WHEN floodwaters from typhoon Tino engulfed Verna Sangilan’s riverside home earlier this month, she believed the worst was over once the
rains eased.
But on Nov. 15, three days after her partner, Jerwen Karl Abellana, developed a fever, she held his hand in the ICU of a Cebu City hospital as leptospirosis, contracted from murky floodwaters, began shutting down his kidneys, lungs and heart.
Although 27-year-old Abellana had no visible wounds, four days in contaminated water was enough for the bacteria to enter his body. He was among many who fell ill after Tino’s flooding on Nov. 4.
As of the third week of November, at least 50 leptospirosis cases had been recorded in provincial and private hospitals.
Leptospirosis, according to the Word Health Organization, is a zoonotic disease caused by Leptospira bacteria, transmitted directly or indirectly from animals to humans.
Source of infection
After Tino’s winds eased on Nov. 4, torrential rains caused flash floods across the cities of Cebu, Talisay and Mandaue, and towns including Liloan, Consolacion, Compostela, Asturias and Balamban. Pagasa reported 183 millimeters of rain in 24 hours — equivalent to a month and a half of rainfall — overwhelming rivers and low-lying areas.
Homes were submerged, some to the second floor, forcing residents onto rooftops or to wade through chest-deep water. When the waters receded, thick mud blanketed streets and homes.
Given the disaster’s magnitude, infectious disease specialist Dr. Christina Tan-Bonghanoy said almost all Cebuanos became vulnerable to leptospirosis.
Data from the Provincial Government show 46,983 people in evacuation centers, most likely exposed to floodwaters. Bonghanoy said exposure to contaminated water is the most common cause of infection. Those with wounds are particularly at risk, though even residents without wounds — like Jerwen — can become infected.
“Anybody can be infected with leptospirosis, with or without a wound,” she said. “The risk is greater when a wound exists. Skin is an important barrier; even a small cut allows organisms to enter and cause infection.”
Bonghanoy noted contamination is not limited to rat urine; water tainted by pigs, dogs, or sheep can also transmit the disease. Dr. Albert Bryan Lim added bacteria can enter through microscopic cuts, the eyes, or mouth, and cleaning mud can also lead to infection.
Stages and symptoms
The Centers for Disease Control and Prevention notes symptoms appear two to 30 days after exposure. Leptospirosis typically has two phases: an initial flu-like illness, a brief recovery, then a more severe stage, potentially causing kidney or liver failure or meningitis.
Sangilan said Abellana’s first symptom — fever — appeared Nov. 12. By Nov. 13, he was vomiting and treated at San Lucas Medical Center. When his eyes turned red, he was admitted to Chong Hua Hospital’s ICU. On Nov. 15 morning, he was still active, speaking to their son, but by afternoon, his lungs were failing. By Nov. 16, Abellana had died.
Measures
Officials are racing to prevent another disaster: a surge of leptospirosis cases that could overwhelm hospitals.
Learning from typhoon Ondoy in 2009, when Philippine General Hospital reported 561 suspected cases and 67 deaths, Cebu Provincial Health Office (PHO) activated a One Health framework immediately after Tino. It mobilized four strategies: communication, coordination, collaboration and capacity building. Local officials were warned early about post-flood leptospirosis risks.
Within 24 hours, Provincial Disaster Risk Reduction Management Office personnel and responders received doxycycline prophylaxis and briefings. “We blasted information on social media, did interviews before the rise in cases and used our emergency response tracker to transparently show medicine distribution,” said provincial consultant Dr. Nikki Catalan.
Four days later, the Province created a Leptospirosis Task Force with provincial, district and private hospitals; infectious disease and nephrology specialists; and the Department of Health (DOH). The governor’s office urged private hospitals to prepare pathways and secure medications. Philhealth was asked to increase coverage. Since Nov. 4, DOH 7 distributed 10,000 doxycycline tablets, with 40,000 more on the way. A hotline and refresher webinar for 75 municipal and provincial doctors were also implemented.
Prophylaxis
Bonghanoy confirmed increased demand for doxycycline, which is available only by prescription and most effective within 24–72 hours of exposure. “Controlling leptospirosis is important, not just treatment. That is why we were racing to distribute doxycycline in the first three days,” she said. Lim noted repeated exposure requires repeated dosing. Residents cleaning mud should continue weekly doses.
A dedicated leptospirosis hotline is also being developed to provide assistance and respond to public queries.
The PHO has likewise made an emergency purchase of intravenous medications in preparation for a potential surge in cases.
Catalan stressed that severe leptospirosis often requires dialysis — something the Province does not have adequate capacity for.
“That’s why we are very aggressive,” she said. “We already don’t have enough hemodialysis facilities for our renal patients — how much more if leptospirosis cases increase?”
Unseen enemy
Abellana’s death is a reminder that danger lingers in mud, puddles and unseen bacteria even after floodwaters recede. As Cebu rebuilds, health officials urge vigilance: every fever, cut, or exposure could determine recovery — or another life lost. / JJL