Toril diarrhea outbreak over

July 29, 2022

The Davao City Health Office has officially declared the Toril diarrhea outbreak fully controlled after two weeks of battling the illness.

Acting CHO Head Dr. Ashley Lopez announced over the Davao City Disaster Radio on Friday, July 29, 2022, that the outbreak is over due to the decreased number of cases. Food source contamination has also been confirmed to be the source of the illness that has so far affected 217 individuals, including children.

“Starting July 21, we have seen that the average number of cases being reported has gradually decreased. After a week of having the same trend, and with the approval and permission of our City Mayor, Honorable Sebastian Duterte, with the powers vested in me as the Officer-in-Charge of the City Health Office, I can officially declare and announce that the diarrhea outbreak in Toril is now over,” Lopez said.

The cases started to decline on July 21 and have not exceeded five per day, contrary to the 67 cases recorded on July 15.

At least 163 admitted patients have already recovered, about 75 percent of the total cases recorded since day 1 of the outbreak. A total of 11 individuals or 5 percent of the total affected individuals remained in hospitals while 26 cases were also being treated at the Outpatient Department of hospitals.  Meanwhile, 11 cases of diarrhea are still being verified to determine if these are related to the Toril outbreak.

“Three-fourths of our cases are already recovered; however, we have additional death, which brought case fatality to 3 percent,” Lopez said. He said added to the list of those who died was a 27-year-old patient who succumbed to cardiopulmonary arrest secondary to severe dehydration. The patient, who felt symptoms starting July 15, did not immediately go to the hospital and was only brought to the hospital after he fainted on July 24. He died three hours later.

Lopez advised the public never to underestimate the signs and symptoms of diarrhea. He said immediate medical care should be sought, especially, if one has had a third episode of acute watery diarrhea, as it is the best way to prevent developing severe complications or even death.

Food Contamination

Aside from the number of cases and deaths, Lopez finally announced the findings of the complete package comprehensive investigation review of the Epidemiology Bureau of the Department of Health. The findings reveal that the cause of the diarrhea outbreak is food-borne.

“The diarrhea outbreak was due to a foodborne microorganism, with Vibrio cholera as the pathogen of concern. The most likely vehicle of transmission is contaminated food,” Lopez said.

He said that from the investigations, the food consumed by the victims may have been contaminated during preparation and handling by an infected handler/s. It was also found that proper storage, delayed serving, and an unsanitary environment may have contributed because of exposure to elements.

The finding from the rectal swabs done on the affected cases and submitted to SPMC reveals that  60 percent turned out positive in the bacteriological culture testing.

Lopez noted that those who were hospitalized had consumed tapioca, isaw, kwek-kwek and juice from Rasay St. and the Toril Public Market.

He also said that the Epidemiology Bureau has concluded that only those patients who had diarrhea or had three or more episodes within 24 hours, after eating a meal in Rasay and/or Toril Public Market from July 12 to 18, 2022, are considered to be part of the outbreak.

“More than 50 percent of these individuals experienced vomiting, with about 35 percent experiencing abdominal pain. It was also found that 41 percent of the affected cases had episodes of eating and drinking in Rasay, while 21 percent of the cases ate and drank at the Toril Public Market. The remaining 38 percent are from multiple sources and are statistically insignificant to be considered exposure for cases,” Lopez said.

Lopez further announced that the drinking water in Toril serviced by Davao City Water District is clean and safe. It is found after repeat testing of samples taken before and after water meters of affected cases. The testing showed that the water samples taken from the microbial analysis are negative for bacteria but samples taken after the meter have a statistically significant number of positive results.

“However, these samples are seen as isolated cases with frequent cases having pipelines submerged in dirty water or, worse, in canals. We also submitted water samples to the Research Institute for Tropical Medicine and it was found that no abnormal growth was found in the bacteriology test of the samples submitted,” Lopez said.

Lopez, however, warned those who are drinking water from the open wells to boil the water, as those wells tested positive during microbial analysis. Hence, boiling water 10 minutes before use for drinking and preparation of food is still highly recommended.

As to the two ice plants, Lopez confirmed that the water from an open well used for ice-making tested positive for E. Coli and Coliform. He said that these ice plants are closed for violation of the Sanitation Code. He said that vendors are oriented not to use ice from ice plants for food preparation. He said it is best to “make your own ice”

Lopez thanked the Davao City Water District, the Southern Philippines Medical Center, and the Epidemiology Bureau of the Department of Health for their collaborative efforts to ensure the transparency of reports and give a better picture of the incident. He likewise said that CHO is currently coordinating with multiple agencies, offices, and departments to ensure strict enforcement of existing rules on food handling, surveillance, and other related activities.

“We are for the regulation of street vendors in compliance with the relative laws, but we also look forward to lobbying (for) legislation in improving the Sanitary Ordinance of this City,” Lopez said.

Lopez said that food handling guidelines at Roxas Night Market will set an example should there be additional regulations in place for street food handling. As to the health card requirement for vendors, this will be for further study and assessment.

He also announced that the Incident Command Center located in front of Magsaysay Elementary School is demobilized and the teams serving there will be transferred to other local health centers to assist in Kadayawan 2022-related responsibilities.

He added that the Task Group Sanitation will continue to function until such time that there will be zero cases and no hospital admissions anymore.

Re-opening of Food Stalls in Toril

Lopez said that since the outbreak is over, the vendors in Toril can now return.

“I officially lift the suspension of operations of the Toril vendors. As of 10 a.m. today (July 29), a dialogue with barangay captain (was held) to give them advisories and reminders,” Lopez said

Lopez underscored that homecooked food and handwashing, and seeking early medical care are still the best way to prevent foodborne illness.

“I call on Davaoeños that food safety is everybody’s responsibility. Let us work hand-in-hand to ensure the welfare of all Davaoeños,” Lopez said. CIO