DOH revives Botika ng Bayan to help LGUs, rural health units

By: Gabriel Pabico Lalu - Reporter / @GabrielLaluINQ

INQUIRER.net / 04:52 PM July 16, 2018

PHOTO by Gabriel Pabico Lalu/INQUIRER.net

The Botika ng Bayan (BNB) program, discontinued in 2011, made a comeback to provide rural areas
with outpatient and pharmacy services, the Department of Health (DOH) said.

“The DOH is relaunching anew the BnB program in partnership with our local government units
(LGUs) to realize President Duterte’s vision that no Filipino should go home without free access to
basic medicines when needed and that quality essential medicines should be accessible and
affordable for all Filipinos,” DOH Undersecretary Enrique Domingo said in a statement on Monday.

The revival of BNB coincided with the launching of the first pilot site in San Mariano, Isabela on
Friday.

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“We emphasize our important partnership with the LGUs, recognizing that the task of providing
quality, affordable and accessible health care services to Filipinos should be coordinated using the
whole of government approach,” Domingo explained.

PHOTO by Gabriel Pabico Lalu/INQUIRER.net

Originally a project under the administration of former President Gloria Macapagal Arroyo, the BNB
was stopped due to the lack of pharmacists and an effective chain supply to ensure the availability of
high-quality generic medicines.

Aside from selling low-priced generic over-the-counter medicines, DOH said the new version of the
BNB will provide important medicines for infections, skin problems, asthma, and chronic non-
communicable diseases

Medicines like antibiotics, ointments, anti-thrombotic, anti-inflammatory, vitamins, antacids and

drugs for hypertension, diabetes, and dyslipidemia would also be available.

Patients would also be educated by licensed pharmacists and trained assistants hired by the DOH and
the LGUs.

“While the DoH earlier issued a moratorium on the establishment of more BnBs, the program served
its purpose of spurring generic competition and providing more affordable access to medicines for
our citizens,” Domingo said.
“The BNB became a viable business model for generic pharmacies now spread out across the country
bringing us toward the vision of more affordable medicines down to our villages,” he added.

Botika ng Bayan. /PHOTO by Gabriel Pabico Lalu/INQUIRER.net

Domingo also said patients from indigenous groups would not be charged for the medicines they
need. Also, soldiers and policemen from the will also benefit from the program.

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“More importantly, the medicines will be dispensed to patients for free to ensure no out-of-pocket
expense for indigents as directed by President Rodrigo Roa Duterte,” he said.

“The DOH recognizes the service and heroism of our armed personnel in ensuring the security of our
country, hence the BNB program was revitalized with a new variant that shall provide free access to
essential medicines for them, the Botika ng Bayani outlets,” Domingo added.

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Dengue cases up 25% in Metro Manila – official

By: Cathrine Gonzales - @inquirerdotnet

INQUIRER.net / 11:18 AM July 11, 2018

Dengue

Aedes aegypti mosquito, carrier of the dengue virus. FILE PHOTO

The Department of Health (DOH) has recorded a 25 percent rise in dengue cases in Metro Manila, a
health official said on Wednesday.

DOH has recorded over 7,200 cases in the Metro since the onset of the rainy season this year,
Undersecretary Eric Domingo disclosed in an interview over dzMM on Wednesday.

In the same period in 2017, there were only about 5,800 dengue cases in the region, he said.

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“Ang peak season natin ng dengue [ay] nag-uumpisa na dahil syempre pag maraming tubig sa paligid
na pinupugaran ng lamok, kung saan sila nanganganak at dumadami,” Domingo explained.
(The peak season of dengue is beginning since there is a lot of water in the environment where
mosquitoes nest and propagate.)

According to Domingo, the Ilocos Region and Cagayan Valley likewise saw an increase, with 80 and
66-percent rise respectively as compared to last year’s record for the rainy season.

Other regions including Central Luzon, Calabarzon, Mimaropa, Bicol, Western Visayas, and Northern
Mindanao have also recorded spikes in dengue cases, he added.

Domingo, however, assured the public that the health department was prepared to attend to
patients’ needs.

“Meron tayong naka-ready [na equipment] dahil nakapaghanda na tayo. Meron tayong mga pang-
test na readily available, hindi lang sa hospital hanggang sa health centers meron din,” he said.

(We have equipment because we have already prepared for it. We have tools for testing that are
readily available, not just in the hospital but also in centers.)

DOH earlier declared a dengue outbreak in Itbayat, Batanes, where a child diagnosed with the
disease died on Friday. /cbb

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DOH declares leptospirosis outbreak in 4 more metro villages

By: Cathrine Gonzales - @inquirerdotnet

INQUIRER.net / 12:32 PM July 07, 2018

INQUIRER FILE PHOTO

Department of Health (DOH) Secretary Francisco Duque III on Saturday announced that four more
barangays in Metro Manila had been declared under leptospirosis outbreak.

This makes 22 the current number of affected Metro Manila barangays from previously reported 18.

“Nadagdagan pa mula 18, ngayon nasa mga 22 barangays. Nadagdagan ng apat mula sa huling
deklarasyon natin ng outbreak [It has increased from 18, now we have 22 villages. The number
increased by four since the last time we declared an outbreak],” Duque said in an interview over
dzBB.

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The added barangays were fall rom Caloocan City. Other cities previously put under the outbreak
situation are Quezon City, Taguig, Pasig, Parañaque, Navotas, Mandaluyong, and Malabon.
READ: DOH declares leptospirosis outbreak in parts of Metro Manila

As of June 16, a total of 1,040 cases have been recorded nationwide, and 99 reportedly died. Of the
reported number of fatalities, 38 were from Metro Manila, the latest report of the DOH revealed.

Duque, however, assured the health department is prepared for the spike in leptospirosis cases in
the country.

“Handa ang ating mga hospital na pangasiwaan ang mga lepto[spirosis] case at sapat ang gamit [at]
gamot. Ang daily reporting ay isinasagawa naman, at ang disinfection at decontamination at isolation
ng mga pasyente,” he said.

(Our hospitals are ready to handle the cases of leptospirosis, and there are enough tools and
medicines. The daily reporting is conducted properly as well as the disinfection, decontamination and
isolation of patients.)

According to the Centers for Disease Control and Prevention, the symptoms of leptospirosis in
humans can include: high fever, muscle aches, vomiting, jaundice (yellow skin and eyes), and
diarrhea, among others. /jpv

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DOH rolls out Hepatitis B testing nationwide

By: Julius N. Leonen - Reporter / @JLeonenINQ

INQUIRER.net / 04:06 PM June 22, 2018

The Department of Health (DOH) has rolled out a nationwide testing program for Hepatitis B to
prevent the disease from further spreading among Filipino children.

DOH Secretary Francisco Duque III on Friday bared the agency’s National Hepatitis B Sero-prevalence
Survey that would be conducted in 25 provinces across the country.

The project would have support from the Research Institute for Tropical Medicine, United States
Centers for Disease Control and Prevention, and the World Health Organization (WHO), Duque said.

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In the nationwide testing program, Duque said survey teams would go to randomly-selected
households, and request for parents’ consent to participate in the activity.
“Around 3,000 children, aged five to six years old, will be tested for hepatitis B in the survey. DOH
partnered with the Field Epidemiology Training Program Alumni Foundation, Inc., in deploying survey
teams to 25 provinces,” Duque said in a statement.

“We appeal to parents or caregivers to allow their child, if he/she is selected, to be tested. Our
survey teams have been trained to observe confidentiality in obtaining information,” the DOH chief
stressed.

Duque, citing data from the WHO, said that around 8.5 Million Filipinos were chronically infected
with the hepatitis B virus.

“However, the number of children affected by hepatitis B, an infectious liver disease, is unknown.
Hepatitis B infection can lead to liver cirrhosis, liver cancer and premature death,” Duque said.

A small amount of blood will be drawn and tested for hepatitis B from the eligible child, he added.

“The concerted efforts of the community, along with its local government leaders, will ensure the
successful conduct of the survey,” Duque stressed. /vvp

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MENU CDC A-Z SEARCH

Leptospirosis

Signs and Symptoms

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In humans, Leptospirosis can cause a wide range of symptoms, including:

High fever

Headache

Chills

Muscle aches

Vomiting

Jaundice (yellow skin and eyes)

Red eyes

Abdominal pain
Diarrhea

Rash

Image of sick person.

Many of these symptoms can be mistaken for other diseases. In addition, some infected persons may
have no symptoms at all.

The time between a person’s exposure to a contaminated source and becoming sick is 2 days to 4
weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two
phases:

After the first phase (with fever, chills, headache, muscle aches, vomiting, or diarrhea) the patient
may recover for a time but become ill again.

If a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several
months

Treatment

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Image of pills in bottle.

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early
in the course of the disease.

Intravenous antibiotics may be required for persons with more severe symptoms. Persons with
symptoms suggestive of leptospirosis should contact a health care provider.

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A to Z Guides Reference

Dengue Fever

Dengue (pronounced DENgee) fever is a painful, debilitating mosquito-borne disease caused by any
one of four closely related dengue viruses. These viruses are related to the viruses that cause West
Nile infection and yellow fever.

CONTINUE READING BELOW

An estimated 390 million dengue infections occur worldwide each year, with about 96 million
resulting in illness. Most cases occur in tropical areas of the world, with the greatest risk occurring in:

The Indian subcontinent

Southeast Asia

Southern China

Taiwan

The Pacific Islands

The Caribbean (except Cuba and the Cayman Islands)

Mexico

Africa

Central and South America (except Chile, Paraguay, and Argentina)

Most cases in the United States occur in people who contracted the infection while traveling abroad.
But the risk is increasing for people living along the Texas-Mexico border and in other parts of the
southern United States. In 2009, an outbreak of dengue fever was identified in Key West, Fla.

Dengue fever is transmitted by the bite of an Aedes mosquito infected with a dengue virus. The
mosquito becomes infected when it bites a person with dengue virus in their blood. It can’t be
spread directly from one person to another person.

Symptoms of Dengue Fever

Symptoms, which usually begin four to six days after infection and last for up to 10 days, may include

Sudden, high fever

Severe headaches

Pain behind the eyes

Severe joint and muscle pain

Fatigue

Nausea

Vomiting

Skin rash, which appears two to five days after the onset of fever

Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

CONTINUE READING BELOW

Sometimes, symptoms are mild and can be mistaken for those of the flu or another viral infection.
Younger children and people who have never had the infection before tend to have milder cases
than older children and adults. However, serious problems can develop. These include dengue
hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood
vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory
system. The symptoms may progress to massive bleeding, shock, and death. This is called dengue
shock syndrome (DSS).

People with weakened immune systems as well as those with a second or subsequent dengue
infection are believed to be at greater risk for developing dengue hemorrhagic fever.

Diagnosing Dengue Fever

Doctors can diagnose dengue infection with a blood test to check for the virus or antibodies to it. If
you become sick after traveling to a tropical area, let your doctor know. This will allow your doctor to
evaluate the possibility that your symptoms were caused by a dengue infection.

CONTINUE READING BELOW

Treatment for Dengue Fever

There is no specific medicine to treat dengue infection. If you think you may have dengue fever, you
should use pain relievers with acetaminophen and avoid medicines with aspirin, which could worsen
bleeding. You should also rest, drink plenty of fluids, and see your doctor. If you start to feel worse in
the first 24 hours after your fever goes down, you should get to a hospital immediately to be checked
for complications.

Preventing Dengue Fever

There is no vaccine to prevent dengue fever. The best way to prevent the disease is to prevent bites
by infected mosquitoes, particularly if you are living in or traveling to a tropical area. This involves
protecting yourself and making efforts to keep the mosquito population down.

To protect yourself:

Stay away from heavily populated residential areas, if possible.

Use mosquito repellents, even indoors.

When outdoors, wear long-sleeved shirts and long pants tucked into socks.

When indoors, use air conditioning if available.

Make sure window and door screens are secure and free of holes. If sleeping areas are not screened
or air conditioned, use mosquito nets.

If you have symptoms of dengue, speak to your doctor.

CONTINUE READING BELOW

To reduce the mosquito population, get rid of places where mosquitoes can breed. These include old
tires, cans, or flower pots that collect rain. Regularly change the water in outdoor bird baths and
pets' water dishes.

If someone in your home gets dengue fever, be especially vigilant about efforts to protect yourself
and other family members from mosquitoes. Mosquitoes that bite the infected family member could
spread the infection to others in your home

What Is Hepatitis B?

Readers Comments 51
Share Your Story

Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two
possible phases; 1) acute and 2) chronic.

Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms
approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis,
symptoms resolve over weeks to months and they are cured of the infection. However, a small
number of people develop a very severe, life-threatening form of acute hepatitis called fulminant
hepatitis.

Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection
becomes chronic, it may never go away completely.

Most infected adults are able to fight off the virus so their infection is cured. A low percentage of
adults infected with HBV go on to develop chronic infection. Children are at much higher risk for
chronic infection. A majority of infected young children will fail to clear the virus from their bodies
and go on to develop chronic infection.

About two-thirds of people with chronic HBV infection are chronic carriers. These people do not
develop symptoms, even though they harbor the virus and can transmit it to other people. The
remaining one third develop "active" hepatitis, a disease of the liver that can be very serious.

The liver is an important organ that filters toxins out of the blood, stores energy for later use, helps
with digestion, and makes substances that fight infections and control bleeding.

The liver has an incredible ability to heal itself, but long-term inflammation caused by HBV can result
in permanent damage.

Scarring of the liver is called cirrhosis, a condition traditionally associated with alcoholism but one
that is also caused by chronic active hepatitis B infection as well as other conditions. When this
occurs, the liver can no longer carry out its normal functions and may fail completely. The only
treatment for liver failure is liver transplant.

Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma.

Any of these conditions can be fatal. About 15% to 25% percent of people with chronic hepatitis B die
of liver disease.

Hepatitis B is the most common serious liver infection in the world.

In the United States, hepatitis B is largely a disease of young adults aged 20-50 years.

The good news is that infection with HBV is usually preventable because there is an effective vaccine.
Use of the vaccine has resulted in a large decrease in the number of new infections reported in the
United States each year.

2/15

How is Hepatitis B Transmitted? How Do You Get Hepatitis B?

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to
another via blood or fluids contaminated with blood. Another important route of transmission is
from an infected mother to a newborn child, which occurs during or shortly after birth.

Direct contract with blood may occur through the use of dirty needles during illicit drug use,
inadvertent needle sticks experienced by healthcare workers, or contact with blood through other
means. Semen, which contain small amounts of blood, and saliva that is contaminated with blood
also carry the virus.

The virus may be transmitted when these fluids come in contact with broken skin or a mucous
membrane (in the mouth, genital organs, or rectum) of an uninfected person.

People who are at an increased risk of being infected with the hepatitis B virus include the following:

Men or women who have multiple sex partners, especially if they don't use a condom

Men who have sex with men

Men or women who have sex with a person infected with hepatitis B virus

People with other sexually transmitted diseases

People with HIV or hepatitis C

People who inject drugs with shared needles

People who receive organ transplants or transfusions of blood or blood products (exceedingly rare
these days)

People who undergo dialysis for kidney disease

Institutionalized mentally handicapped people and their attendants, caregivers, and family members

Health care workers who are stuck with needles or other sharp instruments contaminated with
infected blood

Infants born to infected mothers

People born outside the United States in areas where hepatitis B is common

People who travel to areas of the world where hepatitis B is common

In some cases, the source of transmission is never known.

You cannot get hepatitis B from the following activities:

Having someone sneeze or cough on you

Hugging someone

Shaking a persons hand

Breastfeeding your child

Eating food or drinking water

Casual contact (such as an office or social setting)

Hepatitis:A Visual Guide to Hepatitis

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Digestive Disease Myths:Common Misconceptions

Digestive Disease Myths Slideshow Pictures

Infectious Mononucleosis:Learn About the 'Kissing Disease' Caused by EBV

Slideshow: Infectious Mononucleosis

3/15

What Are the Symptoms of Hepatitis B?

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Share Your Story

Half of all people infected with the hepatitis B virus have no symptoms and may never realize that
they have been infected. Adults are more likely to develop symptoms than children. For those who
do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial
symptoms are often similar to the flu.

Common symptoms of hepatitis B include:

Appetite loss

Feeling tired (fatigue)

Nausea and vomiting

Itching all over the body

Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)

Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color)

Dark urine (the color of cola or tea)

Pale-colored stools (grayish or clay colored)

Other types of acute viral hepatitis such as hepatitis A andhepatitis C have symptoms that are
indistinguishable from hepatitis B.

Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right
away. Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very
suddenly and may include:
Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic
encephalopathy)

Sudden collapse with fatigue

Jaundice

Swelling of the abdomen

Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice
these symptoms:

Extreme weakness

Confusion or trouble concentrating

Headache

Lack of urination

Irritability

Symptoms of liver damage may include the following:

Fluid retention causing swelling of the belly (ascites) and sometimes the legs

Weight gain due to ascites

Persistent jaundice

Loss of appetite, weight loss, wasting

Vomiting with blood in the vomit

Bleeding from the nose, mouth, or rectum; or blood in the stool

Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages,

development of coma)

4/15

When Should I Call the Doctor for Hepatitis B?

Call your health care professional if you have any of the following:

Nausea and vomiting that does not go away in 1-2 days

The inability to keep down liquids

A high fever or fever that persists more than 2 days

Yellow skin or eyes

Dark-colored urine (like tea or cola)

Pain in the abdomen.

For severe symptoms including confusion or delirium go to a hospital emergency department.

You should also contact your health care practitioner if you think you may have been exposed to the
hepatitis B virus.

If you have chronic hepatitis B infection and think you might be pregnant; or if you are pregnant and
think you have been exposed to hepatitis B inform health care practitioner right away.

5/15

How Is Hepatitis B Diagnosed?

Hepatitis B infection is diagnosed with blood tests. These tests can detect pieces of the virus in the
blood (antigens), antibodies against the virus, and viral DNA ('viral load'). Blood tests for HBV are
often done when routine blood work shows abnormal liver function tests or in patients who are at an
increased risk for exposure. If a patient has had a large amount of vomiting or has not been able to
take in liquids, blood electrolytes may also be checked to ensure that the patient's blood chemistry is
in balance.

Other tests may be ordered to rule out other medical conditions.

X-rays and other diagnostic images are needed only in very unusual circumstances.

If a patient is diagnosed with chronic hepatitis B, they will need regular visits to their health care
practitioner. Blood tests can help determine how active the infection is and whether there has been
damage to the liver.

Blood tests alone may not be enough to guide treatment in chronic HBV. Other tests include:

CT scan or ultrasound: These diagnostic imaging tests are used to detect the extent of liver damage
and may also detect cancer of the liver caused by chronic hepatitis B.

Liver biopsy: This involves removal of a tiny piece of the liver. It is usually done by inserting a long
needle into the liver and withdrawing the tissue. The tissue is examined under a microscope to
detect changes in the liver. A biopsy may be done to detect the extent of liver damage or to evaluate
how well a treatment is working.

Hepatitis:A Visual Guide to Hepatitis

A Visual Guide to Hepatitis Slideshow

Digestive Disease Myths:Common Misconceptions

Digestive Disease Myths Slideshow Pictures

Infectious Mononucleosis:Learn About the 'Kissing Disease' Caused by EBV

Slideshow: Infectious Mononucleosis

6/15
What Is the Treatment for Hepatitis B?

Readers Comments 7

Share Your Story

Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe,
symptoms such as vomiting or diarrhea are present, the affected person may require treatment to
restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from
becoming chronic.

If a person has chronic hepatitis B, they should see their health care provider and determine if
medical treatment is appropriate.

7/15

Are There Home Remedies for Hepatitis B?

The goals of self-care are to relieve symptoms and prevent worsening of the disease.

Drink plenty of fluids to prevent dehydration. Broth, sports drinks, gelatin, frozen ice treats (such as
Popsicles), and fruit juices are preferred because they also provide calories.

Ask your physician before taking any medications, even those that are over-the-counter. Some
medications depend on the liver, and liver damage may impair the body's ability to metabolize these
drugs. If you are on prescription medications, check with your physician to see if the doses should be
adjusted or if the medication should be temporarily discontinued.

Avoid drinking alcohol until your health care practitioner allows it. Individuals with chronic HBV
should avoid alcohol for the rest of their lives.

Try to eat a diet that provides adequate nutrition. Take it easy. It may take some time for your energy
level to return to normal.

Avoid prolonged, vigorous exercise until symptoms start to improve.

Call your health care practitioner for advice if your condition worsens or new symptoms appear.

Avoid any activity that may spread the infection to other people (sexual intercourse, sharing needles,
etc).

8/15

What Is the Medical Treatment for Hepatitis B?

Acute hepatitis B infection

Acute hepatitis B infection is not treated with antiviral medications.

If the infected person is dehydrated from vomiting or diarrhea, a doctor may prescribe IV fluids to
help them feel better. Medications may also be used to control these symptoms.
People with mild symptoms can be cared for at home.

Chronic hepatitis B infection

The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the
blood and liver. Regularly measuring the amount of HBV DNA ('viral load') in the blood gives your
physician a good idea of how fast the virus is multiplying. The treatments now in use are classified as
antiviral drugs, because they work by stopping the virus from multiplying.

Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals
with the disease.

There are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug
Administration (FDA). New drugs are always being tested and treatment recommendations are
subject to change.

Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people
whose infection is most likely to progress to active hepatitis or cirrhosis.

Decisions to start medications for treatment of hepatitis B are made by the patient and health care
practitioner, often in consultation with a specialist in diseases of the digestive system
(gastroenterologist), liver (hepatologist), or an infectious disease specialist.

The decision to treat is guided by results of liver function tests, HBV DNA tests, and, frequently, liver
biopsies after a complete history and physical examination.

Treatment is usually started when blood tests indicate that liver functions are deteriorating and the
amount of replicating HBV is rising. Many people never reach this point. For those who do, the
interval between diagnosis and starting treatment is quite variable.

9/15

What Are The Medications for Hepatitis B?

All of the following medications used to treat chronic hepatitis B are antiviral medications. They
reduce the ability of the virus to reproduce in the body and give the liver a chance to heal itself.
These drugs are not a cure for hepatitis B, but they do reduce the damage caused by the virus.
Although these medications are similar in some ways, they differ in other important ways. Talk to
your health care practitioner about the best medication for you.

Pegylated interferon alfa-2b (Pegasys®)

Pegylated interferon is used alone or in combination with other medications.

Pegylated interferon slows the replication of the virus and boosts the body's immune system to fight
the infection.

It works best in people who have relatively low levels of HBV DNA (low viral load).

Pegylated interferon usually is not given to people whose liver damage has progressed to cirrhosis,
because it can make the liver damage worse.
Treatment is often given for 48 weeks, which is shorter than for other medications, but pegylated
interferon requires regular shots (injections) while other medications are taken orally (by mouth).

Pegylated interferon has unpleasant side effects in many people. The side effects are similar to
having the flu. This medication can also cause or worsen depression. For many people, side effects
are so severe that they cannot continue taking the medication.

Liver function tests and HBV DNA tests are used to check how well the treatment is working.

Interferon appears to stop the liver damage in up to 40% of people although relapse is possible.

Nucleoside/nucleotide analogues (NAs)

Nucleoside/nucleotide analogues (NAs) are compounds that mimic normal building blocks for DNA.
When the virus tries to use the analogues, it is unable to make new viral particles. Examples of these
agents include adefovir (Hepsera®), entecavir (Baraclude®), lamivudine (Epivir-HBV®, Heptovir®,
Heptodin®), Telbivudine (Tyzeka®) and tenofovir (Viread®).

NAs reduce the amount of virus in the body. Between 20% and 90% of patients may have levels
reduced so far that they become undetectable. Obviously, this is a broad range. The higher success
rates are achieved in patients who do not have "hepatitis B e antigen" (HBeAg). HBeAg is detected by
a blood test and indicates that the virus is actively multiplying.

Side effects are less common than with pegylated interferon. NAs have been associated with changes
in body fat distribution, reduced blood cell counts, and increased levels of lactic acid in the blood.
Rarely, NAs are associated with a severe flare of hepatitis that can be serious or fatal.

HBV may become resistant to NAs over time.

NAs do not cure the infection. Relapse is possible even in patients who have had a good response to
treatment.

Hepatitis:A Visual Guide to Hepatitis

A Visual Guide to Hepatitis Slideshow

Digestive Disease Myths:Common Misconceptions

Digestive Disease Myths Slideshow Pictures

Infectious Mononucleosis:Learn About the 'Kissing Disease' Caused by EBV

Slideshow: Infectious Mononucleosis

10/15

Is Surgery a Treatment for Hepatitis B?

There is no surgical therapy for hepatitis B.

If liver damage is so severe that the liver starts to fail, liver transplant may be recommended.
Liver transplant is a major process and surgery with an extended recovery period.

It also depends on the availability of a matching donor liver.

If liver transplant becomes a possibility for an individual, a health care practitioner will discuss the
risks and benefits with them.

11/15

What Other Therapy Is Available for Hepatitis B?

No herbs, supplements, or other alternative therapy is known to work as well as antiviral medication
in slowing HBV replication and promoting liver healing in hepatitis B. At this time, no specific herb or
herbal preparation is recommended.

12/15

What Is the Hepatitis B Vaccine?

There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well
to prevent the disease. A total of 3 doses of the vaccine are given over several months. Hepatitis B
vaccine is also produced as a combination product which includes other common childhood
vaccinations. This can reduce the number of shots that a child needs at a single visit.

The following groups should be vaccinated for hepatitis B:

All children younger than 19 years, including all newborns - especially those born to mothers who are
infected with HBV

All health care and public safety workers who may be exposed to blood

People who have hemophilia or other blood clotting disorders and receive transfusions of human
clotting factors

People who have end-stage renal disease including those who require hemodialysis for kidney
disease

Travelers to countries where HBV infection is common. This includes most areas of Africa, Southeast
Asia, China and Central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon
River basin of South America.

People who are in prison

People who live or work in residential facilities for developmentally disabled persons

People who inject illegal drugs

People with chronic liver disease such as hepatitis C

People who have multiple sex partners or have ever had a sexually transmitted disease

Men who have sex with men

Persons with HIV

People who have a sexual partner who is an HBV carrier.

Household contacts of persons who are carriers of HBV.

Anyone who wants to be vaccinated, regardless of risk factors.

Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to
unvaccinated people who have been exposed to hepatitis B.

These include close contacts of people with HBV infection, health care workers who are exposed to
HBV-contaminated blood, and infants born to mothers infected with HBV.

Giving the immune globulin and the vaccine together in these situations prevents transmission of the
disease in 80% to 90% percent of cases.

13/15

What Is the Follow-up for Hepatitis B?

If an individual has acute hepatitis B, a health care practitioner will draw blood and examine the
person periodically to see if the infection is resolving. If the person develops chronic hepatitis B, they
will need periodic examinations and blood tests on an ongoing basis. If these tests indicate that the
virus is actively damaging the liver, the health care practitioner may suggest a liver biopsy or begin
antiviral therapy. The individual will also be given a vaccine against hepatitis A, which is an unrelated
virus that may cause severe liver disease in people who already carry hepatitis B.

Chronic hepatitis B is associated with hepatocellular carcinoma. Fortunately, this is a rare cancer. A
blood test can be used to detect a marker for this cancer or the cancer can be detected by abdominal
ultrasound. Persons with chronic hepatitis B are usually screened periodically (every 6 to 12 months)
for hepatocellular carcinoma, although it is not clear if this screening improves survival.

Hepatitis:A Visual Guide to Hepatitis

A Visual Guide to Hepatitis Slideshow

Digestive Disease Myths:Common Misconceptions

Digestive Disease Myths Slideshow Pictures

Infectious Mononucleosis:Learn About the 'Kissing Disease' Caused by EBV

Slideshow: Infectious Mononucleosis

14/15

How Do You Prevent Hepatitis B?

In addition to the hepatitis B vaccine, other ways to protect yourself from HBV infection include:
If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent
transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing
transmission. Men who have sex with men should be vaccinated against both hepatitis A and
hepatitis B.

If you inject drugs, don't share needles or other equipment.

Don't share anything (including grooming products) that might have blood on it, such as a razor,
toothbrush, fingernail clippers, etc.

Think about the health risks if you are planning to get a tattoo or body piercing. You can become
infected if the artist or person piercing you does not sterilize needles and equipment, use disposable
gloves, or wash hands properly.

Health care workers should follow standard precautions and handle needles and sharps safely.

If you are pregnant or think you might be pregnant, tell your health care practitioner if you have any
of the risk factors for HBV infection.

15/15

Is Hepatitis B Curable?

Some people rapidly improve after acute hepatitis B. Others have a more prolonged disease course
with very slow improvement over several months, or with periods of improvement followed by
worsening of symptoms.

A small group of people suffer rapid progression of their illness during the acute stage and develop
severe liver damage (fulminate hepatitis). This may occur over days to weeks and may be fatal.

Other complications of HBV include development of a chronic HBV infection. People with chronic
HBV infection are at further risk for liver damage (cirrhosis), liver cancer, liver failure, and death.

Hepatitis B Resources and Information

American Liver Foundation

www.liverfoundation.org

(800) 465-4837

Hepatitis B Foundation

www.hepb.org

(215) 489-4900

Hepatitis Foundation International

www.hepatitisfoundation.org
(800) 891-0707

Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in
Infectious Disease

REFERENCES:

Centers for Disease Prevention and Control. Disease Burden from Viral Hepatitis A, B, and C in the
United States.

<http://www.cdc.gov/hepatitis/HBV/StatisticsHBV.htm>

Hepatitis B Related Articles

Liver Blood Tests

STDs Facts Slideshow

Liver Disease Quiz

Hepatitis B Picture

Cirrhosis

Hepatitis Slideshow

Take the STD Quiz

Liver Picture

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FRONT PAGE NEWS

TIMELINE: The Dengvaxia controversy

By CNN Philippines Staff

Updated 15:57 PM PHT Mon, February 26, 2018

Metro Manila (CNN Philippines) — A vaccine aimed at protecting hundreds of thousands of school
children from dengue may have put their lives at risk.

Around 10 percent of over 800,000 students who were immunized with Dengvaxia, but did not have
a prior dengue infection, now face contracting a "severe disease," according to the vaccine's
manufacturer Sanofi Pasteur.

Following the announcement, the Department of Health (DOH) halted its nationwide dengue
immunization program and has demanded billions in pesos as a refund for the vaccines.

Meanwhile, both Congress and the Justice Department are digging deeper into the controversy, with
officials from the current and previous administrations pointing fingers at each other.

Here's how it happened:

2014

Dengvaxia successfully completes its two parallel Phase 3 clinical studies, which compare the safety
and effectiveness of the new treatment.

The Philippines was among the 10 countries that took part in the study.

November 9, 2014
Then-President Benigno Aquino III meets Sanofi Senior Vice President in Asia Region Jean-Luc
Lowinski at the Philippine Embassy in Beijing, China.

June 9, 2015

Then-Health Secretary Janette Garin negotiates with Sanofi to reduce the cost of buying the vaccines.

October 29, 2015

Sanofi Pasteur applies at the DOH for Dengvaxia to be included in the Philippine National Formulary,
a list of drugs that all pharmacies in the Philippines must carry, pending approval by the Food and
Drug Administration (FDA).

December 1, 2015

Aquino and Garin meet Sanofi officials during the UN Conference on Climate Change in Paris, France.

December 10, 2015

Garin submits a proposal to the Budget Department to buy three million doses of Dengvaxia.

December 22, 2015

The Philippines grants marketing approval to Dengvaxia, making it the first vaccine to be licensed for
the prevention of dengue in Asia.

The Food and Drug Administration (FDA) approves the drug for the prevention of disease caused by
all four dengue types in individuals from nine to 45 years old living in high-risk areas.

December 28, 2015

The DOH-Family Health Office submits a request to Garin to exempt Dengvaxia from being included
in the Philippine National Formulary. This excludes it from review by the Formulary Executive Council
(FEC), which determines what drugs are included on the list.

December 29, 2015

The Budget Department issues a ₱3.5-billion Special Allotment Release Order to Garin's office to
purchase the vaccines.

January 21, 2016

The Philippine Children's Medical Center (PCMC) makes a ₱3-billion purchase order for the vaccines
without approval from the FEC.

February 3, 2016

Garin issues a Certificate of Exemption for Dengvaxia vaccines to be utilized in the pilot
implementation in the National Capital Region, Region III, and Region IV-A.

February 11, 2016

The Philippines, under Health Secretary Janette Garin, hosts the nationwide launch of Dengvaxia.

Read: World's first dengue vaccine now available in PH

March 2016

The World Health Organization (WHO) releases a paper saying Dengvaxia "may be ineffective or may
even increase that risk in those who are seronegative at the time of first vaccination."

Seronegative pertains to people who have not yet had dengue.

The WHO calls for more studies into the vaccine.

March 8, 2016

Garin issues a ₱3-billion disbursement voucher to the PCMC to fund the purchase of the vaccines.

March 9, 2016

The PCMC issues its purchase order to Zuellig Pharma, the distributor of Dengvaxia.

April 4, 2016

The government kicks off its ₱3.5-billion, school-based dengue immunization program. The health
department says students would be given three doses, which would be administered every six
months.

Read: DOH starts dengue vaccination program

July 2016

The WHO releases another paper, saying Dengvaxia "may act as a silent natural infection that primes
seronegative vaccinees to experience a secondary-like infection upon their first exposure to dengue
virus."

In other words, the body says the vaccine "may be ineffective or may theoretically even increase the
future risk of hospitalized or severe dengue illness in those who are seronegative at the time of first
vaccination regardless of age."

That same month, former Health Secretary Paulyn Ubial issues a Resolution temporarily suspending
the school-based dengue immunization program.

Only the 489,003 pupils who received the first dose would take the second and third doses.

September 2016

The health department moves to continue the vaccination program.

That same month, the Medical Research Council Center FOR Outbreak Analysis and Modelling at
Imperial College London releases a study saying Dengvaxia could lead to an increase in the number of
cases of the disease if not implemented correctly.
Read: New dengue vaccine could instead cause more cases, experts warn

"Unlike most diseases, the second time you get dengue, it's much more likely to be severe than the
first time you get it," said the center's director Neil Ferguson.

October 2016

The Singapore Health Sciences Authority flags "postulated risk" of Dengvaxia.

"As the vaccine is more effective in those who had previous dengue infection, and that there is a
postulated risk of severe dengue in those who do not have past dengue infections when they
become infected," it said.

November 2016

The House of Representatives probes the allegedly anomalous purchase of the Dengvaxia vaccines.

Its draft report of the Committee on Health, the DOH reported there were 30 cases from March 18 to
August 20, 2016 that were "considered as serious cases that needed hospitalization."

Of the three deaths it monitored, two were not related to the immunization program.

The panel directed the DOH to check the medical records of Christine de Guzman who died months
after taking the vaccine.

It also recommended that the DOH temporarily suspend the expansion of the vaccination program,
pending completion of data collection, evaluation, and analyses on "adverse effects."

Related: House body resumes probe of school-based dengue vaccine program

December 2016

The Senate launches its own investigation into the vaccines, saying the project cost was too big and
was approved without congressional approval.

Read: Senate probes dengue vaccine program

November 29, 2017

Sanofi Pasteur announces the results of new clinical data analysis, which found that Dengvaxia is
more risky for people not previously infected by the virus.

Read: Drug firm warns of 'severe disease' from dengue vaccine for people with no prior infection

"For those not previously infected by dengue virus, however, the analysis found that in the longer
term, more cases of severe disease could occur following vaccination upon a subsequent dengue
infection," it said.

"For individuals who have not been previously infected by dengue virus, vaccination should not be
recommended," it added.

December 1, 2017
Following Sanofi Pasteur's announcement, Health Secretary Francisco Duque III orders the temporary
suspension of the dengue vaccination program.

Read: Gov't halts dengue vaccination program due to health risk

Duque says 733,713 children from Central Luzon, the region of Cavite, Laguna, Batangas, Rizal, and
Quezon, and Metro Manila were administered Dengvaxia. Eight to 10 percent or about 70,000
children have not had dengue yet, the DOH added.

December 4, 2017

The Justice Department orders the National Bureau of Investigation to look into the dengue
vaccination program.

Read: DOJ orders probe of dengue vaccine program

December 5, 2017

The FDA suspends the sale and distribution of Dengvaxia.

Read: FDA suspends sale, distribution of dengue vaccine Dengvaxia

The WHO says it never recommended to countries the use Dengvaxia in their national immunization
programs.

Read: WHO denies recommending Dengvaxia for nat'l immunization programs

December 6, 2017

The health department says more than 800,000 students received the vaccine, up from the 733,713
figure mentioned by Duque.

It is now monitoring 40 cases of children who fell seriously ill, up from 30 in 2016, and nine deaths.

Read: DOH: More than 800,000 children vaccinated with Dengvaxia

December 7, 2017

The Health Department says it will return around 800,000 leftover Dengvaxia vaccines, worth P1.4-
billion, to Sanofi.

Read: Health Department to return ₱1.4 billion worth of Dengvaxia vaccines

December 8, 2017

The health department calls for a refund of the P3.5 billion it paid for the vaccines, adding it has
created a task force to look into the program.

Read: DOH to demand from Sanofi full refund of P3.5 billion spent on Dengvaxia

That same day, the House and the Senate announce they will again investigate the dengue
vaccination program. It begins on Monday, December 11.
Read: Senate to open probe on dengue vaccine scare

December 11, 2017

The Senate starts its probe into the Dengvaxia issue. Former Health Secretaries Janette Garin and
Paulyn Ubial, as well as Health Secretary Francisco Duque III and Sanofi officials, are among those
present.

Before the start of the hearing, former Health Secretary Enrique said Garin, his successor, was "solely
responsible" for the Dengvaxia issue.

Read: Ex-DOH Sec. Ona: Garin solely responsible for Dengvaxia 'nightmare'

Meanwhile, Garin says the purchase of the vaccines was "above board."

Read: Ex-DOH Secretary Garin: No corruption in Dengvaxia purchase

December 14, 2017

Aquino, under whose administration the deal was approved, attends the Senate hearing on the
vaccine program.

Aquino claims no one advised him against procuring Dengvaxia, with health reform advocate Dr.
Anthony Leachon saying that the former President cannot be faulted if he was given "misleading"
information on Dengvaxia.

Read: Ex-President Aquino: No one advised me against Dengvaxia

Presidential Spokesperson Harry Roque says that President Rodrigo Duterte believes the program
was done "in good faith," adding that Duterte would have done the same.

Read: Duterte thinks Dengvaxia purchase done in 'good faith' - Roque

Meanwhile, Ubial reveals that Garin's husband, Rep. Oscar Garin Jr., pressured her to continue the
roll out of the vaccine program.

Read: Ex-DOH Sec. Ubial: Janette Garin's husband asked me to buy more Dengvaxia

January 19, 2018

At an event in San Fernando, Pampanga, Health Secretary Francisco Duque III confirmed Sanofi
Pasteur has refunded P1.16 billion worth of unused Dengvaxia vaccines.

However, Duque clarified the reimbursement does not put the French pharmaceutical company off
the hook, adding the investigation continues on whether Sanofi withheld significant information on
possible risks.

READ: Sanofi refunds P1.16-B for unused Dengvaxia vaccines

January 4, 2018
Sanofi Pasteur says it has complied with international and local laws and regulations when it
launched Dengvaxia, saying it will continue to cooperate with the country's FDA.

January 10, 2018

The Public Attorney's Office (PAO) conducts an autopsy on five vaccinated children who died.

Dr. Erwin Erfe, director of the PAO Forensic Laboratory, says while the findings are inconclusive, signs
and symptoms - as well as the death - occurred within six months after the last Dengvaxia injection.

READ: PAO forensic consultant finds pattern in 5 severe dengue deaths

January 10, 2018

A former DOH official claims 19 officials, including former Health Secretary Garin, were part of a
"mafia" in the department. The "mafia" allegedly benefited from the Dengvaxia purchase, saying that
90 percent of the funds goes back to the DOH, while 10 percent is given to a supposed "financier."

READ: Ex-Health Dept. consultant bares 'mafia' operating in DOH

Garin denies the allegations.

January 19, 2018

At an event in San Fernando, Pampanga, Health Secretary Francisco Duque III confirms Sanofi Pasteur
has refunded P1.16 billion worth of unused Dengvaxia vaccines.

However, Duque clarifies the reimbursement does not put the French pharmaceutical company off
the hook, adding the investigation continues whether Sanofi withheld significant information on
possible risks.

READ: Sanofi refunds P1.16-B for unused Dengvaxia vaccines

January 26, 2018

Duque reveals health officials did not wait for the results of clinical trials of the Research Institute for
Tropical Medicine (RITM) on Dengvaxia to know its risks before launching the nationwide
immunization program.

READ MORE: Health Chief: Vaccine program should have waited for Dengvaxia clinical trial result

He also suggests Executive Order 674, which establishes the RITM, should be reviewed to include
possible conflicts of interest in its research activities in partnership with pharmaceutical companies.

The Health Chief also sends a letter to Sanofi Pasteur formally requesting for a full refund of all the
used and unused vaccines.

READ: Duque: DOH formally demands full refund of Dengvaxia vaccines

January 31, 2018

Some parents in Zamboanga refuse the DOH's deworming program due to the Dengvaxia scare.
READ MORE: Health Chief: Vaccine program should have waited for Dengvaxia clinical trial result

During Duque's confirmation hearing before the Commission on Appointments, committee

members question him over the existence of the DOH "mafia." Duque denies the claims, along with
two other health officials who were supposedly involved.

READ MORE: Duque on Dengvaxia controversy: No 'mafia' at DOH

Health officials add the unused budget for the dengue vaccination program, worth P556 million, is
still with the PCMC.

February 2, 2018

The University of the Philippines - Philippine General Hospital (UP-PGH) experts' panel reports that
out of 14 autopsies they conducted, three died due to complications of dengue. Two of those three
dengue deaths could possibly be related to Dengvaxia failure, they say.

READ MORE: 2 deaths may be due to Dengvaxia failure - experts

However, the panel members suggest to have more tissue analyses on the bodies to come up with
conclusive findings. They also call on parents of dengue victims to have the remains of their children
to be examined only by legitimate forensic pathologists.

A group of doctors from the East Avenue Medical Center also points out a decline in children's
vaccinations against other diseases such as flu, polio, and measles.

READ: Doctors: Parents refusing vaccines due to Dengvaxia scare

The doctors attribute this decline to the Dengvaxia scare, but they maintain other vaccines are safe.

February 5, 2018

Sanofi Pasteur turned down the Health Department's demand to refund used dengue vaccine vials. It
said agreeing to the demand will mean Dengvaxia does not work. The Dengvaxia maker also rejected
the Department of Health's request to financially support hospitalized vaccinated children.

Meanwhile, Duque tells lawmakers that it will up to the Justice Department to consolidate and
reconcile the findings of the Public Attorney's Office (PAO) and University of the Philippines-
Philippine General Hospital's (UP-PGH) panel of experts.

Read: DOJ to consolidate PAO, experts' Dengvaxia findings - DOH

PAO's findings state the deaths showed "strong links" to Dengvaxia, although it added the results are
inconclusive. Meanwhile, the findings by the UP-PGH found no direct link between the deaths and
the vaccine.

The PAO also files a civil case against Garin, former Undersecretary Kenneth Uy, and other health
officials of implementing the program in undue haste even if "the product has no proven safety and
efficacy."
Also included in the case are Sanofi and distributor Zuellig Pharma Philippines for failing to inform
the public of the vaccine's risks. All in all, the PAO is seeking at least P4 million in damages.

February 6, 2018

Senate Blue Ribbon committee chair Richard Gordon says he may recommend the filing of charges
against Aquino, Garin and other former officials over the Dengvaxia controversy.

Read: Gordon: Aquino, Garin may face charges over Dengvaxia mess

"Ang linaw ng paper trail and there is a direct causal connection," Gordon said in an interview
following the panel's Tuesday hearing.

[Translation: The paper trail is clear and there is a direct causal connection.]

Gordon noted the haste in the purchase of the dengue vaccine Dengvaxia, which the government
used for the ?3.5-billion dengue vaccination program it kicked off in April 2016.

"Yung lumalabas talaga, tuwing lalakad sa abroad, bumibilis yung papeles," Gordon said.
"Nagmamadali dun sa pagkuha ng FDA (Food and Drug Administration) permit. Pati yung (Philippine
National) Formulary, ini-influence."

[Translation: What's really emerging is that when there are trips abroad, the papers move faster.
There is a rush to get the FDA permit. And even the Formulary is being influenced.]