Health officials, struck dumb by the unwelcome return of polio, have raised warning signals against diphtheria, an infectious disease that has emerged in some parts of the country due to low vaccination coverage.
READ: PH polio-free no longer; virus reemerges; DOH warning out
The Department of Health on Tuesday said cases of diphtheria—a bacterial infection affecting the nose and throat—were reported in a number of regions including the Cordillera Administrative Region.
“In the last few months, we have also discussed as well several cases of diphtheria emerging as well in some regions of the Philippines,” DOH medical specialist Anthony Calibo said during a Senate hearing on the government’s immunization program.
“There was also an issue of availability of diphtheria anti-toxin because that will also be an important management for those diagnosed with diphtheria,” he added.
With the confirmation of two polio cases, and the continuing incidence of measles and dengue cases, Senator Christopher Go gave assurances Tuesday he would work for the restoration of the P10- billion cut in the proposed budget of the DOH for 2020.
“I will appeal to the Department of Budget and Management. We will talk here in the Senate with the chair of finance on how we can help specially the Health Facilities Enhancement Program,” said Go, chairman of the Senate committee on health and demography.
He also vowed to help restore the P90-million budget slash in the budget of the Research Institute for Tropical Medicine.
“We have discussed the importance of the national immunization program of the DOH. The recent declaration of at least two cases of polio and discovery of the virus in Manila and Davao points to the urgency of situation. We must work hand in hand to address this. The committee has heard the position of the DOH and the other experts,” Go told reporters in an interview.
READ: Half of Manila kids under 5 got polio vaccine
Go also promised to work with the DOH to find short and long term solutions to improve the immunization programs and increase the coverage of immunization for polio, measles and other preventable diseases.
At the same time, he renewed his call to the public to have their children vaccinated.
“Trust the government. The Dengvaxia controversy is an isolated case, but this polio vaccine, you need this. Go to the health centers. Be informed and participate in the public campaign to promote better hygiene as the viruses can be transmitted through contaminated food and water,” said Go.
Speaking in the Senate public hearing on the DOH immunization program, the agency’s Medical Specialist IV Dr. Anthony Calibo told Go’s panel confirmed a polio outbreak with two cases found—in Lanao del Sur and Calabarzon region.
“There’s an outbreak already of polio. Compared with the previous year, there was (sic) no polio cases,” said Calibo.
He said a polio-related event or biologic finding in the sewage of Manila added up that indeed, the threat of polio had emerged in the Philippines.
He also mentioned about the RITM findings on the sewage canal sample detected with poliovirus.
Responding to the query of Senator Nancy Binay, Calibo said the polio vaccine coverage for 2018 was 66 percent.
He said this was a drop from the 2017 coverage, a third dose of our polio from 71 percent.
But the trend, he said, went from 74 in 2014, 75 in 2015 and down to 68 percent over the third dose of our polio.
Calibo also said that 2018 has the lowest coverage of oral polio vaccine. He said the third dose of polio is the last to be given in our public health facilities, our rural health, our rural health units and barangay health centers.
“And this is coupled with an inactivated polio vaccine which is injected, not given orally.”
Unfortunately, he said the coverage compared to its oral polio counterpart is also very low.
In 2016 when the polio vaccine was started, Calibo said we only have 31 percent of children receiving the inactivated polio vaccine.
In 2017, it was only 41 percent and in 2018, it was only 33 percent.
According to Calibo, one determining factors why this proved to be very difficult is multiple vaccinations.
This may also deter some parents to allow it because two injections will be administered to an infant.
“This is a bit uncomfortable already to the infant. This is a three and a half infant receiving two vaccines,” said Calibo, adding that the supply issues may also compound the problem.
With regards to measles for the first dose, he said that in 2014, 67 percent of vaccine coverage. He said there have been improvements of first dose measles given nine months.
This reached as high as 79 percent in 2015, but decreased to 75 percent in 2016 and went down to 70 percent in 2017. It further declined to 67 in 2018.
“This is where the need for a second dose to be given at one-year-old or 12 months to make sure that the full protective effect of two-dose vaccination will ensure the protection of a child,” he said.
Unfortunately, he said that the 2018 measles for the second dose is only 58 percent.
“This is only the reason why we have a measles outbreak that happened of which the government addressed this with supplemental immunization all throughout the country,” further stated Calibo.
According to medical experts, diphtheria is a contagious disease that usually infects the nose and throat.
The hallmark sign is a sheet of grayish material that covers the back of the throat. It is rare in the Western world, but it can be fatal if left untreated.
In countries where there is a lower uptake of booster vaccines, however, such as in India, there remain thousands of cases each year.
In 2014, there were 7,321 cases of diphtheria reported to the World Health Organization, globally.
In people who are not vaccinated against the bacteria that cause diphtheria, infection can cause serious complications, such as nerve problems, heart failure, and even death.
Overall, 5 to 10 percent of people who get infected with diphtheria will die. Some people are more vulnerable than others, with a mortality rate of up to 20 percent in infected people under five years or older than 40 years of age.
Individuals affected by diphtheria, an infection caused by the bacterium Corynebacterium diphtheria, would develop a thick covering called “pseudomembranes” at the back of their throats. These thick
layers block the person’s airways, causing difficulty in breathing.
In severe cases, the disease can also weaken the heart muscles, cause chest pains, and may even lead to heart failure.
Recent data from the DOH shows a relatively low incidence of diphtheria in the Philippines. In 2018, there were a total of 55 confirmed diphtheria cases, including 13 deaths.
Fast facts on diphtheria:
・ Before the development of treatments and vaccines, diphtheria was widespread and mostly affected children under the age of 15.
・ Some of the symptoms of diphtheria are similar to those of the common cold.
・ Complications include nerve damage, heart failure and, in some cases, death.
・ Diagnosis is confirmed by swab specimens and laboratory testing.
・ Treatment is with antitoxin and antibiotics while the patient is isolated and monitored in intensive care.
Vaccination remains as the most successful and cost-effective prevention for the disease, the World Health Organization said.
In the Philippines, infants are encouraged to undergo three doses of the combination vaccine DPT to counter diphtheria.
The Health Department’s Epidemiology Bureau earlier attributed the prevalence and reemergence of infectious diseases to the low immunization coverage in the country.
DOH said the immunization programs was understaffed.
READ: National polio vaccination drive kicks off in Manila