After Tino, Leptospirosis strikes

WHEN the floodwaters from Typhoon Tino engulfed the riverside home of Verna Sangilan earlier this month, she believed the worst was over once the rains finally eased. 

But on Nov. 15, 2025—just three days after her partner, Jerwen Karl Abellana, first developed a fever—she found herself holding his hand inside the intensive care unit of a Cebu City hospital as leptospirosis, contracted from the murky floodwaters they had waded through for days, began shutting down his kidneys, lungs, and heart.

Although the 27-year-old Abellana had no visible wounds, four days of exposure to contaminated floodwaters was enough for the bacteria to enter his body.

He was among the many who fell ill after the deadly flooding triggered by Typhoon Tino in the early morning of Nov. 4. 

As of the third week of November, at least 50 leptospirosis cases had been recorded from Province-run and private hospitals in Cebu.

Leptospirosis, according to the World Health Organization, is a zoonotic disease caused by pathogenic organisms from the genus Leptospira. It is transmitted directly or indirectly from animals to humans.

Source of infection

When the winds of Typhoon Tino began to ease on Nov. 4, torrential rains continued to pound Cebu, unleashing flash floods that engulfed the cities of Cebu, Talisay, Mandaue, and the towns of Liloan, Consolacion, Compostela, Asturias, and Balamban.

The Philippine Atmospheric, Geophysical and Astronomical Services Administration (Pagasa) reported that Cebu received 183 millimeters of rainfall from the morning of Nov. 3 to the morning of Nov. 4—equivalent to a month and a half’s worth of rain in just 24 hours—overwhelming rivers and low-lying areas.

Homes were submerged, some up to the second floor, forcing residents onto rooftops or compelling them to wade through chest-deep water to reach higher ground.

When the water receded, residents faced a new threat: the thick mud blanketing their homes and streets.

Given the magnitude of the disaster, infectious disease specialist Dr. Christina Tan-Bonghanoy said almost all Cebuanos became vulnerable to leptospirosis. 

Data from the Cebu Provincial Government show that at least 46,983 individuals are staying in evacuation centers across the province, most presumed to have been exposed to floodwaters.

Bonghanoy, in an interview with SunStar Cebu’s online health program Vital Signs on Nov. 13, said exposure to contaminated floodwater remains the most common cause of leptospirosis. Those with open wounds are particularly at risk, and many residents who survived the flash floods suffered cuts and injuries from debris swept by the current.

However, even those without wounds are not spared-as in Jerwen’s case.

Bonghanoy said contamination is not limited to rat urine. Water tainted with the waste of pigs, dogs, and sheep can also transmit leptospirosis.

Another Cebuano infectious disease specialist, Dr. Albert Bryan Lim, said the bacteria can also enter through microscopic cuts or through the eyes and mouth. Even rubbing one’s eyes after touching a contaminated surface, or cleaning mud inside flooded homes, can lead to infection.

Bonghanoy said leptospirosis can also be contracted from contaminated puddles or by accidentally drinking water containing rat urine.

Stages, symptoms

The Centers for Disease Control and Prevention (CDC) notes that symptoms generally begin to appear two to 30 days after contact with the bacteria.

Leptospirosis typically occurs in two phases: an initial flu-like illness, followed by a temporary recovery before a more severe second phase, which can potentially cause kidney or liver failure, or inflammation of the membrane around the brain and spinal cord (meningitis).

Bonghanoy said some would think they are onlyexperiencing the flu, without knowing it is already symptoms of leptospirosis.

According to Sangilan’s Facebook posts, Abellana’s first symptom—fever—appeared on Nov. 12. By Nov. 13, he was vomiting, prompting them to visit San Lucas Medical Center in Minglanilla where he was given medication.

Sangilan initially thought it was just a flu. But when Abellana’s eyes turned red, they rushed to Chong Hua Hospital, where he was admitted to the ICU.

On the morning of Nov. 15, Sangilan said Abellana was still active, talking to their son, reminding him to behave. But by afternoon, he was already weak, and doctors warned that the bacteria had begun attacking his lungs.

By the following day, Abellana had died.

Measures

Officials are racing to prevent another disaster—this time, a surge of leptospirosis cases that could overwhelm hospitals and health facilities.

When Typhoon Tino hit Cebu, the Cebu Provincial Health Office (PHO) immediately looked back at the aftermath of Typhoon Ondoy in 2009, the closest comparable event. At the Philippine General Hospital alone, 561 suspected leptospirosis cases were recorded, with 67 deaths.

Learning from that experience, provincial health consultant Dr. Nikki Catalan said the Province activated a One Health framework as soon as Tino exited the island.

Under One Health, the Province mobilized four key strategies: communication, coordination, collaboration, and capacity building.

Local chief executives were alerted early that leptospirosis would be a major post-flood concern.

Within the first 24 hours, personnel from the Provincial Disaster Risk Reduction and Management Office (PDRRMO) and other responders received doxycycline prophylaxis, along with briefings on the severity of the disease.

“We blasted information on social media, did interviews before the rise in cases, and used our emergency response tracker to transparently show medicine distribution,” Catalan said.

Four days after the typhoon, the Province created a Leptospirosis Task Force composed of provincial, district, and private hospitals; infectious disease and nephrology specialists; and the Department of Health (DOH).

The Governor’s office also sent letters to private hospitals, urging them to prepare leptospirosis pathways and secure necessary medications.

“We wanted to make sure that as much as possible, we will not reach severe cases,” Catalan said.

The Province likewise urged PhilHealth to increase its coverage for leptospirosis patients.

Since Nov. 4, DOH-7 has distributed about 10,000 doxycycline tablets, with 40,000 more set for dispatch to municipalities across Cebu.

A refresher webinar on leptospirosis—its early signs, symptoms, management, and treatment—was also conducted for municipal health officers and $75$ doctors in Province-run hospitals. Officials are racing to prevent another disaster—this time, a surge of leptospirosis cases that could overwhelm hospitals and health facilities.

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?”

Prophylaxis

Bonghanoy confirmed that pharmacies have reported increased demand for doxycycline since the flooding.

Doxycycline—available only through a doctor’s prescription—is commonly used to treat bacterial infections, including leptospirosis.

She emphasized the importance of the “golden period”: the first 24 to 72 hours after exposure to contaminated water or soil. Within this window, doxycycline can significantly help prevent infection.

“Controlling leptospirosis is important, not just treatment. As much as possible, we can prevent it. That is why for the first three days (from Nov. 4), we were racing to distribute the doxycycline because it’s our prevention,” said Bonghanoy.

However, she cautioned that taking doxycycline does not guarantee absolute protection.

Lim added that prophylaxis is effective only within the first 24–72 hours after exposure, and repeated exposure requires repeated dosing.

Bonghanoy also noted that residents cleaning mud inside their homes continue to face risks.

“For people who are still cleaning their houses, they are supposed to be taking one Doxycycline once a week,” she said.

Unseen enemy

Abellana’s death is a painful reminder that the danger does not end when floodwaters recede, but lingers in the mud, puddles, and unseen bacteria left behind.

As Cebu rebuilds after Typhoon Tino, health officials urge vigilance—because in the weeks ahead, every fever, cut, and exposure could mean the difference between recovery and another life lost. / JJL