The province of Cebu is grappling with a significant surge in leptospirosis, recording 426 probable cases and 12 fatalities in the single month of November 2025. The alarming data was presented to the Cebu Provincial Board on Monday, December 1, sparking urgent debates about outbreak protocols and systemic delays in disease confirmation.
Outbreak Declaration Debate Ties Response Efforts
During the Provincial Board session, Board Member Stanley Caminero raised immediate concerns about the authority to declare a leptospirosis outbreak. He argued that the absence of confirmatory laboratory results is crippling decisive local action. "If we cannot have the confirmatory tests, our declaration may lack the necessary substantiation, and so the question goes in circles. People are dying, yet our hands are tied," Caminero stated. He formally requested his position be relayed to the national Department of Health (DOH) leadership.
Epidemiologist Eugenia Mercedes Cañal of DOH Regional Office 7 clarified the protocol. She explained that the DOH typically declares outbreaks only for events threatening national security, like a pandemic. For local incidents, the authority rests with Local Government Units (LGUs) due to budgetary and operational intricacies. She cited a 2023 DOH memorandum empowering LGUs to make such declarations but acknowledged a critical bottleneck: the lack of confirmatory results from the Research Institute for Tropical Medicine (RITM).
Caminero countered, insisting the DOH should lead to unlock additional resources. "Why do we have to always be at the mercy of RITM?" he questioned, highlighting that the issue has persisted for decades. Cañal expressed that she shared his sentiments on the need for improved local capacity.
All Cases Remain "Probable" Amid Testing Delays
A key point of concern is that none of the 426 November cases are confirmed. Cañal explained that all are classified as "probable," meaning patients had significant exposure to floodwaters, unlike "suspected" cases with minimal contact. The confirmation awaits PCR and lepto-mat test results from RITM.
To address this dependency, Cañal revealed that DOH 7 Director Joshua Brillantes has ordered the expedited reestablishment of a regional molecular laboratory, which was operational during the pandemic but later displaced. This move aims to expedite local testing and response.
Case Breakdown and Surveillance Hurdles
The data, presented alongside Cebu Province Health Consultant Elisse Nicole Catalan, shows a sharp increase. Province-run hospitals alone recorded 175 cases in November, nearly double the total from January to October.
The breakdown of LGUs with reported deaths is as follows:
- Talisay City – 7 deaths, 117 cases
- Danao City – 2 deaths, 108 cases
- Balamban – 3 deaths, 56 cases
Several other LGUs reported cases but no fatalities. The total leptospirosis cases for 2025 in the province have now reached 689, affecting 474 males and 215 females. The most affected age group is 21 to 30 years old.
Cañal also addressed challenges in disease surveillance:
- Patients bypass rural health units, going directly to hospitals.
- The DOH national information system is offline due to a cyberattack, forcing manual data collection via hospital emails.
Furthermore, Cañal revealed a gag order preventing DOH from publicly disclosing case numbers per LGU, urging media to use regional totals instead. This was to allow LGUs like Talisay City to be formally briefed first. Caminero questioned why LGUs weren't receiving timely updates for local action.
Identified Gaps and Proposed Actions
Health officials outlined several systemic gaps contributing to the crisis:
- Delayed case reporting and communication lapses.
- Difficulty mapping outbreak hotspots.
- Poor sanitation and rodent control.
- Public complacency towards health risks.
Proposed actions to combat the leptospirosis surge include:
- Strengthening community-based surveillance.
- Improving inter-agency coordination and governance.
- Tailoring risk communication to local communities.
- Ensuring health system readiness and providing livelihood support.
