RITM: Working for public good for 25 years

The Research Institute for Tropical Medicine (RITM), the research arm of the Department of Health, was established in 1981 as a special project of the then Ministry of Health. It was a development project of the Japanese government to the Philippines through the Japanese International Cooperation Agency (JICA).

It was authorized to undertake activities in the diagnosis, control and prevention of tropical diseases that were the major causes of mortality and morbidity in the country.

The significant contributions of RITM to infectious and tropical diseases of public health importance are discussed below.

• Acute respiratory infections (ARI)

Intensive studies on important bacterial causes of childhood pneumonia (S. pneumoniae and H. influenzae), manifestations, risk factors and treatment began in the 1980s in Quezon City, Muntinlupa, Pasig, and Bohol.

The effectiveness of the WHO ARI case management protocol in reducing deaths due to pneumonia was studied in Bohol from 1984 to 1990.

The result was the impetus for the DOH to implement the Control of Acute Respiratory Infections (CARI) program. From the treatment-based program, preventive methods were studied.

Acute respiratory infection vaccine studies in Cabuyao, Laguna, and Bohol for the past 10 years addressed issues on vaccine-preventable diseases like pneumonia and meningitis, training of community health workers, improved vaccination coverage, surveillance of side effects of vaccination, and cost-effectiveness of vaccination.

• Dengue

Community and hospital-based surveillances provided epidemiologic, clinical, laboratory, virologic, immunologic, and population susceptibility information essential for strategies in disease control and prevention (including vaccination programs).

This information underscores the necessity of a multisectoral approach to dengue control, and the strengthening of laboratory capacities for diagnosis and continuous epidemiologic and clinical surveillance of the disease.

• Diarrheal diseases

Studies contributed to basic knowledge on local epidemiology and etiology (bacteria, viruses, parasites) of diarrheal disease in the community and hospital settings, and practices of mothers of infants with diarrhea.

Internationally accepted laboratory procedures for detection of enteric pathogens such as human rotavirus, antibiotic resistant Shigella flexneri, and Vibrio cholerae were pioneered in RITM.

A nationwide, laboratory-based food-borne disease surveillance program, prevention and control and risk communication was established.

• Human immunodeficiency virus (HIV)/AIDS

The first case of AIDS in the Philippines was treated in RITM in the mid-1980s. The institution took the lead in raising local awareness of HIV and AIDS through research, training of health care providers, and care of HIV/AIDS patients.

The first surveillance activities among commercial sex workers were carried out from 1989 to 1990.

The natural course of HIV disease among Filipinos was described. An algorithm for HIV testing and national guidelines for HIV/AIDS treatment were also developed.

In 1994, monotherapy for HIV became available, and affordable antiretroviral drugs were made accessible to many HIV/AIDS patients.

The RITM was the National Reference Center for HIV Testing until 2000. A national assessment program for HIV-testing was developed to provide quality control of HIV tests performed by private laboratories.

The National Control Program adopted the use of pooled sera for HIV testing for its surveillance program.

• Leprosy

Prevalence surveys in the National Capital Region in the early 1990s disclosed active transmission in the areas surveyed, delayed diagnosis of leprosy, and under-reporting of the disease.

Seroepidemiological studies from 1988 to 1996 in Culion Island identified individuals at high risk of developing leprosy – household contacts of patients with leprosy. This focused the attention of disease control to this group of individuals.

Chemoprophylaxis of these individuals was initiated and a reduction in incidence of leprosy was observed over the years. In 2005, pilot field evaluations of a rapid diagnostic test showed promise for the leprosy control strategy – detecting cases in communities.

• Malaria

The biological (parasite, human host and vector), epidemiological, social, temporal and geographical dynamics of malaria transmission in the Philippines were better understood through field-based studies in Morong, Bataan from 1992 to 1998.

These led to the simultaneous development and evaluation of new strategies for malaria control from 1993 to 2002 in Morong, and in Tayabas, Quezon, and Agusan del Sur.

These were, among others, community mobilization and organization for malaria control, malaria microscopy diagnosis by non-medical technologists, computerized malaria health information system, and health program management by local governments.

In 1997, the interruption of malaria transmission was documented in Morong, Bataan.

The revision of malaria treatment guidelines in 1992 was based on therapeutic efficacy studies from 1999 to 2001 in various provinces.

• Rabies

In 1990, it was demonstrated in Sorsogon that rabies can be cost-effectively controlled by a massive vaccination of dogs.

The nationwide implementation of rabies vaccination in 1998 was made possible through RITM’s pioneering use of intra-dermal administration of rabies vaccine. This reduced costs of rabies post-exposure vaccination.

Consensus meetings were initiated to update the national guidelines on animal bite management and human rabies.

• Schistosomiasis

Community-based studies in Leyte in 1981 looked at the impact of praziquantel treatment on the prevalence, incidence, morbidity of schistosomiasis.

Cost-effective measures for schistosomiasis control were also developed. These were the basis for recommendations to the national control program for more comprehensive approaches to eliminate schistosomiasis in the Philippines.

Effects of treatment on childhood growth and development, resistance to re-infection, mechanisms of liver disease, anemia and cognitive impairment were more understood.

Fundamental components for the ongoing global efforts to develop vaccines against the parasite, and immunologic and developmental predictors of resistance were studied.

These were hormonal changes during infection in puberty and processes of immune reaction, immunity and nutritional status. A rapid diagnostic test for schistosomiasis (SJ-URIDIP) was also developed.

• Tuberculosis

In the early 1990s, the Camalig Anti-TB Organization in Albay was among the first of RITM’s community-based projects that attempted to establish local health program management.

In 1993, a rapid diagnostic test using nested PCR was developed; it showed great potential in the early detection of TB meningitis.

Clinical, radiological and pathological features of TB infection in people with HIV infection in the Philippines were described in 1994. These helped in early detection of tuberculosis and other mycobacterial infection in people with HIV.

A study in Sta. Cruz, Laguna from 1995 to 1996 established a network of transporting specimens to a central laboratory. From this study, a new TB strain, called Manila family, was discovered. This strain was also identified among Filipino immigrants living in the United States.

• Viral hepatitis

A diagnostic kit for hepatitis B from locally purified surface antigens and antibodies was developed in 1983.

The kit is composed of the following tests: RPHA (reverse passive hemagglutination) assay for detecting viral surface antigen (HbsAg); PHA (passive henagglutination assay) for detecting antibodies to viral surface antigen (anti-HBs); and HI (hemagglutination inhibition) for detecting antibodies to viral core antigen (anti-HBc).

Recently developed is a monoclonal antibody-based enzyme linked immunosorbent assay (ELISA) for detection of HBsAg.

The other significant contributions of the RITM:

• Clinical trials

Clinical trials have contributed to the use of vaccines and other biologicals in the prevention and treatment of rabies, childhood pneumonia, dengue, and influenza, and the management of diarrhea with oral-rehydrating salt solution.

Other studies have contributed to the development of treatment protocols alternative drugs for adult pneumonia, malaria, leprosy and intestinal parasitism.

• Training and post-graduate courses

Medical doctors in pediatric, internal medicine and family medicine residency programs, and infectious disease fellowship programs spend from one to six months of their training years in the institute’s hospital ward and laboratories.

During this period, they gain further experience in the management and control of infectious and tropical diseases.

Regular post-graduate courses and infectious disease treatment guidelines serve as means through which the institute disseminates information gleaned from experiences, research and projects.

All of these undertakings would not have been accomplished without the generosity of individuals, groups and organizations, national agencies, local and foreign colleges, universities and other similar institutions, colleagues in the DOH, and provincial and municipal local government officials. We share their commitment to improve the health and well-being of our fellow citizens.

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The author is a Medical Specialist III and head of the Research Coordinating Unit (RCU) of the Research Institute for Tropical Medicine. E-mail her at [email protected]