This report describes how the Philippines used the World Health Organization’s intra-action review methodology to assess progress in the country’s response to the mpox public health emergency of international concern. It describes the methodology used, the focus areas of the review, and recommendations resulting from the intra-action review.
Problem: Natural disasters increase the risk of communicable disease transmission while disrupting routine disease surveillance systems, leading to delayed detection of outbreaks and weakened public health decision-making during emergency responses. Context: Indonesia is vulnerable to natural hazards, and Aceh Province has experienced recurrent disasters with significant public health impacts. In late 2025, major flooding and landslides affected Aceh Tamiang District, disrupting health services. Field epidemiology support was deployed to strengthen post-disaster disease surveillance during the emergency response. Action: A field epidemiologist strengthened case detection and registration at health posts, standardized disease recording, verified suspected clusters, and established centralized data compilation, analysis and situation reporting via the Health Emergency Operations Centre. Activities were aligned with World Health Organization functions and were adapted to emergency conditions. Outcome: There was substantial disruption to routine health services, with severe damage to 12 of 15 primary health-care centres and the district health office, and moderate damage to two hospitals. Nevertheless, core surveillance functions were maintained during the emergency response, facilitating the reporting and documentation of multiple outbreak-prone diseases, including typhoid, measles and varicella. Surveillance outputs were used to inform timely risk assessment and response actions, including mobilizing laboratory surge capacity to support diagnostic activities. Discussion: Concrete actions translate field data into timely, structured public health responses. Field epidemiologists can help maintain system functionality in resource-constrained emergencies by adapting to paper and mobile tools, synthesizing fragmented data and coordinating directly with laboratory personnel for case confirmation.
Problem: Antiviral therapy for chronic hepatitis B (CHB) reduces morbidity and mortality and improves quality of life. Achieving high levels of adherence is challenging due to multiple barriers, including medication fatigue, stigma, transportation and limited health literacy. Context: Suboptimal adherence to antiviral therapy for CHB is problematic in Kiribati, particularly among high-risk groups including pregnant women and individuals with cirrhosis. Action: During January–August 2025, a community volunteer intervention was initiated on Kiritimati, a remote island of Kiribati, to address adherence to CHB antiviral therapy. Community volunteers were assigned to patients positive for hepatitis B surface antigen who were commencing antiviral therapy and were pregnant or had cirrhosis. During home visits, volunteers provided education and encouraged medication adherence and clinic follow-up. Adherence in the intervention group was compared with adherence in positive patients being treated on other remote islands without the intervention. Outcome: Adherence was measured by medication bottle counts. Outcomes were assessed by overall group adherence and individual adherence >80%. Group adherence was 77.4% (240.5/310.75) in the volunteer intervention group compared with 52.5% (700/1333) in the group without it (P < 0.001). Overall adherence among pregnant women in the intervention group was 89.7% (52/58). Individual adherence >80% was met in 58.8% (30/51) of the intervention group and 34.1% (70/205) in the control group (P = 0.0012). Discussion: Although findings are preliminary and the intervention and control groups were not matched, this pilot suggests community volunteers are a promising intervention to improve CHB treatment adherence in a high-prevalence Pacific island setting. This strategy could also be explored for other chronic conditions where adherence is important.
Objective: This study presents the findings of a joint cholera risk assessment conducted in Eastern Visayas, the region in the Philippines with the highest incidence of the disease in 2022–2023. The study aimed to identify key risk factors, review progress since a 2016 assessment, and highlight persistent gaps in prevention, preparedness and response. Methods: In July 2024, the World Health Organization, the United Nations Children’s Fund and the Philippine Department of Health conducted a joint assessment using a standardized checklist for focus group discussions and interviews across four technical areas: partnership and coordination; epidemiology and surveillance; water, sanitation and hygiene (WASH); and risk communication and community engagement. Epidemiological trends between 2022 and 2024 were analysed, and water samples from wells and refilling stations were tested for Escherichia coli and total coliforms. Results: From 2022 to 2024, 12 284 cholera cases were reported in Eastern Visayas (case fatality rate: 0.5%). Testing showed 100% contamination in Level I and II sources, while 33% of Level III samples tested positive for total coliforms despite no E. coli detection. Partial progress has been made in implementing the 2016 assessment’s recommendations, with good practices in surveillance, water sampling and community awareness, although gaps remain in outbreak response, coordination and WASH access. Discussion: This assessment identified both progress and persistent challenges across the four technical areas. Key limitations were found in the qualitative design and the limited geographical coverage. Conclusions focused on prioritizing the strengthening of national cholera strategies by embedding them within the broader Food and Waterborne Diseases Prevention and Control Program alongside local ownership and equity-focused WASH investments.
Problem: On 26 September 2025, a fire at the National Information Resources Service Data Centre disabled the Infectious Disease Information System and halted automated surveillance in the Republic of Korea. Context: The information system is the backbone of the country’s infectious disease surveillance network, integrating clinical, laboratory and epidemiological data via an automated electronic notification interface. Diseases are categorized into Classes 1–4, based on their potential impact and level of urgency. This supports decision-making on outbreak preparedness and response. Action: The Korea Disease Control and Prevention Agency immediately designated its 1339 call centre as the reporting channel for urgent Class 1 infectious diseases. Within 24 hours, it had developed temporary cloud-based reporting tools enabling local health centres to report Class 2 and 3 diseases. Using Naver Forms, health centres reported only essential infectious disease variables based on notifications received from medical institutions via fax or phone. Sentinel surveillance data for Class 4 diseases were collected using standardized Excel templates via Google Forms. Interagency meetings were routinely held to ensure transparent coordination. Outcome: Class 1 notifications continued through the 1339 hotline during the outage, which lasted until 28 October 2025. Following system restoration, disease-specific totals from the temporary cloud-based reporting tools and the restored datasets showed high overall consistency (Pearson correlation coefficient = 0.99, P < 0.001). Discussion: Essential surveillance functions can be maintained during a nationwide IT outage through adaptive reporting mechanisms and strong institutional coordination. Infrastructure redundancy, disaster recovery capacity and regular simulation exercises are also critical for maintaining surveillance continuity.
Objective: In 2024, following detection of a measles outbreak on Phu Quoc Island, Viet Nam, an investigation was conducted to describe the epidemiological characteristics and assess response timeliness using the 7-1-7 framework. Methods: Suspected measles cases were identified through syndromic surveillance (those with fever and rash, plus respiratory inflammation and/or conjunctivitis) and confirmed by serological testing. Demographic and epidemiological information was collected with standardized questionnaires. Vaccination status was verified using the National Immunization Information System and personal vaccination records, with full vaccination defined as two doses of measles-containing vaccine. The 7-1-7 framework was used to assess timeliness of detection (7 days), notification (1 day) and response (7 days). Results: Of 137 suspected measles cases occurring between 7 April and 7 June 2024, 83 (60.6%) were confirmed. Cases occurred mainly among school-aged children (6–10 years, n = 55; 40.1%), with schools as the primary exposure setting (n = 56; 40.9%). Among the 55 school-aged children, 10 (18.2%) were fully vaccinated. The attack rate was significantly higher among school-aged children who had not received two vaccine doses than among those who were fully vaccinated (0.9% [45/4988] vs 0.1% [10/8917], P < 0.001). Outbreak detection was delayed by 15 days, notification occurred within 1 day of identification of the first suspected case, and response was within 5 days of notification. Discussion: This outbreak was likely caused by gaps in vaccination coverage and delayed recognition of early warning signs. Strengthening immunization, early case detection and reporting systems are essential to prevent future outbreaks.
Objective: A cluster of leptospirosis and brucellosis cases in a semi-nomadic, pastoral community was reported in October 2023 from Village A, Uttarakhand State, India. This cluster was investigated to describe the epidemiology and potential exposures. Methods: Suspected cases were residents with sudden-onset fever or myalgia occurring from 1 August 2023 to 7 January 2024; confirmed cases were suspected cases with laboratory confirmation. Suspected cases were identified through a house-to-house case search and were interviewed regarding sociodemographic variables, symptoms and exposures. Those who consented were tested. Data were cleaned and analysed in Microsoft Excel. Results: Fifty suspected cases were identified among a total of 300 residents across 85 households. Among these, 27 agreed to be tested, and 25 were confirmed (13 with leptospirosis, 7 with brucellosis and 5 with both leptospirosis and brucellosis). The cases began in September 2023 following flooding and continued until January 2024, with no deaths. The median age (range) of cases was 30 (17-82) years for leptospirosis, 39 (25-56) years for brucellosis and 39 (22-50) years for coinfection. Altogether, females accounted for 92% (12/13) of leptospirosis cases, 57% (4/7) of brucellosis cases and 80% (4/5) of coinfections. Symptoms included fever, myalgia and arthralgia. All cases reported contact with floodwater and animal abortus. Discussion: This was a laboratory-confirmed co-occurring cluster of leptospirosis and brucellosis, including five cases of coinfection, following flooding, predominantly affecting female Van Gujjar dairy farmers. Education was provided to the community about the hygienic disposal of animal waste
Problem: In early 2024, the Lao People's Democratic Republic experienced a surge in dengue cases approaching levels of its 2013 epidemic, underscoring the persistent threat of dengue during the monsoon season. Although awareness of preventive behaviours is high, inconsistent adoption has limited their effectiveness. Context: In response, the Ministry of Health, in collaboration with the World Health Organization, implemented an innovative, humour-driven risk communication and community engagement (RCCE) campaign targeting individuals who perceived dengue as a routine health concern. Action: To capture attention and increase message retention, the April to September campaign employed an actor dressed as a giant mosquito who deliberately and humorously interrupted daily activities. The strategy used pre-tested materials, a strong social media presence, and television and radio to promote mosquito control, symptom recognition and timely medical care for severe dengue. The impact was assessed through nationwide phone and online surveys and social media analytics. Outcome: The campaign reached almost 2.9 million unique users (68.2% of whom were using the country's most popular social media platform), generating more than 27 million content views and 86 342 interactions. Post-campaign surveys indicated a sharp rise in public concern about dengue (from 21% [42/200] to 56% [224/400], indicating they were "very concerned") and high awareness of key messages, with 81% (324/400) stating they would seek immediate care for severe symptoms. The humour-based approach was rated as appealing or very appealing by 76% (304/400) of respondents, with 90% (360/400) reporting increased likelihood of preventive action. Discussion: These findings demonstrate that culturally relevant, humour-based RCCE, integrated across digital and traditional media, may be effective in enhancing awareness and shifting perceptions.
This article describes the rapid activation of the Asia Pacific Health Security Action Framework Community of Practice following the MV Hondius hantavirus outbreak. It highlights regional knowledge-sharing, multidisciplinary engagement, preparedness activities, and the importance of timely communication and collaboration in strengthening readiness and response during emerging public health emergencies.
Problem: Papua New Guinea has hosted several mass gatherings in recent years. Yet, there is limited data on the involvement of emergency medical teams in these events, let alone in other low- and middle-income countries. Prior to Pope Francis's state visit in September 2024, the national emergency medical team (EMT) had not simulated its updated clinical patient flow systems. Context: During Pope Francis's visit, an estimated 70 000 attendees gathered at the national stadium. Using Arbon's mass gathering model, the patient presentation rate was calculated to be 330 over 2 days, or 4.7 per 1000, posing a significant challenge to local health-care capacity. Action: The National Department of Health mobilized its EMT to lead clinical operations in collaboration with the National St. John Ambulance service. Planning spanned 6 weeks and involved provincial partners. Outcome: Over 2 days, 257 patients, or 3.7 per 1000, were managed using a hub-and-spoke model. First-aid stations operated by the St. John Ambulance service treated 200 patients for dehydration and headaches, while the Advanced Casualty Management Centre handled 57 cases of heat-related illnesses and chronic condition exacerbations. Discussion: The deployment of the EMT showcased its capability and credibility, setting a national milestone and providing a feasible model for mass-gathering preparedness and response in low- and middle-income countries in the World Health Organization's Western Pacific Region. This report highlights not only the importance of multipartner collaboration in such preparedness, providing baseline data for low-resource settings, but also the scalability of rehabilitation services and the Interagency Integrated Triage Tool as frameworks for future deployments.
Dong Nai province in southern Viet Nam was among the hardest hit in a measles outbreak in 2024–2025 with over 7000 cases. Our analysis outlines major takeaways for measles control in recommending the need for strengthened surveillance, digital communication and intersectoral collaboration to address immunization gaps and build health system resilience in Viet Nam.
Objective:The prevalence of chronic hepatitis B in Vanuatu is high, at approximately 9%. While immunization has been available for infants since 1989, subsets of the adult population remain susceptible, including health-care workers. Prior to a planned roll-out of hepatitis B vaccination for health-care workers, we conducted a knowledge, attitudes and practices survey to inform education programmes aimed at promoting vaccine uptake. Methods:Clinical and non-clinical health-care professionals at risk of occupational exposure to hepatitis B were invited to complete an online survey from April to June 2024. The survey sought information on hepatitis B knowledge (10 questions), attitudes (6 questions) and clinical practices (3 questions), as well as participant demographics. Participant knowledge scores were calculated and potential associations with demographic factors explored using Fisher's exact test. Results:Most of the 50 respondents were female (73%) and worked in either hospitals or the Ministry of Health (82%). Knowledge was high, with a median score of 9 (range: 3-10); 21 participants scored 100%. The proportion of incorrect responses was highest for questions related to treatment availability and transmission risks. We found no evidence of associations between demographic factors and knowledge scores. Most participants believed that hepatitis B vaccines were useful (88%) and prevention and control measures would protect them from infection (96%). Discussion:Our survey revealed high levels of knowledge and generally positive attitudes towards people with hepatitis B and infection control practices. While our respondents are unlikely to be representative of all health-care workers in Vanuatu, findings offer useful insights into specific knowledge gaps that could be addressed in planned health-care worker education sessions ahead of the vaccination roll-out.
Objective: To investigate COVID-19 mortality in Philippine provinces from 2020 to 2023. Methods: Crude mortality rate (CMR), age-standardized mortality rate (ASMR) and age-specific mortality rate were computed for 84 areas (82 provinces and 2 cities) using COVID-19 surveillance data from the Philippine Department of Health, which captured data about confirmed deaths occurring between 20 January 2020 and 9 May 2023. Provinces were ranked by their ASMR. A correlation analysis was conducted to identify possible predictors of COVID-19 mortality. Among the factors investigated were the incidence of poverty, population density, proportion of the population considered elderly (aged >=65 years), hospital bed density and COVID-19 testing rates. Results: Eight of the 10 provinces that had the highest COVID-19 ASMRs were located in the Luzon island group. The province with the highest ASMR was Benguet in Northern Luzon (207.83 deaths/100 000 population), and the lowest rate was in Tawi-Tawi in Southwestern Mindanao (2.22 deaths/100 000 population). The incidence of poverty was negatively correlated with COVID-19 mortality, while hospital bed density and COVID-19 testing rates were positively correlated with CMRs and ASMRs. Discussion: This analysis provides a starting point for investigating COVID-19 mortality in Philippine provinces. The ranking of provinces by their ASMR is useful for directing future epidemiological investigations and, coupled with the results of the correlation analysis, provides insight into the factors that may have impacted COVID-19 mortality in the Philippines. Our analysis suggests that COVID-19 mortality patterns can partly be explained by the streetlight effect and factors linked to the availability of and access to health care.
Objective: On 27 June 2023, the Thailand Department of Disease Control was notified of an incident of carbon monoxide poisoning related to a Thai-style hotpot restaurant. An outbreak investigation was performed to describe the incident, confirm its cause and sources of exposure, and provide preventive measures. Methods: The restaurant owner, restaurant guests and waiting staff were interviewed, and the medical records of hospitalized cases were reviewed. In an environmental survey, air quality parameters were measured, including temperature, relative humidity, carbon dioxide and carbon monoxide. Additionally, a simulation of the incident was conducted, and data were reviewed from previous poisoning incidents in Thailand. Results: There were 11 cases, all of whom were guests who dined in the same private dining room. The median age of cases was 28 years (range 2–62 years). Three cases were hospitalized and received hyperbaric oxygen therapy. The air changes in the dining rooms were below the recommended level. The incomplete combustion of charcoal in a poorly ventilated room led to carbon monoxide build-up, which caused the incident. The simulation experiment showed a high concentration of carbon monoxide (mean 183.16 ± 55.15 parts per million), above the standard level. Ten similar poisoning incidents occurred between 2019 and June 2023, totalling 23 cases and 2 deaths; none occurred in a restaurant. Discussion: Charcoal use in poorly ventilated areas poses a health risk, especially for children. The use of charcoal stoves for hotpot cooking indoors is prohibited. Public health policy should mandate regular restaurant inspections to ensure compliance with occupational and environmental health standards.
The World Health Organization requires States Parties to report significant public health events through National Focal Points (NFPs). However, the nature and adjudication of events reported to NFPs is not well known outside of government. We summarized a sample of Australian NFP event information during 2014–2023 by year, hazard, origin and whether other NFPs were notified.
Many countries record high rates of fireworks-related injuries, especially during national celebrations. In the Philippines, increases in the number of injuries reported around the New Year period in recent years have highlighted the importance of continued strengthening of national fireworks-related injury surveillance. The Philippines’ regional epidemiology and surveillance units play a significant role in surveillance by linking its key stakeholders, the sentinel hospitals and the Department of Health’s Central Office. More specifically, these units promote compliance with reporting standards among sentinel hospitals and support case data validation. Approximately half of the sentinel hospitals that contribute data to the surveillance system are in the nation’s capital, Metro Manila. This concentrated coverage prompted the Regional Epidemiology and Surveillance Unit staff in Metro Manila to implement low-cost, digital strategies to improve the quality and timeliness of fireworks-related injury reporting. During the 2023–2024 surveillance period (21 December to 5 January), the use of virtual coordination spaces and data dashboards contributed to reducing turnaround times for generating surveillance reports from 31 minutes to 8 minutes. Moreover, at least 80% of sentinel hospitals provided timely reports on 11 of the 16 days of the surveillance period. Staff commitment was a major contributing factor in overcoming the time and human resource constraints encountered during implementation of these strategies. However, it is important to recognize that beyond these digital innovations, policy reforms that increase funding are needed to enhance fireworks-related injury surveillance and secure its long-term sustainability and scalability in the Philippines.
We built PHN-Map, an open-data Web-based GIS with geo-linked 360° images to support 15 000 public health nurses (PHNs) during the 2024 Noto Peninsula earthquake and subsequent floods. The map improved pre-deployment triage, home-visit routing and training, logging >300 uses on launch day, proving GIS and 360° imagery useful for PHN disaster activities.
Objective: To determine the causative agent, clinical manifestations and risk factors for infection during a September 2023 outbreak of acute haemorrhagic conjunctivitis (AHC) in Pak Touch village, Ratanakiri province, Cambodia. Methods: A retrospective case-control study was conducted. Cases were age-matched to controls (1:1), who were randomly selected from the village population. Twenty-one conjunctival samples were analysed using real-time reverse transcription–polymerase chain reaction (RT–PCR). RNA sequencing was additionally performed to identify the causative agent of the outbreak. Logistic regression models were used to identify significant risk factors. Results: A total of 73 cases and 73 controls were included in the analysis. Cases had a median age of 20 years (range: 1–70, mean and standard deviation: 27.7 ± 20.0), and 46.6% (34/73) were male. The overall attack rate was 12.3% (73 cases/594 residents). Clinical presentations included conjunctival hyperaemia (100%), subconjunctival haemorrhage (82.2%, 60), pain and discharge (64.4%, 47 each), eyelid swelling (57.5%, 42) and tearing (54.8%, 40). RT–PCR identified enterovirus in 52.4% (11/21) of conjunctival swabs, with RNA sequencing confirming the coxsackievirus A24 variant as the causative agent in five swabs. Statistical analysis identified significant risk factors, including physical contact with patients with acute haemorrhagic conjunctivitis (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.90–10.10), frequent eye rubbing (aOR: 4.56, 95% CI: 2.00–10.37) and poor hand hygiene (aOR: 3.70, 95% CI: 1.64–8.43). Discussion: The outbreak of acute haemorrhagic conjunctivitis in Pak Touch village was primarily caused by coxsackievirus A24. Significant risk factors included physical contact with infected individuals, frequent eye rubbing and poor hand hygiene. Effective hygiene measures are crucial to prevent the spread of AHC.
Objective:This study aimed to demonstrate the benefits of using SaTScan (Boston, MA, USA), a cluster-detection software programme, and whole genome sequencing to investigate a suspected outbreak of Serratia marcescens infections in a tertiary government hospital in the southern Philippines. The hospital is part of the national Antimicrobial Resistance Surveillance Program's network of sentinel sites. Methods:The investigation followed national outbreak investigation protocols. In May 2022, when evaluation of daily hospital laboratory census data revealed an increase in the number of Serratia species in the hospital, an alert was triggered. A concurrent, routine SaTScan analysis of the hospital's surveillance data by the Antimicrobial Resistance Surveillance Reference Laboratory confirmed a cluster of cases. The Reference Laboratory requested isolates from clinical specimens from the hospital for confirmation of bacterial identification, antimicrobial susceptibility testing and whole genome sequencing. Results:Six isolates were submitted for genomic analysis, two of which were from the identified cluster. Although originally identified as S. marcescens, five of the isolates were subsequently confirmed as S. sarumanii. Phylogenetic analysis showed that the two isolates from the cluster were closely related and belonged to the same clade, which may suggest a common source. Three antimicrobial resistance genes were identified, but their phenotypic expression was limited, with one isolate exhibiting resistance mechanisms. Discussion:This study highlighted the utility of SaTScan for the early detection of potential disease outbreaks. The use of whole genome sequencing enhanced the investigation by enabling the analysis of potential transmission pathways at the genetic level, identification of the outbreak source and the detection of novel species.
The article explores the impact of the COVID-19 pandemic on seasonal influenza activity in the WHO Western Pacific Region from 2016 to 2024. It examines epidemiological changes, surveillance enhancements, and the interplay of preventive measures and health security frameworks on influenza detection and management.
