EPI 201

Name: Lester B. Abad Score: _____________

Student No: 2018-30053

General Direction: Write a short report (in 250-300 words) about the findings of Ching et. al. (2015) for
the general public. (Note to the student: it has to be simple, easily understood and will not incite panic. The
deadline of submission is March 4, 2019).

Investigation Report on Henipavirus Outbreak

in the Philippines, 2014

A. Purpose of Investigation

April 2, 2014 – the Philippines National Epidemiology Center (NEC) received a report of
human death cases in two villages of Senator Ninoy Aquino, Sultan Kudarat. Due to this, an
outbreak investigation was immediately organized by NEC to identify the source of infection, its
etiologic agent, mode of transmission and incubation period.

B. Investigation

An outbreak investigation conducted by NEC revealed additional cases of human deaths,

nonfatal infections, neurologic disease, and sudden deaths among horses. With the help of WHO,
an in-depth investigation was done on May 22-24, 2014.

Gathering of relevant information was done among case-patients and family members of
the deceased. Key informants from local animal health agencies were also interviewed and hospital
records of the suspected cases were reviewed. The investigation team defined a human case as
illness in any person with epidemiological link to the said municipality and who had experienced
acute encephalitis syndrome, sever influenza-like illness (ILI), or meningitis during March 3- May
24, 2014.

A total of 17 cases that met the case definition. It was found out that, 11 out of 17 cases
presented signs of acute encephalitis syndrome with 82% case fatality rate. Median incubation
period for case-patients with known exposure was 8 days. 7 (41%) case-patients had participated
in horse slaughtering and horse meat consumption; and 3 (18%) on the other hand, had only
consumed horse meat. In addition, 5 (29%) had been exposed to other human case but not to any
horse; 2 of them were health workers from the hospital were the initial cases were referred, 2 cared
for case-patients in their home and 1 helped in transporting a case-patient to a hospital. Samples
collected from the surviving case-patients were all positive for Henipavirus. Moreover, 10 horse
death were recorded. 2 were found dead, and all but 1of the others showed signs neurologic
condition.

It was concluded that the outbreak was caused by Henipavirus. The mode of transmission
of the disease direct contact to contaminated respiratory secretions of infected horse and human. It
may also be acquired by consuming the meat of an infected horse. The incubation period of the
disease is 8 days. Its major clinical presentation includes influenza-like symptoms, neurologic
problems. The source of horse infection is unclear; however based on known ecology of the disease
is most likely to be fruit bats.
C. Recommendation

o Coordinate with DAR for possible intervention regrading Henipavirus infection among horses.
o Implementation of safety precautions policy in horse slaughtering.
o Use of maximum PPE among health personnel in handling suspect case and implementation of
standard infection control in all referring facility.
o Further investigation to determine source of infection among horses.