Part One
IT was a day Joy Lagayan dreaded as she rummaged through shelves looking for something “valuable”. It was something that Lagayan, a veterinarian working for the government, never thought she would pull out from rows and rows of books. She dreaded that day a glossy-white covered book would be put to use after more than a decade.
Because Lagayan knew, as she took a deep sigh, the book spelled death. “It’s our bible,” Lagayan said, while taking by the head the Avian Influenza Protection Program (AIPP) Manual of Procedures.
Dreaded
LAGAYAN, a staff of the Bureau of Animal Industry’s Animal Health and Welfare Division for five years, explained taking out the AIPP manual is bringing her stress.
“It’s stressful; very, very stressful,” Lagayan told the BusinessMirror, when she learned that the Avian Influenza (AI) virus has landed in the Philippines.
“It’s good we have this. It made things a little bit easier for us,” said Lagayan, a doctor of veterinary medicine for 13 years now, tapping the cover page of the AIPP.
The government, led by then- President Gloria-Macapagal Arroyo, started crafting the AIPP in 2004, when the feared AI, commonly known as “bird flu”, resurfaced in Asia. The goal was to protect the country’s borders from the virus that killed millions of birds in Southeast Asia back then.
Border protection
BY virtue of Executive Order (EO) 280, Series of 2004, Arroyo outlined the powers, functions and responsibilities of government agencies in preventing and addressing the bird-flu virus.
“Due to an outbreak of the bird- flu virus, which has affected many countries in Asia, including the deaths of at least twelve people in Vietnam and Thailand, bold, preemptive, active and immediate measures must be taken by the Philippines in order to avert or minimize its grave effects,” Arroyo said in EO 280, signed on February 5, 2004.
“In the event the epidemic can no longer be prevented and, in order to confine, minimize, restrict or regulate the further spread of the contagion, such measures and actions relative to fowl, poultry, other birds or animals and people, infected or suspected to be infected with the virus, need to be implemented,” Arroyo added.
Through EO 280, the secretaries of Health and Agriculture were designated as crisis manager and comanager, respectively, should the bird-flu virus reach the Philippines.
Both Health and Agriculture secretaries were given full power and authority necessary to restrict the entry of bird-flu virus in the country.
The Department of Health (DOH) is particularly tasked to control any possible transmission and cases of bird flu in humans. The Department of Agriculture (DA) was tasked to protect the monitor and protect the Philippine poultry industry from the virus.
The crisis managers are also given the power to “call” upon all government agencies for assistance and support in carrying their respective duties. These government agencies include the departments of Interior and Local Government, Foreign Affairs, Transportation and Communication, Education, Labor and Employment and National Defense. The Office of the Press Secretary was also called to support the crisis managers.
Secure regions
BY 2005 the government intensified its efforts to keep the country’s borders free from AI.
The government, through the DOH, released the “Preparedness and Response Plan for Avian and Pandemic Influenza”, (PRPAPI) paving the way for the codification and institutionalization of measures the state shall undertake in preventing, controlling and addressing the dreaded virus.
In gist, the document outlines four possible stages the Philippines could encounter with bird flu: 1) an AI-free nation; 2) AI outbreak in poultry; 3) AI transmission from poultry to huimans; and 4) AI transmission among humans.
“The pandemic clock is ticking. It cannot be predicted when the pandemic will occur, but it is always best to be prepared all the time,” then-Health Secretary Francisco T. Duque III said in the preface of the document. “After all, it wasn’t raining when Noah built the ark.”
In the same year the DA and DOH issued Joint Administrative Order 01, which authorized the adoption of the AIPP and the establishment of the National Avian Influenza Task Force.
The order emphasized that the AIPP manual is the official AI prevention and preparedness plan of the country.
Shake the disease
TO date, the AIPP only outlines procedures to undertake for Stage 1 and Stage 2 of a bird-flu scenario as outlined by PRPAPI.
There are generally three types of avian influenza: A, B and C, according to the Food and Agriculture Organization of the UN (FAO). Avian-influenza viruses are divided into: highly pathogenic and low pathogenic (LPAI) strains based on its ability to cause disease in poultry.
An LPAI “is a natural infection of waterfowl that may cause minimal to no signs of disease in domestic poultry and wild birds and is not a serious threat,” the FAO said. “Highly pathogenic avian influenza is rarely found in waterfowl, but causes severe disease in domestic poultry with a high death rate.”
The AI viruses are further classified according to their strains, or subtypes based on two proteins: haemglutinin (H) and neuraminidase (N). There are currently 16 recognized H types and nine N types, according to the FAO. The combination of these strains dictate the extent of effect of the virus: Is it dreadful to humans or just mere sickness among chickens?
For the Philippines, the biggest concern now is whether the confirmed AI subtype, A H5 virus in two barangays in San Luis, Pampanga, could be transmitted to humans. Only H5N1 and H5N6 are known to date to be transmissible to humans.
Recent government laboratory tests ruled out that the AI virus the Philippines has contains the strain of H5N.
As for H5N6? The country is still awaiting further information from the Australian Animal Health Laboratory, where samples from the Philippines were brought to.
“We always boast to the international community that we are AI free, for years, in the region,” Lagayan said. “And they always doubted us. They do not believe we were AI free. But now, it’s real. It’s here,” she added.
Part Two
IT took only one word to make a 13-year-old white manual gathering dust in a shelf into the government’s “bible” against avian influenza (AI): confirmed.
This word also managed to turn an office of at least 10 government veterinarians into a “ghost town”.
“On the Saturday after the AI outbreak in San Luis, Pampanga, was announced, people here were immediately deployed,” government-employed animal physician Joy Lagayan said.
“We used to be noisy here. Now, all of them are in the field. We are now like a ghost town,” added Lagayan, who is with the Bureau of Animal Industry’s (BAI)
Animal Health and Welfare Division office, staring at the empty cubicles in the 30-square meter office.
Armed
WHEN Lagayan’s colleagues were deployed in the town of San Luis—ground zero of the outbreak—they were armed with their bible: the “Avian Influenza Protection Program [AIPP] Manual of Procedures”.
“All of us have this. Even those in the field at the moment,” she told the BusinessMirror in an interview. “It made things a little bit easier for us. What are written here are the things we are following now.”
The contents of AIPP trace back more than a decade ago when the Philippine government was keen in protecting its borders from the intrusion of the dreaded bird-flu virus that resurfaced in Asia in 2003.
It was adopted on April 20, 2005 through the Joint Department of Agriculture (DA) and Department of Health (DOH) Administrative Order 1. This order also established the National Avian Influenza Task Force (NAITF), according to Arlene Asteria V. Vytiaco, the government’s focal person for AI.
“The AIPP Manual of Procedures has become one of the primary references for information on the government’s AI prevention program and preparedness plan,” Vytiaco said in the foreword of the AIPP 2016 updated version. “The courses of action mainly address HPAI [highly pathogenic Avian Influenza] incursion.”
Stages
UNDER the government’s “Preparedness and Response Plan for Avian and Pandemic Influenza” (PRPAPI) there are four possible stages the Philippines could encounter with bird flu: 1) an AI-free nation; 2) AI outbreak in poultry; 3) AI transmission from poultry to humans; and 4) AI transmission among humans.
“The pandemic clock is ticking. It cannot be predicted when the pandemic will occur, but it is always best to be prepared all the time,” then-Health Secretary Francisco T. Duque III said in the preface of the document. “After all, it wasn’t raining when Noah built the ark.”
The AIPP only outlines procedures to undertake for Stage 1 and Stage 2 of a bird-flu scenario as outlined by PRPAPI.
Prevention
THE imposition of import bans is one of the most important preventive measures that the Philippines implements to avert intrusion of bird-flu virus.
Under the AIPP, the Agriculture Secretary is authorized to issue a memorandum order that would temporarily ban the importation of poultry and poultry products from AI-affected countries.
These products include: live poultry, wild birds, day-old chicks, semen, eggs and other poultry products and by-products. Section 1.1.1. of the AIPP states that the DA can impose a temporary ban on these products based on the information provided by the affected countries to the World Organization for Animal Health (OIE) or notification from a Notifiable Avian Influenza (NAI) Affected Countries/Zones.
Upon the imposition of a ban, the Philippines stops the processing of and issuance and giving import permits to NAI-affected countries. Furthermore, products that are in-transit to the Philippines prior to the declaration by the OIE of its source country as NAI-affected shall be denied entry into Manila.
“The DA-BAI shall advise the exporting country or zone of the decision to have cargo entry discontinued and the courses of action to be taken by the Philippines,” Section 1.4.2. of the AIPP said.
“Live poultry and bird importation shall be humanely destroyed upon arrival in the Philippines and buried in a designated area. Poultry and bird
product, including hatching-egg importation, will be destroyed and disinfected prior to burying in designated area,” it added. “Processed poultry-product importation will be rendered and buried in designated area.”
The DA has been strict in imposing this measure for the past years. In fact, whether a NAI-affected country reports an outbreak in a specific region or in the entirety of it, the DA imposes automatically a blanket ban on imports from it.
Biosecurity
UNDER the AIPP, the government shall also conduct a biannual surveillance on identified “poultry critical areas” in the Philippines. These areas are considered the most vulnerable parts of the country that could be infiltrated by the bird- flu virus.
These “critical” areas are identified based on the following: presence of waterfowl and migratory birds, hotspots for illegal trade and wildlife and live-bird markets.
“For every critical area, six barangays shall be identified for sample collection. Thirty blood samples, 30 oropharyngeal [throat] and 30 cloacal [body cavity into which the intestinal, urinary and genital canals empty in birds] swabs shall be collected from target poultry in each of the six identified barangays,” AIPPS’s Section 4.1.3.2. reads. The samples shall be submitted to either the government’s regional laboratories or to the national laboratory in the BAI.
At present there are at least 60 identified poultry critical areas across 13 regions in the country.
The government also established NAI-free poultry-production zones that would allow easier micromanaging of areas in case of an outbreak. These zones are identified based on its natural geographic boundaries, such bodies of water, mountain ranges or controllable points of entry. Under the AIPP, the country’s 17 administrative regions have been divided into 25 NAI-free zones.
The establishment of these zones aims to recognize defined territories with existing administrative jurisdictions that can prevent the entry or control the spread of NAI, according to the document. Another objective is to facilitate a more efficient surveillance and detection of the disease and to ensure availability of distinct and disease-free production areas both for export and local markets.
Surveillance
UNDER the AIPP, the local government units, particularly those in the identified zones, shall serve as “frontliners” in the surveillance of AI.
The surveillance shall be conducted based on a sampling frame. This “sampling frame” includes the list of all farm or poultry owners in a locality, as well as other supporting units or industries that handle poultry and poultry products, according to the AIPP.
The list shall also contain information on the poultry demographics in the area, including the names of farm owners, farm location, species of poultry, disease profile, biosecurity practices and even marketing practice.
“The BAI shall identify the areas to be sampled and the number of samples needed per area. The DA-Regional Field Offices shall be responsible for the collection of samples in the identified areas,” it added, saying the sampling shall be conducted at least twice a year.
The government has made it known that two farms in San Luis, Pampanga, have been struck by the AI subtype A-H5 virus. However, the question how it got there remains unanswered.
Government officials are ruling out the probability that it was caused by migratory birds. Some, like Agriculture Secretary Emmanuel F. Piñol, considers smuggling
of fowls from China as the culprit.
Whatever the cause may be, the outbreak in these towns shows that despite preventive measures, the Philippines—like any other Southeast Asian region—remains vulnerable to the dreaded bird-flu virus.
Part Three
PREVENTION is better than cure. But prevention has its limits; once exceeded, the only remedy left is to solve it.
And this is something that the Department of Agriculture (DA) will not forget, after the dreaded avian influenza (AI) virus landed in the Philippines.
“We will be stricter now and learn from this incident,” Agriculture Secretary Emmanuel F. Piñol said. “If we only had a biosecurity team that regularly inspects the farms, then we could have discovered [AI] as early as May.”
The DA traced back the AI outbreak in two towns in San Luis, Pampanga, and found out that symptoms of the disease were observable as early as April. The government confirmed the AI on August 11.
Stage 2
THE Philippines has reached Stage 2.
Under the government’s Preparedness and Response Plan for Avian and Pandemic Influenza (PRPAPI), there are four possible stages the Philippines could encounter with the bird-flu virus: 1) an AI-free nation; 2) AI outbreak in poultry; 3) AI transmission from poultry to humans; and 4) AI transmission among humans. Stage 1 the Philippines is no longer.
The government, led by the DA, is now addressing the AI outbreak under the guidance of what experts call “the bible” on AI: Avian Influenza Protection Program (AIPP) Manual of Procedures.
Under the AIPP, an area shall be considered as a “Suspect Premises” of having AI upon the observation of any unusual increase in the mortality rate of fowls among commercial poultry operations, backyard poultry raisers and caged birds.
“For commercial poultry operations: Occurrence of a one-day mortality of 3 percent [on the basis of the house population] followed by a twofold increasing trend for the next three days with no evident cause attributable to management, nutritional or environmental factors,” the AIPP read. “For backyard poultry raisers: Any unexplained mortality of poultry in two or more households within a barangay/purok in a span of two days.”
For caged birds, aviaries and wild birds, “any unexplained mortality with no evident cause attributable to nutritional, management or environmental factors or human intervention”, should be suspected of AI, according to the AIPP.
Reporting
ONCE the unusual deaths of fowls in a certain area is reported to the government, a veterinarian in charge shall initiate and complete within 24 hours the recommended diagnostic procedures to confirm the case.
“For farms with diagnostic laboratory capabilities, the veterinarian may opt to initially conduct an in-farm testing of a minimum of 30 tracheal/oropharyngeal [throat] swabs collected from poultry that recently died or from poultry showing any clinical signs, using a rapid test for [the] Influenza-A virus,” the AIPP read.
The veterinarian will submit 30 blood and tracheal/oropharyngeal, or OP, samples (15 from apparently healthy and 15 from sick birds) to the Animal Disease Diagnostic and Reference Laboratory (ADDRL) of the Veterinary Laboratory Division (VLD) of Department of Agriculture (DA)—Bureau of Animal Industry (BAI) or Regional Avian Influenza Laboratories of identified DA Regional Field Offices (Darfos), the AIPP manual said. It added that the samples will also be tested for other avian diseases such as newcastle disease (ND), infectious bronchitis (IB), infectious laryngotracheitis and fowl cholera, among others.
Prohibitions
AFTER the initial report, an investigating team shall be formed to conduct an investigation within 24 hours on the suspected AI-affected premises. The team shall be comprised of local veterinarian; technical staff of the Regional Animal Disease Diagnostic Laboratory; and DENR local officers if the suspicion involved wild birds, according to the AIPP manual.
“The Investigating Team shall submit a written report to the BAI director within 24 hours,” it read.
The AIPP pointed out that all people within the suspected AI-affected premises shall stay in the area for 24 to 72 hours while awaiting the results of the laboratory tests.
“Movement of poultry, poultry products, equipment, supplies, feeds, manure, etc. out of the suspect premises is strictly prohibited and shall be imposed by the veterinarian in authority,” it read. “Additional assistance from the Philippine National Police [PNP] and local chief executives [LCEs] shall be sought in case there is a need to enforce regulations.”
The AIPP manual added that stray animals and rodent in the area shall be also monitored and controlled.
Quarantine
AN area shall only be declared as affected by AI once the BAI-VLD-ADDRL, or the national reference laboratory, confirms the samples from the site tested positive for H5 or H7 via reverse transcription polymerase chain reaction (RT-PCR) tests.
Once confirmed, the BAI-Animal Health and Welfare Division (AHWD) shall submit a formal case reporting the confirmation to the BAI director. The BAI AHWD will also recommend the reclassification of suspect premises to HPAI-infected premises.
“The BAI director will inform the DA secretary and coordinate with the Darfo, DENR, Department of Health [DOH] and local government unit [LGU] concerned before the formal declaration of the area as HPAI-infected premises,” the AIPP read. “The LGU shall acknowledge the declaration through a local ordinance stating the activities to be carried out in an infected premises and the responsibilities of the different government agencies.”
Culling
UPON announcing there’s an outbreak in an area, the DA shall immediately declare a quarantine area, which is a “minimum” of 1-kilometer radius from the infected premises. The DA will then conduct a stamping out, or culling, of all poultry birds found within the quarantine area to contain the spread of the virus.
The stamping out of the poultry in the quarantine area shall be conducted through three possible ways stated under the AIPP: cervical dislocation (breaking the chicken’s neck whether manual or mechanical), carbon dioxide (CO2) suffocation and electrical single application.
Cervical dislocation shall be done by crushing the neck of the fowl using a pair of pliers or by hands. As for CO2 suffocation, the birds shall be placed in a container exposed to an atmosphere of at least 30-percent CO2, which puts the fowl to sleep, and 70 percent to kill them.
Meanwhile, the third option shall involve placing the bird in an electrified water bath wherein a 50Hz frequency current shall be applied for a minimum of 10 seconds to kill them.
Deaths
ONCE the birds are dead, they shall be buried in an identified location within the 1-km quarantine area. A burial pit should be constructed with a dimension as deep as practically possible, where the dead birds will be buried.
“All poultry products and materials associated with euthanized poultry or birds in the infected premises and quarantine area shall be included in the disposal. This shall include rice hulls, eggs, manure, feeds, etc.,” the AIPP manual read. “Every person involved in the destruction of the birds shall wear protective gear, such as cover-all, mask, headgear, rubber boots and waterproof gloves. Farm owners shall be required to secure the necessary protective gears for their farm personnel.”
The protective gears include protective clothing; heavy-duty rubber work gloves that can be disinfected; N-95 masks; safety goggles; and rubber/polyurethane boots.
The AIPP manual also stipulated that people conducting the culling shall be given a prophylactic medication as to prevent transmission of bird flu. It added that they should also wash their hands frequently with soap and water, followed by hand disinfection with 70-percent alcohol or iodine-based hand wash.
Movement of poultry, poultry products, and even live swine in and out of the 1-kilometer quarantine is prohibited. The government shall trace and identify the possible source of the AI by back-tracking 21 days prior to the declaration of the infection. The following are considered potential sources of the virus: hatchery, poultry farms, processing plants, poultry and poultry product retail outlets, live-bird markets, aviaries, egg depots and cold-storage facilities.
Control area
THE BAI director shall also identify a 7-kilometer-zone radius from the periphery of the boundary of the quarantine area as a control area. If he or she deems it possible, the BAI director can extend the control area.
All the avian species within the 7-km radius shall be under strict surveillance for possible detection of Influenza A.
“Observation of clinical signs suggestive of avian influenza in any avian population, such as respiratory and nervous, signs and high mortalities should be immediately reported to the city, municipal, provincial veterinarian or agriculturist so that immediate evaluation of avian health status can be done,” the AIPP manual said. “Animals with respiratory signs shall be subjected to a rapid field test procedure for the detection of Influenza A by the BAI or Darfo. Tracheal or oropharyngeal swabs will also be collected and submitted to BAI-ADDRL for RT-PCR testing.”
The government shall also prohibit the movement of poultry and poultry-related products within and outside the 7-km radius. On top of which, any activity involving the gathering of any/bird species in the control area is not allowed. “This shall include cockfighting, sale of live birds in public market or in any road network, trade fair or show of poultry, etc.”
The government shall only allow movement of poultry and poultry-related products from the control area if there will be new case of AI reported after a 21-day period since the start of stamping out. However, shipments from the 7-km radius must have a veterinary health certificate and shipping permit issued by the BAI.
Recovery
AFTER the stamping of all fowls in the 1-km quarantine area, the government shall start cleaning and disinfecting the affected premises.
The government will also observe a 21-day rest period prior to the restocking of sentinel poultry, which will serve as determinants of the presence of the bird-flu virus in the affected area. The government will use broiler chicks as sentinel birds for this matter.
“Restocking of sentinel poultry at 2 percent of the house population [for commercial poultry operation] or 30 heads [for backyard poultry operation] shall be done in the infected premises and in selected locations within the quarantine area,” the AIPP read. “The poultry shall be given the basic vaccination program for infectious bursal disease, IB and ND. The sentinel poultry shall be grown to a minimum period of 35 days.”
During the 35-day growing period, 30 oropharyngeal or tracheal swab samples from the same set of poultry shall be taken on Days 1, 7, 14, 21 and 28, which will be tested using RT-PCR for H5 or H7. On Day 35, 30 representative sentinel animals (or 10 birds for backyard farms) shall be sacrificed for necropsy and organ sampling for testing, according to AIPP.
Cleaning, repopulation
THE AIPP manual said in the event of a potential repeat of infection in the infected premises, the growing of the sentinel birds shall be immediately terminated.
“The same procedures as [cited] in the Stamping Out activity shall be implemented.” Once laboratory results from the BAI-VLD-ADDRL showed the absence of the NAI virus, the premises then shall be subjected to cleaning and disinfection in preparation for repopulation.
“The director of BAI shall declare an infected area as a disease-free area when no indication of infection is detected in the sentinel population,” the manual read. “The declaration shall be based on RT-PCR test results from BAI-VLD-ADDRL.” Repopulation of the previously infected premises shall be carried out upon approval by the DA-BAI based on results of growing the sentinel poultry, the manual added.
Today, the DA is now halfway the completion of the 21 rest-day period to conduct the dispersal of sentinel birds in the AI-affected areas in San Luis, Pampanga.
If things unfold the way they should be, then the Philippines’s first-ever AI case could be put into rest at the soonest practical time. Should this happen, the government’s 13-year-old manual could prove to be really its bible: an ageless remedy to bird flu.