DOH integrates ILI, SARI, SARS-CoV-2 surveillance operations
Participants of the 6th Philippine National Influenza Center (PNIC) Stakeholders’ Meeting.

The Research Institute for Tropical Medicine (RITM) as the Philippine National Influenza Center (PNIC) held its 6th Stakeholders’ Meeting from January 30 to February 2, 2023 to disseminate and discuss crucial updates on the national influenza sentinel surveillance operations, and to serve as an avenue to raise concerns encountered in the conduct of influenza surveillance activities.

In attendance were delegates from the Department of Health (DOH) Central Office, World Health Organization (WHO) Country Office, WHO Regional Office, United States Centers for Disease Control and Prevention (CDC), Regional Centers for Health Development, and influenza-like illness (ILI) and severe acute respiratory infections (SARI) sentinel sites.

 “The COVID-19 pandemic highlighted the importance of strengthening sentinel surveillance in the country through expansion of laboratory testing, [inclusion of] detection and genomic sequencing of SARS-CoV-2, and addition of sentinel sites in every region,” highlighted RITM Director Dr. Celia C. Carlos in her opening remarks.

Data from ILI/SARI sentinel sites show SARS-CoV-2 as the most common (56%) detected pathogen among laboratory confirmed positive  ILI cases from January 1, 2020 to December 31, 2022. RSV also caused most (45%) of the laboratory confirmed positive cases of SARI.

Co-infections were also detected among positive ILI/SARI samples, wherein SARS-CoV-2 and influenza were the most common pathogen combinations as per data gathered from the ILI/SARI sentinel sites from January 2020 to December 2022.

With these findings, it becomes important to sustain ILI/SARI surveillance in the Philippines for the monitoring of circulating strains. Surveillance data will then be used for vaccine composition and will offer insights about the necessary resources for outbreak/pandemic mitigation.

Establishing a Pan-respiratory Virus Surveillance

Epidemiology Bureau (EB) Director Dr. Alethea De Guzman reported that a “pan-respiratory virus surveillance” is an ideal strategy to be implemented for the monitoring of ILI, SARI, and SARS-CoV-2. Key objectives of the surveillance are to influence public health policies through provision of data on respiratory illnesses, and launch an improved ILI/SARI/COVID case reporting system – TanodKontraCovid (TKC) in lieu of the existing COVIDKaya and Epidemic-prone Disease Case Surveillance (EDCS) information systems.

Spearheaded by EB, the pilot implementation of the pan-respiratory surveillance shall involve RITM, Regional Epidemiology and Surveillance Units (RESUs), Local Epidemiology and Surveillance Units (LESUs), Pan-respiratory virus testing referral laboratories, UP Philippine Genome Center (PGC), Disease Reporting Units (DRU), Department of Agriculture (DA), and the Department of Environment and Natural Resources (DENR).

Coupled with the implementation is the launching of TKC for the promotion of active and passive surveillance of ILI, SARI, and COVID-19 infections. TKC will also allow users to self-report relevant symptoms.

RESUs and COVID-19 pilot implementation sites are currently using TKC for the submission of COVID-19 antigen results, and for the reporting of suspect, probable, and confirmed COVID-19 cases. Meanwhile, LGUs use TKC for contact tracing initiatives.

Through TKC, the data collection process is eased by digitization. TKC encourages the use of the electronic Case Investigation Form (eCIF) to reduce human error of double encoding of cases; increases data quality through built-in validation checks and deduplication; and permits seamless and secure data sharing between national and local units.

Addressing concerns in surveillance activities

During the first day of the event, participants were divided according to ILI NCR sites, ILI regional sites, and SARI sites for the breakout sessions. In the breakout sessions, participants raised and discussed their respective concerns and local challenges they have encountered in the conduct of their regular surveillance operations.

Issues raised include lack of budget and manpower, concerns on shipment of samples to RITM, concerns on procurement of laboratory reagents and other equipment, and lack of capacity-building initiatives.

Upon discussion of the issues, key governing authorities committed to accomplish corresponding action points. For budget concerns, the Disease Prevention and Control Bureau (DPCB) shall provide regular updates, while EB requested that the subnational laboratories (SNLs) provide their respective budget proposals.

For manpower issues in SNL surveillance units, EB shall allocate funds for one (1) disease surveillance officer (DSO) for hospitals included in the pilot implementation of TKC.

For concerns on shipment of samples, EB, OHL, and RITM shall discuss investing in courier services and possible training efforts for couriers. EB and RITM shall also conduct a survey to determine availability of couriers for biological specimens, standard requirements, and budget.

And as for capacity-building concerns, online training modules were proposed to be developed. OHL shall also conduct a series of trainings this 2022.

Integrating ILI, SARI, SARS-CoV-2 surveillance

In the country, pilot implementation of integrated surveillance for ILI, SARI, and SARS-CoV-2 will commence this year, pursuant to DOH Department Memorandum 2022-0526.

This integration will increase the efficiency of the current system to promptly detect and characterize the new virus strains, especially those with pandemic potential, and monitor the circulation or local transmission of new and existing strains. Such enables the timely and appropriate implementation of public health responses for disease control,” said Dr. Carlos.

In the implementation of the integrated surveillance, RITM will play a crucial part in its operations. The RITM Molecular Biology Laboratory (MBL) shall primarily conduct SARS-CoV-2 sequencing, provide support to influenza sequencing, implement quality assurance for influenza, SARS-CoV-2, and MERS-CoV testing, and provide other relevant technical assistance.

Together with EB, MBL, RITM Virology Department and the RITM Surveillance and Response Unit (SRU), shall provide technical support and training to SNLs and sentinel sites to capacitate them on the conduct of laboratory testing quality, quality assurance, and reporting.

by Anel Azel Dimaano