Writer’s note: A similar article appeared in my column way back in January 2012 as the aftermath of typhoon Sendong included an outbreak of leptospirosis in Northern Mindanao Region with a denser population being affected at Cagayan de Oro City, where at least 200 cases of leptospirosis had been recorded within 2 weeks post typhoon. The aim of this article is neither to diagnose leptospirosis nor to prescribe antibiotics, particularly doxycycline but rather for health information dissemination and awareness purposes only. The reader is advised to seek qualified health professionals in order to either access the said antibiotic or to determine if there is a need to take one.
TROPICAL Storm Vinta (international name: Tembin) exited the Philippine area of responsibility three days ago after causing floods that destroyed bridges, houses and other infrastructures and claimed hundreds of lives. One may be tempted to think that the dangers of the said typhoon are already over. Probably in terms of the potential damage to buildings and houses but in terms to health, the perils are yet to surface. Flood-borne diseases, specifically the communicable ones are not evident immediately as it has what is called ‘incubation’ period or the time between exposure to infection and the appearance of first symptoms.
In a series of lectures I had attended in medical sociology, the following had been identified as potential health risks post typhoon: diarrhea; acute respiratory infection; measles; tetanus due to wounds; vector borne diseases such malaria, dengue, schistosomiasis; and diseases associated with animals such leptospirosis and animal bites.
Every location may manifest a rather different distribution of diseases post-typhoon. For example when Snedong hit Cagayan de Oro in 2011, there was an epidemic of leptospirosis. But when Ondoy hit Cebu in 2009, dengue rather prevailed the epidemics.
As defined by medical literatures, leptospirosis is a bacterial infection caused by the microorganism ‘leptospira’ that typically makes its way to its human host through superficial cuts and open wounds after exposure to a contaminated water such floods and moist soil. It is also believed that urines of the infected animals such as water buffaloes, cattle, pigs, dogs, monkeys and especially rats are considered the carriers of the said bacteria that cause leptospirosis.
Epidemiologic data culled from a number of public health studies suggest that an average of 680 cases of leptospirosis are reported every year in the Philippines with 40 of the said cases resulted to death.
The World Health Organization believes that leptospirosis often peaks seasonally sometimes in outbreaks, and is often linked to climate changes, to poor urban slum communities, to occupation or to recreational activities.
In 2009, several professional organizations of physicians in the country to include the Philippine Society for Microbiology and Infectious Diseases, the Philippine Society of Nephrology and the Council on Critical Care and Pulmonary Vascular Diseases of the Philippine College of Chest Surgeons convened to formulate guidelines in the management of suspected leptospirosis cases and its complications.
Organizationally, the said collaboration of prominent medical societies has led to the conception of the 2009 Leptospirosis Task Force in the Philippines (LTFP).
According to LTFP, the following are the specific probable symptoms experienced by a Filipino with leptospirosis according to their studies: fever, body weakness, headache, sore eyes (due to flood), abdominal pain, diarrhea, yellowing of the skin, inability to pass urine or urinate, kidney failure, symptoms involving the lungs that appear like flu infections, low platelet count (often mistaken for dengue), and changes in the level of consciousness such as unusually sleepy.
If any of these manifestations are experienced, the victim or patient is advised to seek medical attention to rule out the possibility of leptospirosis.
LTFP informs that incubation period ranges from 2 to 28 days. Thus, hose who had been soaked in flood water and in the process of struggling for survival, had sustained wounds or cuts that may serve as portals of entry for the bacteria may emerge with leptospirosis anytime soon after the said incubation period is due should they not receive post-exposure prophylaxis with an antibiotic.
LTFP also identified three groups of post-exposure victims to wit: (1) Low-risk exposure or those individuals with a single history of wading in flood or contaminated water without wounds, cuts or open lesions of the skin; (2) the moderate risk exposure, or those individuals with single history of wading in flood or contaminated water and have open cuts or wounds or may have accidentally ingested flood or contaminated water and (3) high-risk exposure or those individuals who have multiple episodes of exposure, with open wounds, have ingested and are swimming in contaminated water or flood.
As a post-exposure preventive measure or simply put, prophylaxis to those who had been soaked or submerged in the flood, LTFP recommends that physicians prescribe the victims with Doxycycline 200mg single dose within 24 to 72 hours for low-risk victims; Doxycycline 200mg once daily for 3 to 5 days to be started immediately within 24 to 72 hours after exposure for moderate risk and Doxycycline 200 mg once weekly until the end of the exposure for the high-risk group.
Fortunately, certain pharmacies in Cagayan de Oro allow the purchase of doxycycline in the absence of a prescription after a flood. However, the risks of self-medication cannot be undermined.
According to a pharmacology textbook, Doxycycline, which belongs to the family of tetracycline antibiotics, works by inhibiting the protein synthesis of its susceptible bacteria such as leptospira that causes leptospirosis leading to its inability to multiply and eventually killing it.
A medical biochemist said that in large doses, Doxycycline is toxic to humans because the proteins that these antibiotics target are similar to the proteins found in human cells.
The Leptospirosis Task Force guidelines emphasize that the following has to be considered when receiving the Doxycycline prophylaxis: (1) do not use if you are pregnant. It can cause more harm to the unborn baby and permanent discoloration of the teeth later in life; (2) if you are nursing or breastfeeding, do tell your doctor as this medication can be passed to the breastmilk and may affect the bone growth and tooth development of the baby; (3) do not give Doxycycline to children less than eight years of age as it can cause permanent yellowing of the teeth and affect the child’s growth; (4) Do not use this medication when you are allergic to similar antibiotics like tetracycline and minocycline as you may be allergic to Doxycycline as well; (5) before taking this antibiotic, tell your doctor is you have liver or kidney problems as you may not be able to tolerate this drug; (6) Doxycycline can make birth control pills less effective; (7) avoid exposure to sunlight or use sunscreen with a minimum SPF 15 as this drug can make your skin more sensitive to sunlight; (8) do not take iron supplements, multivitamins, calcium supplements, antacids or laxatives within 2 hours before or after taking Doxycycline as these can decrease the potency of the antibiotics.
LTFP also warns that side effects of Doxycycline include severe headache, dizziness, blurred vision, nausea, vomiting, upset stomach and diarrhea.
If any of the after- Doxycycline-use symptoms persists, consult your doctor for treatment and never self-medicate.
Other uses of Doxycycline include treatment of traveler’s diarrhea and a host of sexually transmitted diseases.
LTFP believes that leptospirosis is endemic in the Philippines during the rainy months of June to August.