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Status of Measles Response

Immunization in Region 1
Status of Measles Response
Immunization in Region 1

Department Memorandum No. 2018 - 0137


Presentation Outline
• By the Numbers
– Immunization Coverage
– Measles Cases
• Ligtas Tigdas Guidelines
• Vaccine and Vaccine Safety

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
IMMUNIZATION COVERAGE
MCV1 Coverage,
100
Region1, 2015-2017*
90

80

70

60

50

40

30

20

10

0
Ilocos Norte Ilocos Sur La Union Pangasinan

2015 2016 2017

*2017 data - 4th quarter data but may be subject to change after inclusion of late reports; data source: FHSIS
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
IMMUNIZATION COVERAGE
MCV2 Coverage,
100
Region1, 2015-2017*
90

80

70

60

50

40

30

20

10

0
Ilocos Norte Ilocos Sur La Union Pangasinan

2015 2016 2017

*2017 data - 4th quarter data but may be subject to change after inclusion of late reports; data source: FHSIS
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
IMMUNIZATION COVERAGE
MCV1 vs MCV2 Coverage,
Region1, 2015-2017*
2015 MCV1 VS MCV2 2016 MCV1 VS MCV2
100 100
80 80
60 60
40 40
20 20
0 0
Ilocos Norte Ilocos Sur La Union Pangasinan Ilocos Norte Ilocos Sur La Union Pangasinan
MCV2 MCV 1 2017 MCV1 VS MCV2 MCV2 MCV 1

100
80
60
40
20
0
Ilocos Norte Ilocos Sur La Union Pangasinan
MCV2 MCV 1
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
2017 NDHS Result

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
2017 NDHS Result

2.9% 17.5%
decrease decrease
from 2008 from 2008
NDHS NDHS

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Number of Measles Susceptibles
and Population Immunity
Total
Total MCV1 Vaccine Total
2018 Target Population
Province Unimmunized Failure Measles
Population Immunity
(2015-217) (2015- Susceptible
2017)
Ilocos
Norte -8,023 5,215 -2,808 9,495 98
Ilocos Sur -8,778 6,493 -2,285 11,923 100
La Union -467 6,185 5,718 14,136 76
Pangasinan 40,243 28,530 68,773 72,998 68
REGION 1 22,975 46,423 69,398 108,552 75

Note: Data was computed using the Singe Age Cohort (Under 1 Year) of Philippine
Statistics Authority.
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Vaccine Effectiveness
9-11 months

84%
12 months

92.5%
Studies shows that:
• Among children that do not respond to their first dose of MCV,
95% develop protective immunity after the second dose
• A single dose of correctly administered measles vaccine which
results in seroconversion will afford lifelong protection
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Surveillance of
Measles and Rubella Cases

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Case Definition: Measles-Rubella
Reported Measles Case Any person with fever and maculopapular (non-vesicular) rash and
(Suspect measles case) either cough, coryza (runny nose), or conjunctivitis (red eyes)
A case that meets the suspect case definition for measles but for
Measles compatible case which no adequate blood specimen was taken and which has not
(Clinical measles) been linked epidemiologically to another case positive for measles
or rubella

Confirmed measles case Laboratory confirmed + epidemiologically linked measles cases

A suspect case that has not been confirmed by laboratory but has
Epidemiologically linked
close contact and is temporally related to a laboratory confirmed
(Epi-linked case) case or to another epi-linked case during times of epidemic
Laboratory confirmed A suspect case with a positive laboratory test result for rubella-
rubella specific IgM antibodies or other approved laboratory test method
Discarded non- A case that meets the clinical case definition for measles and
measles/rubella tested negative for both measles and rubella testing
A case that is pending for transport or for laboratory testing,
Pending hence with pending classification.

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Reported Measles-Rubella Cases by Case
Classification and Morbidity Week (N=226)
January 1 to August 4, 2018
25

20
No. of Cases

15

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Confirmed Rubella 1
Confirmed Measles 0 0 1 0 1 1 1 1 1 3 1 3 1 3 3 0 3 0 0 2 0 0 1 1 0 0 0 0 0 0 0
Suspect 2 1 8 13 23 6 4 4 8 6 6 9 3 5 6 11 7 11 5 5 2 2 4 3 3 8 4 11 7 8 3

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Reported Laboratory Confirmed Measles Cases
By Province
2015 – 2018*
20

18

16
19 21 91 68
14

12
4 15 73 54
10

0
Ilocos Norte Ilocos Sur La Union Pangasinan
2015 2 3 2 1
2016 1 2 0 4
2017 0 0 2 1
2018* 1 0 7 19
*data as of August 4, 2018

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Distribution of Confirmed Measles Cases (n=1,884)
January 1 to August, 2018

2017 2018 Percent


Province
Cases Deaths Cases Deaths Change
REGION 1 3 0 27 0  800
Ilocos Norte 0 0 1 0  100
Ilocos Sur 0 0 0 0 --
La Union 2 0 7 0  250
Pangasinan 1 0 19 0 1800

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Laboratory Confirmed Measles Cases
CY 2017

Measles
Province/
Barangay IgM Outcome
Municipality/City
Positive and Age
Equivocal
Pangasinan
Dagupan City Mayombo 1 9 mos Alive
La Union
Agoo Santa Ana 1 11 mos Alive
Bacnotan Burayoc 1 1 Alive

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Laboratory Confirmed Measles Cases
CY 2018
Province/ Age in Measles
Lab Confirmed
Municipality/City months Vaccination Status
and Equivocal
Pangasinan
Binmaley Lab Confirmed 10 None
Lab Confirmed 47 None
Lab Confirmed 327 None
Lab Confirmed 5 None
Calasiao Lab Confirmed 301 Yes
Lab Confirmed 232 Unknown
Dagupan City Lab Confirmed 23 None
Lab Confirmed 134 None
Lab Confirmed 87 Yes
Lab Confirmed 6 None
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
Lab Confirmed 135 Unknown
September 6, 2018
Laboratory Confirmed Measles Cases
CY 2018
Province/ Age in Measles
Lab Confirmed
Municipality/City months Vaccination Status
and Equivocal
Pangasinan
Dagupan Lab Confirmed 10 None
Lab Confirmed 5 None
Lab Confirmed 366 Unknown
Mangaldan Lab Confirmed 418 Yes
Mapandan Lab Confirmed 6 None
Rosales Lab Confirmed 293 Yes
Sison Lab Confirmed 88 Yes
Tayug Lab Confirmed 8 None
La Union
Agoo Lab Confirmed 13 None
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
Lab Confirmed 87 Yes
September 6, 2018
Laboratory Confirmed Measles Cases
CY 2018
Province/ Age in Measles
Lab Confirmed
Municipality/City months Vaccination Status
and Equivocal
La Union
Agoo Lab Confirmed 54 Yes
Aringay Lab Confirmed 10 Yes
Lab Confirmed 11 None
Bauang Lab Confirmed 29 Yes
Caba Lab Confirmed 59 Yes
Ilocos Norte
Currimao Lab Confirmed 15 Yes

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Confirmed Measles Cases by Age Group
and Sex (n=27)
January 1 to June 23, 2018

<9mos
9-11 months
1-4 years
5-9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
> 40 years
30 20 10 0 10 20 30 40
%Male %Female

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Vaccination Status of Confirmed Measles
Cases (n=27)
January 1 to August 4, 2018

not eligible for


vaccination
18% vaccinated
41%
unknown
11%

not vaccinated
30%

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Department Memorandum No. 2018 - 0137

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
General Guidelines
• All infants and children 6-59 months
old without documented measles
immunization in the past one month
shall be given one dose of measles
vaccine
• Three (3) phases for the SIA
– April 25-May 24, 2018: NCR
– May 9-June8, 2018: Mindanao
– September 2018: Luzon and Visayas
OCTOBER 2018

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
General Guidelines
• The conduct of the activity shall follow
the mixed SIA strategy
– Fixed points
– House to house vaccination

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Social Preparation
– The Regional EPI manager, through the
Provincial DOH Offices (PDOHO), shall
conduct meetings and consultations with all
Local Chief Executives (LCEs) and all
Barangay Health Officials to support the SIA.
– The Regional EPI Manager, through the
PDOHOs shall conduct community
meetings/assembly together with local health
workers for all parents and guardians on
measles-containing vaccine immunization,
possible reactions following vaccination and
on the importance of seeking early
consultation on any medical condition after
vaccination.

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Social Preparation
– The Regional Health Education and
Promotion Officers (HEPO) shall be
responsible in disseminating all relevant
information regarding measles and the
SIA.
– Regional Expanded Program on
Immunization (EPI)Managers, together
with Provincial EPI managers, shall
conduct orientations on the conduct of
measles supplemental immunization to
concern LGU staff.
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Readiness Assessment
– To help regional, provincial and city levels,
a readiness assessment will be conducted
prior to the Ligtas Tigdas SIA. National
and Regional EPI Managers will assess
capacity of Provincial/City and selected
delivery points to ensure the achievement
of a high quality SIA.

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Target Population
– Infants and children 6-59 months old are
targeted to be vaccinated with one (1) dose
of measles-containing vaccine during
Ligtas Tigdas Supplemental Immunization
Activity

Total Population x 10.8%

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Vaccine

Measles Rubella Mumps

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Vaccine
Live-attenuated virus Live-attenuated virus
vaccine vaccine

5-dose vial vaccine 10-dose per vial

Lyophilized powder
Lyophilized powder
requiring reconstitution
requiring reconstitution
with supplied diluent
with supplied diluent from
from the supplier
the supplier

Safe and effective


Safe and effective

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• General Contraindications
Severe hypersentivity reactions to any
vaccine component including gelatin
Anaphylactic or anaphylactoid
reaction to neomycin
Febrile respiratory illness or other
febrile infection
Immunosuppressive or cancer
treatment
Primary and acquired
immunodeficiency states

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Administration of MCV
– All infants and children aged 6-59 months
shall be vaccinated with one (1) dose of
measles-containing vaccine
– The target 6-59 months old should be
vaccinated with MR/MMR regardless of
immunization status
– All eligible children shall be vaccinated
with MCV 0.5 ml, subcutaneous at the left
deltoid arm

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Give one dose of MCV to 6-59 months
No Outbreak
Response

• Conduct mop-up for all children 6-59 mos


Ongoing ORI • Give one dose of MCV for missed children during ORI

• Conduct mop-up for all children 6-59 mos


ORI • Give one dose of MCV for missed children during ORI
Completed

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines

Infants given MCV at 6-8months old are


considered MCV0 and should be given another
MCV1 at 9 months old during the routine
immunization

Only infants and children that are eligible


for vaccination with MCV shall undergo a
quick health check prior to vaccination

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
MMR and MR vaccines should be stored at +2
to +8 degrees centigrade.

Do not freeze diluents. Use only diluents that


is with the same brand/manufacturer of the
vaccine

Excess unopened vaccines brought in


outreach areas shall be marked with a check
() before returning to the refrigerator for
storage

Protect the vaccine from the light at all times,


light exposure may inactivate the vaccine

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Vaccine Safety
– Always follow the recommended schedule
and the correct dosage, site and route of
vaccination
– Always check the status of vaccine vial
monitor and expiration date before
opening the vials
– Use only autodisabled syringes
– Use of aspirating needles and prefilling are
strictly prohibited
– Do not recap needles
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Vaccine Safety
– Immediate 1 hour
dispose used syringes
after reconstitution, diluted MCV a d
needles into loses
the100%50% of its
safety potency at 20
collector oC and
box
of its potency at 37oC
– Used needles and syringes, empty vials,
used cottonItballs are to
is important considered
ALWAYS put theinfections
DATE
and shall be and TIME of opening/reconstituting
disposed in the recommended
vaccines
appropriate disposal of
infectious/biological wastes
Final disposal of safety collector box(es)
– It is recommended that the
with used needles vaccine
and syringes be used
should
as soon as follow the DOHafter
possible recommended disposal
reconstitution.
for hazardous wastes under the
Opened and reconstituted MCV
Philippine Sanitation Code shall be
discarded 6 hours from reconstitution or
at the end of the immunization period.
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Recording and Reporting
– Appropriate recording and reporting
forms shall be submitted from the service
delivery point to the next higher
administrative level:
• Form 1: Daily Reporting Form
• Form 2: Weekly Consolidation
• Each vaccination team should record each
MCV dose given in the Recording Form 1:
Daily Tally Sheet and in the Routine
infants/child immunization record. The
supplemental MCV dose shall be under
“Other Vaccines”
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Recording and Reporting
– Duly accomplished reporting forms should
be submitted to the next level for review
and consolidation following the standard
reporting flow.
– Weekly accomplishment reports shall be
submitted by the DOH Regional Offices to
the DOH National Office every Friday at
3PM
– Submission of final accomplishment shall
be 2 weeks after the conclusion of the SIA

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Reporting Flow
Municipality/ All reports for the week must be in every
RHU Thursday at 3:30 PM and must be sent to
next high facility at 5pm

PHO/City/District shall validate all reports


PHO/City/District submitted and must send the reports to
next high facility every Friday not later than
12:00 noon

All reports received every Friday shall be


Regional Office validated and consolidated by the LTSIA
secretariat and shall be submitted to the
next high facility not later than 3:00 PM

DOH Central
Office
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Specific Guidelines
• Rapid Coverage Assessment
Supervisors or monitors go from door to door looking for
one child aged 6-59 months in each door to see if they
received their LT vaccine until they have visited 20 houses

The immunization record of the infant / child aged 6-59


months will be checked

If a mother says her infant/child was vaccinated, accept her


history even when there is no record

Supervisors can choose to do more 20 houses if they find no


6-50 months children

If in one community, many unvaccinated infants and


children are found, it may be more efficient to organize an
immediate mop up than continue to find 20 doors
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Thank you…
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Parents and Guardians are advised to bring
the infant/child’s routine immunization record.
If the child has no immunization record, a new
immunization record shall be issued

Put LTSIA
vaccine received
here

Orientation on Ligtas Tigdas Supplemental Immunization Activity


Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018
Orientation on Ligtas Tigdas Supplemental Immunization Activity
Alad Bar Resort, Caoayan, Ilocos Sur
September 6, 2018