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Malaria Cases Malaria Cases Epidemiology Bureau January 1- December 31, 2016 Public Health Surveillance Division Table 1. Quick Facts Trend in the Philippines A total of 6922 suspect malaria cases were reported nationwide from January 1 to December 31, 2016. This is 14% lower compared to the same period last year (Fig. 1). As of December 2016, there were 32 provinces declared as Malaria free, 41 provinces on Elimination status while the remaining 9 provinces were still malaria endemic (Fig.2). Geographic Location Most of the cases (Fig.3) were from the following regions: Region IV-B (93%), Region 12 (2%), Region 11 (2%), and ARMM (1%) while the remaining 2% came from the rest of the regions in the country. Palawan (Table 2) accounted 92% % of the reported cases followed by Sultan Kudarat (2%), Davao Del Norte (2%) while the rest came from the rest of the provinces in the country. Fig. 1 Reported Malaria Cases by Morbidity Week, Philippines, Jan 1 – Dec 31, 2016 2015 v.s 2016 (N=6922) 500 450 400 350 300 250 200 No. Cases of 150 100 50 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 2016 69 54 84 57 1 57 181 84 106 148 89 84 70 104 116 106 216 118 148 214 188 237 394 491 315 217 210 255 263 164 144 178 238 85 66 143 94 59 56 86 94 111 97 107 77 106 58 37 77 79 52 38 2015 77 84 75 41 64 76 95 57 62 89 111 130 102 134 137 149 288 345 410 489 388 451 334 205 347 266 277 270 228 186 144 145 149 168 145 103 116 104 87 94 77 71 80 101 91 63 57 52 79 76 57 24 1 | P a g e *NOTE: Case counts reported here do NOT represent the final number and are subject to change after inclusion of delayed reports and review of cases. Data Source: 2015 & 2016 Cases-Philippine Integrated Disease Surveillance and Response & Phil. Malaria Information System Database Malaria Cases Epidemiology Bureau January 1- December 31, 2016 Public Health Surveillance Division Fig. 2 Malaria Provincial Classification & Reported Cases Fig. 4 Reported Malaria Cases by Change Rate, Palawan Jan1 – Dec 31, 2016, (N=6922) 2015 vs. 2016 Fig. 3 Reported Malaria Cases by Region, Table. 2 Reported Malaria Cases by Province, Jan1 –Dec 31, 2016, (N=6922) Jan1 – Dec 31, 2016, (N=6922) 350 300 250 200 150 100 50 0 04B 12 11 ARMM 3 CARAGA 04A NCR 9 2 6 7 CAR 5 10 1 8 2016 6,469 140 120 95 16 16 15 12 10 7 6 4 4 3 3 1 1 Palawan reported 15% decrease in cases than last year (7471). Large proportion (36%) of reported cases were from the municipality of Rizal ; followed by Brooke’s Point (25%) , Bataraza (18%), and Balabac (9%) while the remaining 12% came from the other municipalities in Palawan. In terms of change rate, the municipality of San Vicente (343%) , Taytay (150%), Balabac (108%) and Brooke’s Point (37%) had more cases than the last year while the city of Puerto Princesa, municipalities of Rizal, Roxas, Bataraza, Narra, Quezon, Aborlan, Sofronio Española and Linacapan had lower reported cases (Fig 4). No case was reported among the municipalities of Agutaya, Araceli, Busuanga, Cagayancillo, Coron. Culion, Kalayaan, and Magsaysay. 2 | P a g e *NOTE: Case counts reported here do NOT represent the final number and are subject to change after inclusion of delayed reports and review of cases. Data Source: 2015 & 2016 Cases-Philippine Integrated Disease Surveillance and Response & Phil. Malaria Information System Database Malaria Cases Epidemiology Bureau January 1- December 31, 2016 Public Health Surveillance Division Figure 5. Reported Malaria Cases by Age & Sex, Profile of Cases Jan 1 – Dec 31 2016, Philippines (n=6915*) Ages of cases ranged from 0 to 96 years MALE FEMALE old with median of 11 y/o. Majority of cases were 60 & above male (57%), most (23%) of the cases belonged 55-59 y/o to the 5-9 year old age-group (Fig. 5). 50-54 y/o 45-49 y/o 40-44 y/o Majority (67%) of the reported cases 35-39 y/o were indigenous people (IP), (Fig. 6) with the IP 30-34 y/o group of Palaw’an having the largest (72%) 25-29 y/o Age Group Age 20-24 y/o proportion of cases followed by Molbog (10%) 15-19 y/o and Manobo (3%). 10-14 y/o 5--9 y/o 1-4 y/o The tendency of IPs to live in <1 y/o mountainous areas in connection to their 1000 500 0 500 1000 livelihood put them at higher risk not only of * Excluded 7 cases with no data on age malaria exposure but as well as limited access to Figure 6. Reported MalariaN Cases by Ethnicity, health care. Jan 1 – Dec 31, 2016, Philippines (N=6922) Malaria Parasite Distribution Majority (79%) of parasite detected were P. Falciparum followed by P. Vivax (12%) with a Non IP, small proportion of Mixed Parasites (4%) and P 33% Malariae (2%) while the rest (2%) were unspecified. IP, The distribution of parasites varied in 67% Palawan and non-Palawan provinces. Large proportion (83.7%) of parasite detected in Palawan was P. Falciparum while P. Palciparum Figure 7. Reported Malaria Cases by Parasite, (28.8 %) and P. Vivax (23.4%) comprise most of Jan 1 – Dec 31, 2016, Palawan vs. Non Palawan parasites in non-Palawan provinces. Provinces (N=6,922) Laboratory Confirmation 3.5% 100% 0.3% Majority (53.8 %) of malaria screening 12.1% 90% 1.1% MIXED PARASITES test was performed thru the use of Rapid 11.4% 80% Diagnostic Test (RDT) while a smaller proportion 20.3% UNSPECIFIED 70% (39.8 %) thru microscopy (Fig. 8). Although microscopy remains a gold standard in 60% 15.4% P. MALARIAE 50% diagnosing malaria, the use of RDT was beneficial as an initial test especially among 40% 23.4% P. VIVAX provinces where trained malaria microscopists 30% P. FALCIPARUM were no longer available. 20% 83.7% 28.8% 10% 0% PALAWAN NON PALAWAN 3 | P a g e *NOTE: Case counts reported here do NOT represent the final number and are subject to change after inclusion of delayed reports and review of cases. Data Source: 2015 & 2016 Cases-Philippine Integrated Disease Surveillance and Response & Phil. Malaria Information System Database Malaria Cases Epidemiology Bureau January 1- December 31, 2016 Public Health Surveillance Division Figure 8. Reported Malaria Cases by Laboratory test , Case Classification Jan 1- Dec 31,2016 , Philippines (N=6,922) Majority (94.1%) of case were Confirmed Uncomplicated, a small proportion were Confirmed Unknown Severe (5.3%) while the rest were classified either as 6.4% Confirmed Malaria Death, Probable Uncomplicated, Probable Severe and Asymptomatic Malaria (Table 3) . Microscopy RDT Severity of the Disease 53.8% 39.8% Out of the 6,922 reported malaria cases, 366 (5.3%) were classified as severe malaria and hospitalized. Seven (7) deaths were reported with a Case Fatality Rate (CFR) of 0.10%, significantly lower by two folds compared last Year (0.20%). Majority (86%) of deaths due to malaria were from the IP group of Palaw’an in the municipalities of Table 3. Reported Malaria Cases by Case Bataraza, Brooke’s Point , Quezon and Marcos Classification, Jan 1-Dec 31,2016 , Philippines (Fig. 9) . Six (6) out of the seven deaths were due to (N=6,922) P. Falciparum while a single death was from a mixed infection (P. Falciparum & P. Malariae). No History of travel was reported among these deaths suggesting that these cases including the parasites were transmitted locally. Turnaround time: Consultation and Treatment The interval of days from the onset of symptoms to consultation and onset of symptoms to receiving anti-malarial treatment significantly varied in terms of outcome of malaria infection (Table 4). Figure 9. Reported Malaria Deaths by Ethnicity . Those who died from malaria had longer median Jan 1- Dec 31,2016 , Philippines (n=7) interval from the onset of symptoms to consultation and receiving anti-malaria medication. This suggests that early recognition of the symptoms and access to anti -malaria medication have a relationship in the NON IP prognosis of the disease. Recognizing that majority of 14% cases (76%) and those who died from malaria were IPs (86%) verified vulnerability of these groups and suggest tailored intervention among them. IP The difficulty of IPs to seek early consultation and treatment may be due to their personal health 86% behaviour, inadequacy of understanding of the disease, and proximity of the health facilities to their communities. Case Fatality Rate= 0.10% 4 | P a g e *NOTE: Case counts reported here do NOT represent the final number and are subject to change after inclusion of delayed reports and review of cases. Data Source: 2015 & 2016 Cases-Philippine Integrated Disease Surveillance and Response & Phil. Malaria Information System Database Malaria Cases Epidemiology Bureau January 1- December 31, 2016 Public Health Surveillance Division Elimination Status Table 4. Interval of days from Onset of symptoms to consultation and Onset of symptoms to Receiving anti- Out of the 6,922 reported malaria cases, malarial medication by Outcome, Jan 1- Dec 31,2016 almost all (99%) were from provinces on “Control Philippines (n=5258) status” such as Palawan, Davao Del Norte and Sultan Kudarat and etc.
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