Message Learning from 2014,
from Dr. Soccorro P. Lupisan, RITM-DOH Director
Dengue vaccine study sets Dr. Capeding in global limelight
Looking forward to 2015 RITM braved a series of challenges last year. We successfully hurdled each one of them, owing to the hardwork and dedication of the RITM staff. We addressed several disease outbreaks last year. From January 2014, we were overwhelmed with over 50,000 samples from suspect Measles cases from all over the country. Last April 2014, the entry of a laboratory confirmed MERS-CoV case in the Philippines tested our preparedness for emerging infectious disease threats. RITM responded with rapid and accurate laboratory diagnosis of the index cases and 385 of the 414 passengers in the same flight. Thankfully, all tested negative.
At about the same time, RITM actively participated in the investigation of unusual deaths among horses and persons who ate horse meat in Southern Philippines. With assistance from foreign research collaborators, international referral laboratories and the World Health Organization (WHO), Henipah virus was confirmed to have caused the outbreak. Bat surveillance with the LGU, DENR, BAI and WHO was initiated and further training in laboratory diagnosis of zoonotic diseases for local staff was planned. We also prepared for our ISO 9001:2008 certification, with our goal to improve the quality of our service to our customers. We reaped the fruits of our efforts when we received our certification on June 30, 2014. In August, WHO declared a Public Health Emergency of International Concern due to the spread of Ebola Virus Disease (EVD) in West Africa. We ensured the preparedness of our hospital and laboratories to respond to suspected cases. With directive from the Secretary of Health, RITM spearheaded the National Ebola Summit last October, an event which spurred collaboration among different sectors in our fight against the dreaded disease. RITM, with support from the National Center for Disease Prevention and Control and technical assistance from the WHO, followed through with five batches of EVD case management and response training of 183 health workers from 102 hospitals. These events highlighted the continuing need for preparedness and collaboration within RITM and with other agencies. Furthermore, 2014 brought opportunities for upgrading our facilities, strengthening and expanding our manpower capacity, and improving our engagement with local and international partners. We bank on what we have learned and gained in 2014 as we further embrace our role in the country’s fight against infectious and tropical diseases I encourage everyone to continue to serve our countrymen as we have done all these years - with excellence, integrity and with love for the country. All the best for RITM this 2015!
Dr. Maria Rosario Capeding, Head of Microbiology Department and Principal Investigator of the Dengue Vaccine Clinical Trial in the Philippines was included by the online biotech news portal FierceBiotech in the list of the World’s Top Women in Biotech Industry. The online portal described the women who made it to their list as ‘those who exemplify the kind of talent in such a demanding field like biotechnology, as well as those who have risen to the top ranks of their respective biotech fields in terms of developing, commercializing, marketing, and investing in the compounds needed by people around the world’. Dr. Capeding is the only Asian woman to be included in the elite list this year. The website also detailed how Dr. Capeding’s clinical efficacy study brought significant contribution to ‘conquer one of the world’s deadliest diseases’. Aside from this recognition, Dr. Capeding’s dengue vaccine publication was also selected as the ‘Paper of the Year 2014’ by the International Society of Vaccines.
WHAT’S INSIDE >> >>
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NEWS/ RITM IRB accreditation
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NEWS/
Ebola Training Series
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FEATURE/
HIV/AIDS in the Age of Social Media
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IN PICTURES/ Christmas at RITM
2 RITM IRB recognized with local and international certifications
The RITM-IRB members with FERCAP and PHREB officials during the awarding of Level 3 Accreditation to the Institute’s ethics reviewers at Taal Vista Hotel on Nov. 28, 2014.
RITM’s Institutional and Ethical Review Board (RITM-IRB) was accredited by the Forum for Ethical Review Committees in Asia and the Pacific (FERCAP) and the Philippine Health Research Ethics Board (PHREB), validating the institute’s competence and capacity to evaluate the research protocols. The awards prove that RITM-IRB satisfied both the National and International Standards in reviewing research protocols at RITM. The Institute is recognized as Level 3 Ethics Review Committee by both FERCAP and PHREB. Level 3
accreditation is the highest recognition that can be granted by both accrediting bodies. FERCAP is a regional forum that aims to improve communication among ethics committees that review health researches in the Asian and Western Pacific Region. PHREB, on the other hand, is the country’s national policymaking body in health research ethics. It is the institute’s third consecutive time to be accredited by FERCAP after 2007 and 2010, while it is the first time for RITM to apply for accreditation and be recognized by PHREB.
Dr. Malbas among the attendees of the Experts’ Meeting on Biological Weapons Convention
[From left to right] Regional Coordinator for the CBRN CoE for South East Asia, Ms. María Eugenia de los Angeles Rettori; Philippine Permanent Representative to the United Nations, Ambassador Cecilia Rebong, and VRD head Dr. Fidel Malbas
Dr. Fidel Malbas, Head of the RITM Veterinary Research Department, attended the meeting of experts on the Biological Weapons Convention in Geneva, Switzerland from December 1-5. Dr. Malbas is a member of
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RITM UPDATE APRIL-JUNE 2014
the National CBRN Centres of Excellence (CBRN-COE) Team. The CBRN COE is an initiative that addresses the mitigation of and preparedness against risks related to CBRN (chemical, biological, radiological and nuclear) materials and agents, which include pandemics.
Dr. Malbas and his colleagues also had a courtesy call to the country’s Permanent Representative to the United Nations, Ambassador Cecilia Rebong. The courtesy call served as an opportunity to present advances of the CBRN CoE Initiative in South East Asia and the Philippines.
NAST confers Scientist I rank to Dr. Lucero
The National Academy of Science and Technology (NAST) conferred the Scientist I rank to Dr. Marilla Lucero of the Medical Department for her valuable contribution to scientific progress in the field of Medical Science. Dr. Lucero’s scientist rank was conferred under NAST’s Scientific Career System (SCS), a system of recruitment, career progression, recognition and reward of scientists in the public service, as a means of developing a pool of highly qualified and productive scientific personnel. As an SCS scientist, Dr. Lucero is entitled to various benefits and entitlements. She is also expected to remain active and productive in performing research and development work and to mentor young researchers to encourage them to progress in the scientific path.
Dr. Carlos is the new RITM Assistant Director
Dr. Celia Carlos, former Laboratory Research Division (LRD) Chief, is the new Assistant Director (Director III under Civil Service Commission’s designation scheme) of RITM. Dr. Carlos’s appointment was made effective on September 5. Prior to this, Dr. Carlos served as LRD Chief from 2010 to 2014 and previous to this, as Head of the Antimicrobial Resistance Surveillance Program.
NEWS RITM conducts EVD Training Series for healthcare and public health workers RITM, with support from the National Center for Disease Control and Prevention Department of Health (DOH), conducted five batches of training on capacity building for hospital and community response teams on the management of Ebola Virus Disease (EVD) in the Philippines.
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As the country’s National Referral Center for Emerging and Re-emerging Infectious Diseases, RITM is the home of the country’s experts for clinical management and laboratory confirmation of emerging and re-emerging diseases such as EVD. Consultants from the World Health Organization (WHO) provided valuable technical guidance to the training series. The capacity building training series was conducted on October 28 to 30, 2014 (for DOH Hospitals), November 4 to 6, 2014 (for private hospitals), November 11 to 13, 2014 (for hospitals under local government units), December 2 to 4, 2014 (for community response teams), and January 13 to 15, 2015 (for selected DOH hospitals, local government hospitals, private health facilities and medical societies). The total number of participants trained is 744.
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The scope of the training series is based on the interim guidelines for the prevention and control of EVD which was developed by RITM and DOH with technical input from WHO. These cover triage, patient transport (for community response teams), patient admission, isolation, case management, specimen collection (including specimen transport and packaging), and infection control, including waste management and post-mortem care.
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4 1 Prof. Rick Speare of the WHO giving his lecture on background of EVD 2 Training participants during the exercise on hand hygiene 3 Exercise on proper donning and doffing of Personal Protective Equipment 4 Respirator fit testing of the participants 5 Participants of the EVD training on community response, during the exercise on transport of patients
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6 Exercise on proper collection, packaging, storage and transport of specimens for EVD testing.
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RITM UPDATE - OCTOBER 2014 2014 RITM UPDATE >>JULY October to December
4 by Leah Melita G. de Ocampo
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I was a normal college student. I loved to go to parties, to explore, to try new things,” shared Marvin*. * not his real name
He also described himself as “happy-go-lucky” and “careless” - changing partners and engaging in “kiss-and-tells” as often as he could. That was Marvin, just barely a year ago. After a report in class, his life changed entirely. Marvin, then a 4th year dentistry student, was assigned to do a report on the Human Immunodeficiency Virus or HIV. As he dug deeper into his references, he became more and more alarmed - his newfound knowledge gave explanation to his recurring fevers, rashes, and creamy white patches appearing on his mouth. A week after his report, he went to the RITM Satellite Clinic in Malate to get tested for HIV. His results were positive.
Rising Cases
Marvin is just one of the 35 million people living with HIV worldwide. HIV, the virus that causes Acquired Immune Deficiency Syndrome (AIDS), destroys the immune system and weakens the body’s ability to fight infections and diseases (UNAIDS, 2011). The cure for HIV has not yet been found, but antiretroviral drugs prevent its progression to AIDS. In the Philippines, there have been 22,527 recorded HIV cases since the first cases were registered in 1984 (Department of HealthNational Epidemiology Center, 2014). As years passed, not only the figures have changed, but also the profile of the people infected by the virus. Dr. Rosanna Ditangco, head of the RITM AIDS Research Group (ARG), shared that heterosexual overseas Philippine workers used to comprise most of the HIV cases seen at RITM. In 2006, they started seeing a surge in the number of cases among men who have sex with men (MSMs) who are less than 30 years old.
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In the December 2014 Philippine HIV/AIDS Registry, 509 new cases were registered, and nearly half of these new infections (250) were transmitted through male-to-male sexual contact. This group is 19 times more likely to be infected by HIV compared to the general population, according to the World Health Organization (WHO).
Online Interventions
Some experts believe that social media, combined with risky behavior and unsafe sex practices, may be one of the factors fueling the alarming rise of HIV infections among the youth, particularly the MSM sector.
“We launch social media-based campaigns and use information and communication technologies. We attract our target population [MSM] by devising tailorfit interventions,” said Vinn Pagtakhan, Executive Director of TLY Foundation.
Easy Access
A study by the Department of Health (DOH) in 2011 concluded that there is a link between social media and the rise of HIV/AIDS cases among MSM. Of the 180 respondents in the study, more than half (67%) said that they use social media for both dating and sex. Three out of four reported having sex with people they met online. There are many social networking sites that cater to the MSM community. In these sites, users can upload a personal profile and search for others’ as well. One of the more popular sites is Planetromeo, which Marvin used to frequent for ‘one-night-stands’.
A DOH study in 2011 concluded that there is a link between social media and the rise of HIV/AIDS cases among MSM in the Philippines. According to the DOH study, it could take about five minutes to over a day to find a sexual partner through social networking sites. The number of sexual partners reported by the respondents attest to the ease of finding partners online - some respondents said they had around 500 sex partners in a year, while the average number of sexual partners found through social networking sites is 82 per year. “There are indications that MSM who meet online have more opportunities for unsafe sex with multiple partners,” said Dr. Eric Tayag of the DOH in an interview with online-based news platform IRIN/PlusNews Media.
Since most of the people-at-risk are online, advocates of HIV/AIDS prevention including the RITM-ARG and its partner, The Love Yourself (TLY) Foundation, have now gone online, too. They have been actively harnessing social media to promote HIV awareness and prevention among MSM and other high-risk populations.
RITM partnered with The Love Yourself Project to reach the MSM commnity. MSM volunteers from TLY are trained by RITM to become peer educators or change agents.
Since most of the people-atrisk are online, advocates of HIV/AIDS prevention including the RITM-ARG and its partner, Love Yourself Foundation, have gone online, too. “Change agents are MSMs who can be role models to their clients - they are sexually active but they remain negative. I engaged them because they speak the same language,” said Dr. Ditangco. Instead of going to physical “hotspots” where MSMs gather, the change agents made the internet their hotspot. They have partnered with social networking sites to reach the MSM community better. “We found that these sites are also good vehicles to disseminate information. They help us disseminate information via message blasts and advertisements. As an example, we had an event with RITM in November, a special mass testing for men in Quezon City, and it was attended by more than 200 people in that single day. A lot of those who attended found the information through those sites,“ said Chris Lagman, Learning and Development Manager of TLY. Because of these sites, it has become easier for
FEATURE MSM to find TLY if they need to ask questions. TLY has volunteers who conduct online Q&A in these sites. Eighty percent of the questions that they get is about HIV Testing: “’Where can I find a testing center?”, “Is it free?”, “Will other people see me during testing?”, “Who will do the test?”, “Basically, their questions revolve around the usual fears of MSM: to be discovered as MSM or to be seen getting tested,” explained Chris. Aside from using social networking sites, TLY also uses its website to encourage MSM to get tested. TLY’s website, which has an average 2.5 million hits per year, has an online-based registration for those who need assistance in getting tested. This service accommodates around 100 cases per week. “We have a group of at least 10 people for this service. We call them the case management team. These case management people are also trained HIV counselors,” said Chris.
Continuum of Care
Aside from encouraging testing, RITM and TLY also aim to reduce the gap between the patients’ diagnosis and treatment. To achieve this, the RITM Satellite Clinic, operated in partnership with TLY, implements a continuum of care model. This ensures that the people who tested positive will be immediately linked to care.
The continuum of care model ensures that the people who tested possitive will immediately be linked to care. Dr. Ditangco explained that when the two rapid same-day HIV tests are reactive, the change agents immediately conduct counselling to the patients, and transfer them to the RITM hospital for CD4 Testing. The counsellors
accompany their clients to RITM hospital or they provide them with clear directions on how to find the place. RITM aims to minimize the gap between diagnosis and treatment by ensuring that patients begin with medical treatment immediately. Marvin is now one of the many change agents at RITM. Through one-one-one counselling, he tries to empower them to lift their self-esteem.
Promising Results
The success of these online interventions and continuum or care is evident on the statistics in Philippines HIV/AIDS Registry. “If you’ll look at the number of people we tested and number of people who turned out to be positive through our efforts for the whole of Metro Manila, 40% of all newly diagnosed people living with HIV actually came from the efforts of RITM and TLY. >> continued on page 7
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RITM UPDATE - OCTOBER 2014 2014 RITM UPDATE >>JULY October to December
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RITM UPDATE APRIL-JUNE 2014
NEWS RITM installs Research and Innovation Office
Training Programs at RITM Intensive Training on Bacterial Pathogens Laboratory Diagnosis RITM Microbiology Department / October 6-17, 2014 A hands-on training course on the laboratory diagnosis of medically-important bacterial pathogens.
Training on Ethical Use of Laboratory Animals in Research
RITM Veterinary Research Department / October 9-10, 2014 Training on technical knowledge and skills on the ethical use of laboratory animals in research, with emphasis on ensuring the welfare of animals.
Training Workshop on Molecular Diagnosis of Infectious Disease by Polymerase Chain Reaction
Molecular Biology Laboratory (MBL) / October20-24, 2014 Training on basic molecular concepts, practical laboratory techniques and DNA sequence analysis for the laboratory diagnosis of infectious diseases.
HIV and Other TTI Proficiency Training Workshop
Transfusion Transmissible Infections-NRL(TTI-NRL) / October20-24, 2014 Training on special proficiency skills in HIV and other TTI testing, consisting of lectures, didactics, laboratory work, and demonstration.
With research as one of RITM’s core functions, the Research and Innovation Office (RIO) was set up to further strengthen the Institute’s capacity. The RIO will also serve as coordinating office for all research projects conducted at RITM or by RITM investigators. Among the activities of RITM-RIO are the establishment of a database of all RITM research projects to serve as public access repository of information regarding RITM researches; monitoring of performance, progress and completion of all RITM research projects; reviewing and updating of the RITM Research Policy; and conducting activities that support investigator-initiated research. RITM-RIO commenced on March 2014, with Dr. Mario Jiz as its Head.
Training Course on Rabies and Animal Bite Management
Clinical Research Division and Rabies Research Group/ November 17-19, 2014 A regular training offering that provides knowledge and skills on the clinical management of rabies animal bites and in the setting-up of animal bite treatment centers for the prevention of human rabies cases.
Proficiency Assessment of Malaria Microscopists
Department of Parasitology/ November 17-21, 2014 Training aimed at pre-qualifying microscopists for areas that need validators and at continually maintaining the proficiency of microscopists who are already performing as validators.
Dengue Clinical Management and Laboratory Workshop
Department of Virology / November 24-28, 2014 and January 5-9, 2015 Workshop enhancing the participants’ knowledge and skills on clinical management and laboratory diagnosis of Dengue Virus.
Training on Management and Recognition of Leprosy and Common Skin Diseases
Dermatology Department / December 1-5, 2014. Training equipping health workers from different government health institutions all over the country with basic skills and knowledge on dermatology to enable them to diagnose leprosy and common skin diseases.
HIV and AIDS in the age of social media >> continued from page 7
Technology may have contributed to the rise of HIV infection cases, but it has also provided HIV advocates with opportunities to reach the MSM and other at-risk population better.
“I do think that it is successful. I don’t think it alone can solve the issue but I believe it’s a good addition to the portfolio of approaches that the Philippines already has.”, explained Chris. Technology has changed a lot since the first HIV infection case was found. Strategies for HIV and AIDS prevention must also evolve and keep up with these changes to remain effective and relevant.
TTI-NRL’s website goes live RITM’s Transfusion Transmissible Infections – National Reference Laboratory (TTI-NRL) launched its official website (www.tti-nrl. com) last December 9. The website was created to improve the turnaround time of releasing of results to referring Blood Service Facilities (BSF) and to lessen the large cost of courier service. The TTI-NRL Website, which serves as the major means of communication of the NRL has the following features: (1) online access to confirmatory results of BSFs, (2) online registration for External Quality Assessment Scheme (EQAS) Proficiency Training of HIV and other TTIs, (2) access to common documents (guidelines, department circulars and forms); and (4) regular updates on the TTI-NRL activities. Anyone may access the TTI-NRL website. However, access to Confirmation and EQAS sections is only limited to registered users to maintain the confidentiality of results.
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RITM UPDATE - OCTOBER 2014 2014 RITM UPDATE >>JULY October to December
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ISO CORNER Revisiting RITM’s journey towards ISO 9001:2008 Certification
Entomology Dept conducts 2nd Dengue Vector Workshop
Dr. Agnes Barrientos, RITM Quality Management Representative
As we strive to maintain the implementation of Quality Management System at RITM, let us revisit our long journey for the ISO 9001:2008 certification. We hit the ground running for ISO 9001:2008 certification in December 2011 when we launched various activities in preparation for this campaign. The Institute underwent internal quality audit training - an intensive one - through Mr. Pete Duran. We wrote and rewrote documents to near perfection for almost two years. In March 2013, the Quality Assurance Committee was renamed the Quality Assurance Office with the addition of four quality teams: Promotions and Capacity Building under Dr. Charm Hufano, Internal Quality Audit Team under Dr. Catherine Masangkay, Process Documentation and Quality Improvement team under Dr Edison
Alberto and Document Control Team under Mr. Johnson Yu. Stage I came in February 2014 and we had our first taste of external audit. The auditors wanted to do Stage 2 after a month from the visit, but we asked for adequate time to comply with the findings. Stage 2 audit was done on April 2014 and finally the certification was granted on June 30, 2014. We have come a long way, but our journey continues. The biggest challenge we have now is how to maintain the quality service we have pledged to offer our clients, and at the same time, maintain our ISO certification. We, the entire RITM community, are all in this together for the long haul.
RECENT PUBLICATIONS/
October to December 2014
as indexed in Pubmed
An audacious goal: the elimination of schistosomiasis in our lifetime through mass drug administration. Ross AG, Olveda RM, Li Y. Lancet. 2014 Nov 20. pii: S0140-6736(14)61417-3.
The Department of Medical Entomology conducted the second phase of the threepart workshop for the development of the National Dengue Vector Surveillance (DVS) plan. The workshop was held on November 17-21 at the City State Hotel, Manila. The second workshop was attended by the health officers from selected cities and provinces in each region of the country. Participants provided suggestions and insights on the initial draft of the National DVS Plan and Administrative Order which were the resulting output of the first DVS Workshop attended by the Regional Centers for Health Development (CHD) coordinators on May 27 to 29, 2014. The third and final phase of the workshop series is set to be held on May 2015. It is expected to bring together the participants of the first two workshops, as well as the other concerned stakeholders, to finalize the National DVS plan for its expected implementation within the year.
A randomized, double-blind, placebo-controlled clinical trial on the efficacy and safety of 3% Rumex occidentalis cream versus 4% hydroquinone cream in the treatment of melasma among Filipinos. Mendoza CG, Singzon IA, Handog EB. Int J Dermatol. 2014 Nov;53(11):1412-6. Are we ready for a global pandemic of Ebola virus? Ross AG, Olveda RM, Yuesheng L. Int J Infect Dis. 2014 Nov;28:217-8. doi: 10.1016/j.ijid.2014.09.001. Epub 2014 Oct 18. The chronic enteropathogenic disease schistosomiasis. Olveda DU, Olveda RM, McManus DP, Cai P, Chau TN, Lam AK, Li Y, Harn DA, Vinluan ML, Ross AG. Int J Infect Dis. 2014 Nov;28:193-203. Mapping infectious disease landscapes: unmanned aerial vehicles and epidemiology. Fornace KM, Drakeley CJ, William T, Espino F, Cox J. Trends Parasitol. 2014 Nov;30(11):514-9. Enhanced and persistent antibody response against homologous and heterologous strains elicited by a MF59-adjuvanted influenza vaccine in infants and young children. Nolan T, Bravo L, Ceballos A, Mitha E, Gray G, Quiambao B, Patel SS, Bizjajeva S, Bock H, Nazaire-Bermal N, Forleo-Neto E, Cioppa GD, Narasimhan V. Vaccine. 2014 Oct 21;32(46):6146-56. Prevention and control of schistosomiasis: a current perspective. Inobaya MT, Olveda RM, Chau TN, Olveda DU, Ross AG. Res Rep Trop Med. 2014 Oct 17;2014(5):65-75. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Capeding MR, Tran NH, Hadinegoro SR, Ismail HI, Chotpitayasunondh T, Chua MN, Luong CQ, Rusmil K, Wirawan DN, Nallusamy R, Pitisuttithum P, Thisyakorn U, Yoon IK, van der Vliet D, Langevin E, Laot T, Hutagalung Y, Frago C, Boaz M, Wartel TA, Tornieporth NG, Saville M, Bouckenooghe A; CYD14 Study Group. Lancet. 2014 Oct 11;384(9951):1358-65. Schistosoma japonicum in Samar, the Philippines: infection in dogs and rats as a possible risk factor for human infection. Carabin H, McGarvey ST, Sahlu I, Tarafder MR, Joseph L, DE Andrade BB, Balolong E, Olveda R. Epidemiol Infect. 2014 Oct 2:1-10.
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RITM UPDATE APRIL-JUNE 2014
RITM Update is a quarterly newsletter published by the Research Institute for Tropical Medicine - Department of Health (RITM-DOH), through its Communication and Engagement Office. Web: www.ritm.gov.ph Mail: 9002 Research Drive, Filinvest Corporate City Alabang, Muntinlupa City 1781 Philippines Tel: (632) 809-7599 / 807-2628 to 32 Fax: (632) 842-2245 For your feedback and article suggestions, please e-mail us at communication.ritmdoh@gmail.com.
Head Jun Ryan C. Orbina / Communication and Engagement Officers Kaymart A. Gimutao and Leah Melita G. de Ocampo Contributor Iza Mae S. Chamen, RMT - TTI NRL Article