FOREWORD

This series, the Manual of Procedures (MOP) for the Philippine National Aedes-borne Viral Diseases
Prevention and Control Program (NAVDPCP), was developed to standardize procedures enabling
effective and efficient prevention and control of the three Aedes-borne viral diseases: Dengue, Zika and
Chikungunya. It is the product of the determined and cooperative efforts of program personnel, experts
and stakeholders, all with a vision of delivering quality care for these diseases, as well as curbing the
associated public health and economic burden.
The making of this manual involved a series of expert consultations, as well as reviews of evidence from
scientific research. These efforts proved to be fruitful, as we now have a comprehensive, evidence-
based national guide for Aedes-borne viral diseases prevention and control. Divided into ten volumes,
each volume focuses on a specific program component, with the intent of informing readers with as
much information as possible, to be able to make evidence-informed decisions in preventing and
controlling the said diseases. I wish to congratulate and thank all the people involved in the making of
this manual, including the members of the technical writing group, program personnel from the national,
regional, provincial and city health offices, as well as experts from research and academic institutions,
non-government organizations, private organizations and other government offices. I wish all of us more
success, as we take the lead in Aedes-borne viral diseases prevention and control.
I call on all individuals and institutions, whether public or private, to join the Department of Health in the
fight against Aedes-borne viral diseases. This fight, indeed, is a tough one. But I believe that the making
of this MOP is an important progress that advances us closer to winning. Let us unite together for a
better, healthier, Aedes-borne viral disease-free Philippines.

DR. FRANCISCO T. DUQUE III, MSc

Secretary of Health

1
Table of Contents

A. Background: The National Aedes-borne Viral Diseases Prevention and Control Program ..... 6
B. Rationale: The Public Health and Economic Burden of Dengue, Zika and Chikungunya ......... 7
C. Characteristics of Aedes-borne Diseases ................................................................................. 11
C.1 The Vector: Aedes aegypti and Aedes albopictus .................................................................. 11
C.2 The Virus .................................................................................................................................. 14
C.2.1 Dengue .................................................................................................................................. 14
C.2.2 Zika ........................................................................................................................................ 14
C.2.3 Chikungunya ......................................................................................................................... 15
C.3 The Disease .............................................................................................................................. 15
C.3.1 Dengue .................................................................................................................................. 15
C.3.2 Zika ........................................................................................................................................ 16
C.3.3 Chikungunya ......................................................................................................................... 16
D. Program Framework ................................................................................................................. 16
References...................................................................................................................................... 22
Contributors ................................................................................................................................... 24

2
List of Acronyms

CDC Center for Disease Control

CFR Case Fatality Rate
DOH Department of Health
GBD Global Burden of Disease
GBS Guillain Barre Syndrome
GDP Gross Domestic Product
IFRC International Federation of Red Cross
MOP Manual of Procedures
NAVDPCP National Aedes-borne Viral Diseases Prevention and Control Program
NDPCP National Dengue Prevention and Control Program
OOP Out-of-pocket
PHEIC Public Health Emergency of International Concern
RNA Ribonucleic Acid
UNDP United Nations Development Programme
WHO World Health Organization
YLD Years lived with Disability
ZIKV Zika virus

3
List of Tables, Boxes and Figures

Tables

Table 1. Average annual direct medical cost of dengue cases by setting and sector, 9
2008-2012 in 2012 USD (equivalent to 2012 Philippine Peso, using OANDA
historical currency exchange rates)
Table 2. WHO ZIKV classification 10
Table 3. Examples of possible breeding sites for A. Aegypti 13
Table 4. NAVDPCP strategic plan objectives, performance indicators, targets and 19
strategies to be used

Figures

Figure 1. Annual number of reported dengue cases, 2010-2017, Philippines 7

Figure 2. Annual dengue case fatality rate, 2010-2017, Philippines 8
Figure 3. Number of dengue cases by region, 2014, Philippines 8
Figure 4. Number of reported zika cases by region, February 2016 -March 2017 10
Figure 5. Life cycle of the Aedes mosquito 11
Figure 6. Aedes aegypti and Aedes albopictus 13
Figure 7. A three-dimensional medical animation still shot of a dengue virus with 14
cross-section showing structural components
Figure 8. Digitally-colorized transmission electron micrograph (TEM) of the zika virus 15
Figure 9. Transmission electron micrograph of Chikungunya virus particles
Figure 10. NAVDPCP Framework 15
18

4
To God be all the Glory.

5
A. Background: The National Aedes-borne Viral Diseases Prevention and Control
Program

The National Aedes-borne Viral Diseases Prevention and Control Program (NAVDPCP) is the primary
arm of the Department of Health (DOH) responsible for guiding the prevention and control of three
Aedes mosquito-borne viral diseases in the Philippines: Dengue, Zika and Chikungunya. There are
other major diseases borne by the mosquito specie - including the Yellow fever and the West Nile
fever - yet these are currently non-endemic in the country. Yellow fever, which is an acute viral
hemorrhagic disease, is currently endemic in the tropical areas of Africa and Central and South
America (WHO, 2018); the West Nile fever - considered a fatal neurological disease - is currently
endemic in Africa, Europe, the Middle East, North America and West Asia (WHO, 2017).

The NAVDPCP was established in 2018, integrating and streamlining all efforts to prevent and control
dengue, zika and chikungunya, considering that they share the same vector and (to a huge extent)
the same set of interventions, especially for vector control. Originally, dengue was the sole focus of
the program; ergo the program was previously called, ‘The National Dengue Prevention and Control
Program (NDPCP)’. The NDPCP was then piloted in Region VII and the National Capital Region as a
response to the growing burden of dengue, but it was not until in 1998 when the program was
implemented nationwide. With the detection of zika and chikungunya, and the ensuing call of the
World Health Organization for countries to address the threat of these diseases, the NDPCP was
expanded to include zika and chikungunya; hence the new NAVDPCP. Currently, the NAVDPCP is
holding its office at the DOH, specifically at the Infectious Disease Office of the Disease Prevention
and Control Bureau. To standardize different program procedures and compile them in an easily
usable format, this NAVDPCP Manual of Procedures was written, composed of 10 volumes:
Volume 1: Program Overview
2: Vector, Virus and Case Surveillance
3: Integrated Vector Management
4: Clinical Case Management
5: Health Promotion
6: Outbreak Preparedness and Response
7: Program Management, Monitoring and Evaluation
8: Program Financing
9: Global Change and Vulnerability to AVDs
10: Research and Development
This document, Volume 1: Program Overview, of the NAVDPCP MOP series, is divided into the
following sections:

Section A. Background: The National Aedes-borne Viral Diseases Prevention and Control Program
B. Rationale: The Public Health and Economic Burden of Dengue, Zika and Chikungunya
C. Characteristics of Aedes-borne Diseases
C.1 The vector: Aedes aegypti and Aedes albopictus
C.2 The virus
C.2.1 Dengue
C.2.2 Zika
C.2.3 Chikungunya
C.3 The disease
C.3.1Dengue
C.3.2 Zika
C.3.3 Chikungunya

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 D. Program Framework

It is hoped that this volume will lead the reader to a broad understanding of the history and
background of the NAVDPCP, its main components and general program direction and strategies. It
also seeks to set the foundation for the reader’s understanding of the volumes that follow.

B. Rationale: The Public Health and Economic Burden of Dengue, Zika and Chikungunya

Dengue has been recognized as a major public health concern, both globally and nationally. Based
on the 2015 Global Burden of Disease (GBD) study, the global incidence of dengue has increased
from 32.7 million in 2005 to 79.6 million in 2015; this equates to a 143.1% increase in a period of ten
years, making dengue the fastest-spreading disease among all 44 global diseases (of acute duration)
tallied in the study. Dengue also accounted for 764,100 years lived with disability (YLDs)1 in 2015,
representing 0.1 % of all global YLDs. There is evidence that dengue imposes a huge economic
burden, with total annual global costs amounting to as much as US$8.9 billion (Shepard et al. 2016).

In the Philippines, latest available data show that the annual number of reported dengue cases has
fluctuated from 173,029 in 2010 to 146,890 in 2017. In-between the said years, the highest number
was recorded in 2016 at 220,518 (Figure 1). Increase in dengue cases has been attributed to multiple
factors such as growing populations, increasing urbanization, improved surveillance and the limited
success of vector control measures. In terms of mortality, the Dengue Case Fatality Rate (CFR)2 has
had a number of fluctuations between 2010 and 2017. Among the said years, the highest CFR was
recorded in 2010 at 0.61, and the lowest, in 2015, at 0.30 (Figure 2). The observed downward trend
of CFR over the last 10 years has been attributed to improved access to dengue case management
services.

Annual number of reported dengue cases,

2010-2017
250000
204,906 213,930 220,518
200000 187,031
173,029
146,890
150000 125,975 121,580

100000

50000

0
2010 2011 2012 2013 2014 2015 2016 2017

Figure 1. Annual number of reported dengue cases, 2010-2017, Philippines

Source: Department of Health, Philippines

1
Years Lived with Disability (YLDs) are a measurement of the burden of disease. YLDs are calculated by
multiplying the prevalence of a disorder by the short- or long-term loss of health associated with that disability
(the disability weight). When YLDs are added to the number of years of life lost for a certain disease or disorder,
the burden of disability associated with a disease or disorder can be reported in units called disability-adjusted
life years (DALYs) (US Burden of Disease Collaborators, 2013).
2
Dengue Case Fatality Rate – computed by dividing the total number of deaths due to dengue with the total
number of dengue cases, multiplied by 100.

7
 Annual dengue case fatality rate, 2010-2017
0.7

0.6 0.61

0.52 0.53
0.5 0.49 0.5

0.4
0.38
0.3 0.32 0.3

0.2

0.1

0
2010 2011 2012 2013 2014 2015 2016 2017

Figure 2. Annual dengue case fatality rate, 2010-2017, Philippines

Source: Department of Health, Philippines

Dengue is endemic in all regions, but based on the latest available data, more cases are reported
from Regions III, IVA and X (Figure 3), particularly in areas that are densely populated.

No. of Dengue cases

16000
14000
12000
10000
8000
6000
4000
2000
0

Region
Figure 3. Number of
reported dengue cases by region, 2014, Philippines
Source: Epidemiology Bureau, Department of Health, Philippines

Data from 2000 to 2010 show that the highest incidence (per 100,000 population) occurs among
children aged 5 to 14 years, followed by children aged 0 to 4 years. Further, 80% of all dengue-related
deaths are among individuals aged <20 years (Department of Health, 2005). The number of cases
usually increases 1 to 2 months after the onset of the rainy season, resulting in a peak of incidence
in the months of July to November, especially August. More cases were reported among males (53%),
but no apparent difference in the number of deaths between male and female cases.

8
Recent evidence suggests that dengue imposes a huge economic burden in the country. Edillo et al.
(2015) showed that the total direct medical cost of a treated hospitalized case averaged US$772.46
(Php32,490) in private hospitals – twice the per patient treatment cost in public hospitals at
US$387.84 (Php16,313). Per patient treatment cost was lowest in ambulatory settings at US$168.31
(Php7,079) in the private sector and US$79.43 (Php3,341) in the public sector (Table 1).

Treatment setting Public Private Combined

Ambulatory cases
Cost per case in hospital US$28.52 US$60.44 US$43.23
outpatient department (Php1,200) (Php2,542) (Php1,818)
Cost per case in other US$50.90 US$107.87 US$77.15
ambulatory settings (Php2,141) (Php4,537) (Php3,245)
Total cost per ambulatory case US$79.43 US$168.31 US$120.38
(Php3,341) (Php7,079) (Php5,063)
Hospitalized cases
Cost per hospitalization US$299.64 US$585.55 US$431.36
(Php12,603) (Php24,628) (Php18,143)
Cost per ambulatory care US$37.30 US$79.04 US$56.53
for hospitalized cases (Php1,569) (Php3,324) (Php2,378)
Cost per care in other US$50.90 US$107.87 US$77.15
ambulatory settings for (Php2,141) (Php4,537) (Php3,245)
hospitalized cases
Total cost per hospitalized US$387.84 US$772.46 US$565.04
case (Php16,313) (Php32,490) (Php23,766)
Table 1. Average annual direct medical cost of dengue cases by setting
and sector, 2008-2012 in 2012 USD (equivalent to 2012 Philippine Peso,
using OANDA historical currency exchange rates)
Adapted from Edillo et al. 2015

Applying the above per patient costs to the estimated number of clinically diagnosed dengue cases
per year, Edillo et al. estimated the total annual direct medical costs at US$345 million (in 2012
dollars) - equivalent to Php14.5 billion3 or 5.7% of the national GDP (~US$250.1 billion, Source: World
Bank) . Divided by the total population, this figure also translates to a national spending of US$3.26
or Php137.12 per capita for the disease. Of the total costs, 89.7% was attributed to hospitalized cases
and 10.3% to ambulatory cases. The share of the private sector was 63.1% compared with 36.9% in
the public sector.

In contrast to dengue, the problem of Zika virus disease in the country is a more recent one. The Zika
virus was first isolated in Africa in 1947 but an outbreak was not confirmed and documented until in
2007, in the Federated States of Micronesia. A more recent outbreak started in Brazil in 2015, which
spread to the Americas, Pacific Asia and Africa. Based on a review by Krauer et al. (2017), the WHO
has concluded that zika virus infection during pregnancy is a cause of congenital brain abnormalities
among newborns, including microcephaly, and that the virus is a trigger of Guillain-Barre Syndrome
(GBS). The spread of the disease since 2015 and the huge gaps in the knowledge and understanding
of the disease have prompted the WHO to declare zika virus disease as a ‘Public Health Emergency
of International Concern (PHEIC) in February 2016. The emergency was lifted in November 2016, but
84 countries still reported cases as of March 2017 (WHO, 2017) including the Philippines.

3
Php figures were derived using historical OANDA currency exchange rates in 2012 (see
[Link]

9
From February 2016 to March 2017, a total 61 cases of zika viral infection have been confirmed,
coming from 7 regions in the country (Figure 4). Among the 61 cases, 7 are pregnant women, 3 of
whom delivered babies without congenital deformities, 1 a missed abortion and 3 are being
monitored. As of 2017, the country has been classified under category 2 of the WHO ZIKV
classification (Table 2).

25

20

15

10

0
I III NCR IV-A V VI VII

Figure 4. Number of reported zika cases by region, February 2016 – March 2017
Source: DOH-Epidemiology Bureau, 2017

Category Description
1 Area with new introduction or re-introduction with ongoing transmission
2 Area either with evidence of virus circulation before 2015 or area with ongoing
transmission that is no longer in the new or re-introduction phase, but where there is
no evidence of interruption
3 Area with interrupted transmission and with potential for future transmission
4 Area with established competent vector but no known documented past or current
transmission
Table 2. WHO ZIKV classification Source: WHO ZIka
Situation Report, 2017

A recent study on the socio-economic impact of Zika virus in Latin America and the Caribbean (UNDP,
IFRC, 2017) reported that the economic costs of the disease reached US$7-18 billion between 2015
and 2017. These economic losses are in the form of tangible losses to country GDPs, tourism
industries, plus stresses imposed on health care systems. As of 2017, no studies on the economic
costs of zika virus disease in the country has been published.

Like zika virus disease, Chikungunya is also a public health problem of a more recent origin in the
country. Mostly, the disease occurs in Africa, Asia and the Indian subcontinent. In February 2005, a
major outbreak of chikungunya occurred in the islands of the Indian ocean, eventually leading to
large outbreaks in India in 2006 and 2007 that affected several other countries in South-east Asia. It
has been reported that since 2005, India, Indonesia, Maldives, Myanmar and Thailand have reported
over 1.9 million cases (WHO, 2017).

In the Philippines, the latest available data show a total of 6,351 suspected chikungunya cases in
2016, 1,804 (28%) of which had blood samples sent to the laboratory for testing. Of the total blood
samples, 817 were confirmed positive, equal to 45% of the samples. A lager number of the cases
came from Region IV-A (37.82%), followed by Region X (14.08%) and Region I (12%). Majority the

10
cases were among females (60.5%), and among individuals aged 25-59 years (29.43%). Among all
cases, two resulted to deaths, equivalent to a case fatality rate of 0.03%.

Vijayakumar et al. (2013) studied the economic impact of chikungunya epidemics in terms of the out-
of-pocket (OOP) health expenditures (incurred by patients in the 2007 outbreak in India) and found
the median total OOP health expenditure to be US$7.4 per patient. The major share (47.4%) of this
expenditure was for buying medicines, although costs for transportation (17.2%), consultations
(16.6%) and diagnoses (9.9%) also contributed significantly. The expenditure was high in private
sector facilities especially in tertiary care hospitals. For more than 15% of the respondents, the OOP
was more than double their average monthly family income, resulting to catastrophic healthcare
spending. As of 2017, no studies on the economic costs of chikungunya disease in the country has
been published.

C. Characteristics of Aedes-borne Diseases

C.1 The Vector: Aedes aegypti and Aedes albopictus

Aedes-borne viral diseases (AVDs) are transmitted to humans by the bite of an infective female
mosquito, mainly of the specie Aedes Aegypti (the primary vector), and to lesser extent Aedes
Albopictus (the secondary vector). The life cycle of Aedes mosquitoes consists of four stages: (1)
eggs, (2) larvae, (3) pupa and (4) adult mosquito. Eggs of Aedes are laid singly either directly on the
surface of stagnant water or on the walls of any water-holding receptacle just above the edge of the
water. Eggs laid on the surface of the water may hatch into the first larval stage 3 to 5 days after
oviposition, while those found above the water line will hatch after the container becomes flooded
either with rainfall or water storage for personal consumption. There are four larval stages which will
take 5 to 10 days to develop, after which, the fourth instar will develop into the last aquatic stage,
the pupa. It will then take about two days before the young adult Aedes mosquito emerges (Figure
5).

Life Cycle Stage Characteristics

Eggs

Larva

Pupa

11
 Adult

Figure 5. Life cycle of the Aedes mosquito

Source: Department of Health, 1998
Aedes eggs are very resistant to desiccation. Even when dried under natural conditions, the eggs
remain viable even up to six months or longer. Repeated flooding, drying and re-submerging of these
eggs into water induce hatching, which is responsible for the high survival and thriving rate of Aedes
mosquitoes. A gravid Aedes may lay an average of 70 eggs per batch.

In order for dengue transmission to occur, the female Aedes aegypti must bite an infected human
during the viraemia phase of the illness that manifests 2 days before the onset of fever and lasts 4-5
days after the onset of fever. After ingestion of the infected blood meal, the virus replicates in the
epithelial cell lining of the mid-gut and escapes into haemocele to infect the salivary glands and finally
enters the saliva causing infection during probing. The genital tract is also infected and the virus may
enter the fully developed eggs at the time of ovisposition; this enables the infected female
mosquitoes to transmit the virus to the next generation, through a process known as trans-ovarian
transmission.

Characterized by a black color with distinctive white patches of scales distributed throughout their
body (Figure 6), A. aegypti have the following characteristics:

 Spend their lifetime in or around the houses where they emerge as adults;
 Have a short flight range (average of 400 meters) which means that infected people rather
than mosquitoes are the main carriers that spread the virus within and between
communities;
 Highly anthropophagic (i.e. feeds on human flesh) as well as being both endophagic (i.e.
feeding indoors) and endophilic (i.e. inhabits or rests indoors) (Gubler and Trent, 1994;
Harrington et al. 2001);
 Feeds during the day, with peak biting periods early in the morning (~6-8 AM) and just before
dusk (~4-6 PM);
 Immature stages develop in stagnant water contained in domestic artificial containers or
natural locations and habitats, which served as the breeding sites (Table 3).

Domestic artificial containers which serve as Natural locations and habitats which
indoor/outdoor breeding sites serve as outdoor breeding sites
Earthen jars used for water storage* Treeholes*
Concrete water storage tanks for bathrooms* Bamboo stumps*
Uncovered water storage tanks*

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 Drums for water storage Leaf axils of various plant species (e.g.
Ant traps for protection of food cabinets in banana, palm, etc.)*
kitchen* Coconut shells*
Water trays of refrigerators with automatic
defrosting and air-conditioner trays*
Tires
Flower pots
Plates under potted plants
Cemetery urns/vases
Buckets
Tin cans
Soft drink bottles*
Plastic containers*
Clogged rain gutters
Ornamental ponds
Water bowls for pets
Birdbaths
Table 3. Examples of possible breeding sites for A. Aegypti
*adapted from Dengue MOP of DOH-NCR

The secondary vector, Aedes Albopictus (Figure 6), is mainly a forest species that has become
adapted to rural, suburban and urban human environments. Also knows as the ‘Asian Tiger’ because
of its dark color with a white dorsal stripe and banded legs, it has the following characteristics:

 Inhabits in and around houses in close association with human habitations

 Highly anthropophagic, can be endophagic or exophagic;
 An aggressive daytime biter both indoor and outdoor;
 Lays its eggs in artificial containers and, in addition, can use natural locations or habitats (see
table 3).

Figure 6. Aedes aegypti and Aedes albopictus

Source: Department of Health, 1998

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The distribution of A. aegypti and A. albopictus differs according to characteristic geographic
locations. In urban areas for example where there is little or no vegetation, A. aegypti tend to be the
predominant or the only species breeding both indoor and outdoor. In rural areas where there is
extensive vegetation, A. albopictus tend to predominate. In semi-urban areas, the two species can
be found breeding in the same habitat, both indoor and outdoor. In indoor situations, Aedes
mosquitoes tend to rest in cool and dark areas like under the furniture, beds, lower portions of walls,
under the sink, in piles of dirty clothing, indoor plants, and back and indoor panels of cabinets. In
outdoor situations, they can be found resting on vegetation (underside of leaves), inside wells, piles
of woods and hollow blocks, in discarded tires, poultry house and other dark and shady areas.

C.2 The Virus

C.2.1 Dengue

The dengue virus is a Flavivirus (i.e. of the family, Flaviviridae), and is a single stranded +RNA genome
(Figure 7). There are two (2) genotypes of the virus circulating in the country – Asian 2 and
Cosmopolitan – and four distinct but closely related serotypes of the virus causing dengue in the
country: DEN-1, DEN-2, DEN-3 and DEN-4. Recovery from infection by one serotype provides lifelong
immunity against that particular serotype. After recovery however, cross-immunity to the other
serotypes is only partial and temporary. Subsequent infections by other serotypes increase the risk
of developing severe dengue.

Figure 7. A three-dimensional medical animation still shot of a

dengue virus with cross-section showing structural components
Source: [Link]

C.2.2 Zika

The zika virus belongs to the Flaviviridae family and the Flavivirus genus, and is thus related to the
dengue virus. Like other flaviviruses, zika virus is enveloped and icosahedral, and has a non-
segmented, single-stranded, RNA+ genome (Figure 8). Its name comes from the Zika forest of
Uganda, where the virus was first isolated in 1947. Since the 1950s, the virus has been known to
occur within a narrow equatorial belt from Africa to Asia. From 2007 to 2016, the virus spread
eastward across the Pacific Ocean to the Americas, leading to the 2015-16 Zika virus epidemic.

14
 Figure 8. Digitally-colorized
transmission electron micrograph
(TEM) of the zika virus
Source: Goldsmith, 2005

C.2.3 Chikungunya

The chikungunya virus is a member of the alphavirus genus, and Togaviridae Family (Figure 9). It was
first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense-single-stranded genome.
Because it is transmitted by arthropods, namely mosquitoes, it can also be referred to as an arbovirus
(i.e. arthropod-borne virus).

Figure 9. Transmission electron

micrograph of Chikungunya virus
particles
Source: Goldsmith, 2005

C.3 The Disease

C.3.1 Dengue

Once the dengue virus enters the human body, it produces a flu-like illness that may affect infants,
young children and adults. The disease should be suspected when a high fever (40⁰C/104⁰F) is
accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and
joint pains, nausea, vomiting, swollen glands or rash. The symptoms usually last for 2-7 days, after
an incubation period of 4-10 days. The incubation period starts after the bite from an infected
mosquito.

15
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation,
respiratory distress, severe bleeding or organ impairment. Warning signs occur 3-7 days after the
first symptoms, in conjunction with a decrease in temperature (below 38⁰C/100⁰F), and include:
severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness
and blood in vomit. The next 24-28 hours of the critical stage can be lethal; proper medical care is
needed to avoid complications and the risk of death (WHO, 2018).
For more details on the characteristics of the dengue disease, including the incubation period,
pathophysiology, the three disease phases, corresponding signs and symptoms, and clinical
management, please refer to Volume 4: Clinical Case Management of the MOP.

C.3.2 Zika
Once inside the human body, the zika virus may or may not produce symptoms. Many people
infected with the virus will not have symptoms or will only have mild manifestations. The most
common symptoms include fever, rash, headache, joint pain, red eyes and muscle pain. These can
last for several days to a week. Infected people usually do not get sick enough to go to the hospital,
and they very rarely die of zika. However, the disease is risky for pregnant women, as it can cause a
birth defect on the brain of newborns/infants called microcephaly4, including other severe brain
defects. It is also linked to other problems such as miscarriage and stillbirth. There have also been
increased reports of Guillain-Barre syndrome5, an uncommon sickness of the nervous system, in
areas affected by Zika (CDC, 2017).
For more details on the specific characteristics of the zika disease, including the incubation period,
signs and symptoms, and clinical management, please refer to Volume 4: Clinical Case Management
of the MOP.

C.3.3 Chikungunya
As the chikungunya virus enters the body, it produces a disease characterized by an abrupt onset of
fever, frequently accompanied by joint pains. Other common signs and symptoms include muscle
pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually lasts
for a few days or may be prolonged to weeks. Hence, the virus can cause acute, sub-acute or chronic
disease.

Most patients recover fully, but in some cases, joint pain may persist for several months, or even
years. Occasional cases of eye, neurological and heart complications have been reported, as well as
gastrointestinal complaints. Serious complications are not common, but in older people, the disease
can contribute to the cause of death. Often, symptoms in infected individuals are mild and the
infection may go unrecognized, or be misdiagnosed in areas where dengue occurs (WHO, 2017).

For more details on the specific characteristics of the chikungunya disease, including the incubation
period, signs and symptoms, and clinical management, please refer to Volume 4: Clinical Case
Management of the MOP.

D. Program Framework

4
Microcephaly - a medical condition in which the brain does not develop properly, resulting in a smaller than
normal head (NINDS, 2015).
5
Guillain-Barre Syndrome – is a rare but serious autoimmune disorder, in which the immune system attacks
healthy nerve cells in the peripheral nervous system. This leads to weakness, numbness and tingling, and can
eventually cause paralysis (Cafasso and Reed-Guy, 2017).

16
The ultimate end-goal of the NAVDPCP is to make the Philippines free from Aedes-borne Viral
Diseases. At present however, the program is set on first reducing both the public health and
economic burden associated with dengue, as well as the containment and prevention of the
transmission of zika and chikungunya. Figure 10 below shows these as part of the current NAVDPCP
framework, used as the basis for its strategic plan set in 2017-2022.

17
 Aedes-borne Viral Disease-free Philippines

Reduced disease burden of dengue, containment and prevention of transmission of

chikungunya and zika

1a. Reduced dengue morbidity 2. Reduced out-of-pocket 3. Increased number of

rate by 25% expenses of households health facilities providing
related to quality and satisfactory
1b. Reduced dengue mortality dengue/chikungunya/zika services for AVDs
rate by 50%

1c. Dengue case fatality rate at

<1% and reduced annually by
0.1%
Strategy 7. Strategy 8.
1d. Reduced chikungunya and
Collaborate with Institutionalize
zika outbreaks by 50% annually
relevant government mechanisms to
agencies and improve ‘client
partners to reduce service’ of health
Strategy 1. Enhance social mobilization out-of-pocket service providers
and promote positive health-seeking expenses of
behaviour dengue/chikungunya
/zika patients and
Strategy 2. Strengthen capacity for expand social
management and implementation of protection measures
AVD prevention and control program at
all levels

Strategy 3. Upgrade information and

surveillance system and research for
informed decision-making and evidence-
based planning and operations

Strategy 4. Expand access to quality

diagnostic, treatment and prevention
and control services

Strategy 5. Strengthen early detection

and prompt and complete containment
of outbreaks

Strategy 6. Scale up implementation of

Integrated Vector Management (IVM)
approach

Figure 10. NAVDPCP Framework

Source: NAVDPCP Strategic Plan, 2017-2022

18
Table 4 shows the objectives, performance indicators, targets and main strategies to be used by the NAVDPCP in
implementing its strategic plan set for 2017-2022.

Long-term Goal: To reduce the disease burden of dengue, and to contain and prevent transmission of chikungunya and
zika

Objectives Performance Baseline Annual Targets Strategies to

By end of 2022: Indicators (2016) Achieve Targets
2018 2019 2020 2021 2022
1a. To reduce Morbidity 395 per Strategy 1. Enhance
dengue rate: No. of 100,000 social mobilization
355.50 335.75
morbidity rate probable and population 375.25 296.25 and promote
per per 316 per
by 25% confirmed per per positive health-
100,000 100,000 100,000
dengue 100,000 100,000 seeking behavior
pop pop pop
cases/total pop pop Strategy 2.
population x Strengthen capacity
100,000 for management and
1b. To reduce Mortality rate: 1.052 per implementation of
0.9468 0.8416 0.7364 0.6312 0.526
dengue No. of dengue 100,000 AVDPCP at all levels
per per per per per
mortality rate deaths/total population Strategy 3. Upgrade
100,000 100,000 100,000 100,000 100,000
by 50% population x information and
pop pop pop pop pop
100,000 surveillance system,
1c. To maintain Case Fatality 0.50% 0.495 0.4901 0.4852 0.4804 0.4756 and research for
dengue case rate: informed decision-
fatality rate at No. of dengue making and
deaths/total evidence-based

19
 Objectives Performance Baseline Annual Targets Strategies to
By end of 2022: Indicators (2016) Achieve Targets
2018 2019 2020 2021 2022
<1% and reduce no. of planning and
annually by .1% probable and operations
confirmed Strategy 4. Expand
dengue case x access to quality
100 diagnostic,
1d. To reduce No. of treatment and
Chikungunya Chikungunya Chikungunya prevention and
and Zika cases cases: (2016) control services
outbreaks by No. of Zika – 817 Strategy 5.
50% cases Strengthen early
Zika cases: detection and
(2017) - 62 prompt and
complete
containment of
outbreaks
Strategy 6: Scale up
implementation of
Integrated Vector
Management (IVM)
approach
2. To reduce Decrease in Establish Strategy 7.
out-of-pocket out-of-pocket baseline Collaborate with
expenses of relevant government

20
 Objectives Performance Baseline Annual Targets Strategies to
By end of 2022: Indicators (2016) Achieve Targets
2018 2019 2020 2021 2022
households expenses of agencies and
related to households partners to reduce
Dengue/Chikun out of pocket
gunya/Zika by expenses of
80% Dengue/Chikunguny
a/Zika patients and
expand social
protection measures
3. To increase No. of health Establish Strategy 8.
no. facilities baseline Institutionalize
of health meeting mechanisms to
facilities standards for improve ‘client
providing AVD services service’ of health
quality and service providers
satisfactory
services for
AVDs by 80%
Table 4. NAVDPCP strategic plan objectives, performance indicators, targets and strategies to be used
Source: NAVDPCP Strategic Plan, 2017-2022

At the middle and the end of implementation period of the strategic plan, evaluation studies will be done to assess the
progress and impact, providing guidance to further strategic planning in the next 6 years.

21
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Contributors
DOH CENTRAL OFFICE:
NAME POSITION/DESIGNATION OFFICE
Dr. Rhodora S. Cruz National Dengue Prevention and Disease Prevention and Control
Control Program Manager Bureau
Dr. Marlene Bermejo HIV Surveillance Database Supervisor Epidemiology Bureau
Ms. June Corpuz Nurse II Epidemiology Bureau
Mr. Brian Avigutero HEPO III Health Promotions and
Communications Service
Mr. Rhoderic Domingo Information Officer I Health Promotions and
Communications Service

RITM-National Reference Laboratory (Virology and Entomology):

Dr. Maria Rosario Z. Capeding Medical Specialist IV Virology Department
Ms. Ava Kristy Sy-Lee Senior Research Science Specialist Virology Department
Dr. Ferdinand V. Salazar Chief Research Specialist Entomology Department
Mr. Wilfredo E. Aure Supervising Science Research Specialist Entomology Department
Mr. Richard Paul Malijan Senior Science Research Specialist II Entomology Department
Ms. Ariza Minelle Aguila Entomologist III Entomology Department
Mr. Jason Angeles Entomologist III Entomology Department
Mr. Brian Bacay Entomologist III Entomology Department
Ms. Mary Ann Ammugauan Entomologist III Entomology Department

DOH Regional Office:

Engr. Ashley B. Antonio Regional Dengue Coordinator RO I
Dr. Romulo A. Turingan Medical Coordinator RO II
Mr. Jeffrey V. De Guzman Entomologist III RO III
Mr. Oscar L. Macam Jr Regional Coordinator RO IV-B
Ms. Maria Cecilia G. Pan Regional Dengue Coordinator RO V
Dr. Ronald Jarvick A. Buscato Medical Coordinator RO VII
Mr. Leonido P. Olobia Regional Program Coordinator RO VIII
Engr. Antonietta O. Ebol Regional Program Manager RO XI
Mr. Ursula P. Segundo Regional Program Coordinator CAR
Mr. Dominic A. Sotto Regional Program Manager NCRO

DOH Hospitals:
Dr. Efren Dimaano Medical Specialist IV San Lazaro Hospital
Dr. Ramon V. Najarro Medical Specialist IV Vicente Sotto Memorial Medical
Center

Developmental Partners:
Ms. Christine Joy Candari Consultant Private
Ms. Norma Joson Consultant Non-Government Organization
Dr. Talitha Lea Lacuesta Member Philippine Society for Microbiology
and Infectious Diseases (PSMID)
Prof. Myra Mistica Assistant Professor College of Public Health- University
of the Philippines, Manila (CPH-UPM)
Dr. Raul Destura Scientist National Institutes of Health(NIH)

Gratitude extended to all DOH Regional Offices, World Health Organization, CPH-UPM, LGU,UP-NIH, Medical
Societies, other Non-Government Organizations and all other stakeholders who were involved in the
development of this manual.

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