Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

December 12, 2022

DEPARTMENT MEMORANDUM

OF
No. 2022-__ 9.595

FOR: ALL DEPARTMENT UNDERSECRETARIES AND ASSISTANT

SECRETARIES; CENTERS FOR HEALTH DEVELOPMENT AND
MINISTRY_OF BANGSAMORO_ AUTONOMOUS REGION_IN
MUSLIM MINDANAO (BARMM); AND BUREAU DIRECTORS;

HOSPITALS
SPECIAL AND SPECIALTY HOSPITAL CHIEFS

AND
;

CONCERNED

OTHER
SUBJECT: Interim Guidelines the Implementation of CY 2023 Measles
_in_

OFFICES
Rubella_and_bivalent_Oral_ Poliovirus Vaccine Supplementary

MEDICAL
CENTERS,
Immunization Activities (MR-bOPV SIA)

SANITARIA;
I. RATIONALE

The Philippines has faced multiple outbreaks for Vaccine Preventable Diseases (VPDs)
such as measles, rubella and polio during the past decade. This is the result of low
immunization coverage rates leading to an increase in the number susceptible cohorts. For
the past 5 years, 2018-2022, around 3 million children under five years old are projected to be
of
susceptible to measles. The projected number exceeds one birth cohort already which
signifies that a measles outbreak is likely to ensue soon.

To address this pressing health concern, Measles-Rubella (MR) and Oral Poliovirus
Vaccine (OPV) Supplemental Immunization Activities (SIAs) were conducted in 2013, 2017
and 2019-2020 which were the outbreak years as officially reported. A series of catch-up
immunization campaigns were also conducted in 2021 and 2022 to address the increasing
numbers of measles cases, however, due to competing priorities with COVID19 and other
multifactorial causes, these catch-up immunization activities were only able to generate
moderate impact on our routine immunization for children.

SIAs help curb the virus transmission and eventually, assist in our long-term goal of
eliminating measles in the country. Normally, the conduct of SIA in the country is usually
done after an outbreak is declared, but for 2023 the Department of Health (DOH) plans to
utilize SIA to address the increasing number of
cases of measles and avert an outbreak.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 4114, 1112, 1113

Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://Avww.doh.gov.ph; e-mail: dohosec@doh.gov.ph
 Additionally, SIA also provides an opportunity for eligible children to have protection
against polio by including bivalent OPV as part of the campaign. These guidelines are hereby
issued to provide guidance in the conduct 2023 MR OPV SIA among children ages 0-59
months old for polio and 9-59 months for measles and rubella.

Il. SCOPE AND COVERAGE

This policy shall provide technical guidance to all immunization program

coordinators, implementers, service providers, and immunization partners in the
implementation of the nationwide measles-rubella (MR) and bivalent oral polio (bOPV)
supplemental immunization activity.

I. OBJECTIVES

1. Ensure a high quality measles, rubella and oral polio immunization response in
every purok, barangay, municipality and city.
2. Interrupt or prevent the transmission of measles and rubella viruses in all Regions
of the country by ensuring that at least 95% of infants and children aged 9-59
months in each barangay, municipality or city are vaccinated with one dose of
measles-rubella (MR) vaccine regardless of past immunization status.
3. Break the chain of transmission of poliovirus types 1 and 3 by ensuring that at least
95% of infants and children aged 0-59 months in
all regions are provided with one
dose of bivalent oral poliovirus (bOPV) regardless of polio immunization status.
4. Provide technical guidance on proper infection prevention and control practices to
minimize the risk of COVID-19 transmission during vaccination sessions.
5. Prevent additional burden to the health system that can be caused by an impending
measles outbreak, and close immunity gaps for
polio.

IV. GENERAL GUIDELINES

1. Supplemental immunization activity for measles-rubella and bivalent oral polio

vaccine shall be conducted in the country to increase herd immunity and to
interrupt the transmission of measles virus and poliovirus in communities. This
activity, as part of essential public health intervention, shall be conducted even in
the current context of COVID-19 pandemic.

Table 1. MR and Oral Polio Vaccine SIA Campaign Schedule and Target Age-Group
Schedule Vaccine to be Administered Age Target

1,
May 2023 to
May 31, 2023
Measles ~- Rubella (MR) Vaccine
Bivalent Oral Polio VAccine (bOPV)
9-59 months old
0-59 months old
95%
95%
 1.1. All children aged 9-59 months old shall be vaccinated with one dose of
MR vaccine regardless of their immunization status.
1.2, All infants and children aged 0-59 months old shall be vaccinated with
one dose of bOPV regardless of immunization status.
1.3. The activity shall be synchronized and completed within (4) weeks
including rapid convenience monitoring (RCM), mop ups for missed
children, follow-ups of deferred children and for refusals.
1.4. All MR vaccines, bOPV and vaccine ancillaries shall be sourced from the
DOH.
1.5. At least 95% of targeted children shall be vaccinated for each vaccine to
achieve herd immunity and to avert measles and poliovirus transmission in
communities in the country.
1.6. All regions shall organize a Regional MR and Polio Operation Center
(see Annex A: Regional MR and OPV Operation Center).
1.7. The Regional MR and Oral Polio SIA Operation Center shall coordinate,
monitor and report the progress of the implementation of the immunization
response to the Public Health Operations Center (PHOC). The involved
provinces, cities and municipalities shall organize their respective
Operation Centers.

Vv. SPECIFIC GUIDELINES

A. Preparatory Activities
1. Planning and Coordination
1 National Level: The Public Health Operations Center (PHOC) shall lead the
conduct of the MR-OPV SIA in close coordination with the National
Immunization Program and other concerned DOH Central Office Units, and
partners.
1.2. Regional Level: Centers for Health Development shall present to the Local
Health Committee/Board the rationale for the implementation of the
MR-OPV SIA. Organize an MR-bOPV Operation Center at the regional
level. Coordinate with the national operations centers and Local
Government Units
1,3. Local Government Unit Level: Activate the MR Polio Operation Center.
Identify the members of the coordination committee (technical, vaccines,
cold chain and logistics, advocacy and social mobilization, risk
management of AEFI and COVID-19). The SIA Operation Center shall be
activated at all levels and shall conduct meetings and consultations with the
Local Chief Executives (LCEs) and other partners. Ensure that supplies for
other health services to be integrated during the SIA are adequate and
personnel are trained to provide these services.
1.3. Health Center Level: Do inventory of health human resources specifically,
those involved in the COVID-19 response or those with COVID-19, and

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 those who
are not.
Calculate the needed human resource based on the target
population. Develop a contingency plan for vaccinators shortage.

2. Orientation
2.1. The Regional Operation Center shall conduct orientations to concerned
health staff of the Provincial/City/Municipal Health Offices and other
stakeholders on the MR-OPV SIA. Standardized reference materials shall
be provided toall, including volunteers.
2.2. In view of the COVID-19 pandemic, online training is recommended when
feasible. In areas where face-to-face orientation will be conducted, physical
distancing and adherence to COVID-19 infection prevention and control
at
(IPC) policies shall be ensured all times.
2.3, It is essential that the health personnel are fully trained and aware of
infection prevention and control (IPC) measures.

3. Work planning and Microplanning

3.1. Microplanning is a "bottom-up" process of detailed planning carried out to
determine the local needs for this activity and to identify what is available
and what is missing in order to ensure smooth and satisfactory
implementation.
3.2. As part of the orientation, the Regional Operation Center shall facilitate
microplanning in LGUs. Microplanning shall include the following key
components:
3.2.1. Eligible population: Provided by the DOH Central Office based on
the recent data from Philippine Statistics Authority (PSA).
3.2.2, Operational Spot Maps: Map the location of underserved and
hard-to-reach populations including the high-risk puroks, areas with
high number of
unvaccinated children and zero (0) dose children.
In each barangay, identify the location of fixed posts (e.g. health
center, rural health unit, barangay health station), and temporary
vaccination posts (e.g. basketball court, community center, market,
terminals, playground). Discuss with church leaders and social
workers if churches and day care centers be used as vaccination
posts. In urban areas with crowded dwellings, discuss with barangay
leaders if tents can be provided in certain puroks as temporary
vaccination posts.
3.2.3. Calculation and identification of the number of children to be
vaccinated per day e.g, 80-100 children per day in urban areas and
50-80 children per day in rural areas and the vaccination teams
needed in order to prepare a daily immunization schedule for the
to
vaccination team including the areas be visited.
3.2.4. Calculation of MR, bOPV vaccines and other ancillary logistics
needed e.g., AD syringes and safety boxes.
 3.2.5. Assessment of cold chain capacity at all levels and the cold chain
equipment needed.
3.2.6. Immunization session plans (daily itinerary) for vaccination
teams. The barangays to be prioritized, schedule of campaign and
teams to be deployed shall be guided by by the “Guidelines on the
Nationwide Implementation of Alert Level System for COVID-19
Response” dated 04 June 2022 of the Inter-Agency Task Force for
the Management of Emerging Infectious Diseases (IATF).
Communicate with the barangay officials the schedule of the
campaign in the respective barangay.
3.2.7. Plan for high-risk puroks and hard-to-reach population to ensure
that no child is being missed.
3.2.8. Supervisory and monitoring schedule: Review implementation
process and address issues. Due to the complexities of this SIA,
monitors should be deployed in high-risk areas.
3.2.9 Rapid Convenience Monitoring (RCM) Plan for finding
unvaccinated children, identifying reasons for non-vaccination and
taking corrective action.
3.2.10. Follow-up schedule and mop-up plans. Revisit plan to vaccinate
missed children in poorly covered areas during campaign.
3.2.11. Human resource mapping and contingency plan to map existing
human resources and re-deploy or re-distribute vaccinators in case
of staff absence due to sickness or other emergencies.
3.2.12. Social mobilization plan to create awareness about SIA, address
barriers to accessing immunization services and strengthen
participation within the community.
3.2.13. Adverse Events Following Immunization (AEFI) management
plan including training on how to manage AEFI, crisis
management, risk communication and reporting.
3.2.14. Waste management plan describing clearly how, when, where and
by whom will filled safety boxes be transported and discarded,
including PPE-related wastes.
3.2.15. Readiness assessment schedule conducting weekly readiness
assessment at the regional, sub-regional level including health
facilities according to the microplan;
3.2.16 Incorporate the provision of other maternal and child health
services in the plan e.g provision of Vitamin A supplements,
micronutrient packs, Severe/Moderate Acute Malnutrition
(S/MAM) assessment and PhilPEN intervention among others, with
due consideration to the implementation of SIA.
3.3. All the operational resource requirements and campaign needs shall be
consolidated at the Municipal, Provincial and Regional levels and included
in the campaign work plans to be developed at each higher administrative
level.
 4. Social Preparation, Advocacy and Communication
4.1. All means of informing the community on the specific schedules and
identified sites of the vaccination campaign in each barangay shall be
widely utilized and disseminated. Communication channels and platforms
shall include, but are not limited to the following: TV ads and radio station
announcements; national and local newspaper ads; social media posts;
community awareness raising such as bandillo or ricorrida; holding of
limited community assemblies with physical distancing; by word-of-mouth,
giving out flyers and use of posters in conspicuous places in the
community.
4.2. Organize briefing and advocacy meetings with different stakeholders such
as professionals societies (e.g. Philippine Pediatric Society, Philippine
Academy of Family Physicians, Association of Municipal Health Officers,
Integrated Midwives Association of the Philippines, etc), civil society
organizations (e.g. Rotary International, Lions Club, Soroptimist, and etc),
church leaders and other influencers;
4.3. Develop risk communication strategies addressing concerns of the parents
on the safety of the vaccine and AEFI management, safety of the conduct of
the campaign during COVID-19 pandemic. Utilize the materials developed
by the Health Promotion Bureau (HPB) such as social media cards and
guide to health workers and barangay officials (developed with the support
of the World Health Organization and UNICEF).
4.4. Conduct advocacy meetings with barangay leaders and inform them of the
dates and location of the campaign, target children and support needed from
them; and
4.5. Social mobilizers shall visit the community ahead of time to ensure that
every household is informed of this campaign, its importance, actual date
and site of the vaccination.

B. Campaign Schedule and Strategies

1. Immunization Campaign Schedule
1.1. The MR - OPV SIA shall be conducted for four (4) consecutive weeks
excluding weekends and holidays.

Table 2. MR and Oral Polio Vaccine SIA Campaign Week Target

Weekly Target
Major Activities Accomplishment
1 | 2 3 4

e Intensive and simultaneous vaccination in all barangays

using fixed vaccination post and temporary vaccination post
in strategic areas.
85%
e Conduct of intra-campaign monitoring and supportive
supervision of vaccination teams (VTs) in the field
© Mop-ups for missed children by the VTs
 Weekly Target
Major Activities Accomplishment
1 2 3 4

e Follow-up of deferred children and refusals as soon as

possible after theinitial visit of the VTs
e Integrated provision of other maternal and child health
services, if applicable.

e@
Follow-up of deferred children and refusals by the VTs
based on the record
@ Mop
up teams to do second or more visits in assigned areas
90%
to mop up for allmissed children
e Conduct of rapid convenience monitoring (RCM) by the
RCM
team to look for missed children to be vaccinated

e Continuation of mop-ups and follow-up vaccination for

missed children 95%
e RCM to look for missed children with mop ups
Remarks:
@ Week 1-2: Intra-campaign RCM may be conducted to ensure proper strategy is being followed.
© Week 3: Teams on fixed sites or posts shall continue to work in assigned areas and locations (RHUs,
health centers, birthing homes, hospital OPDs and clinics)
@ Week 4: Teams on fixed sites or posts shall continue to work in assigned areas and locations
@ RCMs should be conducted and prioritized in all high-risk areas

2. Campaign Strategies
The client flow for fixed and temporary vaccination posts can be accessed in
Figure 1.

Table 3. MR and Oral Polio Vaccine SIA Campaign Strategies

Settings Examples
House-to-House Houses, apartments, and condominiums
Fixed Posts Health Centers, Rural Health Units, Barangay Health Stations,
Private Clinics or OPD of hospitals
Temporary Community centers, basketball courts, school grounds or church
Posts grounds, if possible
Strategic location / area connecting two puroks
Clubhouse subdivision, Drive-through vaccination posts (e.g.,
police checkpoints), transportation hubs (bus stations, seaports and
airports), cemeteries, under the bridge, along railways, parks or
open spaces where some families with eligible children are living,
and areas with highly mobile groups like street children,
indigenous people
Required for areas with very small and/or disperse populations,
hard-to-reach areas or Geographically Isolated and Disadvantaged
 Areas (GIDA), and rural communities which are too remote or too
small in size to have a health facility or fixed vaccination post

2.1. House-to-house: For both vaccines, the “suyod” strategy wherein every
dwelling/ structure used for habitation that is lived in by a family or small
group of people shall be visited throughout the campaign to look for
eligible children.
2.2. Fixed Posts (facility-based): All health facilities shall be used as fixed sites
and shall be open daily for the entire duration of the campaign.
2.3. Temporary post: With consultation from barangay leaders, social workers,
and church authorities, community centers and basketball courts can be
used as temporary posts. School and church grounds may also be used if
allowed by the school and church authorities.
2.3.1. When doing vaccination in the barangays without such facilities, the
vaccination teams shall consult with the barangay and purok leaders
on the identification of possible areas which can be utilized as —

temporary posts. Consultation with the aforecited leaders shall be

done during the preparatory phase of the campaign.
2.3.2. Temporary posts shall be well-ventilated and spacious enough to
allow physical distancing and crowd control. Discuss with barangay
leaders the client flow in the vicinity, and request for support in
crowd control, mobilization and transportation of parents to the
temporary posts and vaccination teams to different locations.

3. Organizing the Vaccination Teams

3.1 Vaccination teams shall be organized based on the target number of
children to be vaccinated per day and the vaccination strategy to be
employed, i.e., 80-100 children per day in urban areas and 50-80 children
per day in rural areas.
3.2 The vaccination team should ensure that every child targeted is vaccinated
based onthe strategies/activities stipulated in the microplans.
3.3 The vaccination team shall be composed of at least:
3.3.1 One (1) vaccinator (trained and licensed health professional —
midwife, nurse or physician) from the health center or from a
volunteer organization;
3.3.2 One (1) recorder (trained volunteer, BHW or a community health
worker);
3.3.3. One (1) guide familiar to the area or a social mobilizer who can
or
also act as a health educator safety officer.

4, COVID-19 Infection Prevention and Control (IPC)

In compliance COVID-19 infection prevention and control protocols (Annex B:
Guidelines for Infection Prevention and Control [IPC] During Mass
Immunization Campaign in the Context of COVID-19 Pandemic), the

8
 vaccination team shall ensure that the Minimum Public Health Standards
(MPHS) shall be implemented at all times guided by the Administrative Order
No. 2021-0043, “Omnibus Guidelines on the Minimum Public Health
Standards” (Annex C) and Department Memorandum 2022-0433, “Updated
Guidelines on the Minimum Public Health Standards for the Safe Reopening of
Institutions” (Annex D).

. Target, Vaccine and Vaccine Administration

5.1. Measles-Rubella (MR) Vaccine
5.1.1. All children aged 9-59 months shall be vaccinated with one dose of
vaccine regardless of immunization status;
MR

5.1.2. Conduct Quick Health Assessment prior to administration of MR

vaccine using the recommended form (Annex E: Quick Health
Assessment Form);
5.1.3. The MR vaccines provided shall be WHO-prequalified and certified
by the Philippine Food and Drug Administration (FDA);
. MR vaccine vial comes in ten (10) doses with a specific diluent.
Use the same diluent from the vaccine manufacturer to reconstitute
the freeze-dried vaccine. Reconstitute only one vaccine vial at a
time;
. A 5 ml mixing syringe should be used to reconstitute the MR
vaccine with the diluent. All contents of the diluent should be used
for reconstitution. After reconstitution, shake the vial gently
without touching the vial’s septum;
. Write the date and time of reconstitution in the MR vaccine vial. Do
not allow the reconstituted vaccine vial to be submerged in water.
After reconstitution, put the MR vaccine vial in a slit in the foam of
the vaccine carrier to keep the vaccine septum clean and dry
(Figure 2: MR Vaccine Administration);
. A 0.5 ml auto-disable syringe with needle shall be used to withdraw
each MR dose from the vial after reconstitution, and the same
syringe shall be used to inject the dose to the child. Aspirating
needles are NOT recommended and should not be used to
aspirate every dose of the vaccine. DO NOT RECAP
needle stick injury. DO NOT PREFILL SYRINGES;
to avoid

. The skin should be thoroughly cleaned with sterile or clean water or

alcohol before injection;
One (1) dose of reconstituted MR is equivalent to 0.5m. It shall be
.

administered subcutaneously to the left upper arm of the child

(Annex F: Proper technique of MR/OPV administration);
5.1.10. Immediately after injecting the child, place the AD syringe in the
injection safety box. Do not recap and do not leave the AD syringe
on the table;
 5.1.11. In fixed vaccination posts, areas for immunization services shall be
separated from areas for curative services where acutely ill
individuals are more likely to be present;
5.1.12. The MR SIA dose shall not be considered as routine dose, and as
such, shall not be encodedin the Target Client List (TCL).

5.2. Bivalent Oral Polio Vaccine (bOPV)

5.2.1. All children aged 0-59 months shall be vaccinated with one dose
(two drops of bivalent oral polio vaccine (bOPV), directly drop into
the mouth without touching the skin or mucosa of the oral cavity.
(Annex F);
Note: Please ensure that the complete dose (2 drops) is
completely swallowed. Repeat the full dose (2 drops) if vomited
or spat-out. If the repeated dose is vomited or spat-out once
again, do not count either doses and readminister on the next
visit or on the client's routine immunization schedule.
5.2.2. The bOPV is presented in a 20-dose vial with a vaccine vial
monitor (VVM) on the label. The vaccine shall be
WHO-prequalified and Philippine FDA certified with the same
operational characteristics as mOPV2;
Note: / dose 2 drops; 1 vial = 20 children or less (not more)
5.2.3. The SIA doses for bOPV shall not be considered as routine dose,
and as such, shall not be encoded in the Target Client List (TCL);
5.2.4. In fixed vaccination posts, areas for immunization services shall be
separated from areas for curative services where acutely ill
individuals are more likely to be present.

§.3. Additional Instructions

5.3.1. Routine immunization services shall continue at all fixed posts
based on the national immunization schedule. These services shall
not be stopped during the campaign schedule and shall be provided
daily for the whole day for the whole duration of the campaign;
5.3.2. At the end of the vaccination day or when the vaccination team
transfers to another vaccination site, the supervisor shall:
a. Cross check and sum the number of children vaccinated on the
tally sheet and the number of MR vaccine vials and bOPV vials
used. One (1) MR vaccine vial contains 10 doses or less while
one (1) bOPV vaccine vial contains 20 doses. Therefore,
vaccine vials should NOT be inside the safety boxes.
b. Ensure that all safety boxes and other hazardous wastes are
collected for safe disposal.
c. Discuss with the barangay leader the number of missed children
and the mop up schedule. Ask support from barangay leaders in
reaching out to missed or deferred children.

10
 d. At the health facility, discard reconstituted vaccine vials. Return
all other equipment including unopened vaccines and supplies.

Table 4. Summary of MR vaccine and bOPV Target, Dose, and Administration

Antigen Target Dose Route
MR Vaccine 9-59 mos 0.5m] Injectable: subcutaneously to the left upper arm
bOPV 0-59mos 2 drops Oral

C. Vaccine Storage, Transport and Disposal

1. Storage and Transport
1.1. MR Vaccine
1.1.1, The MR vaccine is heat- and light-sensitive especially after
reconstitution and shall be stored at +2°C to +8°C temperature
levels of refrigerators at Rural Health Units or Barangay Health
Stations. It is not necessary to store umreconstituted MR
vaccines in the freezer unless for long-term storage or use is
expected;
1.1.2. The diluent must be at the same temperature as the MR vaccine
vial, therefore store the diluents in the refrigerator at least 24 hours
before use;
. MR vaccines should be carefully handled so as not to expose it in
direct heat or sunlight especially after reconstitution as they may
lose their potency;
1.1.4. Place the MR vaccine vials and diluents in standard vaccine
carriers. Standard vaccine carriers should have four (4) ice packs.
Newer vaccine carriers should have seven (7) ice packs. Small
vaccine carriers with 2 ice packs shall be used for house-to-house
polio vaccination campaign only (Figure 3: MR Vaccine Storage
and Transport);
Before reconstitution, check the VVM and expiry date of the MR
vials and the diluent. The VVM of MR vaccine vial should be in the
used point;
The use of MR vaccines DOES NOT follow the multi-dose vial
policy. Any remaining and unused reconstituted vaccine dose must
be discarded after 6 hours or at the end of the immunization
session, whichever comes first. Do not return the reconstituted
to
vaccine the refrigerator.

1.2. bOPV
1.2.1. The bOPV is also heat- and light-sensitive and shall be stored at
+2°C to +8°C temperature levels of refrigerators at Rural Health
Units or Barangay Health Stations. Opened vials of bOPV may still
be used the following day as long as it complies with the

11
 multi-dose vial policy and need not be refrozen once opened or
thawed.
1.2.2. It is not necessary te store bOPV vaccines in the freezer unless
long term storage or use is expected;
1.2.3. The use of bOPV vaccines for this campaign shall follow the
multi-dose vial policy;
1.2.4. bOPV comes with an attached "Vaccine Vial Monitor" (VVM) and
should be regularly inspected or read before vaccine use. Vaccines
with VVM
at
Vial Monitor).
discard point should not be used (Figure 4; Vaccine

1.3. Additional Instructions

1.3.1. Temporary vaccination post: MR vaccines and bOPV shall be
transported and stored using the recommended vaccine carriers with
ice packs. Both vaccines can be stored and transported in one (1)
vaceine carrier as long as both vaccines are placed in separate
re-sealable plastics or plastic containers inside the vaccine carriers;
1.3.2. Fixed vaccination post: MR vaccines and bOPV should be placed
in two (2) separate vaccine carriers and properly labeled during
each immunization session for the duration of the campaign.

2. Disposal of Used MR and bOPV Vials, Syringes and Droppers

2.1. In compliance with the Health Care Waste Management Manual 4th
edition, used needles and syringes classified as sharps shall be disposed
directly to the recommended safety collector boxes (SCBs) without
recapping of the needles to avoid needle-stick injuries to the immunization
service provider. Any puncture proof containers can be used in case of
SCB shortage
in the field or health facility;
2.2. Used MR and bOPV vials and OPV droppers can be disposed in separate
but secured containers for proper disposal as pharmaceutical waste;
2.3. Other potentially contaminated immunization waste materials (used
cottons, face masks, etc) can be disposed of in a safe container for
appropriate disposal based on the infectious waste disposal protocol.
2.4. Waste collection and disposal of MR and bOPV vials, syringes, droppers
and other hazardous waste materials shall follow the existing local policy
and means of medical waste collection. This includes a locally-contracted
third-party medical waste collector and the standard medical waste disposal
(encapsulation, burial in a disposal pit).

D. Co-administration with Other Vaccines, Precautions and Contraindications

1. MR
Vaccine
1.1 MR vaccine can be safely given simultaneously with other injectable or
oral vaccines in the current routine immunization schedule and with
immunoglobulin vaccines such as rabies vaccine;

12
 1.2 Defer giving MR in children with high grade fever (>37.6C), severe and
life-threatening illnesses, primary immune deficiency or lymphoma, other
generalized malignancy or with history of severe allergy to the previous
injectable vaccines or measles-containing vaccine.

2. bOPV
2.1. OPV shall be administered to all clinically healthy and immunologically
stable infants.
2.2. Immunosuppressed infants shall not be given any polio vaccines during the
MR OPV SIA CY 2023. Given a very low percentage of
immunosuppressed children belonging to the target population, it
is highly
encouraged that implementers shall protect them by means of a
high-quality SIA resulting in herd immunity.

E. Recording and Reporting

1. Parents and guardians shall keep the child immunization card of the child with
the note or remarks that his/her child had received vaccines during the
MR-OPV SIA (Figure 5: Remarks for SIA on the Child Immunization
Record). This will help both the health workers and supervisors, monitors and
RCM
validators determine missed children and also ascertain the completeness
of vaccination campaigns in
an area.
1.1 The vaccination event should be recorded in the routine immunization card
of the child. The following entries should be indicated in the card: vaccine and
dosage provided, date of administration as well as the remarks/notes, if
necessary.
1.2 If the routine immunization card is not available, the Local Government
Unit (LGU) may opt to print immunization cards specifically for the SIA and
should contain the following information:
1.2.1 Name of Child
1.2.2 Name of Parent/Guardian
1.2.3 Date of Birth
1.2.4 Age (in years & months)
1.2.5 Home Address
1.2.6 Vaccination Site/Facility Address
1,2.7 Vaccine/Antigen Administered
1.2.8 Dosage Administered
1.2.9 Date of Administration
1.3.0 Remarks

Master-listing before vaccination is NOT recommended and should not be

done for
this campaign;
All vaccination records shall be encoded through the Synchronized Electronic
Immunization Repository (SEIR). The SEIR manual and forms for the

13
 vaccination teams may be accessed through this link:
https://bit.ly/SEJRFormsandManual.
4. All official vaccination reports shall be generated from the SEIR by the
Epidemiology Bureau (EB).
5. Recording of missed children:
6.1. Record any child who is missed including the reason/s for missing the
vaccination and the scheduled time for follow up;
6.2. This information will help the team track and vaccinate all missed children
during the follow-up visits;
7. Recording of MMR and other routine vaccine dose received at fixed posts in
health centers or OPD clinics for the period of the campaign:
7.1. Ask the mother or caregiver if the child has been vaccinated with MR
during this campaign. Check the child immunization card;
7.2. If the child has not received any measles-containing vaccine for the past 4
weeks (MMR or MR), vaccinate with MMR then administer the other
routine vaccines as scheduled;
7.3. The routine immunization dose/s shall be recorded on the immunization
card or mother-child book as .per usual practice;
7.4. No special markings or tally recording shall be done for the routine
immunizations received. The routine vaccine doses can be recorded in the
TCL of the health facility.
Note: Supervisors must ensure that vaccination teams are recording
missed children at the back of the tally sheet for their future use
during follow-up visits.

F. Supervision of the Vaccination Team

The supervisor shall have the following functions (4naex G: Supervisory and
Monitoring Tool):

1. Key Activities: Pre-Campaign

1.1. Oversee and follow up microplan development of their health centers,
RHUs
or BHS assigned;
1.2. Use checklists to review SIA readiness and take timely corrective measures
as needed (Annex H: Readiness Assessment Tool);
1.3 . Review and validate supervisory plans and updating of spot maps;
1.4, Ensure that team geographical boundaries are clear and does not overlap;
1.5, Ensure that all team members have been trained on logistics management,
proper vaccine handling, vaccine administration, -key messaging,
COVID-19 IPC measures, and AEFI management;
1.6. Make onsite supportive supervision to implement corrective actions
immediately on site for improvement;
1.7 . Educate and train more volunteers, if needed;
1.8. Provide feedback to higher supervisor on the issues encountered in the
field and the actions taken;

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 1.9. Conduct daily review meetings with the teams to discuss major challenges
and observations encountered, RCM findings, decisions for corrective
action, and follow up on pending actions from the previous days;
1.10. Compile daily data and report to the city or district focal persons;
1.11. Ensure special attention for high risk areas, in security-compromised or
conflict-affected areas;
1.12. Support monitors in the conduct of RCMs based on the daily activity plan
of the team;
1.13. Ensure that follow-up of deferred/missed children, mop up activities in all
poorly covered areas and follow up of refusals are being done as soon as
possible and within the last few remaining days before the end of the
campaign;
Note: Az least 1 supervisor should be assigned for every five (5)
vaccination teams.

2. Key Activities: Intra-Campaign

2.1. Intensive and simultaneous vaccination in all barangays using fixed
vaccination post and temporary vaccination post in strategic areas, and
house-to-house vaccination;
2.2. Provision of supportive supervision of vaccination teams (VTs) in the field;
2.3. Daily mop-ups for missed children by the VTs. Mop up teams to do second
or more visits in assigned areas to mop up for all
missed children
2.4. Follow-up of deferred children and refusals as soon as possible after the
initial visit of the VTs
2.5 Conduct of rapid convenience monitoring (RCM) by the RCM teamto look
for missed children to be vaccinated

3. Key Activities: Post-Campaign

3.1. Compile final report of coverage at the end of the campaign and share with
the focal personsatthe district, city or provincial levels;
3.2. Monitor the compliance of health facilities to waste management and
disposal protocols;
3.3. Conduct campaign review meetings with all stakeholders to share updates
about the coverage achieved; lessons learned in terms of strengths and
challenges identified and to plan ahead for corrective actions before the
next round of the campaign.

G. Rapid Convenience Monitoring (RCM) of

the Areas Visited for Vaccination
The objectives of RCM are to find unvaccinated children, identify reasons for
non-vaccination, and plan and execute corrective action. RCM data provides
information on the performance of the SIA and suggests how to refine strategies
for reaching the hardest-to-reach children. RCM shall be conducted in high risk
areas following the recommended guide (Annex I: RCM Guide and Form).

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 H. Surveillance and Reporting of Adverse Events Following Immunization
(AEFD
1. All detected AEFIs both minor and serious, shall be reported to the nearest
health facility. The existing DOH guidelines on AEFI surveillance and response
(Administrative Order No. 2016-2006) shall be observed for this purpose;
2. AEFI cases needing hospitalization shall be managed and referred to the
appropriate health facility following A.O. 2016-0025: Guidelines on the
Referral System for Adverse Events.

For your guidance and strict compliance.

——e
By of Health:

F.
NESTOR SANTIAGO, JR., MD, MPHC, MHSA,
Undersecretary of Health
CESO
II
Field Implementation and Coordination Team

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ANNEXES:

Copies of the reference documents, forms and tools may be accessed by clicking the
following hyperlinked Annexes.

Annex A: Regional MR and Polio Operation Center Structure

or through https://bit.lyMROPVSIA_AnnexA

Annex B: Guidelinesfor Infection Prevention an ntrol [IPC] During Mass Immunization

Campaign in the Context of COVID-19 Pandemic
or through https://bit lyMROPVSIA_AnnexB

Annex C: Administrative Order No. 2021-0043, “Omnibus Guidelines on the Minimum

Public Health Standards”
or through https://bit.lyMMROPVSIA_AnnexC

Annex D: Department_Memorandum 2022-0433, “Updated Guidelines on the Minimum

Public Health Standards for the Safe Reopening of Institutions”
or through https://bit.ly/MROPVSIA_AnnexD

Annex E: Quick Health Assessment Form

or through https://bit.lyMROPVSIA_AnnexE

Annex F: Proper technique of MR/OPV administration

or through https://bit.ly/MROPVSIA_AnnexF

Annex G: Supervisory and Monitoring Tool

or through https://bit.lyMMROPVSIA_AnnexG

Annex H: Readiness Assessment Tool

or through https://bit.ly/MROPVSIA_AnnexH

Annex I: Rapid Convenience Monitoring (RCM) Guide and Form

or through https://bit.lyMROPVSIA_ Annex!

Annex J: MR-OPV SIA Microplan Template by Administrative Level

or through https://bit.ly/MROPVSIA_AnnexJ

Annex K: Projected Population / 2023 MP bOPV SIA Targets

or through https://bit.ly/MROPVSIA_AnnexK

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FIGURES:

Copies of the reference documents, forms and tools may be accessed by clicking the
following hyperlinked Annexes.

Figure 1: Client Flow on Fixed and Temporary Vaccination Posts in the Context_of
COVID-1
or through https://bit.ly/MRbOPVSIA_Figure]

Figure 2: MR Vaccine Administration

or through https://bit.ly/MRbOPVSIA_Figure2

Figure 3: MR Vaccine Storage and Transport

or through https://bit.ly/MRbOPVSIA_Figure3

Figure 4: Vaccine Vial Monitor

or through https://bit.ly/MRbOPVSIA_Figure4

Figure 5: Remarks for SIA on the Child Immunization Record

or through https://bit.ly/MRbOPVSIA_ImmunizationRemarks

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