The Sandy Project: Read how losing her daughter inspired helping others

The Sandy Project: ‘I lost my daughter to dengue – nobody should suffer this pain’

The Sandy Project draws from her intense pain from her own loss. Peaches Aranas reaches out to communities in the Philippines so that no mother will lose her child to dengue again.

It was February 2013 when my only daughter Sandy caught dengue and unexpectedly passed away seven days later. She was only 10 years old. She had the disease for just seven days! We detected it early and she was hospitalized on day two of her fever. We were in the best hospital and had the best medical care. And yet, we still lost her.

Four years later, I feel like I have not even touched the surface of the pain of losing my daughter. I told myself, ‘I have to do something.’ Imagine, one second was all it took. One second for that mosquito to infect my daughter, for me to lose her. That realization is not easy. One second changed our lives forever. That’s how dangerous dengue is, and yet we took it for granted, and so many still do not take it seriously. Don’t think it can’t happen to you.

Losing her changed me. There is a black hole that’s too deep, I don’t even know its bottom. There are an emptiness and a longing that is choking and suffocating. But every day, the sun rises and I can’t stop it. The rays are bright and beautiful and shine on my emptiness. I just learned to see that and appreciate it for what it is, a ray of hope.

This is a tragedy I had vowed no other parent or child should suffer, so later that year, I launched, “The Sandy Project.”

It’s a self-funded advocacy initiative that I hope will help bring down the dengue menace and bring honor to the memory of my unica hija.

Dengue in Davao: Zarah went to the Philippines for work and wound up in hospital

When she passed away, it really broke our hearts and broke our whole family. We didn’t know what hit us. So as a way to cope, I thought of doing something to leave a legacy for Sandy, so her life would not have been for naught.

The Sandy Project is a gift that I want to give to fathers, mothers, and siblings who can lose a loved one to dengue.

Together with partners from the public and private sector, the Sandy Project goes to schools and localities and educates children and parents on the importance of preventing and protecting against the deadly dengue virus.

The campaign provides children and its beneficiaries with anti-mosquito sprays and lotions, mosquito nets and other anti-insect medicine and equipment, and teaches children about dengue through games, songs, dances, and books that are also given away to communities to aid their dengue education efforts. Just recently, we came out with a book, slippers, and a Dengue NS1 test kit to give away.

The campaign has a dual focus – an awareness component and a prevention component. The book came about to address the awareness component. It is a poem where a little girl named Sandy talks about what could have been if she were water, fire, wind, or earth. It goes on with the little girl talking about herself, about dengue, and about the power of many kids put together to defeat dengue. The book seeks to address the (dengue) awareness part of the campaign.

The slippers and the (dengue) test kit seek to address the prevention part of the campaign. Every morning, when the children wake up and put on their slippers, they will be reminded of The Sandy Project and Sandy. The slippers have button pins with a picture of the logo of The Sandy Project or of a scary-looking mosquito or an anti-dengue button. This will remind them to check their surroundings for stagnant water. Every time they put on the slippers, it serves as a reminder to them.

The test kit is to give them an early and easy way of checking if they have dengue. They don’t need to go to the hospital and wait so long. They won’t also need to pay so much. With the home test kit, which I plan to give to the health centers, early detection is possible.

I share Sandy’s life story and our horrible weeklong experience of fighting this virus with the children, in the hope that they will crusade with me in fighting dengue and saving lives.

I hope I can reach 5,000 kids a year. That’s the amount I can afford, out of my own pocket, even without donors. It is also our family’s gift to Sandy to honor her short life with a legacy that speaks of purpose and hope. And it is my humble gift to God, in thanksgiving, for the blessing of 10 years with a beautiful daughter. It is a reminder that we are but stewards of this earth.

Has doing this helped in coping with my daughter’s loss? I’m not sure. To be honest, I don’t even know if I am coping. I haven’t reached the bottom of my pain. I think I’m only at the surface.

What I do know is that losing Sandy is not an experience I wish even on my worst enemy.

To all the parents out there, you are so blessed if you can still touch and embrace your children. You are so blessed if you can watch them grow up. Right before your very eyes, you witness the changes in them, the way they are, their thoughts, interests, and passions. I really wish I could do the same. I really wish I can have new experiences, memories, and pictures of and with Sandy.

Dengue is different: why the dengue vaccine is still needed

The truth is, because of dengue, I will never have another day with her.

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Click below to learn more about dengue fever and how to prevent it.

Dengue perspectives

Dengvaxia rollout: full steam ahead, despite challenges

The Denvaxia rollout continues as more countries around the globe approve the world’s first dengue vaccine.

In April, Argentina and Malaysia joined 14 other countries to have already given the dengue vaccine a green light. A total of 16 countries approved Dengvaxia for rollout to date.

French drugmaker Sanofi Pasteur has focused on the most vulnerable countries, with the goal of getting the product to at least 30 endemic countries before taking the Dengvaxia rollout to more developed regions.

When Dengvaxia was first launched, analysts expected sales to hit 200 million euros by the end of 2016. After all, the dengue vaccine was highly anticipated, took 1.5 billion euros, and nearly 20 years to develop. But, the company pulled in only a quarter of the sales predicted by some forecasters and sales are still lagging.

The culprits? Political and economic turmoil in Latin America and parts of Asia. The Philippines saw a change in administration following the launch of its public health vaccination program against dengue fever. In the Philippines, the vaccine remains widely recommended by pediatricians and is popular in the private market.

Presidential changes in Argentina, Brazil, and Peru followed an overall decline in the region’s economy, and likely slowed the approval and implementation of public health programs.

The Brazilian state of Parana which has seen a three-fold increase in dengue incidence over the last few years made up most of the Dengvaxia sales in 2016.

In Parana, individuals ranging from age 15 to 27 from 30 municipalities were vaccinated against dengue fever in the Parana dengue vaccine program in August of 2016. Heath officials are hoping to see a decrease of 74 percent in cases over the next five years.

The first ever public immunization program was launched in the Philippines in April last year, where close to 600,000 public school students from 6,000 schools received the first dose. According to a study done by the University of the Philippines National Institute of Health, the vaccine program is expected to reduce dengue cases by over 24 percent in the next five years if the vaccination rate is unhampered.

Towards regional mobilization

So far, only the Philippines and Parana have announced public health vaccination programs. Sanofi Pasteur says it expects more regulatory decisions on the vaccine throughout 2017.

At the recent 2nd Asia Dengue Summit, there was a shift for the ASEAN region to move towards regional collaboration. At the conference, chairman of the Global Dengue and Aedes-Transmitted Diseases Consortium Professor Duane Gubler said regional collaboration could work, as it did with the Yellow Fever epidemic that gripped the American region back in 1946.

“We know that we can do it if we have the dedication and if we use the right approaches,” he said in a panel discussion. “The fact remains that this vaccine if we use it properly, will decrease transmission. It will decrease epidemic activity, decrease the frequency of the epidemic. It’s been shown that it nicely decreases severe disease, it decreases hospitalization and, therefore, it will decrease deaths.”

University of the Philippines College of Medicine’s Dr. Lulu Bravo, addressing the role of politics, said it would be better if lawmakers left the safety surrounding the dengue vaccine and the evaluation of Dengvaxia, to the health experts. “We should not put this in the hands of politicians because the experts and the scientists have already produced the evidence.” Asian Dengue Vaccination Advocacy chairperson Prof. Usa Thisyakorn says, “We did not see any safety concerns. It is safe, so that’s the first key thing. If it’s not safe, then it will not go on and on with any trial.”

Despite all the challenges, regional medical expert Dengue Asia JPAC, Anh Wartel-Tram told Break Dengue, Sanofi Pasteur is running at full capacity. “We produce 100 million doses a year,” she says. “Asia has 70 percent of the dengue burden, which means 1.8 billion people are at risk.”

Addressing the challenges the vaccine has faced, Anh says, “From the company’s perspective, as it is a new vaccine, the challenge really is that we need to have multiple stakeholders in terms of engagement and commitment. We also need to convey the right message to the private and public sectors in understandable and lay language. Bringing this message to the public is essential.”As with most vaccines, it may take a while for results of Dengvaxia’s public vaccination program to show, but some triumphs for the dengue vaccine are now apparent.

As with most vaccines, it may take a while for results of Dengvaxia’s public vaccination program to show, but some triumphs for the dengue vaccine are now apparent. The Philippines’ Central Luzon Department of Health chapter, which ran its third and final round of anti-dengue vaccinations last April, reported to local media that the program saw some 200,000, grade-school students vaccinated from seven provinces. DOH Regional Epidemiology and Surveillance Unit Head Jessie Fantone says that since the first immunization reported cases fell 50 percent.

While the Dengnvaxia story is taking a little longer to unfold than might have been expected, successful rollout in the Philippines and Parana, Brazil, set the stage for wider adoption.

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Dengue Track

Working towards a dengue-free Philippines: a look at the country’s vaccination program

Lessons and challenges from the first country in the world to vaccinate in a public health program.

Could a dengue-free Philippines be on the horizon? The populous southeast Asian nation is moving in the right direction but the dengue burden remains high.

For many doctors and public health stakeholders, the Philippines taking the lead in providing its citizens with a free dengue vaccine couldn’t have been more appropriate. Professor Tikki Pang of Singapore’s Lee Kuan Yew School of Public Policy says it’s the country coming full circle.

“The first dengue epidemic was recorded in the Philippines in the 1950s,” he says, “and now you see the Philippines is also the first country to take its fight against dengue seriously by taking the initiative to vaccinate its children.”This tropical country in Asia sees about 200,000 infections a year, and dengue has become a year-round threat.

This tropical country in Asia sees about 200,000 infections a year, and dengue has become a year-round threat.

Asia currently bears 70 percent of the world’s dengue burden. An analysis published in the New England Journal of Medicine reports that the Philippines had the highest incidence of confirmed dengue in the 10 endemic countries that participated in the clinical efficacy studies for Dengvaxia. The analysis also reported that up to 15 percent of febrile disease in children 9 years and older in the Philippines is due to dengue.Different administrations have handled the dengue burden differently, all with the goal towards greatly reducing the mortality rate, but the dengue prevention program—first initiated in 1993 and launched in 1998—seemed less and less effective.

Different administrations have handled the dengue burden differently, all with the goal towards greatly reducing the mortality rate, but the dengue prevention program—first initiated in 1993 and launched in 1998—seemed less and less effective.The Philippines’ plan of action included spraying insecticides during outbreaks, employing chemical and biological larvicides, physical removal of breeding sites, and health education. It also started what became known nationally as the “4S Strategy”: Search and destroy, self-protection, seeking early consultation, and saying no to indiscriminate fogging.

The Philippines’ plan of action included spraying insecticides during outbreaks, employing chemical and biological larvicides, physical removal of breeding sites, and health education. It also started what became known nationally as the “4S Strategy”: Search and destroy, self-protection, seeking early consultation, and saying no to indiscriminate fogging.

The “4-‘o’-clock Habit” was a community-led activity that reminded citizens to clean their surroundings and search for possible breeding sites every 4 p.m.

But the cases continued to climb, and mortality rates spiked. The dengue control measures were largely reactive, and the mosquitoes have developed resistance to common insecticides. A dengue-free Philippines seems a long way off.Insufficient prevention and control, lack of a specific treatment, lack of prophylactic measures,

Insufficient prevention and control, lack of a specific treatment, lack of prophylactic measures, pressure to do more have pointed to one thing—the need for vaccines.

To exhausted doctors and emergency personnel, a solution couldn’t come soon enough.

And then Dengvaxia, the world’s first dengue vaccine that took nearly 20 years to develop and $2 billion dollars to produce, was launched in December 2015.

The then-President and his administration worked quickly to procure the vaccines. On Dec. 22, 2015, the Philippines granted marketing approval to Dengvaxia. Four months later, in the first week of April 2016, the first dengue vaccine program was launched in the suburb of Marikina, one of the hardest hit cities in greater Manila.

The dengue vaccine program

In an ideal world, it would have been a no-brainer for a majority of the stakeholders to show support for a vaccine that has been greatly anticipated and much needed in the country.

In the face of staggering statistics that magnify the dengue danger, Philippine health officials have decided to be pioneers in the use of the vaccine at a massive scale.

The Department of Health (DOH) worked quickly to put a structure in place and targeted 733,000 children from three regions in the first wave. The premise was simple: Start with the provinces that have reported the largest number of cases, and provide free dengue immunization to children in the fourth grade who go to public schools. In the Philippines, this means providing economically-challenged families from the pre-selected 4,827 schools the option of giving their children Dengvaxia.

Of the 733,000 targeted, 539,000 signed up. The DOH provided a ‘Quick Health Assessment Test’ and ‘Acknowledgment and Consent’ forms to the parents of these children. These set out all the conditions that were to be met before availing of the dengue vaccine.

The national school-based immunization program structure included a committee with members from various government departments including Logistics, Technical and Operations; Training and Education; Research, and Surveillance. The group worked to follow several steps: The master listing and screening of eligible pupils, the administration of dengue vaccine, the surveillance of adverse events following immunization, and recording and reporting each case diligently.

The reporting process was also flawless: The school-level nurse reported to the district school nurse, who in turn reported either to the Department of Education (DepEd) office or the local municipality, who would file reports to the central offices of DepEd and the DOH.

When the actual immunization rolled around, only 491,990 students were vaccinated.

The Challenges

Dr. Lyndon Lee Suy, a Director of Disease Prevention and Control Bureau at the DOH, says that while the government was earnest in fighting dengue, the project ran into some serious challenges: The timing of the introduction of the dengue vaccine—it was nearly vacation time when the government started the program; the looming election, which was due to happen in a month, and which meant a change in governance and health priorities and policies; and the most pressing issue of all—the lack of the World Health Organization’s SAGE recommendation, which, while not necessary in introducing the vaccine, was used by opponents to question the introduction of Dengvaxia leading to political vaccine resistance. (The WHO Strategic Advisory Group of Experts has reviewed Dengvaxia in April 2016 and recommended the introduction of the vaccine in countries or places where dengue is endemic even while awaiting WHO prequalification. The WHO has since endorsed it for use in the Philippines.)

A few stakeholders publicly questioned the safety and efficacy of the vaccine, and media coverage was largely unfavorable due to the challenges presented by these issues.

The six-months interval of dosage also increased the risk of dropouts—many children from poor families transfer schools or stop schooling, and may be unavailable to get the second dose. The issues resulted in low parental consent.

In an interview with Break Dengue, Dr. Janette Garin, the former Secretary of the Health Department, and the person responsible for kickstarting the school-based immunization program, said, “We started the program, during my time as Secretary of Health, because we see what a big difference the vaccine would have made if everybody had access to it. It’s about making something available, easily accessible. Vaccines are mostly a prerogative of the rich, and the only time the government gave the public a vaccine program was if there was extra money. But if you do that, you don’t create real immunity among the population. If the government could afford it—and we could—why wait? The dengue vaccine could reduce the epidemic, and also help the Filipinos as it will relieve them of spending on hospitalization and buying the vaccine themselves.”

Last year, under the new Duterte government, the Congress and Senate held an inquiry into the school-based immunization program. While they moved to expand the school-based immunization program to the Central Visayas, lawmakers have also proposed waiting five years before they expand the program nationwide.

With the issue still being finalized, Dr. Lyndon Lee Suy says that the dengue vaccination program has proven that the immunization initiative has at least laid the groundwork for a future nationwide agenda: “Now we can see that we have responsive national and local partners, that we were able to disseminate high awareness in the local community,” he says. “We have also trained our teachers as reporters, and many of our health partners are now considered vaccinators.”

Doctors in private practices, however, have reported an increase in patients who choose to pay for vaccination for their children and themselves.

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Vector control technology: A look at the tools stopping the mosquitoes that spread dengue

MANILA, PHILIPPINES—At last month’s second Asia Dengue Summit in Manila, top infectious disease experts from the region met with government officials and public health stakeholders to discuss the increasing burden of dengue and the advances in science and technology that may help combat the spread of the disease. Vector control technology was high on the list.

Dr. Grace Yap, a senior research scientist and program head for the National Environmental Agency’s Environmental Health Institute, shared how technology has helped her home country of Singapore fight the disease. In Asia, Singapore has the most advanced technologies in vector control, and at the core of their strategy is source reduction and environmental management.

Globally, current transmission control relies mainly on insecticide sprays, which are plagued by many issues including insecticide resistance and toxicity.

Here is how Asia, particularly Singapore, has been trying to improve current tools and advancing the development of products that will help with vector control.

Genetic control

Called Project Wolbachia, Singapore’s six-month study involves the release of male Wolbachia-carrying Aedes aegypti mosquitoes to help suppress the population of urban Aedes aegypti.

Eggs produced from the male Wolbachia-infected Aedes aegypti mosquito and a female urban Aedes aegypti mosquito will not hatch due to incompatible matching.

While the male mosquitoes may fly around and enter homes to seek out females and find shelter, they will not bite or transmit disease.

Since October 2016, the male Wolbachia bacteria-carrying Aedes aegypti mosquitoes have been released on a regular basis at three selected sites.

The viability of Aedes aegypti mosquito eggs collected from a site at Tampines West has been reduced by about half.

Read how Oxitec’s ‘friendly mosquitoes’ are protecting thousands from dengue

85-92 percent of households have no objections to releasing male Wolbachia-infected mosquitoes. Says, Dr. Tan, “The NEA has found that the use of male Wolbachia is promising, but cannot be the sole strategy of Aedes control. It must be complemented with a strong integrated control program with strong community participation.”

Intelligent Gravitrap

Schematic design (A) and picture (B) of Environmental Health Institute, Singapore, sticky Gravitrap. Image via The American Society of Tropical Medicine and Hygiene

Singapore’s Environmental Health Institute developed Gravitraps, designed to lure and trap gravid female Aedes with a sticky lining. The traps exploit the behavior of female Aedes aegypti, who distributes her eggs in multiple containers during each cycle, a behavior that increases the survival of her young.

The Gravitrap is simple and cheap to make and is made of a black container containing 10 percent hay infusion and an inner shorter cylinder lined with adhesive glue to trap gravid females searching for oviposition sites. The smaller inner cylinder is fitted with a wire net base, which sits above two holes punctured through the outer container to prevent the emergence of adult mosquitoes just in case eggs are laid before females are trapped.

It is important that the design is simple and failsafe, so it can be used by ordinary people, an approach consistent with Singapore’s advocacy for community participation. Currently, a chemical lure is under development to replace the hay infusion water to enable its wide and regular use by the community to prevent dengue transmission.

Spatial repellents

Image showing how spatial repellents work via BioMed Central

Spatial or area repellents (pyrethroids) are chemicals that “work in the vapor phase” to prevent mosquitoes biting humans by disrupting their behavior within a certain area. The benefit of spatial repellents is that unlike regular insecticide sprays, it can be applied to specific areas both indoors and outdoors.

Volatile chemicals at ambient temperatures are used. When these chemicals are applied, they can “repel” rather than kill mosquitoes. Chemicals used include transfluthrin.

Big data analytics

In the Philippines, big data analysis helped a Singapore-based IT expert to track dengue incidences in his home province of Pangasinan when he pored through figures that pointed to a certain school that reported the most cases. Looking at his district’s topography, Wilson Chua detected catch basins around the area during rainfall and found out there were deeper areas where rainfall could possibly stagnate.Having identified these places, Chua then bought from Singapore mosquito dunks that contained BTI, a bacterium that kills mosquitoes and their eggs, and spread it in these areas, which greatly reduced dengue in the area.

Having identified these places, Chua then bought from Singapore mosquito dunks that contained BTI, a bacterium that kills mosquitoes and their eggs, and spread it in these areas, which greatly reduced dengue in the area.

In Singapore, experts use meteorological services—from climate data, temperature, absolute humidity—to see how the weather in coming days may affect the spread of the illness. It is supplemented with information on house index, breeding index, and population data to create a three-month real time dengue forecast model. Armed with early warnings of outbreaks, the Singaporean government’s EHP can now craft long-term strategies and public health response to avoid impending outbreaks.

Regional surveillance

In a highly mobile world, collaboration among neighboring states is highly essential—and in Asia, Singapore leads the way with the creation of an organization founded by Singapore’s NEA, Malaysia’s Ministry of Health, and Indonesia’s Andalas University. The network has expanded to 10 countries that include Sri Lanka, Brunei, Pakistan, Laos, Thailand, and Vietnam. Through such cross-border collaboration and sharing of dengue information, timely sensing of the dengue situation can improve preparedness within each country in the event of an outbreak.

Centers and laboratories of these countries stay in close contact with each other, and the World Health Organization shows its support by providing technical and financial support to manage dengue. In pooling their resources together, these countries hope to avert or lessen dengue in the region that is most hit by dengue.

Looking ahead

Until the development of Dengvaxia, the world’s first dengue vaccine, there were no clinical preventive measures available to healthcare professionals. Classified as “moderately” effective, the vaccine nevertheless prevents eight out of ten dengue hospitalizations, and nine out of 10 severe dengue cases.

The vaccine’s arrival in the market, much anticipated after 20 years of intensive research, is perhaps the most encouraging indication that we could keep up with dengue. “Control is possible if we combine vaccines with best vector control tools,” says Dr. Hasitha Tissera, a medical epidemiologist leading the National Dengue Control Program of the Ministry of Health in Sri Lanka. “To completely combat dengue, we need three things: Vector control, vaccinate, and surveillance. That is the way forward.”

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Dengue Track

Dengue disaster: Lessons from a tragedy

Image shows the natural disaster, Typhoon Haiyan which added to dengue cases in Philippines.

Debris line the streets of Tacloban, Leyte island following Typhoon Haiyan in 2013.

Experts are working together to curb dengue outbreaks after natural disasters

On November 8, 2013, Typhoon Haiyan hit the central provinces in the Philippines with a force that had never been seen before. The most commonly used satellite-based intensity scale showed that the typhoon was literally off-the-charts—registering at above 8.0.

The Philippines is the most typhoon-ridden nation on Earth, walloped with an average of 20 typhoons a year. Add this, coupled with the fact that dengue is endemic in the country, is a recipe for disaster.

In the Philippines, dengue has become a year-round risk, but dengue outbreaks are particularly common after natural disasters such as earthquakes, typhoons, and floods.

Typhoon Haiyan rapidly destroyed houses, hospitals, and infrastructure on a massive scale, with worst-hit Leyte bearing the brunt. The rains that poured days after Haiyan struck Leyte contributed to the pooling of stagnant water that was trapped under debris, which caused a large increase in potential mosquito breeding sites.

In 2013, there were 3,200 cases of dengue. After Haiyan hit, the health authorities found a 61 percent increase in infections, driving the total to 5,200 cases in the two months after Haiyan.

At the 2nd Asia Dengue Summit in Manila last month, leading experts from all over the region gathered to swap notes and share best practices in the global fight against dengue. Leonido Olobia, program manager for dengue, malaria, and research at the Department of Health of Region 8, the region hit hardest by Haiyan, talked at length about how the region’s experts tried to cope with the challenges of a potential outbreak.

“Our aim was to prevent an outbreak in the immediate aftermath of the typhoon and to reinstate dengue control, surveillance, and response,” he says.

The WHO public health risk assessment for Typhoon Haiyan recognized dengue fever as one of the health priorities for the affected areas, with a potential increase in cases occurring in the next six weeks.

“We did the best we could given the circumstances,” Olobia said. “The team was faced with many challenges: We were short on personnel as the local staff has been affectedly greatly, and there was immense difficulty in coordinating operations among the local and international vector control teams. Around this time, communication lines were down.”

The department also had no control over local governments and city mayors, and funding was low. Olobia’s team had to quickly create a new system and a multifaceted response was swiftly set up. To address the lack of funding, the Department of Health (DOH) tapped the help of international agencies to sponsor salaries of civilian emergency workers on a Cash-for-Work program for vector control operations in Tacloban, the capital city.

Additional health personnel from the DOH and foreign medical teams worked on surveillance reporting. Vector control operations were stepped up: Fogging, larviciding (applying a chemical on stagnant water), and search-and-destroy activities happened 12 days after Haiyan and were conducted in areas around hospitals, damaged schools, evacuation centers, and other public areas.

Help had to be sourced through staff from other regions and foreign medical teams who continued to stream in to offer their help. Sanitation teams, as well as communities, were quickly trained in vector control, with the DOH promoting search-and-destroy activities with the support of the civilian brigades.

The government worked double-time to ensure garbage collection in hard-hit areas to reduce mosquitoes and flies, which was important due to the continuous rainfall in the months following Haiyan.

Runners with motorbikes—the debris has not been cleared and cars could not pass through most roads—were hired to collect data and submit them to the provincial level, which in turn were turned over to the national and regional offices. Dengue case maps were continually updated, shared among coordinators and program managers at meetings among stakeholders.

Four weeks after the typhoon, commercial dengue rapid diagnostic tests (RDTs) were distributed to eight hospitals and health centers, with positive cases reported to the authorities to guide response and targeted interventions.

As very few hospitals were operational (with most of them badly damaged), health experts conducted refresher training of health staff in both hospitals and rural health centers. Long-lasting insecticide-treated nets were distributed to government hospitals to prevent transmission to patients.

Assessments continued to be done by the WHO and regional health authorities three months after the typhoon. Three cycles of vector control were administered within two-week intervals in the places that were hardest hit.

The DOH and WHO launched awareness campaigns through radio programs, and foreigners were given instructions about how to deal with dengue, as many of them were also victimized.

Through strengthening dengue surveillance for early detection, targeted vector control, close collaboration with the community, and with the help of the international community, the worst possible scenario—a dengue outbreak in what is already a massively damaged and struggling community—was averted.

Olobia says, “We were faced with an overwhelming situation that threatened to escalate into a huge problem, and what we learned will benefit the country both in emergency and non-emergency responses in the future.”

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Dengue Summit: The Philippines Leads the Way

Manila, Philippines — Leading infectious disease experts from Asia, together with some of the region’s principal policymakers, public health authorities, and government officials, gathered at the 2nd Asia Dengue Summit on March 1 and 2 to discuss the rapidly increasing burden of dengue, which has become one of the most pressing health issues in modern times.

In the last 50 years, dengue has spread from just a few tropical countries to over 128 countries, with a 30-fold increase, lending urgency to the dengue summit. Countries are also reeling from the great financial cost and number of lives lost. Worldwide, the economic toll is $9 billion annually, with Southeast Asia spending $1 billion per year, spanning 2001 to 2013.

Cost of dengue per person examined at the Dengue Summitgraphic.

The costs of dengue are not completely understood in many dengue-endemic countries which continue to struggle with the economic burden.

Learn more about the economic burden of dengue

The two-day summit was organized by the Asian Dengue Vaccination Advocacy (ADVA), a scientific working group, in partnership with the South East Asian Ministers of Education Tropical Medicine and Public Health Network (SEAMEO TROPMED) Sanofi and Takeda. It focused on The Philippine’s public health program (the first in the world to include the dengue vaccine; the second public dengue vaccine program was launched in Parana State, Brazil), explored new developments in prevention and control, and aimed to formulate a roadmap for other countries to instigate their own strategies for prevention and vector control.

All eyes on the Philippines

Lulu Bravo, the executive director of the Philippine Foundation for Vaccination, says the country is front and center in the fight against dengue, and experts have come from all over the world to see how the Philippines’ Department of Health has carried out the mass immunization program with Dengvaxia, the first vaccine against dengue.

“All eyes are on the Philippines because we are the first country to do the dengue immunization program publicly, as the others are all just contained within the private sector,” Bravo said. She touched on the controversies surrounding the vaccine: “There will be those who do not agree with it and say we treat our children as ‘guinea pigs,’ but we have scientific evidence that it is safe. No vaccine in the world has 100 percent efficacy, but Dengvaxia is both effective and safe.”

Many of the leading players in Asia’s continuing fight against dengue confirm they are monitoring the development of the program in the Philippines. Medical experts from Indonesia, Malaysia, Thailand, Singapore, Sri Lanka, Korea, and Vietnam attended the summit, while advocates and public health specialists from Peru, France, and Mexico gave talks on hot topics in dengue control.

Some of the most notable speakers included Belinda Ching of the Milken Institute Asia, Pilar Collantes of Voces Ciudadanes, lead researcher and scientist Dr. Isabelle Delrieu, WHO’s Dr. James Heffelfinger, and Dr. Janette Garin, who kick-started the Philippines’ public program during her time as the minister for health.

Dengue Summit: sharing best practices

Malaysian infectious disease expert Zulkifli Ismail, secretary general of the Asia Pacific Pediatric Association, says they attended the event to study best practices in fighting dengue. Ismail said that while his country has a satisfactory mosquito control system, Malaysia still documents 100,000 dengue cases annually. The vaccine is not yet licensed in the country.

“There are a few Malaysians at the summit because we really want to know what the Philippines is doing,” he added.

Thailand’s Usa Thisyakorn, a professor of Pediatrics at Chulalongkorn University and this year’s chairman of ADVA, said, “A collaborative approach which encourages the sharing of research findings, epidemiological trends, disease surveillance methods, and vaccine implementation strategies will allow countries to harmonize their existing dengue prevention and control efforts.”

She also lauded the Philippines’ effort in leading the public program. Prof. Thisyakorn recounted how, during a visit in 2010 in which she met with other pediatric infectious diseases experts, she witnessed how the Philippines has always been at the forefront in addressing the disease.

Prof Thisyakorn added, “At the Summit this year, we aim to build on the ongoing efforts of countries, strengthen the implementation of vector control, as well as prevention measures such as the use of the dengue vaccine that can ultimately benefit the local population.”

Prof Duane Gubler, emeritus professor at Singapore’s Duke-NUS Medical School and chair of Global Dengue and Aedes-Transmitted Diseases Consortium, said, “The recently released WHO position paper on dengue vaccine supports the use of vaccination to help prevent dengue as part of a comprehensive dengue control strategy in each endemic country, especially in areas where there is a high burden of disease.”

The event concluded with Prof. Thisyakorn’s symbolic passing of the torch to Dr. Rose Capeding, the Philippines leading researcher on the dengue vaccine studies conducted by Sanofi, who will be ADVA’s next president. The next Asia Dengue Summit will be held in Malaysia.

“In the war against dengue countries should fight together, not alone,” said Prof. Thisyakorn. “There’s a lot more work that needs to be done.”

Dengue Vaccine Facing Political Resistance in the Philippines, Where It is Most Needed

Philippines politicians threaten to cut health budget, vaccine program at risk

Lawmakers in the Philippines are holding a Congressional hearing on the 2017 annual budget—the first budget planned under the new government led by President Rodrigo Duterte. Some politicians have trained their sights on the P3 billion (€55.7 million) dengue vaccination program kick-started last April under then President Aquino.

On October 11, Senator Richard Gordon said that he may file a formal resolution to investigate the provision of the vaccine, the first dose of which has already been given to almost half a million children. This comes in the wake of calls from other government officials and private groups to temporarily put the program on hold.

The Philippines is the first country in Asia – and the second in the world – to have approved the world’ first dengue vaccine, Dengvaxia. It is also the first country in the world to make the vaccine commercially available.

Dengvaxia is a tetravalent vaccine taken in three shots at six-month intervals and is recommended for individuals aged 9 to 45. Due to the difficulty of creating a vaccine capable of protecting against all four dengue serotypes, Dengvaxia was 20 years in the making. 25 clinical studies were conducted in 15 countries, with over 40,000 subjects included in the research phase. The Philippines participated in each phase of the study. The vaccine is now approved in nine countries including Brazil, Mexico, El Salvador, Paraguay, Costa Rica, Guatemala, Peru, and Indonesia.

Many who opposed the introduction of the vaccine the first time did so on the grounds that the World Health Organization (WHO) had not given its “go-signal” at the time. However, the WHO has since recommended the vaccine’s use in dengue-endemic countries or regions.

WHO estimates that almost 1 hospitalization every minute results from dengue infection. With the help of vector control and the vaccine, the organization hopes to reach its goal of reducing mortality by half, and morbidity by 25 percent by 2020.

In a statement, the WHO said that the vaccine is urgently needed as the growing global epidemic has become a serious concern, with 3.9 billion at risk: “WHO expects vaccines to be an integrated part of the global dengue prevention and control strategy.”

Not only is the Philippines a dengue-endemic country—one of more than a hundred—the mosquito-borne illness was also first recorded here as far back as 1954.

“It is actually the Philippines leading the way, taking ownership of the disease,” says Prof. Tikki Pang of the National University of Singapore’s Lee Kuan Yew School of Public Policy. “The Philippines has the world’s first public dengue immunization drive, and that sends a message. After all, dengue fever was initially known as Philippine hemorrhagic fever.”

The Philippines, he added, has been at the forefront of the studies, having participated in all three phases of the vaccine’s clinical studies. This, he says, cemented its pioneering role and leadership in dealing with a major public health program.

More than fifty years later, the country is still grappling with controlling dengue, logging an average of 150,000 cases a year, representing a significant cost burden. The estimated cost per hospitalized case can reach $565, which may be more than one month’s income for the average family in the Philippines.

According to Dr. Su-Peing Ng, global medical head of Sanofi Pasteur, dengue impacts a country’s economy: “The Philippines spends P16.7 billion a year dealing with this disease. For one hospitalized patient that would be about P27,000 worth of bills not including the lost days in school or work.”

Prof. Tikka Pang continues, “Aside from the individual protection from the illness, there is also indirect protection for the whole population, and reduction in frequency and size of the outbreaks if many people will get vaccinated.”

Despite calls for the discontinuation of the public program, many private doctors have endorsed the vaccine, recommending it to their patients. In an interview for this article, Dr. Cynthia Balza Gomez, a pediatrician at the Medical City, says she has had many patients ask for the vaccine and has not personally seen any adverse reactions or side effects.

Dr. Gomez says resistance to Dengvaxia is typical of the dogged opposition new vaccines face. Like the vaccine against HPV, she says, anti-vaccine campaigns play on safety fears, even when the safety and efficacy of the vaccine have been reaffirmed by numerous investigations.

The country’s government-funded, public-school-based dengue vaccination program has benefited 489,003 Grade 4 pupils in the National Capital Region, Central Luzon (Region 3) and Calabarzon (Region 4A). Within four months, the program has achieved 67 percent coverage.

On Oct. 4, the Department of Health (DOH) announced that it plans to expand the immunization program to include students in Central Visayas, and wants to start the first dosage this month.

And it may be just as well. Despite recording 200,000 dengue cases in 2015, higher than average, the DOH has already listed nearly 71,000 suspected dengue cases as of July, a 19 percent increase from the same period.

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