Republic of the PhiliPPines

DePartment of Health
CENTER FOR HEALTH DEVELOPI'IENT
Cordillera Administrative Region

BGHMC ComPound, Baquio CitY 2600

o TRUNKLINE#s:09399876270;09399887280;09399817406;ffi178132604 r WEBSITE:www'caro'doh'gov'ph
ADVISORY

TO: AII ProvinciaUMunicipal/Cify Epidemiology Surveillance Units (ESU) and

Dil;" Reporting Units in tlie Cordillera Administrative Region
SUBJECT: Advisory on the Specimen Collection for Measles and other Exanthems

DATE: May 30,2023

In order to strengthen the detection of measles and rubella cases in the country, all concemed,
,hd1 il guided o"f the following laboratory procedures confirmation, for strict compliance.
l. A single serum sample obtained at first contact with the patientand/or at any time
within-2g duyr no* rash onset shall be taken from all suspected measles rubella
cases.

2. Alternatively, a dried bloodspot (DBS) sample can be taken if there is difficulty in blood
extraction or maintenance of reverse cold chain'

- Aside from serum, collection of

3. Nasopharyngeal (NPS) and/or Oropharyngeal
from all-cluiteisi outbreaks of suspecte9 *:ryl-.!
swab (OpS) for virus isolation
cr.es ihall-be performed within 7 days from rash onset (AO No. 2014-0003).
Virus isolation is significant to confirm whether transmission of indigenous
measles strains have b-een intemrpted. This shall provide evidence that the country
has achieved measles elimination goal. The NMRL shall refer to the guide below for
the sample collection of cases in ailuster/outbreak should high measles transmission is
reported.

Table 1. Strategy for NPS/OPS collection for Virus Isolation based on A.O.2014-0003)

Number of Measles SusPected Sample Collection

Cases Encountered

3 cases Collect at lease 1-2 NPS/OPS samples

5 cases Collect a minimum of 3 NPS/OPS samples

10 cases Collect a minimum of 5 NPS/OPS samples

>10 cases Collect a minimum of 10 NPS/OPS samples

Page 1 of4

The round metal gong of the Cordillera known locallyas'gangsd is a symbol of the upland people's culture that has been passed on
from generations to another.
The profile of a person blowlng a "tangguyub- represents a community being called for an important matter or action.
The line3 that shape the mountalm, tho rlce terraces, clouds and rlyers symbolize the connectivity and f low of human interaction
in a geographic oreo such os the Cordillero.
All the 3ymbols combln€d represent unity and harmony of its people with culture and environment in beating the gonq for
self-determination.
 L
i
Republic of the Philippines
at o. Department of Health
H,
g CENTER FOR HEALTH DEVELOPMENT
Cordillera Ad ministrative Region

BGHMC Compound, Baguio City 2600

o TRUNKLINE#s:09399876270;09399887280;09399817406;09178132604 o WEBSITE:www.caro.doh.gov.ph
F
AI\NEX A. GUIDELINES FOR SPECIMEN COLLECTION AND STORAGE
Summary of Specimen Collection, Storage, and Transport for Suspected Measles
.":
Sample Timing of Collection and
Quantity Handling and Transport
Type Collection Storage
Serum First contact .2ml . Collect in plain or red . Specimen should be received
or anytime (Adults) top tube or yellow at RITM within 72 hours/3
within 4-28 SST days from collection
days from
.1ml
onset ofrash
(infants) .Allow to clot . Store inside the refrigerator
(4-8'C or lower
. Separate serum from
blood

NPS/ Within 7 days 2 swabs . Use dacron or rayon . Specimen should be received
OPS from onset of tipped swabs with at RITM within 72brsl3 days
rash plastic shafts from collection
. Suspend in VTIW . Store inside the refrigerator
UTM (2 to 8"C)/ thermobox.with at
least 4 frozen ice packs while
awaiting transport

Dried Anytime Adequate . Prick the finger . Samples can be stored at room
Blood within 28 collected 3 (either side of the temperature (20 to 25'C) for a
Spot days after circles filled middle or 4ft finger) maximum of trvo weeks if
(DBS) onset ofrash DBS or the sides of the immediate shipment is not
heel for infants and possible
small children using
a microlancet.
. Although samples do not need
Allow blood to fill to be kept refrigerated or
frozen during transport, it is
completely at least 3
circles advisable to store in a cool
place and transport to the
. Venous blood (lml), laboratory as soon as possible
immediately dropped
unto the circles of
the DBS card

Page 2 of 4

The round mstal gong of the Cordillera known locally as "gangsa'is a symbol of the upland people's culture that has been passed on
from generations to another. {
The profllc dt a p.rton blowing a'tangguyuH represents a community being called f or an important matter or action.
The llna3 that shape thc mountalns. the rlce terraca3, clouds and rlvers symbolize the connectivity and flow of human interaction
in a geogrophic areo such os the Cordillero.
All thc symbole comblncd represent unity and harmony of its people with culture and environment in beating the gong for
self -determination.
 \
Republic of the Philippines
I
,al

v
C.. Oepartment of Health

o CENTER FOR HEALTH DEVELOPMENT

Cordil lera Ad m i nistrative Reg i o n

BGHMC Compound, Baguio City 2600

o TRUNKLINE#s:09399876270;09399887280;09399817406;09178132604 o WEBSITE:www.caro.doh.gov.ph

I. Outbreak Investigation
A. Specimen Type and Timing of Collection based on A.O. No. 2014-0003

a. Serum: Obtain a single senrm sample at the first contact with a suspected case of measles
or any time within 4-28 days after onset of rash. This is to ensure that the IgM antibody
response to the Measles virus is detectable.

b. NPS/OPS: Collect samples from suspected cases with onset of symptoms within 7 days
from onset of rash. This is to be used for genotyping analysis to confirm whether the
transmission of indigenous measles strains has been intemrpted.

c. DBS: Obtain DBS at the first contact with a suspected of measles or anytime within
case
28 days after onset of rash. It is used as an alternative for whole blood extraction only
under specifi ed circumstances.

B. Storage and Transport based on A.O. No.2014-0003

a. Label the sample container with patient's name, agelsex, type of specimen, and date of
collection.
b. Immediately reftigerate the samples in 2 to 8"C until shipment. For DBS samples,
it may not be kept refrigerated or frozen during transport however it is advisable to store
in a cool place.

c. For serum samples

Place the sample container into a sealable plastic bag or pouches containing absorbent
materials such as cotton to soak up any leakage that may occur. Insulated containers shall
be used to contain the sealed bags of specimen.

For OPSAIPS samples

Wrap the VTM tubes with specimens in tissue paper or any absorbent material;
place upright in a separate 50 ml centrifuge tube or any leak/puncture_ proof container;
place the 50 ml tube or any container in a resealable plastic bag (ZiplockrM).

For DBS samples

Place the individually packed DBS in an envelope big enough to accommodate all DBS
received from the region. Ship the DBS sample via ordinary postage.

Page 3 of4

The round m.t!l gong of the Cordillera known locally as'gmg!.'is a symbol of the upland people's culture that has been passed on
from generations to another.
The prc?llo ol a pcrson blowlng a'tangguyub'represents a community being called f or an important matter or action.

tuT
The llna3 that shape thc mountaim, tha rlca tGrnces, clouds and rluers symbolize the connectivity and f low of human interaction
in a geogrophic oreo such os the Cordillero.
All thr rymbols comblncd r€present unity and harmony of its people with culture and environment in beating the gong for
self -determination.
I

Republic of the Philippines

&
z4* D' Department of Health

0 CENTER FOR HEALTH DEVELOPMENT

Cordillera Adm inistrative Region

BGHMC Compound, Baguio City 2600

o TRUNKLINE#s:09399876270;09399887280;09399817406;09178132604 r WEBSITE:www.caro.doh.gov.ph

d. Seal the CIF in a separate plastic bag and enclose within the shipping box.
e. Place the specimens in the transport box with at least 4 frozen ice packs fitted around
the specimens.
f. Coordinate shipment such that arrival of specimens at RESU does not fall on
weekends or holidays. Otherwise, make an advance notice of such arrival via
mobile number (+6985-364-1700), messenger ('Resu Doh Car') or
e-mail (resubaguio@gmail.com). Kindly include the following details :

Bus/Van No./Tracking Number:

Departure/Terminal:
ETA:
Quantity: eg. 1 box
Type of Sample/Disease:

Transport to the address mentioned below.

Note: For routine surveillance and outbreak investigation address shipment to:

JETHRO L. SIMEON
RESU HEAD

DOH-CHD CAR, BGHC Compound, Baguio City

0985-364-1700

4. Serum and DBS specimen shall be received at RESU upon collection, accompanied by a
completely filled-up Measles and Rubella Case Investigation Form (CIF) Version 2022.
5. NPS/OPS shall be received at RESU upon collection with completely filled up Measles and
Rubella CIF.

For your guidance and strict compliance.

L. MAGPANTAY, MD, PHSAE, CESO III

Director [V
RESU

X..rr,
Page 4 of 4

The round mctal gong of the Cordillera known locally as "gangra'is a symbol of the upland people's culture that has been passed on
from generations to another.
The proflle of a porcon blowlng a "tangguyub'represents a community being called for an important matter or action.
The llnc. that 3hape thc mountalna, thc rlcr tGtraccr, clouds and rlvcrc symbolize the connectivity and flow of human interaction
tr
in a geogrophic oreo such os the C ordillero.
All thc aymbola comblnad represent unity 6nd harmony of its people with culture and environment in beating the 9on9 for
self -determ ination -
 teasles/Rubella Case lnvestigation Form Version 2022

V. LABORATORYTESTS

Specimen collected Date received

in RlTIll Virus PCR
(Put /
Measles lgM Rubella lgM
in the box (to be filled up Result Result lsolation Result Result
Provided) If YES, Date eent to
Date Collected RlTlrl by RITM)

ESerum
tt"
TM- 56-WW
tl
frii- ED-ffi-
lt
frr ED-ffi
_t_1, l- l---..'- I l__-r_
trDried Blood Spot MM DO YYYY MM DD YYYY frM DD
-
trOropharyngeal/
Nasopharyngeal swab
_t_l__
MM OO YYYY ilii-
l
ED-wvY
l" _t_t_:'
MM DD YYYY

VI. FINAL CLASSIFICATION VII. SOURCE OF INFECTION

tr Laboratory Confirmed Measles tr Labpratory Confirmed Rubella tr Endemic
D EpiJinked Confirmed Measles D Epi-linked Confirmed Rubella D lmported
tr Clinically Compatible Measles tr Non;Measles/Rubeflq Discarded Case EI lmport-related
D Unknown
Vlll. OUTCOME: n Alive tr Died Dau.Dbd _______.,/J_
MM DD YYYY
CASE DEFINITION AND CLASSIFICATION
CASE DEFINITION

, with the following signs and symptoms

a Fever (38'C or more) or hot to touch; and
a Maculo-papular rash (non-vesicular) anQ.*
a at least one of the following: cough, coryza (runny nose), or conjunctivitis (red eyes)

CASE CLASSIFICATION
Laborabry-conflrmed f,feasles.' a suspected measles case that has Laboratory-confirmed Rubella: a suspected measles case with a
been confirmed by a proficient laboratory as positive for Measles lgM positive laboratory test results for rubella-specific lgM antibodies or
antibodies and/or positive for measles virus isolation or Pblymerase other laboratory test method
Chain Reaction (PCR)
Epidemlologlcally Ltnked Conflrmd Rubellat a suspected case
Epidemiologically Linked Confirmed M&sles..a suspecte'd wfio hai direct contact with another laboratory confirmed rubella case
measles case that has not been confirmed by a laboratdry but was with rash onset occuned 12-23 days before the present case
geographical|yandtemporallyrelatedwithdatesofrashonset'occurring--
-
I
6"ti"eh ana 2g days'apart from a laboratory-confirmed case or Non-Mqsles/Rubella Discarded Case: a suspected case that has
another epidemiotogi6ary c;nfir."J r"""iu" 6r"" il , li:?:ff.Jlt-f,:lril*fffl.;j"T
a non-measles (and non-rubella)

Clinicaily Compatibte lleasles.. a suspected measles case, for -negative laboratory testing in a proficient laboratory on an
a@rite clinical Jpecimen was iafen and the casg has not
,vt'icti n<i adequate specimen collected during the proper time period
beenlinkedepidemio|ogicallytoalaboratory-confirmedcaseoimeaslesafter.rashonSet..
or other communicable disedse OR laboratory confirmation is still - epidemiological linkage to a laboratory confirmed.outbreak of
pending another communicable disease that is not measles/rubella
- confirmation of another etiology

SOURCE OF INFECTION: LABORATORY CONFIRMATION

Endemic: a confirmed measles case acquired the infection within the o positive serologic tesl result for anti-measles lgM antibodies
country wherein the chain of measles virus transmission is cohtinuouso :Fourfold rise in anti-measles lgG antibodies in acute and convales-
for >12 months cent serum
tmporte4 a returning traveler or visitor exposed to measles out- o lsolation of measles virus
side the country during_the 7-21 d?ys prior to rash onset and supported r Dot immunobinding assay
by epidemiological or virological evidence , . polymerase chain reaction (pcR) testing for measles nucleic acid
lmport-related a locally acquired infection that occurs as part of a
chiin of transmjssion originating from an imported case as sgSiported by Therapeutic Dosage of Vitamin A for iieasles cases:
epidemiological or virological evidence o 50,000 lu for chirdren <6 months old
llnknown'. a confirmed case for which no epidemiological or viro- o 100,000 lU for childlEh 6 to 1 1 months old
logical link to importation or endemic transmission can be established r 200,000 lU for children 12lo 71 months old
after a thorough investigation
Nap: The therapeutic dosage of Vitamin A for measles bases shoutd be given upon diagnosls regardless of when fhe /asl dose of
vitamin A capsule was given.

Deliberately providing false or misleading, personal lnformation on lhe part of the patient, or the next of kin in case of patient's incapacity, may
constltute non+ooperation punlshable under the Republlc Ac{ No. 11332.
 Case lnvestigation Form Version 2022

Epidemic-prone Disease
teasles/Rubella 't \.
Case Surueillance (lCD 10 Code: B05; 806) o
Name of DRU:
Type: trRHU trCHO trGov't Hospital EPrivate Hospital trClinic
DRU Complete Address: 11";*6 Street/Purok
trGov'tLaboratory EPrivateLaboratory tlAirporUSeaport
----E6rsry ----T@- G@ Type of Site: DSentinel ENon-sentinel
--T@iM--
I. PATIENT INFORMATION
Patient Number EPI Patient's First Name Middle Name Last Name
'D

Sex:DMale DFemale Date of Birth Age:

tr _
Days
Complete Gurrent Address: (Specify House/Lot #, StreeUPurok/
Subdivision, Barangay, Municipality/City, Pmvince, Region)
Pregnant? trYtrNtrU tr
ilr lt56-WW
Months
lf Yes, weeks of pregnancy _ tr Years
Patientadmitted? trY trN Date Admitted/ MM ea YYYY Gomplete Permanent Address: (specify House/Lot #, StreeuPurou
Seen/Consult Subdivision, Barangay, Municipality/City, Province, Region)

ls the case a momber of lndi

,me of rraren os.:
MM DD YYYY
Date of Report: Name of reporter: Contact Nos,:
Date of l\,tM DD YYYY
Name of lnvestigator/s: Contact Nos.:
lnvestiqation
II. CLINICAL DATA
Fever: trY trN Arthral gia/arthritis : trY trN Are there any complications?
Date onset: _J_l_
MM OD YYYY_
Swollen lymphatic nodules: trY trN trY trN
lf YES, specify:
Rash: I]Y trN lf YES, specify location Other symptoms:
Date onset: _l_l_ E cervical E sub-occipital
MM OD YYYY
Cough: trY tr N E post-auricular Working/Final Diagnosis:
Kopliksign: trY trN fl others, specify
Runny nose/coryza: tr Y trN
Red eyes/conjunctivitis: tr Y trN
III. VACCINATION HISTORY AND VITAMIN A SUPPLEMENTATION
Patient received measles-containing vaccine (MCV)? tr,Y. trN
lf Yes, indicate the number of doses whichever is applicable: MV MR- MMR_
Date last dose received MCV:
MM oD ','^ryy

Measles vaccine received validated through: tr Vaccination Card tr Logsheet tr By recall tr _(others, specify)
Was vaccination received during special campaigns? BY trN
lf patient did not receive any MCV, state the reason/s:
tr Mother was busy tr Child was sick tr Forgot schedule
tr Against belief E No vaccine available tr Other reasons, speciff
tr Medicalcontraindication Et Vaccinator not available
tr Fear of side effects tr Not eligible for vaccination

Was the patient given Vitamin A during this illness? tr Y ON

IV. EXPOSURE HISTORY
With history of travel within 23 days prior to onset of rash? : trN trY lf YES, specify place and timing:
Place of travel: Date of travel: _t_t_
MM DD YYYY
tr <7 days from rash onset tr 7-23 daysfrom rash onset
llVas there contact with a confirmed Measles case 7-23 days prior to rash onset? tr Y tr N tr U
"ll\las there contact with a confirmed Rubella case 7-23 days prior to rash onset? tr Y tr N tr U
lf YES, name of contact: Plaenof residence:. Dateofconta** r* r*_
Tick the type of place where exposure probably occur: EDay care ElBarangay EHome trschool OHealth Care Facility
DDormltory trOthers, speclfy
*Are there other known cases with fever and rash (regardless of presence of 3 C's) in the community? tr Y tr N tr U
Note: lf the answer to any of the two questions was YES, cardinate with the ESU for validation and field investigation.
Continue at the back

Deliberately providing false or mi:leading, personal informdion on the part of the patient or the next of kin in case of patienf e incapacity, may
constihrte non+oooeration punishable under the Republic Act No. 'l1332,