RSS | Register/註冊 | Log in/登入
Site search:
Home>ONE HEALTH APPROACH: THE PHILIPPINE EXPERIENCE
facebook分享

ONE HEALTH APPROACH: THE PHILIPPINE EXPERIENCE

 

Dr. Simeon S. Amurao Jr., Dr. Emelinda L. Lopez, and Dr. Maria Glofezita O. Lagayan,

Dr. Noverlee P. Calub, and Dr. Daphne L. Jorca

Bureau of Animal Industry, Visayas Avenue, Diliman, Quezon City, Philippines

e-mail: bai_dir@yahoo.com, bairabiesteam@gmail.com

 

ABSTRACT

The One Health concept simply states that there should be a unified interaction between veterinary, human health medicine, and public and environmental health professionals, clinicians, researchers, agencies and governments working together for the benefit of sustainable and effective community health interventions in solving global and environmental health challenges. Such interactions may take place at many levels – from management of zoonotic infectious disease outbreaks to integrated policy making and funding decisions. This paper focuses on the One Health Approach of the Philippines at the national and local levels from the view of Animal Health Program Implementers, with focus on the creation and mechanisms following: 1) the National Rabies Prevention and Control Program (NRPCP), 2) the Avian Influenza Protection Program (AIPP), 3) the Philippine Inter-agency Committee on Zoonoses (PhiICZ), and 4) other important diseases with inter-agency collaboration (Henipavirus, Ebola Reston Virus and Neglected Tropical Diseases (NTDs) such as Schistosomiasis). The said programs and committees are discussed with their own committees and examples of One Health Approach in the prevention, control and eventual elimination of emerging and re-emerging zoonoses. The NRPCP is a multi-agency program formed through Republic Act 9482 or the “Anti-rabies Act of 2007” with the aim to prevent and control rabies. The same program has a special committee (National Rabies Prevention and Control Committee NRPCC) that meets regularly in the implementation of the program. The AIPP has its own Task Force and Manual of Operations in preparing and protecting the country against the dangers of Avian Influenza and its possible route of entry. While the PhiICZ is a formal committee created specifically to support the One Health and zoonotic disease collaborations. It endeavors to develop a national strategy on prevention, control and elimination of zoonoses, and establish a functional and sustainable mechanism to strengthen the animal-human interface for the effective prevention, control and elimination of zoonotic diseases. Lastly, other forms of success in the One Health Approach include inter-agency cooperation in other important diseases such as Henipavirus, Ebola Reston Virus and Shcistosomiasis. The recognized One Health partnership in the Philippines assures that any emerging diseases can have conclusive and immediate action leading to a quick response and better resolution.

Key words:  Animal Health, Human Health, Collaboration, National Rabies Prevention and Control Committee (NRPCC), Philippine Inter-agency Committee on Zoonoses (PhiICZ)

INTRODUCTION

The 'One Health' concept simply states that there should be a seamless interaction between veterinary and human medicine with clinicians, researchers, agencies and governments working together for the benefit of domestic and wild animal and human health and the global environment. Such interactions may take place at many levels - from management of zoonotic infectious disease outbreaks in the field, to joint research programs to integrated policy making and funding decisions.1

The concept of “One Health” is recognized both nationally and globally, and is being interpreted in different ways, and at different ways in different countries. Like many countries, for years the Philippines has been quietly practicing this concept at the local setting with different labels such as coordination, collaboration, and biosecurity. These efforts are unfortunately poorly documented and unofficially recognized then. In the advent of the growing trend of Emerging (and Resurging) Infectious and Transboundary Animal Diseases, the Philippines has accepted that the present health issues faced globally is linked to the increasing contact between humans and animals, intensification of food production, and the growth of international travel. Environmental factors such as global warming, urbanization, climate shift, and globalization also contributes to this increasing development.

ONE HEALTH APPROACH ACTIVITIES IN THE PHILIPPINES

The National Rabies Prevention and Control Program (NRPCP)

Rabies in the Philippines is present since the early times and collaborative activities within the national and local government units have existed as far back as the 1800s.  However, this unfortunately lacked sufficient documentation. Today, rabies continues to be a serious public health issue in the Philippines causing 200 to 250 deaths yearly to Filipinos. In 2015 alone, there were 702 laboratory confirmed animal rabies cases recorded out of 2,653 samples submitted.

Recognizing the need to address this problem, the “Anti-Rabies Act of 2007” otherwise known as the Republic Act 9482 was passed. It provides for the control and elimination of human and animal rabies, prescribing penalties for violation thereof and appropriating funds therefor. It was signed into law on the 25th of May 2007. Pursuant to this act is the creation of the National Rabies Prevention and Control Program, a multi-agency effort in controlling and eliminating Rabies in the country. The program is implemented by the National Rabies Prevention and Control Committee chaired by the Bureau of Animal Industry (BAI) of the Department of Agriculture (DA) and vice-chaired by the National Center for Disease Prevention and Control (NCDPC) of the Department of Health (DOH). The committee is composed of one duly representative for each of the following departments: DA, DOH, Department of the Interior and Local Government (DILG) and Department of Education (DepEd); and one representative each for the following: Department of Environment and Natural Resources (DENR), Non-Governmental Organizations (NGOs), People’s Organizations (POs), academe, Local Government Units (LGUs), and Provincial, City, and Municipal Veterinarians League of the Philippines (PCMVLP). Among its component activities include: (1) Mass registration and vaccination of dogs; (2) Establishment of central database system for registered and vaccinated dogs; (3) Impounding, field control and disposition of unregistered, stray and unvaccinated dogs; (4) Conduct of information and education campaign on the prevention and control of rabies; (5) Provision on pre-exposure treatment to high-risk personnel and post-exposure treatment to animal bite victims; (6) Provision of free routine immunization or Pre-Exposure Prophylaxis (PEP) of school children aged five to fourteen in areas where there is high incidence of rabies; and (7) Encouragement of the practice of responsible Pet ownership (RPO).

The program includes specific responsibilities of the agencies and organizations mentioned, including pet owners’ roles and responsibilities, with supporting penalties in its implementation.

 

Table 1. Roles and responsibilities of pet owners, government agencies, LGUs, NGOs and academe

  1. Pet Owners
    1. Have their dog regularly vaccinated against rabies and maintain a registration card which shall contain all vaccination conducted on their dog, for accurate record purposes.
    2. Submit their dogs for mandatory registration.
    3. Maintain control over their dog and not allow it to roam the streets or any public place without a leash.
    4. Be a responsible owner by providing their dog with proper grooming, adequate food and clean shelter.
    5. Within twenty-four (24) hours, report immediately any dog biting incident to the concerned officials for investigation or for any appropriate action and place such dog under observation by a government of private veterinarian.
    6. Assist the dog bite victim immediately and shoulder the medical expenses incurred and other incidental expenses relative to the victims’ injuries.
  1. Department of Agriculture
    1. Improve and upgrade existing animal rabies laboratory diagnostic capabilities to ensure better services to the people.
    2. Ensure the availability and adequate supply of animal anti-rabies vaccine at all times.
    3. Undertake free anti-rabies Vaccination of dogs giving priority to high risk depressed areas.
    4. Maintain and improve animal rabies surveillance system.
    5.  Establish and maintain rabies free zone in coordination with the LGUs.
    6. Immediately facilitate for the approval of the sale and use of Veterinary and Human Barbiturate drugs and veterinary euthanasia drugs by the DOH and the Philippine Drug Enforcement Agency (PDEA).
    7.  Strengthen the training of field personnel and the Information Education and Communication (IEC) activities on Rabies prevention and control and responsible pet ownership.
    8.  Conduct research on Rabies and its control in coordination with other agencies.
    9.  Formulate minimum standards and monitor the effective implementation of this Act.
    10. Encourage collaborative activities with the DOH, DepEd, DILG, DENR, NGOs, POs and other concerned sectors.
  1. Department of Health
    1. Ensure the availability and adequate supply of DOH pre-qualified human anti-rabies vaccine in animal bite treatment centers at all times and shall coordinate with other implementing agencies and concerned NGOs for this purpose.
    2. Provide Post-Exposure Treatment at the minimum expense to individuals bitten by animals suspected of being rabid which will consist of the initial vaccine and immunoglobulin dose.
    3. Provide Pre-Exposure Treatment to high-risk personnel, such as, but not limited to, laboratory staff, veterinarians, animal handlers, vaccinators and other persons working with Rabies virus for free.
    4. Coordinate with the DA in the development of appropriate health education strategy to inform the public on Rabies prevention and control and responsible pet ownership.
    5. Develop and maintain a human Rabies surveillance system.
    6. Encourage collaborative activities with the DA, DepEd, DILG, DENR, NGOs, POs and other concerned sectors.
    7. Immediately approve the registration of Veterinary and Human Barbiturate drugs and veterinary euthanasia drugs in coordination with the PDEA.
  1. Department of Education
    1. Strengthen Rabies education program through school health teaching/curriculum.
    2. Assist in the dog mass immunization campaigns in the community.
    3. Encourage collaborative activities with the DA, DOH, DILG, DENR, NGOs, POs and other concerned sectors.
    4.  Integrate proper information and education on responsible pet ownership in the relevant subjects in the Elementary and High School levels.
  1. Local Government Units
    1. Ensure that all dogs are properly immunized, registered and issued a corresponding dog tag for every immunized and registered dog.
    2.  Strictly enforce dog impounding activities and field control to eliminate Stray Dogs.
    3.  Ensure that dogs are leashed or confined within the premises of the Owner’s house or Owner’s fenced surroundings.
    4.  Allocate funds to augment the implementation of the National Rabies Prevention and Control Program, particularly on the financing of supplies and human and dog vaccines needed for immunization.
    5.  Ensure the enforcement of Section 6 of Republic Act No. 8485 or “The Animal Welfare Act of 1998”.
    6.  Enact additional local ordinances that will support the National Rabies Prevention and Control Program that should include the regulation of treatment locally known as “tandok.”
    7.  Prohibit the trade of dogs for meat.
    8. With respect to cities and first class municipalities, establish and maintain a dog pound where Impounded dogs shall be kept, in accordance with Section 9 herein: Provided, That the other municipalities, shall, on their own, establish a dog pound or opt to share the expense of establishing and maintaining a dog pound with other adjoining municipalities and/or with private animal shelters and control facilities.
    9.  Prohibit the use of electrocution as a euthanasia procedure.
    10. Appoint a veterinarian and establish a veterinary office in every province, city and first-class municipality: Provided, that the other municipalities shall, on their own, opt to share the expense of having a veterinary office.
    11.  Require pet shops to post information regarding Rabies and responsible pet ownership. For purposes of ensuring the administrative feasibility of implementing the provisions of this Act and subject to paragraph 8 of this Section, the LGU shall collect the fines imposed under Section 11 subparagraphs (1). (3), (4), (5) and (6) hereof. Any and all fines collected pursuant to this Act shall be used for the enhancement of the National Rabies Prevention and Control Program within the locality concerned, as well as the achievement of the objectives envisioned in this Act. The DILG shall ensure compliance of these responsibilities by the LGUs.
  1. Assistance of the NGOs and the Academe
    1. Community mobilization.
    2. Health education/information dissemination on Rabies and responsible pet ownership.
    3. Mass anti-rabies campaign
    4. Promotion of the anti-rabies campaign during pet or any animal shows.
    5. Surveillance/reporting of Rabies cases in animals and humans.
    6. Any other activities geared towards the prevention and complete eradication of rabies.

Penalties

  1. Pet owners who fail or refuse to have their dog registered and immunized against rabies shall be punished by a fine of Two thousand pesos (P2,000.00)
  2. Pet owners who refuse to have their dog vaccinated against rabies shall be liable to pay for the vaccination of both the dog and the individuals bitten by their dog.
  3. Pet owners who refuse to have their dog put under observation after said dog has bitten an individual shall be meted a fine of ten thousand pesos (P10,000.00).
  4. Pet owners who refuse to have their dog put under observation and do not shoulder the medical expenses of the person bitten by their dog shall be meted a fine of twenty-five thousand pesos (P25,000.00).
  5. Pet owners who refuse to put leash on their dogs when they are brought outside the house shall be meted a fine of five hundred pesos (P500.00) for each incident.
  6. An impounded dog shall be released to its owner upon payment of a fine of not less than five hundred pesos (P500.00) but not more than one thousand pesos (P1,000.00).
  7. Any person found guilty of trading dog for meat shall be fined not less than five thousand pesos,(P5,000.00) per dog and subjected to imprisonment for one to four years.
  8. Any person found guilty of using electrocution as a method of euthanasia shall be fined not less than Five thousand pesos (P5,000.00) per act and subject to imprisonment for one to four years.
  9. If the violation is committed by an alien, he or she shall be immediately deported after service of sentence without any further proceedings.

 

Currently, the National Rabies Prevention and Control Committee (NRPCC) have regular meetings every two months or as often as maybe necessary to implement the program. All other roles and responsibilities of the Committee are stated under the Implementing Rules and Regulations Implementing Republic Act 9482, Rule 4.

With the realization in the NRPCP in the importance of mass dog vaccination as key strategy to control and eventually eliminate human rabies at its source, the objective of the program is to cover at least 70% of the estimated dog population of the country. With this objective, in 2014, the Department of Health has allocated sixty nine million five hundred forty five thousand pesos (PhP 69,545,000.00) to transfer to the Department of Agriculture to augment the much needed purchase of dog anti-rabies vaccines. This is a first of its kind to be done in the immediate need to achieve a common goal, and a collaborative effort between multiple agencies. 

Avian Influenza Protection Program (AIPP)

The Philippine Avian Influenza Protection Program (AIPP) was developed during the height of the outbreak of Highly Pathogenic Avian Influenza (HPAI) in South East Asia. It was formally implemented on April 20, 2005 through Joint Department of Agriculture (DA) and Department of Health (DOH) Administrative Order No. 001 which also established the National Avian Influenza Task Force (NAITF), jointly implemented by the poultry industry. The AIPP Manual of Procedures has become one of the primary references for information on the government’s AI prevention program and preparedness plan. The courses of action mainly address HPAI incursion, especially with the increased arrival of international visitors and Filipinos, and in the importation of live domestic and wild birds, poultry and/or poultry products from notifiable Avian Influenza affected countries or zones.

Since then, there have been developments in the knowledge on Avian Influenza. Technological advancements have improved the understanding of the disease – information on new pathologic strains, development or improvement of control measures, and increased preparedness and capabilities to address related situations. In 2010, the DOH has released the Philippine Preparedness and Response Plan for Pandemic and Avian Influenza to address AI and other emerging infectious diseases with special consideration to the human sector. Since then, over the course of time, developments have necessitated the review and revision of the said document in consultation with representatives from the national, regional and local government offices, the academe and the poultry industry organizations.

 

There are 4 stages in the AIPP, and the Philippines is currently implementing Stage 1 under the Department of Agriculture –

Department of Agriculture

Stage 1

Keeping the Philippines Bird-Flu Free

Stage 2

Controlling and Eradicating Bird Flu in Domestic Fowl

Department of Health

Stage 1

Prevention and Control of AI in humans

Stage 2

Mitigation of Public Health and Socio-Economic Impact of Pandemic Influenza

                                                                                               

The Prevention Program includes a (1) Ban on Importation from AI-Affected Countries, (2) Minimum Biosecurity Measures, (3) Surveillance and Prevention Programs at Airports and Seaports, (4) Surveillance of Poultry in Critical Areas in the Philippines,  (5) Preparedness from the National to Local Level, (6) Establishment of Compartmentalized Poultry Zones, (7) Upgrading of Laboratory facilities – PAHC and RADDLs,  (8) Enforcement of the Wildlife Act, and (9) Preventive Measures in Humans. With this ongoing program and through the strong collaborative efforts of the different sectors involved, the Philippines remain as one of the Avian Influenza free countries in South East Asia.

Philippines Inter-agency Committee on Zoonoses

The Philippine Inter-agency Committee (PhiICZ) on Zoonoses (formerly Philippines National Committee on Zoonoses) was created with the vision to establish animal and human health sector collaboration between the Department of Agriculture (DA), Department of Health (DOH), and Department of Environment and Natural Resources (DENR) for the prevention and control of zoonoses. At this time, collaborative activities already exist between the said agencies in specific diseases such as the Rabies Prevention and Control Program, Highly Pathogenic Avian Influenza (HPAI), and the Ebola Reston Virus in Pigs Disease Control and Management.

In 2010, the Philippines participated in the “Regional Workshop on Collaboration between Human and Animal Health Sectors on Zoonoses Prevention and Control” in Sapporo, Japan. The additional learnings and increased commitments from joint workshops and local meetings helped in the completion of PhiICZ’s creation through Administrative Order No. 10 dated 11 April 2011 signed by President Benigno S. Aquino III, entitled “Creating the Philippine Inter-agency Committee on Zoonoses, Defining Its Powers, Functions, Responsibilities, Other Related Matters and Providing Funds Thereof.” The Committee is composed of the Department of Health (DOH), Department of Agriculture (DA), Department of Environment and Natural Resources (DENR) and their respective agencies as members. The Secretary of each Department or his duly authorized representative serves as Chairperson of the PhiICZ on a two-year rotational basis. It is currently chaired by the Department of Health (2015 to 2016), previous chairmanship includes: DENR-Protected Areas and Wildlife Bureau (2013 to 2014), DA-Bureau of Animal Industry (2011 to 2012), and DOH-National Center for Disease Prevention and Control.

The details of the members of the PhiICZ are the following:

  1. Department of Health
  1. National Center for Disease Prevention and Control (NCDPC)
  2. Health Emergency Management Staff (HEMS)
  3. National Epidemiology Center (NEC)
  4. National Center for Health Promotion (MCHP)
  5. National Center for Health Facilities Development (NCHFD)
  6. Bureau of Quarantine (BOQ) g) Research Institute for Tropical Medicine (RITM)
  1. Department of Agriculture
  1. Bureau of Animal Industry (BAI)
  2. National Meat inspection Service (NMIS)
  3. Agriculture and Fisheries Information Service (AFIS)
  1. Department of Environment and Natural Resourcesa.

a. Biodiversity Management Bureau (BMB)

The PhiICZ endeavors to: a) develop a national strategy on prevention, control and elimination of zoonoses; and b) establish a functional and sustainable mechanism to strengthen the animal-human interface for the effective prevention, control and elimination of zoonotic diseases.

The PhilCZ’s function are the following: (1) Ensure that the animal and human health sectors’ plans, programs and activities are consistent with the National Strategic Work Plan; (2) Review and develop policies, programs and guidelines to ensure the proper implementation of the prevention and control program on zoonoses; (3) Develop and coordinate capacity building programs and prioritize activities towards improving national and local capabilities; (4) Foster cooperation and commitment between the animal and human health sectors through coordination of activities and exchange of advice and assistance whenever possible; (5) Provide recommendations to the President of the Philippines through the Secretaries of the DA, DOH and DENR in times of crises or as may be deemed necessary (i.e. epidemics of zoonotic nature); (6) Recommend research priorities and ensure dissemination and use of research findings; (7) Organize a pool of experts who will provide technical advice on zoonotic diseases; (8) Coordinate and collaborate with other sectors/organizations as may be necessary, to carry out its duties and responsibilities; and (9) Monitor and evaluate proper implementation of programs and policies.

Responsibilities of agencies:

  1. All agencies shall:
  1. Develop and disseminate policies, guidelines and issuances on zoonotic diseases;
  2. Provide epidemiologic data on zoonotic diseases as basis for policy formulation and decision-making;
  3. Provide accurate and timely information to specific target audiences;
  4. Undertake research priorities and ensure dissemination and use of research findings; and
  5. Serve as chairperson, vice-chairperson and secretariat of the committee.
  1. DOH shall serve as Chairperson and Secretariat of the PhilCZ for the first two (2) years and DA shall serve as the Vice-Chairperson.
  2. DA shall serve as Chairperson and Secretariat of the PhilCZ for the next biennium and DENR shall serve as the Vice-Chairperson.
  3. DENR shall serve as Chairperson and Secretariat of the PhilCZ for the third biennium and DOH shall serve as the Vice-Chairperson.
  1. The DOH shall serve as the lead agency on the prevention and control of zoonotic diseases in humans. It shall:
  1. Conduct pro-active response to public health concerns on matters pertaining to food safety, sanitation and vector control; and
  2. Adopt appropriate measures upon the recommendation of the PhilCZ to be undertaken in the health facilities for the prevention and control of zoonotic diseases
  1. The DA shall serve as the lead agency on the prevention and control of zoonotic diseases in livestock, poultry and other domestic animals. It shall:
  1. Conduct pro-active response to public health concerns on matters pertaining to food safety, sanitation, vector control and proper disposal of animals; and
  2. Adopt appropriate measures that may be recommended by the PhilCZ to be undertaken in animal facilities to include, but not limited to, farms, slaughterhouses, markets, feed establishments and pharmaceuticals/drugs/biologics outlets for the control and prevention of zoonotic diseases.
  1. The DENR shall serve as the lead agency on zoonotic diseases in wild fauna. It shall adopt appropriate measures upon the recommendation of the PhilCZ to be undertaken in protected areas, in wildlife facilities such as, but not limited to, zoological parks, wildlife rescue centers and in identified risk areas for the control and prevention of zoonotic diseases.

The Secretaries of Agriculture, Health and Environment and Natural Resources shall provide the guidelines for the operationalization of the PhilCZ through a Joint Administrative Order, and promulgate rules and regulations, as may be necessary, related, incidental or consistent with the purpose, intent and objective of this Order. All instrumentalities of government are directed to support and assist the PhilCZ when deemed necessary.

The Committee’s future plans for the next few years include plans to increase the advocacy on the PhiICZ; the regional implementation of the PhiICZ at the country level; the finalization, approval, and implementation of the Joint Department Administrative Order on the “Guidelines to Operationalize the PhiICZ”; and the conduct of joint DA-DOH-DENR trainings and its actual operation.

Other collaborations and cooperation

Aside from Rabies, AI and the PhiICZ, part of the experiences of the Philippines on One Health is addressing Henipavirus, Ebola Reston Virus and Neglected Tropical Diseases (NTDs) such as Schistosomiasis. On Henipa, detection of the virus and institutionalizing quarantine procedures and control measures was conducted along with the DOH, Provincial Veterinary Office and the Philippine National Police (PNP). On Ebola Reston, the Bureau was able to deal with the virus in swine and monkeys in terms of detection, IEC, depopulation and bat surveillance with DOH, DENR-PAWB, LGUs and concerned stakeholders. Also for Schistosomiasis, a project is currently being tackled with the DOH and WHO.

CONCLUSION

As stated by Dr. Enrique A. Tayag, Assistant Secretary of the DOH during the “Perspectives in Intersectoral Collaboration during the National Consultative Workshop on Zoonoses” last 16-17 November 2011: “Collaborative partnerships have the best chance for success when members lay the foundation in the first mile for the last mile success and take mutual responsibility along the journey for leadership, management, and culture within the partnership.” Any program to combat a disease challenge faced by public health can be successful through effective collaboration and coordination with different sectors – One Health. Though it might be interpreted differently from other countries and the One Health approach has been existing and effective at the local settings of the Philippines in the control of numerous diseases. The Philippine agencies involved are aware that existing collaborative activities and One Health partnerships are essential in the conclusive and immediate action towards the control and eventual elimination of emerging and re-emerging diseases.

REFERENCES

Administrative Order No. 10, series of 2011, “Creating the Philippine Inter-agency Committee on Zoonoses, Defining its Powers, Functions, Responsibilities, Other Related Matters and Providing Funds Thereof.

Joint DA, DOH, DepEd, DILG Administrative Order No. 01, Series of 2008. “Implementing Rules and Regulations Implementing Republic Act 9482 for the Control and Elimination of Human and Animal Rabies, Prescribing Penalties for Violation Thereof and Appropriating Funds Therefor

Michael J Day (2011). “One health: the importance of companion animal vector-borne diseases”. Parasites & Vectors 20114:49. DOI: 10.1186/1756-3305-4-49. BioMed Central Ltd. 2011. Received: 7 January 2011. Accepted: 13 April 2011. Published: 13 April 2011.

Pappaioanou M (2004). "Veterinary medicine protecting and promoting the public's health and well-being". Preventive Veterinary Medicine 62 (3):153-163.doi:10.1016/j.prevetmed.2003.11. 001PMID 15041202.

Republic Act No. 9482 (“Anti-Rabies Act of 2007”), “An Act Providing for the Control and Elimination of Human and Animal Rabies, Prescribing Penalties for Violation Thereof and Appropriating Funds Therefor.

 

1 Michael J Day (2011). “One health: the importance of companion animal vector-borne diseases”. Parasites & Vectors 20114:49. DOI: 10.1186/1756-3305-4-49. BioMed Central Ltd. 2011. Received: 7 January 2011. Accepted: 13 April 2011. Published: 13 April 2011.

 

 

 

 

 

 

 

 

 


Download the PDF. of this document (290), 356,614 bytes (348 KB).