ADMINISTRATIVE ORDER 2017#_____

Guidelines in the Nationwide Implementation

of the Enhanced 4S

November 09, 2017

Puerto Princesa, Palawan
 RATIONALE

• 69% increase in dengue cases (2011-2015)

• Although there has been progress for some regions
in the prevention and control under the proposed
2013-2016 Dengue Prevention and Control Midterm
Strategic Plan, the burden of dengue in the country
continues to increase.
• Continuous disease transmission: Dengue,
Chikungunya, and Zika
 RATIONALE

• To shift from focusing primarily on attempting to

contain outbreaks to redirecting steps to reduce the
impact of Dengue, Chikungunya, and Zika on
communities.
• To strengthen the response to Dengue, Chikungunya,
and Zika requiring increased collaboration and
coordination within and beyond the health sector.
 OBJECTIVE
(OF THIS AO)

• To provide a guideline in the nationwide

implementation of the enhanced 4S-strategy against
Dengue, Chikungunya, and Zika.
 SCOPE
• DOH –
• Central Office,Regional Offices, DOH – ARMM,
• Retained Hospital,
• Accredited Treatment & Rehabilitation Centers,
• Attached agencies & other facilities under the
administrative jurisdiction of the DOH
• Local Government Units
• Government and Non-Government Organizations
• Public and Private Sectors
 DEFINITION OF TERMS

• Aksyon Barangay Kontra Dengue (ABKD) -

nationwide campaign for massive clean-up drive
starting from the barangay level to mobilize all
sectors concerned in reducing dengue morbidity and
mortality.
• Dengue Fast Lane – established system in prioritizing
dengue patients in different health facilities by
administering efficient and prompt case management
during dengue season.
 DEFINITION OF TERMS

• Rapid Diagnostic Test (RDT) – a collection of reagents and other

materials for in-vitro diagnostics, intended for the detection of either
antigen or antibody from clinical samples, usually blood, within a
shorter period.
• Targeted Indoor Residual Spraying (TIRS) – application of long-acting
chemical insecticides on the walls and roofs of all houses and domestic
animal shelters in a given area, in order to kill the adult vector
mosquitoes that land and rest on these surfaces.
• Targeted Outdoor Residual Spraying (TORS) – application of long-
acting chemical insecticides on outdoor surfaces.
 DEFINITION OF TERMS
• World Health Organization Pesticides Evaluation Scheme
(WHOPES) – WHO Programme which serves as reference for
setting norms and standards for public health pesticides and its
life-cycle management.
• Key containers – type of water holding containers where most
Aedes breeding a given locality.
• Essential containers – any water-holding container/area
wherein it cannot be destroyed/eliminated but may serve as
Aedes breeding sites.
• Non-essential containers – objects considered as trash/rubbish
that could collect water and serve as Aedes breeding sites.
 GENERAL GUIDELINES
• In reference to the standard message in the ABKD campaign,
the 4S namely (1) Search and destroy breeding sites; (2) Seek
early consultation: (3) Self-protection, and (4) Say yes to fogging
only in hotspot areas where increase in cases is registered for
two consecutive weeks, this 4S will be translated and shall be
implemented as an enhanced 4S prevention and control strategy
against Dengue, Chikungunya, and Zika.
• The enhanced 4S-strategy shall constitute the framework of
actions towards reducing morbidity and mortality from Dengue,
Chikungunya, and Zika.
SPECIFIC GUIDELINES
1. Search and destroy breeding sites:
• Vector control measures shall be implemented through the
coordinated and/ integrated efforts of the local government
units (LGUs), and other stakeholders such as but not limited to
concerned government agencies and the private sector which
includes the organized groups, civil societies, religious groups,
academe, media and the business sector.
• Implementation of the vector control measures shall be guided by
the result of the monthly vector surveillance.
• All LGUs shall conduct monthly vector surveillance and submit
report to the DOH regional offices which will be forwarded to the
Infectious Disease Office, Disease Prevention and Control Bureau,
DOH Central Office.
 1. Search and destroy breeding sites:

• Vector control measures shall be implemented through the coordinated

and/ integrated efforts of the local LGUs and other stakeholders shall
conduct regular clean-up drive and shall initiate the reactivation of the
“4 o’clock habit”.
• The “4 o’clock habit” shall be done daily at 4 o’clock in the afternoon all shall search
for all water-holding containers and other breeding sites of mosquitoes to destroy.
For any water holding container/ area wherein it cannot be destroyed/ eliminated
(essential container), prevention of mosquito breeding can be done by putting
cover/lid or the application of biological/ chemical larvicides shall be done.
• To monitor and evaluate the “4 o’clock habit”, Ovi-Larval Traps shall be used to
validate the absence of mosquitoes and the reduction of mosquito population size.

•
1. Search and destroy breeding sites:

• LGUs to pass and implement appropriate legislations

to institutionalize this “S” (- search and destroy
breeding site) in the locality including the:
• Inter-sectoral approaches and community mobilization for
year round source reduction.
• Establishment of a public health workforce for surveillance,
risk assessment and response.
• Funding all activities under this “S” (- search and destroy
breeding site).
 2. Seek early consultation:
Early clinical case detection, diagnosis and management are
key factors in reducing dengue* morbidity & mortality and
shall be facilitated by:
• Encouraging early treatment seeking behavior.
• Reiteration of the nationwide implementation of the Dengue Rapid
Diagnostic Test (RDT) for early detection of the disease.
• Implementation of the guidelines for clinical case management and
referral.
• Conduct of systematic mortality review as needed.
• Monitor trends in the distribution of dengue over time and
geographically.
 3. Secure self-protection
Securing self-protection from the bite of mosquitoes shall be
facilitated by:
• 3.1 Use of light colored clothing and long-sleeves top and long pants during
daytime.
• 3.2 Application of insect repellant on uncovered skin surface.
• 3.3 Use of screen door and windows or insecticide treated screens/curtains for
doors and windows (at least full WHOPES certified), as physical barrier and
chemical intervention.
• 3.4 Using spatial repellents which have shown effect against insecticide
resistant populations and also have added benefit in areas where traditional long-
lasting insecticidal nets or indoor residual spray interventions may not offer full
protection or have reached their efficacy limits – especially in areas with residual
transmission.
 4. Say yes and support fogging activity only in
hotspot areas where increase in cases is registered
for two (2) consecutive weeks:
• The objective of space spraying is the massive, rapid destruction
of the adult vector population. Space spraying is recommended
for control only in emergency situations to suppress an
ongoing epidemic or to prevent an incipient one.
• Fogging / Misting operations (coupled with clean-up drive and
search and destroy breeding sites of mosquitoes) should be
conducted using the right insecticides (WHOPES and FDA
approved and at least tested locally for biological efficacy within 5
years upon purchase), right dilution, right method of application,
right timing, conducting it using right personal preventive
equipment, and proper community preparation. Fogging/
Misting operations must be done for at least 7 days interval per
cycle.
 4. Say yes and support fogging activity only in
hotspot areas where increase in cases is registered
for two (2) consecutive weeks:

• Conduct Targeted Indoor Residual Spraying (TIRS)

may be done for 2-3 cycles a year to reduce the density
of mosquitoes.

• Conduct Targeted Outdoor Residual Spraying (TORS)

as a SUPPLEMENTAL CONTROL for adult
mosquitoes may be done for 2-3 cycles in a year.
 ROLES AND
RESPONSIBILITIES
• Disease Prevention and Control Bureau (DPCB)
• Issue the implementing guidelines for the nationwide
implementation of the enhanced 4S strategy
• Provision of logistical support for the implementation of
the 4S-strategy
• Conduct monitoring activities in coordination with
ARMM, and regional offices and local health officials
 ROLES AND
RESPONSIBILITIES
• Health Promotions and Communication Services
(HPCS)
• Develop prototype IEC materials, ads for print media, and
the broadcaster’s manual for radio
• Conduct periodic evaluation of IEC materials, ads for print
media, and the broadcaster’s manual for radio
 ROLES AND
RESPONSIBILITIES
• ARMM and Regional Offices
• Mobilize resources for the implementation of the
enhanced 4S strategy.
• Provide technical assistance and augmentation of needed
commodities for implementing the 4S- strategy.
• Lead in the implementation of the enhanced 4S strategy
• Monitoring and evaluate the implementation of the
enhanced 4S strategy.
• Submit report to the Infectious Disease Office of the
Disease Prevention and Control Bureau of the
Department of Health Central Office.
 ROLES AND
RESPONSIBILITIES
• DOH Retained Hospitals
• Maintain a functional Dengue Fast Lane to serve all dengue
cases and manage them in accordance to the Revised
Dengue Clinical Case Management Guidelines 2011
• Coordinate with their DOH regional office in the
implementation of the enhanced 4S
 ROLES AND
RESPONSIBILITIES
• Local Government Units (PLGU)
• Mobilize resources for the implementation of the
enhanced 4S-strategy.
• Implement the enhanced 4S-Strategy
• Provide technical assistance to the
municipality/city/barangay in the implementation of the
enhanced 4S-strategy
• Coordinate with the various stakeholders in the province.
• Monitor and evaluate the enhanced 4S implementation.
• Submit report to the DOH-Regional Office.
 ROLES AND
RESPONSIBILITIES
• Other stakeholders such as but not limited to
government agencies, other government
organizations, non-government organizations,
academe, media, private sectors
• Implement the enhanced 4S strategy appropriate to their
setting and condition.
• Coordinate with the DOH in the full implementation of
the enhanced 4S strategy
• Advocate and communicate campaign against Dengue.
Chikungunya, and Zika
 REPEALING CLAUSE

• All other previous related

issuances found inconsistent
with this issuance shall be
repealed.
 EFFECTIVITY

• ***Immediately upon the

approval of the
SECRETARY OF
HEALTH
Thank you !
WORKSHOP
 OBJECTIVES

• To identify the sentinel sites for vector

surveillance
• To come up with the number of sentinel sites
for Aedes Mosquito Surveillance
• To design an expansion plan for Aedes
Mosquito Surveillance Sentinel Sites (AMS-
SS)
 METHODOLOGY

• Mini lecture
• Group Discussions ( Grouping per region)
• Presentation
 CHARACTERISTICS OF EFFECTIVE
SENTINEL SITES
1. There should be high probability or chance of observing the event of interest.
2. Site should have large population (household)
3. Good facility
4. Well-qualified and trained personnel
5. Willingness of community to participate
6. Participation of local government unit.
7. Sentinel sites within a specific geographical area should have unique
demographic or socio-economic characteristics
8. Sentinel site s are preferably distant or non-neighboring from each other to
require novel information about geographic variations.
 STEPS
1. Per region, select and list all possible sentinel sites using
Characteristic #1 and #2
2. From the shortlist, select sentinel sites using
Characteristic #7 and #8
3. From the trimmed shortlist made in number 2, select
sites that satisfy Characteristics #3,#4,#5, and #6
4. The sites from number 2 that were removed in number 3
should be considered in the future for expansion of
AMS-SS.
GROUP DISCUSSION
30 minutes
OUTPUT PRESENTATION
 EXPECTED OUTPUT

• AMS-SS per region identified

• Expansion Plan
 NEXT STEPS

• To include the 5 Ws of vector surveillance in the

MOP (Dengue, Chikungunya, Zika)
• To attach all forms related to vector surveillance as
annexes in the MOP (Dengue, Chikungunya, Zika)
• To consider the flow of reporting
Thank you !