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Strengthening the Local Capacity Response to Pandemic H1N1 Influenza and Other Emerging Infectious Diseases in the Philippines
THE BARANGAY HEALTH EMERGENCY RESPONSE TEAM OPERATIONAL GUIDEBOOK (BHERT-BOG)
THE BARANGAY HEALTH EMERGENCY RESPONSE TEAM OPERATIONS GUIDEBOOK (BHERT-BOG)
FOREWORD
Emerging and re-emerging infectious diseases (EIDs/REIDs) pose grave threats to the health and life of the individual, the stability of the family, and the overall economic development of the country. They are, therefore, not mere health concerns, but are also economic and security threats which should be addressed at all levels, including at the community level where disease transmission takes place. The revitalization and/or creation of barangay health emergency response teams (BHERTs) in all barangays in the country is an important step towards EID/REID prevention and control as it enables the expansion of the outreach of the Department of Health (DOH) in early detection, prevention, and control. Through the BHERTs, individuals and families are engaged as partners of the health system in the detection, prevention, and control of the spread of infectious diseases. This Operations Guidebook for BHERTs is intended to serve as guide in organizing and mobilizing the community for active and sustained efforts in disease detection, prevention, and control, and should be read and studied carefully by each BHERT member.
PREVENTION AND CONTROL OF AVIAN INFLUENZA IN ASIA AND THE PACIFIC (TA 6313-REG): STRENGTHENING THE LOCAL CAPACITY RESPONSE TO PANDEMIC H1N1 INFLUENZA AND OTHER EMERGING INFECTIOUS DISEASES IN THE PHILIPPINES
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BHERT OPERATIONS GUIDEBOOK
ACKNOWLEDGEMENT
This Operations Guidebook for BHERTs would not have been possible without the technical inputs and the active participation of the City of San Jose del Monte in the province of Bulacan, at a three-day Writeshop on the Development of the Guidebook, which was held in Grotto Vista, San Jose Del Monte, Bulacan on 20-22 April 2010. The Guidebook is the product of the collaboration among the PRIMEX Consultant Team, the DOH-National Center on Disease Prevention and Control (NCDPC), and the City of San Jose del Monte under the Asian Development Bank (ADB) technical assistance project, Prevention and Control of Avian Influenza in Asia and the Pacific (TA 6313-REG): Strengthening the Local Capacity Response to Pandemic H1N1 Influenza and Other Emerging Infectious Diseases in the Philippines. Ms. Anna Zaniza M. Dumlao of PRIMEX documented the writeshop proceedings, which served as the basic document for the development of the Guidebook by the PRIMEX Consultant Team, particularly Mr Henry Briones, Community Development Specialist, who prepared the first draft jointly with Dr. Ramoncito Navarro and Ms. Eireen Villa, Training Specialists. The draft Guidebook was subjected to technical review by Dr. Antonio B. Bautista, Team Leader, and subsequently refined based on comments and suggestions of the local health facility and barangay participants at the five batches of regional workshops on the Prevention and Control of Avian and H1N1 Influenza. Ms. Therese Y. Loyloy, PRIMEX Technical Services Manager, handled the layouting and formatting of the Guidebook, and Ms. Elvira C. Ablaza, PRIMEX President and CEO, did the final edits on the draft manuscript prior to its printing. PRIMEX extends its sincere thanks and appreciation to the following people who made this publication possible: Dr. Betzaida B. Banaag, City Health Officer of San Jose del Monte City, who organized and coordinated the participation of the barangay captains, barangay kagawads, barangay health workers, rural health midwives, public health nurses, and rural health physicians at the writeshop that gave birth to this Guidebook; Dr. Lyndon L. Lee Suy, DOH-NCDPC Program Manager for Infectious Diseases, for ensuring that the Guidebook is aligned with DOH policies and complements efforts at the higher levels of operation; and
Dr. Jacques Jeugmans and Dr. Gerard Servais, ADB Practice Leader for Health and Health Specialist, respectively, for their technical direction and guidance and, most importantly, for their trust and confidence in our ability to deliver the project outputs.
TABLE OF CONTENTS
Page I. II. III. INTRODUCTION .................................................................................................................... 1 OBJECTIVES OF BOG .......................................................................................................... 1 ORGANIZATION OF THE GUIDEBOOK................................................................................ 2 A. B. C. D. E. What is the current situation of EIDs and REIDs in the Philippines? .................. 3 What are the consequences of EIDs and REIDs? .............................................. 3 Why is Community Participation Important? ....................................................... 3 What does BHERT mean? .................................................................................. 4 What are the legal bases for creating and revitalizing BHERTs?........................ 4
SECTION 1: IMPORTANCE OF COMMUNITY PARTICIPATION IN ADDRESSING E/REIDS..... 3
SECTION 2: REVITALIZING AND STRENGTHENING THEORGANIZATION OF BHERTS ........ 6 SECTION 3: BHERT PROCESS FLOW FOR DETECTION, RECORDING, REPORTING/NOTIFICATION, AND ACTION-RESPONSE .................................... 11 SECTION 4: DESCRIPTION OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES/CONDITIONS ........................................................................................ 14 A. Diphtheria .......................................................................................................... 19 B. Human Avian Influenza (BIRD FLU) ................................................................. 20 C. Influenza-Like Illness (ILI) ................................................................................. 21 D. Pertussis ........................................................................................................... 22 E. Severe Acute Respiratory Syndrome (SARS) ................................................... 23 F. Acute Bloody Diarrhea ...................................................................................... 25 G. Acute Flaccid Paralysis (AFP) ........................................................................... 26 H. Cholera .............................................................................................................. 27 I. Paralytic Shellfish Poisoining (Caused By Red Tide) ..................................... 28 J. Typhoid And Paratyphoid Fever ........................................................................ 29 K. Acute Hemorrhagic Fever Syndrome ................................................................ 31 L. Dengue .............................................................................................................. 32 M. Japanese Encephalitis (Acute Encephalitis) ..................................................... 33 N. Leptospirosis ..................................................................................................... 34 O. Malaria .............................................................................................................. 36 P. Rabies ............................................................................................................... 37 Q. Acute Viral Hepatitis .......................................................................................... 40 R. Adverse Events Following Immunization (AEFI) ............................................... 41 S. Anthrax .............................................................................................................. 42 T. Bacterial Meningitis ........................................................................................... 43 U. Measles ............................................................................................................. 44 V. Meningococcal Disease .................................................................................... 45 W. Neonatal Tetanus .............................................................................................. 46 X. Non-Neonatal Tetanus ...................................................................................... 47 SECTION 5: PUBLIC HEALTH MEASURES TO ADDRESS E/REIDs ........................................ 49 A. Guide for Monitoring Home Care for Volunteer Worker .................................... 49 B. Promotion of Personal Hygiene......................................................................... 50 C. Backyard Biosecurity ......................................................................................... 51 D. How to manage Risk Communication ............................................................. 52 SECTION 6: ASSESSING THE FUNCTIONALITY OF BHERTs AND PREPARING THE ANNUAL ACTION PLAN AND BUDGET ........................................................ 54 A. Assessing the Functionality of the BHERT........................................................ 54 B. Assessing the Level of Competence of the BHERT .......................................... 55 C. How to Assess your Current Action- Response ................................................ 56 D. Preparation of the BHERTs Annual Plan and Budget ...................................... 57
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LIST OF FIGURES
Page 1 2 3 4 5 Organization Structure of BHERT Disease Reporting Advocates .................................... 8 Proposed Schematic Diagram of the Process Flow for Detection, Reporting, and Action-Response ..................................................................................................... 12 Diagram showing the Interaction of Disease Agent, Host, and Environment ................. 14 Timeline of Infectivity ...................................................................................................... 17 Comparison between AI (H5N1) and H1N1 ................................................................... 17
LIST OF TABLES
Page Table 1: Relationships between the BHERT and Other Groups in the Barangay ............................ 9 Table 2: BHERTs Tasks/Activities per Broad Function.................................................................. 11
LIST OF APPENDIXES
1 2 3 4 5 Sangguniang Barangay Resolution/Ordinance BHERTs Risk Mapping Tool (Avian Influenza and E/REIDs) BHERTs Recording/Reporting Form (Human) BHERTs Recording/Reporting Form (Animal) BHERTs Sample Action Plan Format
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LIST OF ABBREVIATIONS
ADB Asian Development Bank
AEFI AFP
BDCC BHERT BHS BHW BOG CBMIS DILG DOH DRA E/REID EID EO H1N1 H5N1
Adverse Effects Following Immunization Acute Flaccid Paralysis

Barangay Disaster Coordinating Council Barangay Health Emergency Response Team barangay health station Barangay Health Worker BHERT Operations Guidebook community-based monitoring and information system
Department of Interior and Local Government

Department of Health disease reporting advocate emerging and re-emerging infectious disease emerging infectious disease Executive Order Influenza A
ILI
MHO/CHO NCDPC NGO PIDSR RHM RHU SARS TA TT
influenza A virus Influenza-like Illness

municipal or city health office National Center for Disease Prevention and Control
nongovernment organization
Philippine Infectious Disease Surveillance and Response rural health midwife
rural health unit

Severe Acute Respiratory Syndrome technical assistance tetanus toxoid
I.
INTRODUCTION
1. In the past 10 years, the Philippines has not been spared from the onslaught of emerging infectious disease outbreaks that have occurred in Asia and the rest of the world. In early 2000, the country was besieged with the occurrence of Severe Acute Respiratory Syndrome (SARS), followed by an isolated outbreak of meningococcal infection in several provinces in Luzon that lasted for more than three years. In mid-2000, the country persevered when it remained unaffected by the Avian Influenza (AI) that hit neighboring countries. However, in 2009, the Philippines, together with other countries worldwide, experienced deaths from the H1N1 virus. 2. These events clearly illustrate the undeniable threat of emerging and re-emerging infectious diseases (E/REIDs) that can appear suddenly and in full force. They also bring to the fore our countrys vulnerability to these threats and its ability, or lack thereof, to cope with such threats. They also lead us to ask how prepared our national and local health systems are in responding to similar or worse scenarios (such as epidemic outbreaks and pandemic influenza) in the future. 3. It is with these apprehensions in mind that the Department of Health (DOH) - National Center for Disease Prevention and Control (NCDPC) requested the Asian Development Bank (ADB) for technical assistance to enhance the ability of the Philippine health care system to manage and coordinate disease outbreaks, particularly Influenza A (H1N1), by improving the capacity for detection and response among health facilities, laboratories, and the communities at large. 4. ADB responded favorably to DOHs request, with a technical assistance (TA) grant for Strengthening of Local Capacity in the Surveillance and Response of AI/H1N1, which has four components: (i) (ii) (iii) (iv) Capacity building of health offices in case management of A(H1N1); Strengthening of the network of laboratory support facilities in accurate and prompt diagnosis of A(H1N1); Improvement of the community response system for A(H1N1); and Assessment of local surveillance and response mechanisms for emerging infectious diseases (EIDs) in devolved health systems.
5. The problem of emerging and re-emerging infectious diseases (E/REIDs) can be prevented if individuals and communities act together and undertake the necessary measures to cut the transmission of these diseases. Infectious diseases recognize no boundaries we need to watch out for one another.
II.
OBJECTIVES OF BOG
6. The Barangay Health Emergency Response Team (BHERT) is a community-based partner of the health system for the early detection and response to E/REIDs. The BHERT Operations Guidebook (BOG) is a community guide for preventing and controlling the spread of infectious diseases at the family and community levels. It will teach the community (especially the BHERTs) how to recognize the presence of the disease and promptly report this in order to cut the spread within the family and the community. It will guide the community on what to do to prevent the occurrence of the disease and control its potential spread in the community. Specifically, the BOG aims to:
(i) (ii) (iii) (iv) (v)
enlighten the community on the threats and challenges posed by infectious diseases; share the experiences of the various communities, especially the BHERTs, in actively participating in the prevention and control of infectious diseases; help the community leaders (especially the BHERTs) in assessing the current level of community preparedness in addressing infectious diseases; strengthen the knowledge and skills of various community organizations for timely recognition of the disease, reporting and responding to the problems; and guide the community (especially the BHERTs) in developing a community preparedness plan for the prevention and control of infectious diseases and in undertaking public health
measures for the prevention and control of infectious diseases.
III.
ORGANIZATION OF THE GUIDEBOOK
7. The BHERT Operations Guidebook has six sections. Each section deals with a specific concern related to how best to prepare the community to address the problem of infectious diseases. The BHERT should read each section carefully and apply what is appropriate to its situation in the barangay. 8. Section 1 describes the threats and challenges posed by E/REIDs to public health and the economy. It also provides experiences of communities, especially the BHERTs, in actively participating in the detection, reporting, and control of infectious diseases. 9. Section 2 describes the proposed composition and functions of the BHERT. It also describes the proposed organizational network for the disease reporting advocates (DRAs). The relationships of the BHERT with other organized groups in the barangay are likewise described to guide the community on whom to work with in carrying out a specific task or activity. 10. Section 3 describes the process flow of the activities of the BHERT. This will guide the BHERT and the community on what to do from detection of the disease to implementation of public health measures. It also explains the tools to be used for risk mapping, recording and reporting/notification of any unusual events and observed signs and symptoms of the presence of the disease. 11. Section 4 is a guide to recognizing the presence of the infectious diseases at the family and community level. There are 24 diseases/conditions included in this section. For each disease/condition, the cause of the disease is discussed and the route of transmission is described. For easy recognition of the disease/condition, the early observable common signs and symptoms are described. Further, the predisposing factors that can influence the occurrence of infectious diseases are presented. The probable actions of the family and the community to prevent and/or cut the disease transmission are listed. 12. Section 5 is a guide to undertaking preventive and public health measures. It includes the following: Tips on Home Care for Volunteer Workers on Infectious Diseases; Practice of Hand-Washing; Practice of Cough Etiquette; Backyard Bio-Security; and Risk Communication Management. 13. Section 6 is a guide to assessing the current capability and level of preparedness of the BHERT/community to adequately address the problem of infectious diseases. It is also a guide to preparing the BHERT/Community Annual Action Plan and Budget on Prevention and Control of Infectious Diseases. Section 6 provides a list of activities to consider when preparing the plan.
SECTION 1: IMPORTANCE OF COMMUNITY PARTICIPATION IN ADDRESSING E/REIDS

1. Section 1 discusses the current situation of E/REIDs in the Philippines and the threats and challenges these pose to individual and family health and economic development. It describes the importance of community participation in the prevention and control of E/REIDs as an example of what a community can do to prevent and control the spread of disease. It also presents the experiences of different barangays in mobilizing various community organizations and the BHERTs in actions related to detection, prevention, and control of infectious diseases. The section also describes the history of BHERTs, as organized in early 2003, and provides the legal basis and guidelines for the creation and/or revitalization of BHERTs in a community. A. What is the current situation of EIDs and REIDs in the Philippines?
2. The Philippines, like other countries in the world, faces threats and challenges to development brought about by the emerging and re-emerging infectious diseases. In the past ten years, new infectious diseases emerged, e.g., avian influenza, H1N1, etc., that caught the global health community unprepared including the Philippines. Globally, the pandemic H1N1 affected about 123 countries. In 2003, the Philippines was also affected with the SARS with reported two deaths out of the 12 confirmed cases. Re-emerging infectious diseases that are preventable (e.g., dengue, malaria, cholera, leptospirosis, etc.) continue to affect individuals and communities. In 2005, one city in the north was severely affected with meningococcemia. Very often, we hear of people dying due to dengue, malaria, and rabid dog-bites. In 2009, Metro Manila was devastated by floods spawned by typhoon Ondoy, and as a consequence, many people were infected with leptospirosis and several deaths were reported. B. 3. What are the consequences of EIDs and REIDs? Among the reported negative effects and consequences of E/REIDs are: An increased number of individuals have been affected and hospitalized, thus draining the resources of the family and the country, as a whole. In one city in the Philippines, the overall economy reportedly lost about PhP150 million in just one year due to the presence of an infectious disease that scared tourists away for fear of getting infected. In many countries, there were reports of millions of infected poultry and swine that were disposed to prevent the spread of infection, which resulted in huge economic losses. In the Philippines, reports also showed that during the SARS and pandemic H1N1 outbreaks, the movement of people was restricted, e.g., people could not go to office, schools were closed, and in some cases, even the community was isolated to contain the spread of infections. Many preventable deaths were also reported due to E/REIDs.
4. The E/REIDs are not only health problems but also economic and security threats. It is important to work together to jointly address the early detection, prevention, and control of the spread of EIDs and REIDs. The country must act as one big community in the fight against these infectious diseases. C. Why is Community Participation Important?
5. Community participation is very critical in cutting the route of disease transmission to prevent the spread of infection. Families and communities play a vital role in the early detection and reporting of common observable signs and symptoms of infectious diseases. The simple cleaning of ones surroundings and the practice of proper hygiene and sanitation will minimize the transmission of the
disease. 6. Every individual and family must be an active participant in the early detection, prevention, and control of a disease. The health system alone will not be able to detect early unusual events happening in the community unless the families and the community know how to detect and report such events. This is everyones concern. Anyone can be infected, and it will take the whole community to ensure that unusual events are detected and reported early and responded to swiftly to cut the spread of the disease. Everyone is affected. Everyone is responsible. Everybody can play a role. This is everybodys concern. D. What does BHERT mean?
7. The BHERT is a community-based partner of the health system for the early detection and response to emerging and re-emerging infectious diseases. It was initially organized in 2003 as a component of the Philippine response to address the problems posed by SARS. The organization of the BHERT is an example of how the community can actively participate in the early detection, prevention, and control of infectious diseases. E. What are the legal bases for creating and revitalizing BHERTs?
8. Consistent with the provision in Section 16 of the General Welfare Clause of the Local Government Code, which states that local government units are charged with the promotion of health and safety within their jurisdiction, the following legal documents were issued for the creation of the BHERTs in all barangays in the Philippines: Presidential Executive Order (EO) 201 dated 2003 defining the powers, functions and responsibilities of government agencies in response to SARS and designating the Secretary of the Department of Health to coordinate the activities of the different agencies of the government; DILG Memorandum Circular No. 2003-95 enjoining the creation of BHERTs in all barangays in the Philippines; and DILG Memorandum Circular No. 2003-97 to guide action against SARS.
9. These three legal documents are still binding since there have been no other issuances or memoranda rescinding their validity. Further, Presidential Proclamation No. 366, s. 2003 declared 5-9 May 2003 as Anti-SARS Consciousness and Clean-Up Week and directed the Secretary of Health and the Secretary of DILG to jointly lead the occasion. F. Why is the BHERT important?
10. After SARS, many barangays, in consultation and coordination with their local health system, continued to mobilize the BHERTs to help address emerging and reemerging infectious diseases, e.g., H1N1, malaria, dengue, rabies, and measles. DOH, seeing the important role the BHERTs play in the prevention and control of infectious diseases, decided to further build on the capacity and capability of the BHERTs to become the health systems partner in community health development efforts. 11. Indeed, the BHERTs play a very important role in the early detection, reporting, and response to emerging and reemerging infectious diseases. The BHERTs have been mobilized to implement health measures to prevent and control the spread of diseases like dengue and malaria. 12. The BHERTs, being community-based groups, get to hear what is happening within the community and are therefore in a good position to know if there are unusual events occurring. With the BHERTs, the health system has an ally for the early detection and reporting of the potential spread of infectious diseases in the community. Given the proper training and the skills, the BHERTs will be able to provide timely and accurate information on imminent danger of infectious diseases that pose grave
threats to human life and economic development. 13. Based on experiences of the different barangays, the BHERTs can assist the local health system in implementing appropriate interventions for preventing, controlling, and containing the spread of infectious diseases. G. What are the Experiences of BHERTs/Communities in Addressing EIDs and REIDs?
14. Since 2003, the BHERTs have been active community-based partners of government, especially the health system, in implementing preventive and control measures that help cut the transmission route of infectious diseases. The BHERTs have assisted and are assisting the local health system in many ways, i.e., mapping out vulnerability risks of families and communities, early detection and reporting of observed common signs and symptoms of a disease, assisting in tracking and monitoring potential case/s, providing various support in implementing control and containment measures, conducting public awareness campaigns, among others. 15. After SARS, the BHERTs were continuously mobilized to support efforts to address other issues, e.g., H1N1, dengue and malaria prevention, monitoring and reporting dog bites, monitoring reemerging cases of measles and polio, etc. Seeing the potential of BHERTs as community-based health partners, DOH, in consultation with other concerned government agencies, is now embarking on revitalizing the BHERTs and mobilizing them to become community-based disease reporting advocates for the early detection and reporting of common signs and symptoms of different infectious diseases afflicting the population.
SECTION 2: REVITALIZING AND STRENGTHENING THE ORGANIZATION OF BHERTS

16. This section provides guidelines for revitalizing the BHERT and strengthening its capability in the early detection, prevention, and control of infectious diseases. It describes the proposed composition and functions of the BHERT and describes the proposed organizational network for the disease reporting advocates. It also presents the relationships of the BHERT with other organized groups in the barangay in order to guide the community on whom to work with in the conduct of specific tasks and activities. A. Who comprises the BHERT?
17. Based on DILG Memorandum Circular 2003-95, one BHERT shall be organized for every 5,000 population and will be headed by an Executive Officer appointed by the Punong Barangay (Barangay Chairman) with the following members: one Barangay Tanod and two Barangay Health Workers. However, based on field consultations and observations, there are many variations in the composition of BHERT. In many cases, the BHERT is headed directly by the Punong Barangay. 18. For the revitalization of the BHERTs, the focus will not only be limited to SARS but will include other emerging and reemerging infectious diseases that continuously affect the health of the population. The BHERT will act as the village core group that will coordinate and monitor activities related to the detection, prevention, and control of infectious diseases. Based on this broad function, it is recommended for the revitalized BHERTs to have the following composition: Chairperson Vice-Chairperson Members Punong Barangay Kagawad for Health Barangay Health Workers (BHWs) Purok Leader Barangay Tanod Rural Health Midwife (in BHS)
Technical Adviser
19. The composition of the BHERTs may vary based on the situation in your barangay. There are barangays that include all the BHWs as members of the BHERT. In some cases, the composition of the BHERT is multisectoral, viz., health, agriculture, education, welfare, NGOs, etc. While the above composition is recommended, the decision on who will compose the BHERT will be decided by your Sangguniang Barangay (Barangay Council). 20. The revitalization and/or creation of the BHERT in your barangay must be covered by a resolution issued by the Sangguniang Barangay. This will give your BHERT the legal personality to perform its proposed functions and tasks. For your guide, a prototype Sangguniang Barangay Resolution is attached in Annex A. 21. It is also possible for the BHERT to serve as the overall Barangay Health Committee under the Barangay Development Council, if this has not yet been organized in the community. Since prevention and control of infectious diseases is considered as an emergency, the BHERT must closely work with the existing Barangay Disaster Coordinating Council (BDCC) for better access to logistical support, e.g., Calamity Fund. The BHERTs Action Plan and Budget can be an integral part of the overall plan of the BDCC. B. What are the Proposed Functions of the BHERT?
22. Under the authority of the Sangguniang Barangay, the BHERT will act/serve as the overall coordinative body and link of the Sangguniang Barangay with various stakeholders for activities related to EIDs and REIDs early detection, recording, reporting, and action-response. Specifically, the BHERT will perform the following functions:
1.
Detection/Recording Facilitate the orientation of the barangay disease reporting advocates for early detection and recording of infectious diseases; Coordinate the activities of disease reporting advocates (BHWs, BNSs, BSPOs, barangay tanods, purok leaders, schools, NGOs, etc.) for monitoring and generating information related to early detection of infectious diseases; Gather and maintain information related to vulnerability risk or index of suspicion that predisposes the family and the community to infectious diseases; and Record any unusual events and/or observed common signs and symptoms on the presence of the disease.
2.
Reporting/Notification Report to appropriate authority any unusual event and/or observed common sign or symptom of the disease; and Coordinate with the different disease reporting advocates for the reporting of any unusual event and observed signs and symptoms of infectious diseases.
3.
Case Investigation Assist the health investigating team in the conduct of case investigation, i.e., locating case, scheduling visits, accompanying the team, etc.
4.
Management and Treatment Assist the health team in implementing measures, e.g., monitoring and follow-up for home care, implementing containment measures, providing communication and transport support, etc; and Implement appropriate measures based on the health advisory.
5.
Public Measures Prepare the BHERTs Annual Action Plan and Budget and submit to the Barangay Council for approval and budget allocation; Organize/conduct community awareness campaign (as part of preparedness for any infectious diseases); and Coordinate with various stakeholders (health, veterinary, school, NGOs, etc.) for the implementation of different interventions, e.g., clean-up drive, vaccination of dogs, etc.
6.
Documentation Prepare/submit periodic reports on activities undertaken.
C.
What is the relationship between the BHERT and Existing Barangay Health Workers (BHWs) and Other Groups in the Barangay?
23. The BHERT, as the overall coordinating body of the barangay, coordinates and works with existing groups in the barangay, e.g., BHWs, barangay tanods, purok leaders, home associations, NGOs, etc. All existing groups or entities in the barangay must be organized and mobilized to be part of the network of disease reporting advocates. The proposed functional structure for the network of the disease reporting advocates is shown in Figure 1.
Figure 1: Organization Structure of BHERT Disease Reporting Advocates
Office of the Mayor (Municipal/City)
Municipal Health Office / City Health Office
Other Agencies, e.g., Veterinary, Agriculture, etc.
Rural Health Unit / City Health Center
Barangay Health Station (BHS)
Sangguniang Barangay
Barangay Health Emergency Team (BHERT)
Barangay Disaster Coordinating
Barangay Health
Barangay Tanods
School
Other groups (Purok Leader, Cluster Leaders, BNSs, BSPOs, etc
Families
24. The structure does not mean supervisory and hierarchical relationships. It simply shows the relationships and flow of communication between each level of operation. As it is, the barangay may modify the structure according to its situation to make it more functional and relevant to the existing organizations in the barangay. 25. The BHERT works under the authority and supervision of the Sangguniang Barangay since its creation (or revitalization) emanated from a resolution issued by the Sangguniang Barangay. As the problem of infectious diseases may be considered as an emergency, it is therefore recommended that the BHERT coordinate and work closely with the Barangay Disaster Coordinating Council (BDCC) for better access to the barangay calamity fund that may be used for pre-disaster preparedness activities, during disaster, and post-disaster.
26. The BHERT is technically guided by the rural health midwife (RHM) manning the barangay health station (BHS). The link between the BHERT and the rural health unit (RHU)/city health center (CHC) is through the BHS. In this manner, reports coming from the BHERT, in general, will be submitted to the BHS for verification and validation before sending to the RHU/CHC. 27. As needed, the BHERT, through the Sangguniang Barangay, may have direct links with the RHU/CHC, municipal or city health office (MHO/CHO), other agencies of the local government, e.g., Veterinary Office and the Office of the Mayor. This direct line of communication is important especially in times of emergency. The relationships between the BHERT and other groups in the barangay are summarized in Table 1. Table 1: Relationships between the BHERT and Other Groups in the Barangay
BHERT with RHM-BHS Seek overall technical advice in the conduct of activities related to detection, recording, reporting, prevention, and control of infectious diseases Coordination in the conduct of following activities: o Risk mapping o Early detection and reporting o Case investigation o Implementation of public health measures o Monitoring and follow-up of cases Coordination in early detection (through teacher-child-parent approach) Coordination in the conduct of community awareness campaign Coordination in implementing containement and isolation measures Coordination in early detection and reporting Coordination in community awareness campaign Coordination in undertaking preventive measures, e.g., clean-up drive, waste disposal, etc.
BHERT with BHWs
BHERT with School
BHERT with Barangay Tanod BHERT with other groups, e.g., homeowners association, NGOs, etc.
D.
What are the Expected Functions/roles of Each Player in the BHERTs Network of Disease Reporting Advocates?
28. For a BHERT to effectively monitor and track early signs and symptoms of the impending spread of infectious diseases, it is important to mobilize all entities in the community to be part of the disease information advocates. These advocates will be the eyes and ears of the BHERT in finding out what is happening in every family and the community. Figure 1 describes the proposed structure of the disease information advocates. Every family in the barangay plays a vital role in early detection and reporting of observed signs and symptoms of imminent infectious diseases. The BHW, together with the Barangay Tanod and Purok Leader, monitor what is happening in the families within their assigned area of responsibility. Below are the proposed functions and roles of the different players in the BHERT network of disease reporting advocates. These functions and roles can be enriched and modified based on the prevailing situation in the barangay and the municipality/city. 1. Family Monitor any sign or symptom observed human and animal that may pose imminent danger on the spread of infectious diseases and any unusual events; Immediately inform the assigned BHW (Tanod/Purok Leader) about the observed signs and symptoms; Undertake necessary precautionary measures based on the advice of the BHERT and the health system, e.g., personal hygiene such as washing hands and cough etiquette, etc; and Implement interventions as needed e.g., self-quarantine, quarantine of animals, etc.
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2.
BHW/Tanod/Purok Leader Verify reported observed signs and symptoms using Annex C; Advise families on what to do while awaiting investigation and confirmation of the observed signs and symptoms; Report immediately to the BHERT (or directly to the BHS and the Barangay Chairman [BC], if needed) the verified signs and symptoms; Assist in the conduct of investigation; and Implement necessary actions as per advice of the health system (BHS, RHU/CHC, MHO/CHO).
3.
Cluster Leader for every 25 families (including school, NGOs, homeowners associations) Assist the BHW in monitoring every family in the cluster; Immediately inform the BHW of any observed/reported signs and symptoms of infectious diseases; Assist in the investigation; and Assist in the implementation of preventive and control measures in the cluster, e.g., clean-up drive, information dissemination, etc.
4.
Barangay Council Pass resolution creating the BHERT; Include the BHERT plan in the annual budget allocation; Coordinate with other agencies such as Health, Social Welfare, Veterinary, NGOs, etc. for needed actions to prevent the spread of infectious diseases; Implement general precautionary actions, e.g., community clean-up activity, information dissemination; Implement laws related to prevention of infectious diseases, e.g., Anti-Rabies Law, etc; and Monitor and evaluate BHERTs activities.
5.
Barangay Health Station (Rural Health Midwife) Assist the Barangay Council in revitalizing/organizing BHERT and the CHIN; Orient BHERT members and community (using the community health intelligence network) on different emerging and re-emerging infectious diseases; Support BHERT in community information dissemination campaign; Conduct case verification/validation of observed/reported signs and symptoms of infectious diseases; Report immediately validated/verified case/s to RHU/CHC; Provide early interventions to affected families, e.g., prevention and control of infectious diseases; and Implement, in coordination with the BHERT and Barangay Council, recommended actions based on the advisory of the health system.
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SECTION 3: BHERT PROCESS FLOW FOR DETECTION, RECORDING, REPORTING/NOTIFICATION, AND ACTION-RESPONSE
29. This section provides the process flow showing the different tasks to be performed by the BHERT (and the disease reporting advocates in the barangay) in the early detection, recording, reporting/notification, and action-response. Although the process flow shown here focuses on Avian Influenza and H1N1, the same set of tasks can be applied to other E/REIDs. A. Functional Process Flow for AI/H1N1
30. Table 2 is a guide for carrying out the BHERTs tasks from early detection to the implementation of public measures for AI and H1N1. There are two major concerns presented for Animal Influenza and for Human Influenza. For each concern, the different tasks are presented for each broad function related to the early detection, recording, reporting, prevention, and control of AI/H1N1. Table 2: BHERTs Tasks/Activities per Broad Function
Broad Function Case Detection/ Screening Task / Activity Animal Influenza Human - H1N1 Conduct mapping of vulnerability risk Identify new arrivals and frequent using prescribed form and tool travelers Early detection of unusual events Identify febrile cases and observe clustering or sudden increases in cases After case investigation and confirmation, identify possible contacts of suspect cases Provide immediate IEC Record observations using prescribed Record observations (what, who, form where, when) Report immediately unexplained sudden Immediately report to RHM-BHS animal deaths, particularly poultry (birds/ observations: chicken) who (name, age, sex) Report immediately entry of exotic or where (location / exact address) smuggled birds to municipal agriculturist what (signs and symptoms observed) when (the time signs and symptoms occurred) Request Municipal Agriculture Office or Accompany health staff doing the local veterinary office to conduct case investigation investigation Assist in the implementation of Assist in implementing recommended interventions as recommended by the interventions from health authorities local authority assist in monitoring home care of suspected cases Facilitate provision of logistical support, Facilitate provision of logistical support, e.g., communication, transport, etc. e.g., communication, transport, etc. Promote responsible animal ownership, Conduct information dissemination animal health (biosecurity) Promote public health measures promote environmental sanitation
Recording
Reporting/ Notification
Case Investigation / Confirmation Infection Control, Management and Treatment Referral Public Health Measures
31. As presented in the above table, the first activity for detection is the mapping of vulnerability risk of the barangay. This activity aims at identifying the different predisposing factors or conditions that can influence the spread of infectious diseases. Knowing the predisposing factors present in a barangay will guide the planning and implementation of preventive public health measures.
12
32. The recommended tool for conducting mapping of vulnerability risk is in Annex B. For this, it is important that other organized groups in the community (e.g., BHWs, BNSs, BSPOs, tanods, etc.) are involved. This will make the work easier and will also make them aware of the presence of these predisposing factors. The results of the mapping of vulnerability risk must be presented to the Sangguniang Barangay together with your action recommendations to address the situation. It is also important to inform the families affected by these conditions so that they can take necessary preventive actions. 33. For recording and reporting unusual events (e.g., animal deaths or sudden increase of sickness) and observed signs and symptoms of the presence of the disease, the tools you will use are in Annex C. Study these tools carefully and orient your disease reporting advocates so that they, too, can use the tools. B. Proposed Schematic Diagram of the Process Flow for Detection, Reporting, and ActionResponse for other E/REIDs
34. Figure 2 describes the process flow for the early detection and action-response on emerging and reemerging infectious diseases. The schematic diagram shows the action to be taken from the family level up to the BHS and the linkages and the functions of the RHU/CHC and the MHO/CHO to show the continuity of the detection-reporting and action-response. This process flow complements the flow defined in DOHs Philippine Infectious Disease Surveillance and Response (PIDSR) system. Figure 2: Proposed Schematic Diagram of the Process Flow for Detection, Reporting, and Action-Response
NOTIFY RHU/CHC
YES
IMPLEMENT MEASURES
RHMBHS
PreInvestigation
NO
Give Advice
REPORT
INVESTIGATE
BHERT
VerifyInformation VERIFY REPORT
BHW(others)
VerifyInformation VERIFY INFORM
Family
Observedsigns/symptomsand unusualevents
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35. At the barangay level, the reporting time from the time of detection between operating levels must be done within two hours. This will enable the completion of the overall detection and actionresponse within 24 hours, starting from the detection of the signs and symptoms up to the actionresponse at the MHO/CHO level. The quick and accurate reporting will facilitate the timely response to prevent and control the spread of the disease. 36. Based on the schematic diagram, the families in the barangay are the starting points for early disease detection and reporting. The BHWs and other groups, upon contact with the families, will report any unusual events or observed signs and symptoms to the RHM-BHS. The BHERT will coordinate with all the disease information advocates for recording and reporting of any unusual events and observed signs and symptoms of infectious diseases and will report the findings to the BHS and inform the Sangguniang Barangay. The RHM-BHS will undertake the pre-case investigation and validation and report the findings to the RHU/CHC and/or to the MHO/CHO.
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SECTION 4: DESCRIPTION OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES/CONDITIONS

37. This section provides a detailed description of the 24 emerging and re-emerging infectious diseases (E/REIDs) that could affect families in a community. These diseases could pose grave threats to health and life and to the productivity, economic growth, and development of the family and community. This section is intended to help the BHERT and other disease reporting advocates in recognizing the different signs and symptoms of infectious diseases/conditions. 38. Each disease/condition is described in a simple manner that is easy for the families, disease reporting advocates, and community leaders to comprehend. This can serve as guide in identifying the activities - early detection, information-dissemination campaign, etc. - that need to carried out in the community. One page is devoted per disease, and each page can be detached and photocopied for distribution to target families, as needed. 39. For each disease, the scientific name is given, followed by the colloquial name used by or known to the community. The causes (or agents) of the disease are given, and the various ways/modes of disease transmission are described and illustrated for easy comprehension. Figure 3 below describes the usual interaction of the agent (the cause of the disease), the host (human and animal), and the environment (climate, weather, sanitation, etc.). The imbalance in the interaction of the agent, host, and environment creates the disease and/or condition. Understanding this interaction will help prevent and control the occurrence and spread of the disease. Figure 3: Diagram showing the Interaction of Disease Agent, Host, and Environment
40. The common early signs and symptoms that need to be watched and observed by every family and health worker (including all disease reporting advocates) are presented and illustrated. For early detection and response, it is important for every family and volunteer worker in the community to know these common early signs and symptoms to determine and/or recognize the presence of the disease and/or unusual events. 41. The different predisposing factors/conditions (unusual events, risk, and index of suspicion) that can increase the probability of the occurrence or presence and spread of the disease are listed. These can be used in prioritizing target families, puroks, and/or groups of people in the community who are highly vulnerable and susceptible to the disease.
15
42. The doable actions for disease prevention and control at the family and community levels are listed. The family and community (BHERT) actions aim to cut, prevent, and control the route of disease transmission. These actions can be used in preparing the BHERTs Annual Action Plan and in implementing public health measures, e.g., educational campaign, clean-up drive, personal hygiene, etc. 43. For ease in remembering the different diseases, they are broadly grouped into four major clusters based on the mode of transmission and portal of entry. The mode of transmission is the mechanism by which an agent is transported from a reservoir to a human host. It is the process or way by which a person gets infected. The portal of entry is the point of entry by which the agent enters the host, e.g., through the respiratory system, mouth, skin, etc. Mode of Transmission Droplets / Airborne Food and Waterborne Vector-borne Others (combination) animal bites) Portal of Entry Respiratory (naso-pharyngeal) Oral (eating/drinking) Skin/open wound (mosquito/insect) Varying entry points
44. Each of the 24 infectious diseases must be studied. This disease recognition guide makes it easier to explain the different infectious diseases to the families and other stakeholders in the community. The following are important facts to remember about infectious diseases: 45. Causative Agent. A causative agent is any element or substance, whether living or non-living, the presence of which can initiate or perpetuate the disease or condition. The types of agents that cause the different diseases or conditions include: (i) (ii) (iii) (iv) (v) bacteria (e.g., Salmonella typhi) viruses (e.g., Influenza A virus, SARS corona virus) protozoans (e.g., Plasmodium falciparum) fungi (e.g., toxin produced by the microorganism, Dinoflagellates) helminths (worms)
46. The agent is one of three elements that interact and cause a disease. Most infectious diseases are caused by microorganisms (microbes/mikrobyo). Knowing the agent of the specific disease/condition is important in choosing the right intervention to manage and treat the disease. (i) If the disease is caused by a virus, there is usually no need to medicate since a virus is self-limiting, i.e., the disease leaves or disappears on its own. Thus, a person with a disease caused by a virus need not take antibiotics. If the disease is caused by bacteria, the usual medication or treatment is the use of antibiotics. If the disease is caused by fungal infections, it usually takes a longer time to heal (matagal gumaling).
(ii) (iii)
47. Mode of Transmission. This refers to the mechanism by which an infectious agent is transported from the reservoir (carrier) to a susceptible human/animal host. There are various mechanisms by which the agent is transported to the host. The three most common mechanisms are: (i) (ii) (iii) Direct transmission: by direct contact or spread of droplets; Indirect transmission: vehicle-borne (fomite) or vector-borne (mechanical/biological); and Airborne: droplet nuclei or dust.
48. When an infective agent is airborne (e.g.,microbial aerosols), it may remain suspended in the air for long periods. Since it is airborne, other people, though more than a meter away from the infected person, may still get the infection. Droplet transmission involves the spray of droplets to the mucous membrane of the eyes, nose, and mouth through sneezing, coughing, spitting, or talking (usually limited
16
to a distance of one meter). Knowing the mode of transmission is important for the choice of preventive measures to cut or prevent the transmission. For example, If the mode of transmission is through the bite of an infective mosquito, the preventive measures could be the use of treated mosquito nets or destruction of mosquito breeding places. If the mode of transmission is through droplets, the preventive measures would include voluntary self-confinement, practice of personal hygiene, avoidance of public crowded places, etc.
49. Clinical Manifestations (Signs and Symptoms). Signs are observable manifestations of a disease, while symptoms are manifestations of the disease that are usually felt, not usually seen/observed, by the person who is sick. Many infectious diseases begin with non-specific signs and symptoms such as fever, cough, chills, headache, and muscle and joint pains. A doctor is often needed to properly diagnose a patient by obtaining a thorough medical history and doing physical examination. Sometimes, a laboratory examination/test is essential. 50. The presence of signs and symptoms is important in the diagnosis, management, and treatment of a disease. The signs and symptoms indicate the progress of the infection into a disease. One should not make final conclusions about the existence of the disease by merely looking into the signs and symptoms. These must be reviewed and assessed vis--vis other factors. There are certain cases where a patient does not manifest any signs and symptoms. However, the absence of signs and symptoms does not guarantee the absence of the infection. If one knows the signs and symptoms, any person manifesting these should be advised to immediately consult with a health care provider or health facility. 51. Predisposing Factors (Contributing or Influencing Conditions). These refer to conditions in the environment that expose the host to a higher risk or make a person more vulnerable to the infection. Examples are poor sanitation and improper waste disposal, not practicing personal hygiene, pregnant women not having TT vaccination, presence of mosquito breeding places, etc. 52. Knowing the predisposing factors will guide the families in taking preventive measures and help the community (BHERT) in preparing an action plan for the prevention and control of E/REIDs. The mere presence of predisposing factors does not automatically make the individual vulnerable to infection. Other factors, such as low resistance of the individual and the virulence of the agent, also come into play. 53. Timeline for Infectivity/Communicability. The timeline for infectivity and/or communicability of the different infectious diseases is shown in Figure 4 below. Study the timeline from the time of exposure to the infection, the incubation period, and the time when an infected person can infect another person. It is important to understand the timeline of infectivity in order to be able to explain to the community when an infected person can infect other persons. It is also a guide in contact tracing. To better understand the timeline, the terminologies listed below must be studied: Time of infection is the time when a person is exposed to the infective agent. Incubation period is the interval between the time of entry of the agent into the host and the onset of the signs and symptoms. Clinical manifestation is the time when the signs and symptoms appear. Asymptomatic infective period is the time when a person is infected but does not yet manifest any signs and symptoms. Infectivity/communicability period is the time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to humans, or from an infected person to animals.
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Figure 4: Timeline of Infectivity
54. Though the timeline of infectivity shown here is based on AI/H1N1, the same may be true for all other infectious diseases. What is important is to understand when an infected person can or may infect another person. 55. Table 3 compares AI (H5N1) and H1N1 in terms of agent, mode of transmission, incubation period, common signs and symptoms, and period of communicability. Take note that both AI/H1N1 are already infective 1-2 days before the signs and symptoms appear up to about 5-7 days after the signs and symptoms appear. Figure 5: Comparison between AI (H5N1) and H1N1
Primary Mode of Transmission
Portal of Entry (Point of Entry)
DROPLETS / AIRBORNE
NASO-PHARYNGEAL (RESPIRATORY)
DISEASES / CONDITIONS A. B. C. D. E. Diphtheria Human Avian Influenza Influenza-like Illness (ILI) Pertussis Severe Acute Respiratory Syndrome (SARS)
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A.
DIPHTHERIA
1. What is diphtheria?
56. It is a contagious, sometimes fatal, infection caused by the bacterium Corynebacterium diphtheria. 2. How is the disease transmitted to humans? By direct exposure to oral or nasal droplets/secretions/discharges of an infected person through coughing or sneezing Through contact with objects contaminated with discharges from the nose and mouth of an infected person
3.
What are the common observable signs and symptoms? Sore throat and hoarseness Painful swallowing Swollen glands in the neck Thick, gray membrane covering the throat and tonsils Difficulty of breathing and rapid breathing Nasal discharge Fever and chills
4.
What are the predisposing conditions that increase the probability of getting infected? Poor hygienic practices, especially in crowded settlements
Child has NO or INCOMPLETE DPT immunization Low coverage of DPT immunization in the community
c.
What must the family and community do to prevent/control the disease? Family Action Give your child complete DPT immunization. Report cases immediately. Disinfect the house and contaminated things. BHERT / Community Action Support health workers in contact tracing. Support/facilitate immunization of children (missed and booster) and contacts.
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B.
HUMAN AVIAN INFLUENZA (BIRD FLU)

1. What is Bird Flu?
57. Bird Flu is a contagious disease caused by influenza A virus (H5N1) affecting birds and poultry which can be transmitted to human. 2. How is the disease transmitted to human? By direct contact with infected birds or poultry; By inhalation or contamination with infected discharges or feces of sick birds.
3.
What are the common observable signs and symptoms?
Fever, Headache, Sore Throat
Mild to Severe Cough Muscle Pains

(may have difficulty breathing)
4.
What are the predisposing conditions that increase the probability of getting infected?
Presence of migratory birds Unsanitary poultry farm Increased number of unexplained sick or dead birds, poultry and animals
5.
What must the family and community do to prevent/control the disease?

Family Action Report immediately cases of unexplained bird/poultry sickness and deaths. Stay away from sick birds/poultry. Eat properly cooked eggs/poultry. Practice proper hygiene and sanitation, e.g., hand washing. BHERT / Community Action Report presence of migratory birds. Report cases of unexplained bird/poultry sickness and deaths. Report selling of live poultry in the market during suspected outbreaks. Conduct awareness campaign.
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C.
INFLUENZA-LIKE ILLNESS (ILI)

1. What is ILI?
58. It is an acute viral disease of the respiratory tract caused by the influenza virus affecting children and adults. 2. How is the disease transmitted to humans? By direct exposure to oral or nasal droplets/secretions/discharges of an infected person through coughing or sneezing Through airborne spread in enclosed areas (virus may persist in air for hours)
3.
Fever, headache, sore throat Coughs and colds Muscle pain Feeling of not being well
4.
What are the predisposing conditions that increase the probability of getting infected? Person has NO immunization. Low coverage of immunization in the community History of travels in areas with known ILI cases such as SARS and H1N1 Poor hygienic practices, e.g., not practicing cough etiquette especially in crowded and enclosed places
5.
What must the family and community do to prevent/control the disease? Family Action Have members of the family immunized. Report cases immediately. Voluntary home confinement of case Practice proper and frequent hand washing. Practice cough etiquette. BHERT / Community Action Report arriving persons coming from areas with known cases. Monitor development of signs and symptoms especially among arriving persons from known infected areas. Report findings of monitoring.
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D.
PERTUSSIS
1. What is pertussis?
59. Whooping cough, as it is commonly known, is a highly communicable infection of the respiratory tract caused by the bacteria, Bordetella pertussis. It is a major cause of childhood sickness and death. 2. How is the disease transmitted to humans? By direct contact of person with infected persons by airborne droplets By indirect contact through articles (things) freshly contaminated with discharges of the infected person
3.
Running nose, sneezing, nasal congestion, mild fever, dry cough
Red Watery Eyes Red watery eyes
After a week, thick phlegm and whooping cough followed by vomiting
4.
What are the predisposing conditions that increase the probability of getting infected? Child has NO or INCOMPLETE immunization Low coverage of DPT immunization in the community Poor personal hygiene, e.g., not practicing coughing/sneezing etiquette, not washing hands, etc.
5.
What the family and community must do to prevent/control the disease? Family Action Give your child complete DPT immunization Practice personal hygiene, e.g., coughing etiquette, hand washing Seek immediate medical assistance if signs and symptoms are observed BHERT / Community Action Support immunization activities in the barangay Conduct awareness campaign
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E.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

1. What is SARS?
60.
It is an emerging fatal influenza disease caused by the SARS coronavirus. 2. How is the disease transmitted to humans? By close contact with infected persons: Kissing, embracing, sharing utensils, close conversation Through droplet transmission: Infected person coughs or sneezes within 3 feet from another person Person touches object contaminated with droplets and touches his/her eyes, nose, and mouth Airborne inhaling virus
3.
What are the common observable signs and symptoms? Fever Sore throat Muscle pain Cough Difficulty of breathing or shortness of breath
4.
What are the predisposing conditions that increase the probability of getting infected? Contact with person coming from areas with known SARS Highly congested and overcrowded areas
5.
What must the family and community do to prevent/control the disease? Family Action
Voluntary self-confinement at home of people with influenza like illness (ILI) Report family members with ILI coming from country with SARS Practice proper hand washing and cough etiquette Avoid crowded places
BHERT / Community Action

Report arrivals of persons coming from known SARS areas Monitor any manifestation of ILI in arriving persons Report observed signs/symptoms of ILI Conduct awareness campaign Implement health advisory
Portal of Entry (Point of Entry)
FOOD AND WATERBORNE
ORAL (EAT/DRINK)
DISEASES / CONDITIONS F. G. H. I. J. Acute Bloody Diarrhea Acute Flaccid Paralysis (AFP) Cholera Paralytic Shellfish Poisoning (Red Tide) Typhoid and Paratyphoid Fever
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F.
ACUTE BLOODY DIARRHEA

1. What is acute bloody diarrhea?
61. It is a sign of intestinal infection caused by bacteria (e.g., Shigella, Salmonella, Amoeba, E. coli), which can result in serious illness and death. 2. How is the disease transmitted to humans? By eating food and drinking water contaminated with feces/stool of an infected person.
3.
Fever
Bloody Diarrhea
Dehydration
4.
What are the predisposing conditions that increase the probability of getting infected? Poor personal hygiene, e.g., not washing the hands Lack of access to safe drinking water No sanitary toilet Improper disposal of garbage Overcrowded area, e.g., evacuation centers, resettlement areas
5.
What must the family and community do to prevent/control the disease? Family Action Practice proper personal hygiene Drink safe potable water Use sanitary toilet Dispose garbage properly Refrain from eating uncooked food BHERT / Community Action Improve access to safe water Report unhygienic food handling of street foods Promote sanitary toilet Conduct awareness campaign, e.g., clean and green Report sudden increase of cases
G.
ACUTE FLACCID PARALYSIS (AFP)

1. What is acute flaccid paralysis (AFP)?
62. AFP is the sudden onset of weakness or paralysis of the arm or leg usually caused by polio virus infection. Children under five years old, especially those without or incomplete polio immunization, are at high risk. 2. How is the disease/condition transmitted? By using utensils or hands contaminated with feces/stool of infected person when eating By eating food and drinking water contaminated with feces/stool of infected person
3.
Fever and headache
Nausea and vomiting
Muscle/joint pains and neck and back stiffness
Extreme tiredness
Sudden onset of weakness and paralysis of arm/leg
4.
What are the predisposing conditions that increase the probability of getting infected? Child has No or INCOMPLETE polio immunization Low polio immunization coverage in the community Poor personal hygiene, e.g., hand washing Poor environmental sanitation, e.g., no sanitary toilet and improper garbage disposal
5.
What must the family and community do to prevent/control the disease? Family Action Report case immediately to health worker Have the child immunized against polio Practice proper hygiene and sanitation, e.g., hand washing, use of toilet Dispose garbage properly BHERT / Community Action Assist in immunization activities Clean-up drive, e.g., Clean and Green Implement strictly proper waste disposal Promote sanitary toilet Conduct community awareness campaign
27
H.
CHOLERA
1. What is cholera?
63.
It is an acute bacterial intestinal infection caused by toxin of Vibrio cholera. 2. How is the disease transmitted to humans? By eating food and drinking water that is contaminated with vomitus and feces of infected person.
3.
Continuous and painless watery diarrhea
Nausea and Vomiting
Dehydration
4.
What are the predisposing conditions that increase the probability of getting infected? Poor personal hygiene, e.g., not washing hands Lack of access to safe drinking water No sanitary toilet Improper disposal of garbage Eating uncooked food, e.g., shellfish Eating in large gatherings of people Contact with person who died of cholera
5.
What must the family and community do to prevent/control the disease? Family Action Practice proper personal hygiene Drink safe potable water Use sanitary toilet Dispose garbage properly Refrain from eating uncooked food BHERT / Community Action Report sudden increase of cases Improve access to safe water Report unhygienic food handling of street foods Promote sanitary toilet Conduct awareness campaign, e.g., clean and green
I.
PARALYTIC SHELLFISH POISOINING (CAUSED BY RED TIDE)

1. What is red tide?
64. It is a fatal seafood poisoning caused by eating fish or shellfish containing saxitoxin produced by dinoflagellates, aquatic microorganisms. 2. How is the disease transmitted to humans? By eating fish or shellfish with saxitoxin
3.
Tingling sensation on skin Numbness of oral mucosa, lips, arms, and legs Dizziness and floating sensation Difficulty in speaking, swallowing, and breathing Weakness or paralysis of arms and legs
4.
What are the predisposing conditions that increase the probability of getting infected? Seafoods harvested from areas with red tide Polluted sea waters due to poor garbage disposal Summer time
5.
What must the family and community do to prevent/control the disease? Family Action Refrain from eating seafoods harvested from areas with red tide Immediately seek medical assistance on onset of disease Report case to local officials and health workers BHERT / Community Action Report entry to the market of seafoods harvested from areas with known red tide Inform community of areas with red tide Control throwing of garbage along the shoreline
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J.
TYPHOID AND PARATYPHOID FEVER

1. What is typhoid and paratyphoid fever?
65. It is a disease caused by the bacteria Salmonella typhi and Salmonella paratyphi. 2. How is the disease transmitted to humans? By eating or drinking food and water contaminated with feces and/or urine of infected person Flies may spread the bacteria directly from feces to food.
3.
Sustained fever, headache Feeling of being sick Loss of appetite Heartbeat is lower than normal Constipation or diarrhea Non-productive cough (cough without phlegm)
4.
What are the predisposing conditions that increase the probability of getting infected? Unsanitary food handling and preparation Poor/unsanitary toilet Improper disposal of garbage, especially diapers Not practicing proper personal hygiene, i.e., hand washing Poor access to safe drinking water Presence of untreated or incompletely treated cases continuing carriers
5.
What must the family and community do to prevent/control the disease? Family Action Handle and prepare food properly Use sanitary toilet Dispose garbage properly Practice proper personal hygiene Drink safe potable water Complete treatment Community Action Improve access to safe drinking water Implement proper waste disposal Promote sanitary toilet Conduct awareness campaign
Portal of Entry (Portal of Entry
VECTOR BORNE
SKIN / OPEN WOUND (mosquito/insect and animal bites)
DISEASES / CONDITIONS
K. L. M. N. O. P.
Acute Hemorrhagic Fever Syndrome Dengue Japanese Encephalitis (Acute Encephalitis) Leptospirosis Malaria Rabies
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K.
ACUTE HEMORRHAGIC FEVER SYNDROME

1. What is acute hemorrhagic fever syndrome?
66. It is a febrile syndrome associated with bleeding manifestations caused by various viruses, bacteria, and rickettsia. 2. How is the disease transmitted to humans? It is commonly transmitted by mosquito and tick bites, which become infected from biting infected animals, e.g., domestic animals and birds.
3.
What are the common observable early signs and symptoms?
Vomiting of blood Coughing out blood Skin rashes
Fever, nose/gum bleeding
Blood in stool
4.
What are the predisposing conditions that increase the probability of getting infected? Presence of breeding places of mosquitoes and ticks Unclean surroundings due to improper garbage disposal Overcrowded places
5.
What must the family and community do to prevent/control the disease? Family Action Destroy mosquito/tick breeding places Use mosquito net/screen windows/insect repellant Clean house and surroundings BHERT / Community Action Conduct awareness campaign Destroy mosquito/tick breeding places Report cases Conduct contact tracing
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L.
DENGUE
1. What is dengue?
67. It is a severe disease caused by any of the serotypes of dengue virus (types 1, 2, 3, 4). 2. How is the disease transmitted to human? Transmitted by infected person to another person through mosquito bites (Aedes aegypti /albopictus)
3.
What are the common observable signs and symptoms? Fever, headache, sore throat Muscle and joint pain Skin rashes Abdominal pain Bleeding of nose and gum Blood in stools
4.
What are the predisposing conditions that increase the probability of getting infected? Presence of Aedes aegypti or albopictus mosquito in the community Presence of Aedes breeding places clear stagnant water Rainy season Crowded areas, e.g., schools, offices, etc.
5.
What must the family and community do to prevent/control the disease? Family Action Remove mosquito breeding places covering water containers, flower vases, etc. Report/seek immediate medical assistance if signs and symptoms are observed Dispose garbage properly BHERT / Community Action Support vector survey and control Eliminate mosquito breeding places Conduct clean and green campaign Implement waste segregation and disposal
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M.
JAPANESE ENCEPHALITIS (Acute Encephalitis)

1. What is Japanese encephalitis?
68. It is a mosquito-borne brain inflammation commonly caused by a virus called Japanese encephalitis virus. 2. How is the disease transmitted to human? Virus is transmitted to man from infected pigs, water birds, cattle, and horse through the bites of Culex mosquitoes
3.
Fever
Behavior change, e.g., irritability
Convulsions/seizures
4.
What are the predisposing conditions that increase the probability of getting infected? Irrigation flooded rice fields Pig (swine) farm areas Seasonal (June to September) Farmers and pig farm workers are at high risk
5.
What must the family and community do to prevent/control the disease? Family Action Wear protective clothes especially those working in rice fields Use mosquito nets/ window screens /insect repellant BHERT / Community Action Eliminate mosquito breeding places Conduct awareness campaign Report cases to health facility
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N.
LEPTOSPIROSIS
1. What is leptospirosis?
69. It is a group of infections caused by leptospira bacteria coming from urine or tissues of infected animals. 2. How is the disease transmitted to human? Direct contact of the skin, especially with wounds or breaks, with water or soil contaminated with urine and tissues of infected animals Drinking or eating of food contaminated with urine of infected animals, e.g., rats Breathing in or inhalation of droplets of contaminated fluids
3.
What are the common observable signs and symptoms? Sudden onset of fever, chills, and headache Severe muscle pain Yellowish discoloration of the skin Bleeding manifestations may occur Scanty urine or no urine at all
4.
What are the predisposing conditions that increase the probability of getting infected? Rainy season Presence of flooded areas with rodents Presence of rice fields with water and clogged drainage Poor environmental sanitation Presence of rodents/rats in the area
5.
What must the family and community do to prevent/control the disease? Family Action BHERT / Community Action
35
Avoid walking in flooded areas Clean house and surroundings properly Seek immediate assistance if signs and symptoms are observed Proper handling and disposal of urine of infected person Practice proper and frequent hand washing
Conduct cleanliness of community especially breeding places of rodents Report sightings of herd of rodents Report cases
36
O.
MALARIA
1. What is malaria?
70.
It is a parasitic disease caused by Plasmodium malariae. 2. How is the disease transmitted to human? 3. Through the bite of an infective female Anopheles mosquito from dusk to dawn with peak at 10:00 pm Transfusion of contaminated blood Use of needle previously used by person with malaria Infected mother to baby
Periodic attacks of fever, headache, chills, sweating
Back and muscle pain
Nausea/vomiting and feeling of being sick
4.
Presence of dirty streams with slow flowing water and with grass and overarching branches Presence of Anopheles mosquitoes Living in areas endemic for malaria People traveling from endemic areas Neighboring communities with malaria cases Poor environmental sanitation
5.

Family Action Regular use of treated mosquito net / screening of windows and doors Wearing protective clothes / use of repellent Compliance with treatment and follow-up blood examination BHERT / Community Action Conduct cleanliness of community especially de-clogging streams Conduct house spraying with recommended insecticides Conduct fever surveillance in endemic areas Conduct mass blood examination in endemic areas
P.
RABIES
1. What is rabies?
71.
It is a fatal acute viral infection caused by the rabies Lyssa virus. 2. How is the disease transmitted to human? Direct contact with saliva of infected animals (dog, cat, etc.) through bites, scratches, and licking of open wound Body fluids of infected animals getting in contact with mucosa or membrane, e.g., eating kinilaw na aso, animal body fluids entered eye, etc.
3.
What are the common observable signs and symptoms? Headache Fever Feeling sick Fear of air and water (aerophobia / hydrophobia) Seizures (convulsions)
4.
What are the predisposing conditions that increase the probability of getting infected? Low coverage of rabies vaccination on dogs Uncontrolled stray dogs due to irresponsible pet owners
5.
What must the family and community do to prevent/control the disease? Family Action Seek immediate health assistance when a person is bitten by dog Restrain dog that bit Take good care of your pets, e.g., put on leash or cage your dog, feed well BHERT / Community Action Support dog immunization campaign Support implementation of RA No. 9482: Rabies Act 2007 Promote responsible pet ownership Report the sighting of suspected rabid dogs immediately
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Portal of Entry (Portal of Entry
OTHERS (combination)
VARYING ENTRY POINTS
DISEASES / CONDITIONS Q. R. S. T. U. V. W. X. Acute Viral Hepatitis Adverse Effects Following Immunization (AEFI) Anthrax Bacterial Meningitis Measles Meningococcal Disease Neo-natal Tetanus Non-neonatal Tetanus
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Q.
ACUTE VIRAL HEPATITIS

1. What is acute viral hepatitis?
72.
It is an acute viral illness caused by hepatitis A,B.C,D,E viruses. 2. How is the disease transmitted to human? Hepatitis A and E Hepatitis B, C, and D eating of food and drinking water contaminated with feces of an infected person transfusion of contaminated blood sharing of needles especially among drug addicts infected pregnant women transmits virus to newborn during birth sexual intercourse
Hepatitis B 3.
What are the common observable signs and symptoms? Yellowish discoloration of the skin and eyes Dark or tea-colored urine Loss of appetite Body weakness Extreme fatigue Abdominal pain
4.
What are the pre-disposing conditions that increase the probability of getting infected? Eating unsanitary street foods Poor hygiene and sanitation Unclean surroundings due to improper garbage disposal High incidence of drug addiction Low coverage of hepatitis vaccination Unsafe or doubtful water source
5.
What must the family and community do to prevent/control the disease? Family Action Have child vaccinated against hepatitis Eat well cooked food Drink safe potable water Practice proper personal hygiene and sanitation Clean house and surroundings BHERT / Community Action Support immunization activities Conduct awareness campaign Promote environmental sanitation, e.g., sanitary toilet, garbage disposal Implement laws on use of prohibited drugs Report cases immediately
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R.
ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI)

1. What is AEFI?
73. It is a sign of adverse or unwanted reactions immediately after immunization, maybe due to vaccine reactions, program error, incidental events, and injection-reactions such as pain and anxiety. 2. How is the disease/condition transmitted to human? Directly transmitted to a person through vaccination
3.
Pain and swelling on injection site
Allergic reactions (rashes)
Fever
4.
What are the predisposing conditions that increase the probability of getting infected? Poor vaccine handling and management Mass vaccination in the community Not properly trained health personnel Lack of monitoring and follow-up
5.
What must the family and community do to prevent/control the disease? Family Action Practice proper hygiene and sanitation Seek immediately medical attention if AEFI signs and symptoms are observed BHERT / Community Action Support training of health staff and health volunteers Conduct awareness campaign on immunization e.g., addressing misconceptions
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S.
ANTHRAX
1. What is anthrax?
74. Anthrax is a highly contagious disease caused by bacteria called Bacillus anthracis, which can infect the skin, lungs, and gastrointestinal tract. 2. How is the disease transmitted? Direct contact with meat of infected animals (cow, carabao, goat, sheep, horse, pig) Eating undercooked meat of infected animals Inhalation of the virus from contaminated soil and animal products, e.g. wool hair
3.
Skin anthrax skin sores/blisters
Abdominal anthrax nausea/vomiting, loss of appetite, diarrhea, fever
Pulmonary anthrax fever, cough, difficulty of breathing
4.
Increased number of persons manifesting the signs and symptoms Low coverage of anthrax vaccination of animals Increased number of sick/dead large animals Poor enforcement of the law on meat distribution Unsanitary disposal of dead animals
5.

Family Action Report case to health worker Eat only well cooked meat Have your large animals vaccinated Maintain cleanliness of animal pens Report undetermined animal deaths BHERT / Community Action Promote strict enforcement of the law on slaughtering and disposal of dead animals Promote vaccination of animals, e.g., cow, carabao, etc., in the community
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T.
BACTERIAL MENINGITIS
1. What is bacterial meningitis?
75. It is a bacterial infection caused by Neisseria meningitidis, streptococcus pneumonia, and Haemophilus influenzae Type B, most common to children between ages of 1 month to 2 years. 2. How is the disease transmitted to human? Transmitted through droplets of saliva when infected people sneeze, cough, kiss or share utensils NOTE: Not usually spread by casual contact or simply breathing air where infected person has been
3.
What are the common observable signs and symptoms? Older children / adults Fever Headache Sore throat Vomiting Neck stiffness Altered consciousness Convulsions
Child ages 1 month to 2 years Fever Feeding problems Vomiting Irritability Seizures High pitch crying
4.
What are the predisposing conditions that increase the probability of getting infected? Low immunization coverage Poor hygienic practices Overcrowded places e.g., schools, offices, gatherings
5.
What must the family and community do to prevent/control the disease? Family Action Practice proper hygiene and sanitation Seek immediately medical attention if signs and symptoms are observed Avoid contact and sharing things with infected person BHERT / Community Action Conduct awareness campaign Conduct clean-up operations
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U.
MEASLES
1. What are measles?
76.
It is a highly communicable disease caused by the measles virus. 2. How is the disease transmitted to human? Inhaling small airborne droplets coughed out by infected persons Direct contact with things freshly soiled with secretions from nose and throat of infected person
NOTE: Infected person is contagious

2-4 days before the rash appears and remains so until the rashes disappear.
3.
Fever
Cough, colds, running nose
Red eyes
Skin rashes
4.
What are the predisposing conditions that increase the probability of getting infected? Child has NO measles immunization Low coverage of measles immunization in the community Poor hygiene and sanitation practices Crowded and poorly ventilated houses
5.
What the family and community must do to prevent the disease? Family Action Have child immunized against measles Isolate measles case at home Report measles case to health worker Maintain good ventilation in the house Practice proper hygiene, e.g., hand washing, cough etiquette (covering mouth/nose when coughing/sneezing) BHERT / Community Action Promote increased coverage of measles immunization Conduct awareness campaign Assist BHW/RHM in maintaining updated community-based monitoring and information system (CBMIS)
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V.
MENINGOCOCCAL DISEASE
1. What is meningococcal disease?
77. It is a highly communicable disease caused by the bacteria, Neisseria meningitidis. Children are easily infected. 2. How is the disease transmitted to human? Breathing-in of respiratory and throat droplets from an infected person Sharing eating or drinking utensils with an infected persons
3.
What are the common observable signs and symptoms
Fever, rashes (flat reddishbluish color), cough
Neck stiffness, convulsions, loss of consciousness
Irritability
4.
What are the pre-disposing conditions that increase the probability of getting infected? Child has NO immunization against meningococcemia. Low coverage of meningococcemia immunization in the community Poor personal hygiene NOT practicing cough etiquette and hand washing History of travel in endemic areas for meningococcemia
5.
What must the family and community do to prevent/control the disease? Family Action Have child immunized against meningococcemia Isolate suspected case at home Report case immediately Practice proper hygiene, e.g., washing hands, cough etiquette BHERT / Community Action Report immediately suspected cases Conduct awareness campaign
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W.
NEONATAL TETANUS
1. What is neonatal tetanus?
78. It is an acute, often fatal disease, in newborn (0-28 days) caused by the bacterium, Clostridium tetani. 2. How is the disease transmitted to humans? Direct contact or entry of bacteria through the umbilical cord of the newborn due to unhygienic practices in cutting umbilical cord, e.g., use of unsterilized scissors, blades, etc.
3.
What are the common observable signs and symptoms? Poor sucking Muscle rigidity Irritability and restlessness Muscle spasm and rigidity Difficulty in swallowing
4.
What are the predisposing conditions that increase the probability of getting infected? Mother does not have complete tetanus toxoid (TT) immunization Delivered by poorly trained birth attendant (hilot) at home Poor access to birthing station or health facility Low coverage of TT immunization among women of child-bearing age, especially pregnant women
5.
What must the family and community do to prevent/control the disease? Family Action Give women (15-45 yrs) complete TT immunization (5 doses) Attend regular antenatal care Seek trained health worker to assist in delivery Deliver in certified birthing station or health facility BHERT / Community Action Support immunization campaign Facilitate access to birthing station or health facility Promote birth spacing and responsible parenthood Conduct awareness campaign
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X.
NON-NEONATAL TETANUS
1. What is non-neonatal tetanus?
79. Tetanus, commonly known as lockjaw, is a disease caused by a toxin produced by the tetanus bacillus (Clostridium tetani), which grows at the site of a wound or injury. 2. How is the disease transmitted to humans? Direct entry is through cut/wound (superficial and deep wound) caused by things contaminated with Clostridium tetani in soil and animal feces. Use of non-sterile needles especially among drug users and tattooing. 3. What are the common observable signs and symptoms? Hardening of the abdominal muscle Painful muscular contraction Difficulty in swallowing Fever, headache, sore throat, chills Stiffness of neck, arms, legs Lockjaw Convulsions/seizures 4. What are the predisposing conditions that increase the probability of getting infected? Person has NO or INCOMPLETE immunization Low coverage of DPT immunization in the community Poor environmental sanitation Poor garbage disposal
5.

Family Action Have complete DPT immunization Clean surroundings Dispose garbage properly Seek immediate medical assistance if signs and symptoms are observed BHERT / Community Action Promote environmental cleanliness Support immunization activities Conduct awareness campaign
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49
SECTION 5: PUBLIC HEALTH MEASURES TO ADDRESS E/REIDs

80. Section 5 provides some important guidelines on specific actions related to the implementation of public health measures. These include guides for home-care monitoring and follow-up of cases, promoting the practice of personal hygiene, and promoting backyard biosecurity. Additional information can be obtained from health workers (doctor, nurse, and midwife) of local government units.
A.
Guide for Monitoring Home Care for Volunteer Worker
81. The following are guidelines for community volunteer workers in monitoring home-care for cases of infectious diseases: Ensure that there are conditions for isolation at home. Separate the patient from others at home, in a separate room, if possible, until 24 hours after fever resolves without any fever medication. Keep the door of the room closed. If this is not possible, the patient must use a surgical mask whenever he or she is in the presence of others. Patient and caregivers should be trained to wear and dispose masks properly during the infectious period. Where supplies of masks are limited, the patient must be given priority in the use of a surgical mask. Patient and caregivers must wash their hands frequently. The patient must follow cough and sneeze etiquette and personal hygiene practices. Drinking glasses and other utensils used for eating by the patient must be thoroughly washed with soap and water before they are subsequently used by someone else. Household surfaces should be cleaned regularly with soap and water or disinfectant. Keep windows open and allow for room ventilation. All household members should be educated on hand hygiene and cough/sneeze etiquette.
82.
Patient should seek emergency medical care according to the following: (i) If adult experiences any of the following: (ii) Difficult breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worsened cough
If child experiences any of the following: Fast or troubled breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worsened cough
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B.
Promotion of Personal Hygiene
83. The practice of proper personal hygiene will help prevent and control the spread of infectious diseases. It is important for the BHERT member to continuously promote personal hygiene, which is a critical component of infection control. The practice of personal hygiene must be reinforced. People should be encouraged to practice it to minimize potential infection transmission. There are two easy ways of practicing personal hygiene: proper hand washing and the practice of cough etiquette. 84. As part of your community campaign and public health measures, coordinate with the school head and daycare center teacher for the conduct of hand washing and cough etiquette drills among the pupils. 1. Practice of Hand Washing
85. The practice of proper hand washing and cleaning may be the most basic but most important measure to prevent or control infection. (i) Wash your hands often, especially: (ii) before, during, and after you prepare food, before you eat, after you use the toilet, after handling animals or animal waste, when your hands are dirty, more frequently when someone is sick, always before and after contact with each client, before putting on gloves and whenever hands get dirty.
Avoid touching your eyes, nose or mouth. Infections are often spread when a person touches something that is contaminated with microorganisms and then touches his/her eyes, nose, or mouth. Keep hands away from the mucous membranes of the eyes, mouth, and nose. Ensure that adequate supplies of hand hygiene products are available. This is a high priority in planning as there may be interruptions in the supply or shortages of soap and hand towels. Communicate hand washing and personal hygiene to family members and visitors. Use brochures, newsletters, emails, employees notice board, and information attached to pay slips to inform employees of the importance of hand hygiene and environmental cleaning during a pandemic. Hand hygiene notices should be posted in all the workplace entrances, washrooms, hand washing stations, and public areas. The Proper Way of Washing Hands Wet hands and wrists and apply soap. Rub right palm over left palm and then rub left palm over right palm. Rub palm to palm, the fingers interfaced. Rotational rubbing of right thumb clasped in left palm and vice-versa. Rotational rubbing backwards and forwards with tips of fingers and thumb of right hand in left and vice versa.
(iii) (iv)
(v) (vi)
(vii) (viii)
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Wash with clean water and wipe hands with hand towel or tissue.
2. 86.
Practice of Cough Etiquette
Cough etiquette is very simple and doable. Below are good practices of cough etiquette: (i) (ii) (iii) (iv) Cover nose and mouth when sneezing or coughing. Use tissue or handkerchief to cover mouth or nose when sneezing or coughing. Wash handkerchief separately. Do not mix with the rest of laundry. Dispose used tissue in a sealed bag or envelope.
C.
Backyard Biosecurity
87. Biosecurity simply means taking measures to prevent diseases from being spread to animals and humans. Listed below are the identified risk factors for appropriate prevention. Contact between domestic and wild waterfowls Smuggling of birds and bird products from infected areas (e.g., Indonesia, Vietnam) Movement of humans and equipment from infected areas Lack of proper cleaning and disinfection of equipment and footwear, etc.
What can backyard poultry owners do to prevent disease? 1. Biosecurity for the Birds a. b. Restrict access of people, other birds, and animals. Keep it clean. Wear dedicated clothes and footwear. Clean cages, equipment, footwear with soap and water. Regularly disinfect cages.
2.
Preparation of Home-sased Disinfectants a. b. Household bleach (Chlorox): cup to 1 liter of water. Leave for 30 minutes for disinfection to take effect. Mix 1 cup of household bleach per gallon of water. Leave for 30 minutes.
3.
Dont bring the virus home. a. b. Dont borrow or loan equipment. Remove/change clothes after coming from one poultry and entering another poultry.
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D.
How to manage Risk Communication
88. It is an interactive process of exchange of information and opinion among individuals, groups, and institutions. 89. It often involves multiple messages about the nature of risk or expressing concerns, opinions, or reactions to risk messages or to legal and institutional arrangements for risk management. 90. The cardinal rule is: first do no harm. A threatening crisis combined with heightened public emotions and limited access to facts compounded by rumor, gossip, speculation, assumption, and inference results in an unstable information environment. 1. Risk Messages a. b. Risk messages are written, verbal, or visual statements containing information about risk. A formal risk message is a structured written, audio, or visual package developed with the express purpose of presenting information about risk.
2.
Two Key Foci a. Instill confidence Prevent panic. Keep calm and make the public feel comfortable and self-assured. Provide information to the public Educate public in advance, if possible. Provide necessary information. Do not confuse them.
b.
3.
Bottom Line We want to have the public respond, en masse, in a logical, predictable manner designed to ensure the greatest good to the greatest number
4.
Seven Cardinal Rules of Risk Communication Accept and involve the public as a partner. Plan carefully and evaluate your efforts. Listen to the publics specific concerns. Be honest, frank, and open. Work with other credible sources. Meet the needs of the media. Speak clearly and with compassion.
5.
In summary, managing risk communication asks: What do I want to say? (MESSAGE) To whom do I want to say it? (AUDIENCE) Through what means can I convey it most effectively? (CHANNEL) When will it have the most advantageous effect? (TIMING) What do I want to have happen as a result of my message? (IMPACT) How will I assess the effect of my message? (EVALUATION)
53
How will I improve the message for its next presentation? (MODIFICATION)
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SECTION 6: ASSESSING THE FUNCTIONALITY OF BHERTs AND PREPARING THE ANNUAL ACTION PLAN AND BUDGET
91. Assessing the current capability and capacity of the BHERT and having an annual action plan that defines activities to be undertaken are vital to strengthening the functionality of the BHERT. This section provides guidelines for assessing the level of functionality of the BHERT (or other organized groups) and in preparing the BHERT (Community) Action Plan on Prevention and Control of Infectious Diseases. A. Assessing the Functionality of the BHERT
92. This matrix will help you assess the functionality of your BHERT in the barangay. If you answered No to the Concern, the column on Do the following will identify the task that needs to be undertaken to help make the BHERT functional. This will form part of the activities in your BHERT Action Plan.
Concern Does your BHERT (or other designated group in the barangay) have a clearly defined composition (chairperson, vice chairperson, members, technical adviser)? Does your BHERT have a clearly defined set of functions? Is the creation of your BHERT covered/supported by a Sangguniang Barangay Resolution/Ordinance? Has your BHERT established links/ coordination with other organized groups/ entities in the barangay to be part of the community disease reporting advocates? Does your BHERT have an approved annual plan and budget integrated in the Barangay Development Plan or Barangay Disaster Coordinating Council Plan? Are members of your BHERT (and other community groups) trained in doing risk mapping, detection, recording, reporting/ notification of disease and any unusual evnts? Has your BHERT performed/ implemented any of the functions on prevention and control of infectious diseases (risk mapping, detection, recording, reporting/notification, and action-response)? Do the members of your BHERT meet regularly? Has your BHERT identified and/or organized the different stakeholders in the barangay to be actively involved as disease reporting advocates? Yes No If No, Do the following . . . Request Sangguniang Barangay (SB) (and/or Barangay Captain) to define the composition of BHERT. Review the BHERTs function in the BOG and adopt what you think is appropriate to your situation. Request SB, through the Barangay Captain/ Kagawad for Health, to issue a resolution or pass an ordinance creating the BHERT. Request the Barangay Captain to call a meeting of all organized groups in the barangay for networking. Request Barangay Captain / Kagawad for Health to present the plan to the SB for approval and budget allocation Request your MHO/CHO to provide technical assistance in conducting the BHERT functional training. Request the SB for logistical and financial support for the conduct of the training. Coordinate/link with the federation of BHWs encourage them to be members.
Schedule regular meetings (at least once per quarter). Identify/list all the stakeholders in the barangay. Coordinate/link with the different stakeholders for collaboration and organize them into a network of disease information/reporting advocates.
55
B.
Assessing the Level of Competence of the BHERT
93. This matrix will help you assess the current level of competence of your BHERT. If you answered No to the Concern, the column on Do the following will identify the tasks that will help improve the competence of your BHERT. This will form part of the activities in your BHERT Action Plan.
Concern Yes No If No, Do the following . . . Are the members of your BHERT trained on: Use and analysis of the risk Link with your BHS and RHU for the training mapping tool of your BHERT members on mapping vulnerability risk. Use of the recording and reporting Request Sangguniang Barangay for logistics forms (both for animal influenza and fund support. and human influenza) Organize/conduct the training of BHERT Risk communication management members. Familiarity with the signs and symptoms of the different infectious diseases, especially those that are highly prevalent in the barangay Skills in mobilizing community for action Skills in advocacy, especially in generating logistics and financial support from the Sangguniang Barangay and other potential funding sources in the community Are the different stakeholders (disease reporting advocates) in your barangay trained/oriented in conducting: Link with your BHS and RHU for the training Mapping vulnerability risk using of the different stakeholders on mapping the recommended tool vulnerability risk. Organize/conduct training of stakeholders on mapping vulnerability risk. Link with your BHS and RHU for the training Use of form for detection, of the different stakeholders on mapping reporting, prevention, and control vulnerability risk. Organize/conduct training of stakeholders on mapping vulnerability risk. Has your BHERT conducted risk Request RHM to guide you in the conduct of mapping? mapping vulnerability risk. Conduct mapping of vulnerability risk. Are the families oriented on how to Conduct awareness campaign, e.g. detect/report the presence of the House-to-house infectious diseases and/or unusual Group/cluster educational activity events? Distribute leaflets on different E/REIDs Conduct Barangay Assembly
1.
2.
3.
4.
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C.
How to Assess your Current Action- Response
94. This activity guides in identifying public health measures that must be done in order to prevent the occurrence of the infectious diseases and prevent or cut their transmission. Answer the matrix below. If you answered No to the Concern, the column on Do the following will identify the tasks to be done to improve action-response. You will include these action-points in your BHERT Action Plan.
Concern Yes No If No, Do the following . . . 1. Has your BHERT conducted any of the following public awareness measures for disease detection, prevention, and control? House to house visits or public Conduct house-to-house visits to orient assembly. families Distribution of leaflets Distribute leaflets on disease recognition to all families Group learning sessions Organize/conduct group learning sessions Others, specify.. 2. Has your BHERT conducted any campaign to promote the practice of personal hygiene School drills on hand washing Coordinate/link with the school authority and cough etiquette for the conduct of drills on hand washing and cough etiquette among school children. Do the families in your Coordinate/link with your barangay council barangay have access to and other stakeholders for provision of safe/drinking water? safe/drinking water. Do the families in your Coordinate/link with your barangay council barangay have access to and health workers for appropriate sanitary latrine? measures to promote sanitary latrine. 3. Has your BHERT undertaken measures for the prevention and control of vectors? clean-up drive Coordinate/link with various stakeholders and the community for conduct of the e.g., garbage, canal, esteros, clean-up drive. creeks, etc. rabies vaccination Four oclock habit (cleaning of potential breeding places) In case your barangay is endemic for malaria, do the families use treated mosquito-nets Others, pls specify. 4. Do the families in your barangay practice biosecurity? Coordinate/link with the veterinary office of your LGU for dog vaccination. Organize and promote Four Oclock Habit in your barangay. Coordinate / link with the health sector for provision of treated mosquito-nets.
Organize and conduct biosecurity learning sessions with families having animals and poultry.
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D. 95.
Preparation of the BHERTs Annual Plan and Budget The following steps are guides in preparing the BHERT annual action plan and budget.
Step 1: Check the gaps (marked No) that you have identified in the following sections of your BOG. Assessing functionality of BHERT Assessing competencies of BHERT Assessing current action-response Step 2: Select the activities you need to do from the column Do the following and list these in the plan matrix (Annex-5: BHERT Action Plan Matrix). Discuss the different activities with the group members and identify which of the activities you will include in the plan. List the activities you selected under the major headings in the column Activity. Organizing/Revitalizing BHERT Developing competencies of BHERT Implementation Monitoring and Evaluation Step 3: Fill up the other columns in the BHERT Action Plan Format. The BHERT Action Plan Matrix has the following components as described below. The selection of activities to be included in the plan must be based on the defined roles and functions of the BHERT. Review your functions and identify activities that will help you accomplish the function. Target: This is usually defined in numbers e.g., number of resolutions, number of families to be covered, number of disease advocates to be mobilized/oriented, etc. Timeframe: This is your estimated period of time to complete the said activity. Person responsible: This identifies the person (in name) who will take the lead in doing the said activity. Requirement: Type: List of the resources you will need to do the activity, e.g.: paper, IEC materials, travelling cost, etc. Cost: Put the estimated cost (in Pesos) of the resources you have listed. Source: This identifies where the fund/resources will come from. It may also be good to already describe how you intend to get these resources. Activities:
96. Your BHERTs Action Plan must be presented to the Sangguniang Barangay for inclusion in the Barangay Annual Plan and Budget. It is therefore necessary to prepare and submit your plan before or during the regular barangay planning cycle in your respective Local Government Unit. 97. Based on discussions with other barangay leaders, the BHERTs plan can also be an integral part of the Barangay Disaster Coordinating Council Plan. The BDCC is authorized to plan and budget activities related to pre-disaster preparedness, during disaster activities, and post-disaster actions. Since infectious diseases is considered as an emergency, you can always link the BHERTs Action Plan with the BDCC plan.
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BHERTS OPERATIONAL GUIDEBOOKI
Appendix 1
SANGGUNIANG BARANGAY RESOLUTION / ORDINANCE
Appendix 1: SANGGUNIANG BARANGAY RESOLUTION / ORDINANCE
PROTOTYPE SANGGUNIANG BARANGAY RESOLUTION / ORDINANCE
Republic of the Philippines Province / City of ___________________ Municipality of ___________________ Office of the Sangguniang Barangay Barangay ___________________ RESOLUTION / ORDINANCE No. ________ Series of _____
Revitalization/Creation of Barangay Health Emergency Response Team (BHERT) for the Early Detection and Control of Infectious Diseases
WHEREAS, the Sangguniang Barangay is aware of the challenges and threats that the different infectious diseases pose to the health of the individual, the economy of the family, and the overall economic development of the community and the country, WHEREAS, the Sangguniang Barangay is aware that these infectious diseases are preventable and controllable with the active participation of the community and the barangay leaders in the early detection and reporting of the common signs and symptoms of the these infectious diseases, and with the implemention of measures that can control the spread of the diseases, WHEREAS, the Sangguniang Barangay believes that community participation, with the leadership of the Sangguniang Barangay, is one of the key factors to cutting the route of transmission of the infectious diseases, BE IT RESOLVED AS IT IS HEREBY RESOLVED THAT, the Sangguniang Barangay hereby revitalizes and/or creates the Barangay Health Emergency Response Team (BHERT) as the community-based partner of the national and local health system for the prevention and control of the different infectious diseases.
Appendix 1: SANGGUNIANG BARANGAY RESOLUTION/ORDINANCE
Be it further resolved that the BHERT will have the following composition (officers and members): Chairperson: Vice-Chairperson: Members: a. Selected BHWs (1-2 person) b. Selected Tanod (1 2 person) c. Purok Leaders d. Etc. Technical Adviser: Rural Health Midwife of the BHS It is further resolved that the BHERT will mobilize the different BHWs, Barangay Tanods, Purok/Cluster Leaders for every 25 families, the school, the existing homeowner associations, and the different barangay-based NGOs, to be part of the overall community disease reporting advocates for the early detection and control of the different infectious diseases The functions of the BHERT will be as follows: (refer to the proposed functions in BOG) The annual action plan of the BHERT will be an integral part of the Annual Barangay Development Plan (or Barangay Disaster Coordinating Council Plan) with corresponding budget allocation.
This Resolution will take effect immediately upon signing of the Officers and Members of the Sangguniang Barangay.
Signed:
Barangay Captain: (name and signature) Chairperson/Kagawad for Health: (name and signature) Members of Sangguniang Barangay: (names and signatures) Date: (dd / mm / yy)
Appendix 1: SANGGUNIANG BARANGAY RESOLUTION / ORDINANCE
Appendix 2
BHERTS RISK MAPPING TOOL (AVIAN INFLUENZA AND E/REIDs)
Appendix 2: BHERTs RISK MAPPING TOOL (AVIAN INFLUENZA AND E/REIDS)
PROTOTYPE: BHERTs Risk Mapping Tool (Avian Influenza & E/REIDs)

Barangay: ___________________________________________________ Municipality / City: _____________________________________________ Date conducted: _____________________________________________
AI / H1N1 and Other Infectious Diseases 1. Presence of migratory birds Yes 2. Presence of: Poultry Farm Commercial: Backyard/Small Scale No Yes Yes Yes No No No
Note: Having 1,000 layers or 5,000 broilers is considered backyard/smallscale; more than these would be considered commercial. Presence of Swine Farm Commercial: Backyard/Small Scale Yes Yes Yes No No No
Note: Having 10 sows or 20 fatteners is considered backyard/small-scale; more than these would be considered as commercial. 3. Increased number of unexplained animal/poultry deaths 4. Poor sanitation/biosecurity in poultry/swine farm 5. Families with persons usually travelling to country/area with reported cases of AI / H1N1 For Mosquito/Vector Diseases 1. Presence of body of water, e.g., Rivers Creeks Irrigation canal/dike Open drainage/canal Uncovered containers Flood prone areas 2. Not using treated mosquito net 3. History of dengue/malaria in barangay 4. Presence of stray dogs 5. Unvaccinated dogs No. Families ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ Yes Yes Yes No No No
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
No No No No No No No No No No
No. of unvaccinated dogs: ____
Appendix 2: BHERTs RISK MAPPING TOOL (AVIAN INFLUENZA AND E/REIDS)
BHERTs Risk Mapping: Food/water/hygiene 1. Water/sanitation/hygiene-related: No sanitary latrine Poor access to potable water Poor garbage disposal Poor hygiene practice (hand washing / cough etiquette) 2. Food related: Practice of eating raw and not properly cooked food Presence of ambulant food vendor Unhygienic food handling and preparation 3. Immunization related (low coverage) No. Families ___________ ___________ ___________
Yes Yes Yes Yes
No No No No
Yes Yes Yes
No No No
Appendix 3: PROTOTYPE: BHERTs RISK MAPPING TOOL (AVIAN INFLUENZA AND E/REIDS)
Appendix 3
BHERTS RECORDING/ REPORTING FORM (HUMAN)
Appendix 3: BHERTS RECORDING/REPORTING FORM (HUMAN)
PROTOTYPE:
BHERTS RECORDING/REPORTING FORM (HUMAN)
Name of Person: ___________________________ Birth Date: (dd) ___ / (mm)___ / (yy)___ High-Risk: Pregnant <5 years old
Sex:
( ) Male
( ) Female
Age: (completed month / year) _______ > 60 yrs old with Chronic Disease / Obese
Address: House No.:_______ Street: _______________________ Purok / Zone: _______________ Barangay:_____________________ Municipality/City: ____________________________
Observed Signs and Symptoms: 1. 2. 3. 4. 5. _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ YES NO
Date of Onset: ________________ ________________ ________________ ________________ ________________
History of travel:
If YES, WHERE? ___________________
Prepared / submitted by: Name: ___________________________Position: Time: __________________________ Date: ______________________ ____________________________
Appendix 4: PROTOTYPE: BHERTs ND E/REIDS)
Appendix 4
BHERTS RECORDING/ REPORTING FORM (ANIMAL)
Appendix 4: BHERTs RECORDING/REPORTING FORM (ANIMAL)
PROTOTYPE: BHERTS Recording/Reporting Form (Animal)
Prototype: AI Recoding/Reporting (unexplained deaths) Name of Owner: _____________________________ Address: House No: _____________________________ Street: _____________________________ Barangay: _____________________________ Mun. / City _____________________________ Type of Animal:
Total Heads Number Sick Number Died Date Occurred
Chickens Ducks Swine (Pig) Goat Cattle Others
_________ _________ _________ _________ _________ _________
__________ __________ __________ __________ __________ __________
__________ __________ __________ __________ __________ __________
___________ ___________ ___________ ___________ ___________ ___________
Biosecurity: Practice Not Practice
Reported by: _____________________ Date: ____________________
Position: ________________________
Appendix 5: PROTOTYPE: BHERTs SAMPLE ACTION PLAN
Appendix 5
BHERTS SAMPLE ACTION PLAN
Appendix 5: BHERTS SAMPLE ACTION PLAN
BHERTS SAMPLE ACTION PLAN FORMAT (Activities listed are just examples)
Activity Target Output Sangguniang Resolution issued Time frame Person Responsible Requirements Type Cost Source
A. Organization/Revitalization of BHERTs 1 Securing issuance of Sangguniang Barangay Resolution regarding the creation of BHERTs __ No. of Establishing linkage and stakecoordination with different holders stakeholders for establishing disease information/reporting advocates B. Capability Building/Development All Training of BHERT members BHERT and other stake holders on members mapping vulnerability risk and stakeholders All Training of BHERT members and other stakeholders on early BHERT members detection/reporting using the and stakeprescribed tool holders All Training of BHERT members BHERT and other stakeholders in organizing and promoting public members and stakehealth measures holders
Linkage established with different stakeholders (list of stakeholders)
BHERT members and other stakeholders trained on mapping vulnerability risk BHERT members and other stakeholders trained on early detection/reporting BHERT members and other stakeholders trained on organizing and promoting public health measures
Appendix 5: BHERTS SAMPLE ACTION PLAN
Activity C. Implementation Conducting mapping vulnerability risk Detecting/reporting presence of disease and/or unusual events Implementing public health measures: Conduct personal hygiene drills in school (hand washing/ cough etiquette Conduct clean-up drive Promoting use of treated bednets Others, specify D. Monitoring and Evaluation Conducting regular BHERT meeting (monthly /quarterly)
Target All families All families
Output Report on findings with action recommendations Report submitted timely
Time frame
Person Responsible
Requirements Type Cost
Source
All classrooms All families All families
Number of drills conducted and pupils participating Number of families participating in the clean-up drive Number of families using treated bed nets
Minutes of the meetings

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Strengthening the Local Capacity Response to Pandemic H1N1 Influenza and Other Emerging Infectious Diseases in the Philippines

THE BARANGAY HEALTH EMERGENCY RESPONSE TEAM OPERATIONAL GUIDEBOOK (BHERT-BOG)

THE BARANGAY HEALTH EMERGENCY RESPONSE TEAM OPERATIONS GUIDEBOOK (BHERT-BOG)

BHERT OPERATIONS GUIDEBOOK

SECTION 1: IMPORTANCE OF COMMUNITY PARTICIPATION IN ADDRESSING E/REIDS..... 3

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

Adverse Effects Following Immunization Acute Flaccid Paralysis

Department of Interior and Local Government

influenza A virus Influenza-like Illness

rural health unit

BHERT OPERATIONS GUIDEBOOK

measures for the prevention and control of infectious diseases.

ORGANIZATION OF THE GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

SECTION 1: IMPORTANCE OF COMMUNITY PARTICIPATION IN ADDRESSING E/REIDS

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

SECTION 2: REVITALIZING AND STRENGTHENING THE ORGANIZATION OF BHERTS

BHERT OPERATIONS GUIDEBOOK

Documentation Prepare/submit periodic reports on activities undertaken.

BHERT OPERATIONS GUIDEBOOK

Figure 1: Organization Structure of BHERT Disease Reporting Advocates

Office of the Mayor (Municipal/City)

Municipal Health Office / City Health Office

Other Agencies, e.g., Veterinary, Agriculture, etc.

Rural Health Unit / City Health Center

Barangay Health Station (BHS)

Barangay Health Emergency Team (BHERT)

Barangay Disaster Coordinating

Other groups (Purok Leader, Cluster Leaders, BNSs, BSPOs, etc

BHERT OPERATIONS GUIDEBOOK

BHERT with BHWs

BHERT with School

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

VerifyInformation VERIFY REPORT

VerifyInformation VERIFY INFORM

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

SECTION 4: DESCRIPTION OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES/CONDITIONS

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

Figure 4: Timeline of Infectivity

Primary Mode of Transmission

Portal of Entry (Point of Entry)

BHERT OPERATIONS GUIDEBOOK

BHERT OPERATIONS GUIDEBOOK

HUMAN AVIAN INFLUENZA (BIRD FLU)

What are the common observable signs and symptoms?

Fever, Headache, Sore Throat

Mild to Severe Cough Muscle Pains

What must the family and community do to prevent/control the disease?

BHERT OPERATIONS GUIDEBOOK

INFLUENZA-LIKE ILLNESS (ILI)

What are the common observable signs and symptoms?

BHERT OPERATIONS GUIDEBOOK

What are the common observable signs and symptoms?

Running nose, sneezing, nasal congestion, mild fever, dry cough

Red Watery Eyes Red watery eyes