Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

March
1, 2019
DEPARTMENT MEMORANDUM
No. 2019-_ 6) 4}

TO: CENTERS FOR HEALTH AND DEVELOPMENT

DIRECTORS, MEDICAL CENTER CHIEFS AND
CHIEFS OF HOSPITALS, AND OTHER CONCERNED
UNITS

SUBJECT: Advisory on Dengue Preparedness and Outbreak Response

Dengue is considered as the most important mosquito-borne viral disease in the

world. The virus has four circulating serotypes (DENV1, DENV2, DENV3, DENV4)
transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Symptoms range from mild
fever, persistent vomiting, lethargy and to potentially fatal severe dengue characterized by
severe plasma leakage leading to shock, fluid accumulation, severe bleeding and severe organ
impairment. Dengue outbreaks exert a huge burden on populations, health systems and
economies.

From January 1 to February 16, 2019, there are thirty-one thousand seven hundred
thirty-three (31,733) dengue cases reported to the PIDSR. The number of dengue cases
increased up to 61% higher compared to the same period last year (19,752 cases). Moreover,
the year 2019 is anticipated as possible dengue outbreak year due to switching of circulating
dengue virus serotype. In view of the increasing trend of dengue in some parts of the country,
all Centers for Health Development (CHDs) DOH ARMM, Local Government Units (LGUs),
Department of Education (DepEd), Department of Interior and Local Government (DILG),
schools and other partners are hereby informed and reminded of these guidelines:

This memorandum provides guidance and directives to all Centers for Health
Development and DOH Hospitals on the management of dengue cases and response to
outbreaks in all primary care facilities and hospitals.

I. PREVENTION AND CONTROL

1. Implement Enhanced 4S-Strategy pursuant to Administrative Order No. 2018-0021
dated 25 July 2018.
a. Search and destroy mosquito breeding sites
b. Secure self-protection
c. Seek early consultation
d. Support fogging/spraying only in hotspot areas where increase in cases is
registered for two consecutive weeks to prevent an impending oufbreak.
2. Reactivate Dengue Task Force

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1413
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e¢ URL: http://www.doh.gov.ph; e-mail: ftduque@dohl gov.ph
 3. Intensify health education and awareness campaign against Dengue (refer to
Philippine National Aedes-borne Viral Diseases Prevention and Control Program
(NAVDPCP) Manual
IEC materials)
of
Procedure (MOP), Volume 5. Health Promotion for sample

II. CASE MANAGEMENT Refer to Philippine NAVDPCP MOP, Volume 4. Clinical

Case Management and follow the Algorithm for Dengue Diagnosis and Management

A. Primary Care Facilities

Assessment/Recognition of Infection
a. Perform quick assessment using the Dengue Patient Diagnosis and
Algorithm
b. Patients not needing confinement, parents and caregivers must be
properly instructed on home care and detection of dengue warning signs.

B. Hospital
1. Triage
a. Nocases, whether suspected or probable dengue, shall be refused.
b. Reactivate dengue fast lane.
c. to
Place visible signs at the facility directing patients a “fast lane”
d. Designate Hospital Navigators to assist dengue patients
e. Limit companion to one per patient as appropriate.

2. Isolation of Cases
a. Provide a separate room for dengue patients and ensure that the doors and
windows are provided with long lasting insecticide treated
curtains/screens.
Dengue ward shall be installed with Long Lasting Insecticide Treated
Nets (LLINs) or provided with mosquito bed nets.
Attending health workers and patient caregivers are encouraged to wear
protective clothing and use insect repellents.

3. Strengthen Service Delivery Network

Ill. LOGISTICS
a. The Centers for Health Development (CHDs) shall provide/ augment dengue
supplies and commodities to health facilities (i.e. Long Lasting Insecticide
Treated Nets (LLINs), larvicides, adulticides, Ns! RDT)
b. Conduct regular inventory of dengue supplies up to Facility Level and submit
timely request for replenishment every Sunday to Supply Chain Management
Office.

IV. OUTBREAK RESPONSE Refer to Philippine NAVDPCP MOP, Volume 6.

Outbreak Preparedness and Response

A. Prioritize areas for community-based intervention

1. Criteria for prioritization
Clustering of cases
Location adjacent to a barangay with active cluster
of
aogp
Number weekly cases
Occurence of an outbreak in the past years
Recent. dengue-caused deaths
mo
Vector indices (refer to Volume 2: Vector, Virus and Case
Surveillance)
 g. Population density
h. Presence of informal settlers (i.e indigenous population, etc.)
i. Presence of schools, hospitals

B. Create Regional Dengue Task Force and designate Dengue Control Officer (refer to
DPO No. 2019- 1001 dated March 1, 2019 re: Creation of Task Force for Prevention,
Control and Response to Dengue Outbreak

V. DISEASE SURVEILLANCE AND REPORTING

A. Collect Dengue Cases and Deaths by Morbidity Week and Report to
Epidemiology Bureau (PIDSR Manual of Operations, 3rd Edition Vol. 1)
B. Submit Dengue Outbreak Phase Response Report every Sunday using the
prescribed template in the Annex 6, Philippine NAVDPCP MOP, Volume 6.
Outbreak Preparedness and Response to
idped.avd2018.doh@gmail.com.

V) MISCELLANEOUS PROVISIONS
A. All CHDs shall coordinate and/or partner with stakeholders (i.e. DILG, DepEd,
LGUs, and other regional government offices) in the conduct of outbreak
response.
B. All CHDs and Medical Center Chiefs to coordinate with PhilHealth on the dengue
benefit package and point-of-service (POS) enrolment.
C. All CHDs to ensure the availability of the Philippine NAVDPCP MOP
levels.
atall

By Authority of the Secretary of Health:

A C. CABOTAJE,
Undersecretary of Health
MD, MPH, CESO
III
Public Health Services Team
Annex 6. Template for Preparing an AVD Outbreak Phase Response Report

Aedes-borne Viral Diseases Outbreak Phase Response Report

Name of the Reporting Unit/Facility:

Name of Coordinator:
AVD
Date prepared:

Response Steps Done? If done: If not done: Other

strategy Yes No remarks
Case surveillance |e Update the outbreak What were the updates? Why was the
investigation report updating not done?
as necessary.

Laboratory- For dengue and How many samples were Why

were blood
based chikungunuya: taken? samples not taken?
surveillance Collect blood samples When will the samples be
from 5-10% of the sent for lab
suspected cases for confirmation
laboratory testing and
confirmation by the
national reference

36
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