

Check for Malnutrition and Anemia

• Look for visible severe wasting
• Look for edema or both feet (to check kwashiorkor)
• Look for palmar pallor
→ Severe palmar pallor? Some palmar pallor?
• Determine weight for age
→ Very low
Indicators of Visible Severe Wasting
• Very thin, has no fat, looks like skin and bones
Nurse Must Undress the Child and Look for
• Severe wasting on the muscles of the shoulders, arms, buttocks, legs and ribs is easily seen
• Hips is smaller compared to chest and abdomen
• Many folds of skin on buttocks and thighs as if child is wearing baggy pants
Looking for Palmar Pallor
Some Pallor Skin of palm is pale
Severe Palmar Pallor Skin is very pale or looks white
TECHNIQUE
I. Hold child’s palm open by gently grasping from the side
II. DO NOT STRETCH fingers backwards as this may cause pallor by blocking the blood supply

Assessing for Edema of Both Feet

• Use thumb to press gently for a few seconds the top side of each foot
• Edema is present if there is DENT remaining in the child’s foot after thumb has been lifted
Classifying Nutritional Status
CLASSIFYING NUTRITIONAL STATUS
No Anemia and Not No other signs of malnutrition
Very Low Weight
Anemia or Very Low Some palmar pallor
Weight Very low weight for age
Severe Malnutrition or Severe visible wasting
Severe Anemia Severe palmar pallor
Edema of both feet

Check the Child’s immunization Status

• BCG
• DPT1, DPT2, DPT3
• OPV1, OPV2, OPV3
• HEPB1, HEPB2, HEPB3
• Measles
Recommended Vitamin A Schedule
First Dose 6 months or above 100,000 IU
Subsequent Dose Every 6 months up to 4 years and 11 200, 000 IU
months
Assess the Child’s Feeding is Child has ANEMIA or VERY LOW WEIGHT or is less than 2 years old
• Do you breastfeed your child?
→ If yes, how many times in 24 hours?
→ Do you breastfeed during night?
• Does the child take any other food or fluids?
→ If yes, what food or fluids?
• How many times per day?
• What do you use to feed the child?
→ If very low weight for age: How large are servings?
→ Does the child receive his/her own serving?
→ Who feeds the child and how?
• During the illness, has the child’s feeding changed?
→ If yes, how?
Assess Care for Development?
Ask question about how the mother cares for her child. Compare the mother’s answers to the Recommendations for
Care and Development for the Child’s Age
• How do you play with your child?
• How do you communicate with your child?
Assess Other Problems
Management of the Sick Child Aged 2 Months Up to 5 Years
• Child’s name
• Age
• Weight
• Temperature
• Ask:
→ Child’s problem
→ Initial visit
→ Follow up visit
• Assess: Circle all signs present
• Check for Possible Bacterial Infection\
• Has the infant had convulsions?
• Count the breaths in one minute
→ Repeat if elevated
→ Fast breathing? (f 60bpm or more)
• Look for severe chest indrawing
 • Look for nasal flaring
• Look and feel for bulging fontanelle (meningitis)
• Look for pus draining form the ear
• Look at the umbilicus. Is it red or draining pus?
→ Does the redness extend to the skin
• Fever (37.5°C or above or feels hot) or low body temperature (below 35.5°C or feels cool)
• Look for skin pustules. Are there many or severe pustules?
• See if the young infant is abnormally sleepy or difficult to awaken
• Look at the young infant’s movement. Less than normal?
Does the young infant have diarrhea?
• For how long?
• Is there blood in the stool?
• Look at the young infant’s general condition. Is the infant
→ Abnormally sleepy or difficult to awaken?
→ Restless or irritable
• Look for sunken eyes
• Pinch the skin of the abdomen. Does it go back?
→ Very slowly (longer than 2 seconds)?
→ Slowly
Check for Feeding Problems or Low Weight
• Is there difficulty feeding?
• Is the infant breasted?
• What do you use to feed the child?
• Does the infant usually receive any other foods or drinks?
If the infant has difficulty feeding, is less than 8 times in 24 hours, is taking any other food or drinks, or is low weight for
age AND has no indications to refer urgently to hospital:
Assess Breastfeeding
• Has the infant breastfed in the previous hour?
• If not, ask the mother to put her infant on her breast
• Observe the breastfeed for 4 minutes. Is the infant able to attach? To check, look for
→ Chin touching breast
→ Mouth wide open
→ Lower lip turned outward
→ More areolae above than below mouth
No Attachment at all
Not well attached
Good attachment
• Is the infant sucking effectively? (That is, slow deep sucks, sometimes pausing?)
→ Not sucking at all
→ Not sucking effectively
→ Sucking effectively
• Look for ulcers or white patches in the mouth (thrush)
Assess for Care Development
• How do you play with your child
• How do you communicate with your child’
Check Immunization Status?
• BCG
• DPT1
• OPV1
• HEPB1
 CONTROL OF COMMUNICABLE DISEASES
Leading Cause of Morbidity
1. Acute respiratory infection
2. Acute low respiratory tract infection and pneumonia
3. Bronchitis/bronchiolitis
4. Hypertension
5. Acute watery diarrhea
6. Influenza
7. Urinary tract infection
8. TB respiratory
9. Injuries
10. Acute febrile illness
Epidemiologic Triangle

Chain of Infection
 I. Pathogenicity
II. Infectivity
III. Virulence
IV. Antigenicity
V. Toxigenicity
Functions of Public Health Nurse in the Control of Communicable Diseases
1. Report to the local authorities (MHO) any known case of notifiable disease as required by the law (RA 11332)
2. Refer any known case of notifiable disease to the nearest health facility
3. Initiate health education drive directed towards prevention of outbreaks in communities
4. Assist in the diagnosis of potential cases of communicable disease based on sign and symptoms
5. Conduct epidemiologic investigations together with the public health team during an outbreak
Communicable Diseases
TUBERCULOSIS
Causative agent Mycobacterium tuberculosis, M. aficanum from humans, but occasionally by M. bovis
from cattle, or M. canetti
Mode of Transmission Airborne droplet through coughing, sneezing, and spitting. Thus, close contacts with
infected
Incubation period 4 – 6 weeks
Signs and symptoms Fever: low grade late afternoon, loss of appetite, easy fatigability, night sweats, dry
cough, later productive with hemoptysis, chest pain
Risk Factors Contacts of TB patients
Those ever treated for TB (i.e., with history of previous TB treatment)
People living with HIV (PLHIV)
Elderly (>60 yo)
Diabetics
Smokers
Health—care workers
Urban and rural poor (indigents)
Those with other immune-suppressive medical conditions

Sundan ang mga sumusunod na hakbang sa pagkuha ng maayos na sampol ng plema para sa eksaminasyon para sa TB
1. Pumunta sa sputum collection area
2. Magmumog ng tubig at siguraduhin na walang tirang pagkain o iba pang laman ang bibig
3. Huminga ng malalim ng tatlong (3) beses at siguraduhing malakas ang pagbuga ng hangin palabas sab aga
4. Idahak ang plema mula sa iyong baga
 5. Buksan ang takip ng lagayan ng plema, ilapit sa iyong mga labi at maingat na idura ang iyong plema sa loob ng
lagayan
6. Siguraduhing may isang (1) kutsarita ang nakolekta mong plema. Isarang mabuti ang lagayan
7. Dalhin ang sampol ng iyong plema sa tagapangasiwa ng iyong kalusugan
8. Siguraduhing maghugas ng iyong mga kamay
Systematic screening for pulmonary PTB in adults ≥ 15 years old with unknown HIV infection status in health facilities

Philippine TB Clinical Practice Guidelines (CPG)

• Pulmonary Tuberculosis (PTB)
→ DSSM
→ TB Culture (Gold Standard)
→ XpertMTB/RIF
x As initial diagnostic test in adults with presumptive TB
x As initial diagnostic test in adults with presumptive drug-resistant TB
x As an ancillary test to smear-negative patients with CXR findings suggestive of active PTB
• Extrapulmonary TB (EP-TB)
→ Direct microscopy
→ TB culture
→ XpertMTB/RIF of a biological specimen
 • Drug Resistant TB (DR-TB)
→ Drug Susceptibility Testing (DST)

• H: Isoniazid
• R: Rifampicin
• Z: Pyrazinamide
• E: Ethambutol
REGIMEN ELIGIBLE TB PATIENTS
Regimen 1 PTB or EPTB (except central nervous system [CNS], bones, joints) whether new or
2HRZE/4HR retreatment, with final Xpert result:
→ MTB< RIF sensitive
→ MTB, RIF indeterminate
New PTB or new EPTB (except CNS, bones, joints), with positive SM/TB LAMP or clinically
diagnosed, and:
→ Xpert not done*
→ Xpert result is MTB not detected
Regimen 2 EPTB of CNS, bones, joints whether new or retreatment, with final Xpert result:
2HRZE/10HR → MTB, RIF sensitive
→ MTB, RIF indeterminate
New EPTB of CNS, bones, joints, with positive SM/TB LAMP or clinically diagnosed, and:
→ Xpert not done*
→ Xpert result is MTB not dedtected
Regimen 1
DRUG INTERVAL CONTINUATION PHASE
H, R, Z, E 7 d/wk for 56 doses (8 wk), or
5 d/wk for 40 doses (8 wk)
H,R 7 d/wk for 126 doses (8 wk), or
5 d/wk for 90 doses (18 wk)

Regimen 2
DRUG INTERVAL CONTINUATION PHASE
H, R, Z, E 7 d/wk for 56 doses (8 wk), or
5 d/wk for 40 doses (8 wk)
H,R 3 times weekly for 54 doses (18 wk)

First Line Drugs

DRUG PREPARATION
Isoniazid Tablets (50mg, 100mg, 300mg); elixir (50mg/5ml); aqueous solution (100mg/ml)
Rifampicin Capsule (150mg; 300mg). powder may be suspended for oral administration.
Aqueous solution for intravenous injection
Rifabutin Capsule (150mg)
Rifapentine Tablet (150mg film coated)
Pyrazinamide Tablet (500mg scored)
Ethambutol Tablet (100mg; 400mg)

Second Line Drugs

DRUG PREPARATION
Cycloserine Capsule (250mg)
Ethionamide Tablet (250mg)
Streptomycin Aqueous solution (1g vials) for IM or IV administration
Amikacin/kanamycin Aqueous solution (500mg and 1g vials) for IM or IV administration
Capreomycin Aqueous solution (1g vials) for IM or IV administration
Para-amino salicylic Granules (4g packets) can be mixed in and ingested with soft food (granules should not be
acid chewed)
Levofloxacin Tablets (250mg, 500mg, 750mg); aqueous solution (500mg vials) for IV injection
Moxifloxacin Tablets (400mg); aqueous solution (400mg/250ml) for IV injection
Roles and Responsibility of the Nurse in the NTP and DOTS Strategy
Nurse as:
• Administrator • Community organizer
• Health educator • Treatment partner
• Case manager and coordinator • TB advocate

LEPROSY
Causative agent Mycobacterium leprae, Hansen’s bacillus
Mode of Transmission Prolonged skin contact, droplet
Incubation period 5 months – 5 years
Signs and symptoms Skin
→ Discolored patches of skin, usually flat, that may be numb and look faded
(lighter than the skin around)
→ Growths (nodules) on the skin
→ Thick, stiff or dry skin
→ Painless ulcers on the soles of feet
→ Painless swelling or lumps on the face or earlobes
→ Loss of eyebrows or eyelashes
Nerves
→ Numbness of affected areas of the skin
→ Muscle weakness or paralysis (especially in the hands and feet)
→ Enlarged nerves (especially those around the elbow and knee and in the side
of the neck)
→ Eye problems that may lead to blindness (when facial nerves are affected)
Mucous Membranes
→ Stuffy nose
→ Nose bleeds
Advance/Late Stage
→ Paralysis and crippling of hands and feet
→ Shortening of toes and fingers due to reabsorption
→ Chronic non-healing ulcers on the bottoms of the feet
→ Blindness
→ Loss of eyebrows
→ Nose disfigurement
Laboratory/Diagnostic Skin Slit Test (Lepromin Skin Test)
Test Skin biopsy
Acid-fast staining
RA 4073 Sec. 1058. Persons afflicted with leprosy not to be segregated
Sec. 1059. Confinement and treatment in sanitarium when necessary
Classification Tuberculoid leprosy
Borderline tuberculoid leprosy
Mid-borderline leprosy
Borderline lepromatous leprosy
Lepromatous leprosy
Types Paubacillary: (-) Skin slit test, <5 lesions
Multibacillary: (+) Skin slit test, >5 lesions
Treatment Multi Drug Therapy (MDT)
→ Dapsone (Aczone)
→ Rifampin (Rifadin)
→ Clofazimine (Lamprene)
→ Minocycline (Minocin)
→ Ofloxacin (Ocuflux)
Prevention and Control BCG Vaccination
Avoidance of prolonged skin contact with active untreated case
Good personal hygiene
Adequate Nutrition
Health Education

DENGUE
Causative Agent Dengue Virus (DEN)
Vector Aedes aegypti
Aedis albopictus
Mode of Transmission Bite of mosquito
Incubation Period 3 – 14 days, commonly 5 – 7 days
Laboratory and Torniquet Test or Rumple - Leads Test
Diagnostic Examination Capillary Refill Test or Nail Blanch test
Platelet Count
→ Platelet: 150,000 to 400,000 cu.mm
→ Hematocrit: F = 36-46%, M = 41 – 53%
 Hemagglutination-Inhibition (HI) Test
Dengue NS1 Kit

Tourniquet Test for Dengue

>Take the patient’s blood pressure and record it, for example, 100/70
>Inflate the cuff to a point midway between SBP and DBP and maintain for 5 minutes. (100/70) / 2 = 85mmHg
>Reduce and wait 2 minutes
>Count petechiae below antecubital fossa
Capillary Refill Test
>Should be less than 3 seconds
 Dengue Time Frame

Treatment Paracetamol q4-6h

→ DO NOT GIVE: aspirin, ibuprofen and NSAIDs
Oral rehydration
→ ORESOL/ORS
→ IVF
Avoid dark colored foods
Strict bed rest and protect from trauma
Do not give IM injections
Instruct caregivers that the patient should be brought to the hospital immediately if
any of the following occur
→ No clinical improvement, deterioration around defervescence, severe
abdominal pain, persistent vomiting, cold and clammy extremities, lethargy
or irritability/restlessness, bleeding, not passing urine for more than 4 – 6
hours
For epistaxis, maintain elevated position and apply ice compress
Blood transfusion should be given as soon as severe bleeding is suspected or
recognized
In case of shock, position patient in dorsal recumbent
Monitor laboratory results
Prevention and Control 4s Strategy for Dengue Prevention
→ Search and destroy
→ Seek early consultation
→ Self-protection measures
→ Support spraying/fogging
 MALARIA
Causative Agent Plasmodium falciparum, vivas, ovale, malariae (Protozoa)
Vector Female anopheles mosquito
Mode of Transmission Bite of mosquito
Incubation period 7 days longer
Laboratory and Diagnostic Clinical diagnosis
Examinations Fluorescent microscopy
Rapid Diagnostic Tests (RDTs)
Antigen detection
Serology
Polymerase chain reaction
Signs and Symptoms Fever and flu-like illness
→ Shaking
→ Chills
→ Headache
→ Muscle aches
→ Fatigue
Anemia
Jaundice
Kidney failure
Seizures
Mental confusion
Coma
Death
Treatment Chloroquine phosphate 250mg (all species except P. malariae)
Sulfadoxine 50mg (for resistant P. falciparum)
Primaquine (for relapse P. vivax and P. ovale)
Pyrimethamine 25mg/tab
Quinine sulfate 300mg/tab
Tetracycline HCL 250mg/tab
Quinidine sulfate 200mg/cap
The Artemether0Lumefantrine (AL) combination will be the first line medicine in the
treatment of confirmed uncomplicated and severe Plasmodium falciparum malaria,
replacing CQ+SP combination
 Quinine (QN) in combination with either tetracycline or doxycycline or clindamycin
(QN+T/D/C x 7 days), will be the second-line treatment
Artesunate (AS) suppository for severe malaria cases
ACT can be used for all Plasmodium species and mixed infections
Prevention and Control RA 4832 Malaria Eradication Law
Vector Control
→ Insecticide-treated nets (ITNs)
→ Indoor residual spraying (IRS)
→ Zooprophylaxis-larva eating fish
Preventive Chemotherapies
→ Intermittent preventive treatment of infants (IPTi)
→ Pregnant women (IPTp)
→ Seasonal malaria chemoprevention (SMC)
→ Mass drug administration (MDA)
Vaccine
→ RTS,S/AS01
Screening of blood donors

FILARIASIS
Causative Agent Wucheria bancrofti, Brugia malayi
Vector Aedes poecilus, Culex quinquefasciatus
Mode of Transmission Bite of mosquito
Incubation Period 8 – 16 months
Signs and Symptoms Chills
Fever
Myalgia
Lymphangitis with gradual thickening of the skin (limbs and scrotum)
Laboratory and Diagnostic Circulating filarial antigen (CFA) – Finger prick
Examination
Treatment Diethycarbamazine citrate (Hetrazan)
Prevention and Control Eradication of vectors
 THYPOID FEVER
Causative Agent Salmonella typhosa
Mode of Transmission Ingestion of contaminated food or water with feces or urine of infected individual
Incubation Period 7 – 14 days
Signs and Symptoms Prodromal
→ Headache, fever, anorexia, lethargy, diarrhea, vomiting, abdominal pain
Fastigial
→ Ladder-like curve of temperature, rose spots on trunks, splenomegaly
Defervescence
→ Fever gradually subsides, onset of complication such as hemorrhage,
peritonitis
Convalescence or recovery stage
Laboratory and Diagnostic Thypidot test
Examination
Treatment Chloramphenicol
Prevention and Control Measures Directed to Reservoir
→ Case detection and treatment
→ Isolation
→ Disinfection of stools and urine
→ Detection and treatment of carriers
Measures at Routes of Transmission
→ Water sanitation
→ Food sanitation
→ Excreta disposal
→ Fly control
Measures for Susceptible
→ Immunoprophylaxis
→ Health education
Nursing Care Practice enteric precaution and observe character of stool for signs of bleeding
 DYSENTERY
Causative Agent Shigella dysenteriae
Mode of Transmission Ingestion of contaminated food or water
Incubation Period 3 – 4 days
Signs and Symptoms High grade fever
Colicky abdominal pan with tenderness
Diarrhea with straining, bloody mucoid stool
Laboratory and Diagnostic Fecalysis
Examination
Treatment Co=trimoxazole
Chloramphenicol
Prevention and Control Safe water supply
Handwashing
Nursing Care I & O monitoring
Increase OFI
Prevent dehydration

CHOLERA
Causative Agent Vibrio cholerae (El tor)
Mode of Transmission Ingestion of contaminated food or water or milk
Incubation Period 1 – 3 days
Signs and Symptoms Rapid explosive diarrhea and vomiting
Laboratory and Diagnostic Fecalysis
Examination
Treatment Tetracycline
Furazolidone
Prevention and Control Safe water supply
Handwashing
Sanitary disposal of human waste
Vaccine
Nursing Care I & O monitoring
Increase OFI
Prevent dehydration
 MEASLES
Causative Agent Morbilli virus (family paramyxoviridae)
Mode of Transmission Airborne
Incubation period 8 – 20 days, ave. of 10 days
Signs and Symptoms Dry cough and runny nose
Body pains and headache
Sore throat
Watering and swelling in eyes
Discomfort and fatigue
Loss of appetite
Diarrhea
Light sensitivity
Inflammation in lymph nodes
Koplik’s Spots (blue and red spots in the mouth)
Laboratory and Diagnostic Tissue culture of naso-pharyngeal secretions and serological testing
Examination
Treatment Supportive care, antibiotic if with pneumonia
Prevention and Control MMR vaccine (9 mos and 12 mos)
Nursing care Antipyretic
Provide eye, nasal and oral care
Strict isolation
Increase OFI

MUMPS
Causative Agent Mumps virus (family paramyxoviridae)
Mode of Transmission Airborne or droplets
Direct contact
Incubation Period 16 – 18 days, range of 14 – 25 days
Communicability Period 2 – 4 days before onset of parotitis but range can be 7 days before to 15 days after
onset
Signs and Symptoms Fever
Headache
Swollen glands under the ears or jaw
Muscleache
Tiredness
 Complications (meningoencephalitis, permanent hearing impairment, orchitis in
post pubescent males, but rarely sterility)
Laboratory and Diagnostic Isolation of virus from oral and throat spray
Examination Urine and cerebrospinal fluid
Treatment Supportive care
Prevention and control MMR Vaccine (9 mos and 12 mos)
Nursing Care Apply warm and cold compress for pain on affected area, strict isolation, use of
mask when handling patient, terminal disinfection, provide oral care and soft to
semi-solid food

RUBELLA AND GERMAN MEASLES

Causative Agent Rubella virus family togoviridae
Mode of Transmission Droplet of direct contact with nasopharyngeal secretions of infected person
Incubation Period 10 – 21 days
Signs and Symptoms Fever
Headache
Malaise
Maculopapular rash
Enlarged post auricular occipital and posterior cervical lymphadenopathy
Sore throat
Rhinitis
Conjunctivitis
Bronchitis
Forchheimer’s spot on soft palate
Laboratory and Diagnostic Serological testing
Examination
Treatment Supportive care but for exposed pregnant woman in 1st and 2nd trimester, serum
immunoglobulin is administered to protect the fetus
Prevention and Control MMR Vaccine (9 mos and 12 mos)
Nursing Care Antipyretic, increase OFI, bedrest
 CHICKEN POX
Causative Agent Varicella Zoster Virus
Mode of Transmission Droplet or indirect contact with droplets from respiratory passages or vesicle fluid
Incubation Period 14 – 16 days, range of 2 – 3 weeks
Signs and Symptoms Body malaise
Fever
Itchy vesiculo-pustular lesions first appearing on the chest and trunk spreading to
extremities
Treatment Supportive care, anti-viral drugs
Prevention and Control Immunization (Varivax) for 2 doses at 12 to 18 mos
Nursing Care Antipyretic, strict isolation, handwashing, trim fingernails, daily bath

POLIOMYELITIS
Causative Agent Legio debilitans or poilio virus
Mode of Transmission Fecal-oral
Droplet
Incubation Period 7 – 21 days
Types and Signs and Abortive
Symptoms Fever, sore throat, low lumbar backache/cervical stiffness on anteflexion of spine
Non-Paralytic
Recurrence of fever, poker spine, tightness and spasm of hamstring,
hypersensitiveness of the skin, deep reflexes are exaggerated
Paralytic
With paralysis depending on part affected
Laboratory and Diagnostic Blood and throat culture
Examinations Fecalysis
Lumbar tap
Treatment Supportive and symptomatic care
Prevention and Control Proper disposal of fecal waste, handwashing, proper preparation of food and
immunization of OPV (3 doses)
Nursing Care Enteric isolation, bed rest, passive ROM exercises

PARASITIC INFECTION
Ascariasis Enterobiasis Ancylostosomiasis Schistosomiasis
Causative Agent Ascaris Enterobius Ancylostoma Schistosoma
lumbricoides vermicularis (human duodenale japonicum, S.
(round worm) pinworm or mansoni, S.
seatworm) haematobium
Vector: Oncomelania
quadrasi (snail)
Mode of Transmission Fecal-oral Vehicle-ingestion of Contact Indirect contact
contaminated food
Incubation Period 8 weeks 4 – 6 hours 4 – 6 weeks 2 months
Signs and Symptoms Abdominal pain Perianal itching, Dermatitis, Rash at site of
and passing out disturbed sleep and abdominal pain, inoculation,
of worms nervousness, anemia, mentally and enlargement of the
irritability physically abdomen, diarrhea,
underdeveloped body weakness
Laboratory and Diag. Fecalysis Scotch tape swab Fecalysis Fecalysis
Exam. test
Treatment Mebendazole or Mebendazole single Mebendazole Praziquantel
Albendazole dose repeated at 2nd (Biltricide),
week for effectivity Oxamniquine for S.
mansoni and S.
haematobium
Prevention and Control Proper disposal of feces, handwashing, proper washing of Proper irrigation
vegetables before consumption, personal hygiene, proper of all stagnant
preparation, avoid walking barefooted bodies of water
 Prevent exposure
to contaminated
water
Eradication of
breeding sites
(snails)
Use of
molluscides

RABIES
Causative Agent Rhabdovirus
Mode of Transmission Bite of rabid animal (saliva)
Incubation Period 20 – 90 days (humans)
1 week to 7.5mos (dogs)
Laboratory and Post-mortem direct fluorescent antibody staining test
Diagnostic Examination
Signs and Symptoms Dogs Uncoordinated
Changes in attitude and behavior Paralysis
Changes in bark Pica (appetite for non-nutritious
Dropped jaw substances)
Excessive salivation Seizures
Extreme excitability Shyness or aggression
Fever Unable to swallow
Humans
Prodromal Excitative Paralytic/Endstage
Lasts 1-3 days “mad-dog” phase Foaming at the mouth
Loss of appetite Lasts less than a week Slack jawed
Lethargy Sometimes skipped appearance
Intermittent fever Lack of coordination, Full body paralysis,
Irritability twitching, and/or which results in death
seizures It should be noted that
Aggressive behavior the virus can remain
Restlessness and active inside a dead
roaming animal for 48hrs
 Lack of recognition for
familiar people and
places
Lack of fear toward
natural predators
Nursing Care Isolate
Encourage family to provide care and compay
Darken room and observe silence
Give food if patient is hungry
Keep water out of sign
Observe universal precaution, which are essentially wearing gloves
Wash hands frequently
Remove oral and nasal secretions
Dispose contaminated materials
Perform terminal disinfections
Treatment (post Wash wound with soap and water and seek consultation
exposure treatment for Administer ATS/TT; suturing for severe wounds
dog bites) Observe dog for 10 days
Recommended vaccines (active)
→ PCVC (purified vero cell vaccine) – 0.1ml
→ PDEV (purified duck embryo vaccine) – 0.2ml
Multi-site IM schedule (2-1-1)
→ Day 0 – 2 doses
→ Day 7, 21 – 1 dose
2 site ID regimen (2 doses each)
→ Day 0, 3, 7, 30
→ Deltoid, ID
Recommended immunoglobulins (passive) IM
→ Given at day 0
→ Equine rabies = KBW x 2.0ml
→ Human rabies = KBW x 0.133ml
Prevention and Control Pre-exposure prophylactic treatment for high-risk individuals
Vaccination of dogs/pets
 RABIES
CATEGORIES OF CONTACT WITH SUSPECT RABID ANIMAL POST-EXPOSURE PROPHYLAXIS
MEASURES
Category 1 None
Touching or feeding animals, licks on intact skin
Category II Immediate vaccination
Nibbling of uncovered skin, minor scratches or abrasions Local wound treatment
Category III Immediate vaccination and
Single or multiple transdermal bites or scratches, contamination of mucous administration of rabies immunoglobulin
membrane or broken skin with saliva from animal licks, exposures due to direct (RIG)
contact with bats Local wound treatment

LEPTOSPIROSIS
Causative Agent Leptospira interrogans (bacteria)
Mode of Transmission Inoculation into broken skin, mucous membrane or ingestion of contaminated food
and water with urine of animals
Incubation period 7 – 13 days
Laboratory and Blood/urine culture done on the 1st weeks
Diagnostic Examination Leptospira Agglutination test (LAT) done on 2nd to 3rd week
Signs and Symptoms Sepsis stage (4-7 days) – high fever, calf and abdominal stage
Immune/toxic stage
→ Anicteric stage – disorientation
→ Icteric stage – jaundice
Convalescence – symptoms will disappear but relapse may occur at 4th – 5th weeks
Treatment Doxycycline, penicillin or tetracycline
Prevention and Control Eradication of rodents, avoid wading in flood water
Nursing Care Symptomatic/supportive, increase OFI
 SCABIES
Causative Agent Itch mite, sarcoptes scabiei
Mode of Transmission Prolonged skin contact with infected human or indirect contact with infested linens or
clothing
Incubation Period 4 – 8 weeks
Laboratory and Scraping of skin off burrow, ink test, mineral oil or fluorescence tetracycline test
Diagnostic Examination
Signs and Symptoms Itchy papulo – vesicular eruptions on warm fold and areas of friction of the body
Treatment Permethrin cream or scabicide lotion applied to all areas of the body from the neck
down to the feet and toes
Prevention and Control Laundry and iron soiled clothes, practice personal hygiene, terminal disinfection
Nursing Care Contact isolation

ANTHRAX
Causative Agent Bacillus anthracis
Mode of Transmission Cutaneous (skin) anthrax
Inhalational anthrax
Gastrointestinal anthrax
Laboratory and Gram staining (+)
Diagnostic Examination
Treatment Formaldehyde, fluoroquinolones, ciprofloxacin
Prevention and Control BioThrax, although it is commonly called Anthrax Vaccine Absorbed (AVA)
Signs and Symptoms Fever and chills Nausea, vomiting, or stomach pains
Chest discomfort Headache
Shortness of breath Sweats (often drenching)
Confusion or dizziness Extreme tiredness
Cough Body aches
 SEXUALLY TRANSMITTED INFECTIONS (STI)
4Cs in Syndromic Case Management for STI
1. Compliance 3. Contact tracing
2. Counselling and education 4. Condom use
 HIV/AIDS
Causative Agent HIV 1 and HIV 2
Mode of Transmission Sexual contact
Blood transfusion
Contaminated syringes, needles, nipper, blades
Direct contact of open wounds/mucous membranes with contaminated blood, body,
fluid, semen and vaginal discharges
Incubation Period Varies from 3 – 6 months to many years (8 – 10 years)
Signs and Symptoms

Laboratory and Enzyme Linked Immuno Sorbent Assay (ELISA) test – Presumpite test
Diagnostic Examination Western Blot – confirmatory test
Treatment Antiretroviral drugs that suppress the virus
Prevention and Control Blood and blood products
→ Screen blood donors
→ Observe universal precaution
→ Refrain from using contaminated needles and syringes
Sexual transmission
→ Abstain from promiscuous sexual contact
→ Be faithful to your partner
→ Follow correct and consistent use of condoms
Mother to Child
→ For HIV (+) mothers, consult with health workers to have access to care,
treatment and support to services during pregnancy, labor and delivery, and
postpartum
PrEP or Pre-Exposure Prophylaxis for Peopleat High Risk by taking drug Truvada
RA 11166 of 2018 An Act Strengthening the Philippine Comprehensive Policy on Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)
Prevention, Treatment, Care, and Support, and Reconstituting the Philippine National
Aids Council (PNAC), Repealing for the Purpose Republic Act No. 8504, otherwise
known as the “Philippine Aids Prevention and Control Act of 1988”, and Appropriating
Funds Therefor

EMERGING INFECTIOUS DISEASES

Department Memorandum No. 2022-0501: Interim Revised Case Definitions for COVID-19
A. Suspect, Probable, and Confirmed Case
I. Suspect Case
a) A person who meets either clinical OR epidemiological criteria
Clinical Criteria:
1. Acute onset of fever AND cough (influenza-like illness); OR
2. Acute onset of ANY THREE OR MORE of the following signs or symptoms: fever, cough,
either general weakness or fatigue, headache, myalgia, sore throat, coryza, dyspnea,
nausea, diarrhea, anorexia
OR
Epidemiological Criteria:
1. Contact of a probable or confirmed case or linked to a COVID-19 cluster; or
b) A patient with suspect, probable, or confirmed severe acute respiratory illness (SARI) as defined
in the Philippine Integrated Disease Surveillance and Response (PIDSR) Manual of Procedures
c) A person:
i. With neither clinical signs or symptoms NOR meeting epidemiologic criteria, AND
ii. With a positive professional use OR self-test SARS-CoV-2 rapid antigen test
II. Probable Case
a) A person who meets BOTH clinical and epidemiological criteria as stated above; or
b) Death, not otherwise explained, in an adult with respiratory distress preceding death AND who
was a contact of a probable or confirmed case or linked to a COVID-19 cluster
III. Confirmed Case
a) Any individual, regardless of presence or absence of clinical signs and symptoms OR
epidemiological criteria, who was laboratory confirmed for COVID-19 in a test conducted at the
national reference laboratory, a subnational reference laboratory, and/or DOH-licensed COVID-
19 testing laboratory; OR
b) Any individual meeting suspect case criterion A or probable case criteria testing positive using
rapid antigen tests in areas with outbreaks and/or in remote settings where reverse
transcription-polymerase chain reaction (RT-PCR) is not immediately available; provided that
the antigen tests were done by a trained health professional AND satisfy the recommended
minimum regulatory, technical, and operational specifications set by the Health Technology
Assessment Council, the list of Food and Drug Administration (FDA) certified, and Research