Republic of the Philippines

April 22, 2024

DEPARTMENT MEMORANDUM
No. 2024 -_
(98

TO : ALL DIRECTORS OF CENTERS FOR HEALTH DEVELOPMENT,

MINISTRY OF HEALTH OF BANGSAMORO AUTONOMOUS
REGION IN MUSLIM MINDANAO (MOH-BARMM), CHIEFS OF
DOH. HOSPITALS, HEAD OF ATTACHED AGENCIES, LOCAL
HEALTH SYSTEMS DIVISION CHIEFS, PROVINCIAL HEALTH
NITS. HIGHLY__URBANIZED__CITIES, AND OTHER:
NCERNED

SUBJECT : Guidelines on the Implementation of the Bivalent Oral Polio Vaccine

Catch-up and Supplemental Immunization Activity (SIA) for CY 2024

Rationale

The Department of Heaith (DOH) has continuously endeavored to maintain a

polio-free status through environmental and disease surveillance, and increasing
immunization coverage. Over the past decade, the immunization target of 95% has yet
to be reached, a situation exacerbated by the constraints imposed during the
COVID-19 pandemic. In 2023, immunization coverage for the Polio vaccine has
plateaued at 75.1%, leaving 24.9 % of the population unvaccinated against polio,
thereby increasing the risk of a polio outbreak.

To mitigate the risk of a polio outbreak and achieve herd immunity through gut
mucosal immunity to polio virus, the DOH implemented a nationwide
Measles-Rubella and bivalent Oral Polio Vaccine Supplemental Immunization
Activity (MR-bOPV SIA) last May to June 2023, prioritizing areas with the highest
risk of developing outbreaks for polio. For Calendar Year 2024, the Department aims
to expand the polio vaccination to cover all municipalities and intensify the routine
and catch-up activities for polio vaccination to increase the immunization coverage.

I. Objectives
This policy aims to provide comprehensive technical guidance to all immunization
program coordinators, implementers, service providers, and immunization partners on
facilitating the execution of bivalent Oral Polio Vaccine (bOPV) catch-up vaccination
and Supplemental Immunization Activity for all infants and children 6 weeks to 59
months of age.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 Direct Line: 711-9501
Fax: 743-1829; 743-1786 © URL: http://www.doh.gov.ph; e-mail:dohosec@doh.gov.ph
 Ill. Scope and Coverage

This nationwide policy shall actively guide all immunization

program coordinators,
with Local Government Units (LGUs) as implementers, along with service providers,
and immunization partners in the implementation of the second phase of bivalent Oral
Polio Vaccine (bOPV) catch-up vaccination and Supplemental Immunization Activity
for children under 2 years old and non-selective vaccination for 24-59 months for CY
2024,

IV. General Guidelines

I. All stakeholders shall actively participate in catch-up and vaccination for all
eligible children, especially those with missed or zero doses of bOPV.

2. The catch-up program in 2024 shall aim to achieve the following

targets:
a. At least 95% of infants and children aged 0-23 months in all regions have
completed three (3) doses of bivalent Oral Polio Vaccine (bOPV); and
b. At least 95% of all 24-59 months are given 1 dose of bOPV regardless of
polio immunization status.

3. All stakeholders shall identify opportunities for providing immunization services

in activities with the same target population.

4. Catch-up immunization may be simultaneously implemented with the National

Nutrition Council’s (NNC) Operation Timbang (OPT) Plus and growth monitoring
activities, based on local assessment and planning for implementation, or
integrated with other public health program services.

V. Specific Guidelines

A. Activities
a. National Activities

i. The Department of Health through the Public Health Services Cluster

(PHSC) and the Disease Prevention and Control Bureau (DPCB), shall
coordinate and involve the Department of the Interior and Local
Government (DILG), the Department of Social Welfare and
Development (DSWD), the League of Municipalities of the Philippines
(LMP), the Union of Local Authorities of the Philippines (ULAP), and
other stakeholders, including the private sector, and Civil Society
Organizations (CSOs) (e.g., Rotary and Philippine Red Cross) for the
implementation of the bOPV roll-out.
 ti. The 2023 projected population for 0-59 months issued by the
Epidemiology Bureau shall be used as the target number of eligible
children for bOPV administration, and basis for the allocation of
vaccines, ancillaries and other commodities.

b. Regional Activities

All Centers for Health Development (CHD) and the Ministry of

Health-Bangsamoro Autonomous Region in Muslim Mindanao
(MOH-BARMM) shall collaborate with the National Nutrition Council
in
in the integration of bOPV administration and other routine vaccines
the Operation Timbang Plus and growth monitoring activities, for CY
2024 and onwards.

All CHDs and MOH-BARMM shall ensure that the bOPV vaccines,
ancillaries and other supplies, which were already delivered by the
Research Institute for Tropical Medicine (RITM) and/or the’ DOH
Supply Chain Management Service in February 2024, are distributed to
all implementing units (City Health Offices and Rural Health Units) in
their respective jurisdictions

iii. All CHDs and MOH-BARMM shail lead in the microplanning and
orientation of Local Government Units for this activity.

iv. All CHDs and MOH-BARMM shall augment vaccinators and/or data
encoders to priority cities and municipalities lacking human resource
to implement the bOPV implementation and catch-up immunization.

All CHDs, MOH-BARMM Provincial and Local Health Units shall

map and engage all non-government agencies, champions, medical
professional societies, civil society organizations, partners, etc.
providing support to the immunization program.

c. Local Activities

Provincial and Local Health Units shall develop plans,

map human
resources, and determine additional funding requirements for the
implementation of this activity.

ii. Provincial and Local Health Units, with the assistance of CHDs, shall
be responsible for the orientation and training of non-health personnel
on the administration and handling of bOPV.
 iii. Barangay Local Officials shall disseminate bOPV administration and
catch-up immunization schedule through barangay general assembly.

iv. Barangay Health Workers and Volunteers shall conduct house-to-house

visits to reiterate the routine immunization and bOPV catch-up
immunization schedule.

B. Social Preparation, Advocacy, and Communication

The following activities may be done at the national, regional, provincial and LGU
level:

1. National (COM & HPB)

a. Update and disseminate communication plans for bOPV vaccination
and risk communication strategies for possible adverse effects
following immunization (AEFI).
b. Update risk communication and health education materials
on catch-up
immunization activities.

2. Regional (CHD-HPUs) & LGU

a. Incorporate demand generation strategies to the regional catch-up
microplan for bOPV catch-up vaccination.
b. Conduct advocacy meetings with different stakeholders such
as local
chief executives, local health board, private medical societies, civil
service organizations, youth groups, etc.
c. Deploy social mobilizers to inform and educate the community in line
with the updated communication package and risk communication
messaging.

C. Campaign Schedule and Strategies

The catch-up and SIA for bOPV shall be implemented in April to July of 2024. The
following strategies may be implemented for this roll-out. However, this does not
limit implementers to develop strategies they see
fit
to meet the activity’s objectives:

1. The LGU and barangay will incorporate it into the immunization schedule for
all
intensified routine and catch-up activities for antigens;

2. Setting temporary/fixed vaccination posts such as transport terminals, plaza,

playgrounds, basketball court, malls, church, and in sitios where most children
are situated.
 3. During the monthly 4Ps Family Development Sessions, beneficiaries with
children aged 0-59 months will undergo a monthly check-up a side activity;
as
4. Other routine activities at the primary care facility which caters to the same
age group or their caregivers such as family planning counseling sessions,
prenatal check-ups, oral health services, etc.

5. Simultaneously, Operation Timbang Plus and growth monitoring will be

implemented in close coordination with the National Nutrition Council
(NNC), Provincial Nutrition Action Officer (PNAO), and Municipal Nutrition
Action Officers (MNAO);

6. Vaccination drive as a kick-off activity for the World Immunization Week;

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

1. OPV shall be administered to all-clinically healthy infants with a minimum

interval of four weeks between doses. It may be given simultaneously with
other vaccines given through an intramuscular, subcutaneous route without
any interval.

2. For children under 2 years old, confirm the child’s immunization status. If the
child completed 3 doses, may not give another dose. If the child has no
vaccine or incomplete doses, vaccinate to complete 3 doses of bOPV.
Complete other missed antigens and record as Completely Immunized Child
(CIC).

3. For children 24-59 months old, give one (1) dose of bOPV regardless of
immunization status. This includes the children who have received the bOPV
dose in the MR bOPV SIA implemented last May-June 2023.

4. Bivalent OPV (bOPV) may be administered with monovalent or

simultaneously or sequentially with pentavalent rotavirus vaccine. There is no
interval required for bOPV and Rotavirus vaccine administration. Although
concomitant administration of OPV slightly reduced the immune
response to
rotavirus vaccine, there is currently no evidence that clinical protection against
severe rotavirus gastroenteritis would be affected. (European Medicines
Agency. https.//www.ema.europa.eu/) It is recommended that the sequence of
the co-administration shall be: OPV first followed by Rotavirus vaccine then
other recommended appropriate vaccines. (DM 2012-0157: Administration
of
Rotavirus Vaccine)
 5. Infants and children with mild illnesses such as cough and colds may be given
bOPV, followed by appropriate referral to a primary care provider for
treatment and counseling. Postpone vaccination if the child has moderate to
severe illness and refer to emergency care.

Immunosuppressed infants and children such as, but not limited to cancer
patients ongoing chemotherapy, diagnosed with primary or secondary
immunodeficiency such as severe combined immunodeficiency (SCID) or
Human Immunodeficiency Virus (HIV) infection, or with history of prolonged
use of systemic steroids, shall not be given polio vaccines or any live vaccines
due to contraindication, as outlined in the General Best Practice Guidelines
for Immunization: Guidance of the Advisory Committee.on Immunization
Practices by Kroger et al. (2023) . Instead, Inactivated Poliovirus Vaccine
(PV) shall be administered as a 3-dose series for immunodeficient and
immunosuppressed infants and children and their eligible household members.

Infants and children who exhibited allergic reactions or adverse reactions

following the previous OPV administration may not receive the vaccine.

E. Recording and Reporting

To confirm the immunization status of the infant or child, refer to their vaccination
card or the Target Client List (TCL). Consider the following guidelines for recording
and reporting:

1. For infants 0-11 months old, record as routine dose and complete three doses
at least 4 weeks apart. Review immunization records for missed doses for all
antigen and schedule appropriately. Record vaccination as routine doses.

A weekly accomplishment report (Annex B) shall be submitted every

Monday for 3 months from the start of implementation and every other week
for the next 3 months through this link https://bit.ly/2024bOPVAccomp.

All Linelist data will be submitted to the Synchronized Electronic

Immunization Repository (SEIR) by the deadline, which is set for every Ist
Monday
of the following month to the Synchronized Electronic Immunization
Repository (SEIR). Please see Annex D for the Operational Guidelines.

F. Monitoring
The Universal Health Care - Health Services Cluster (UHC-HSC) Technical Office
shall act as operations oversight while the Disease Prevention and Control Bureau
(DPCB) through the NIP shall act as technical oversight for the implementation of
this activity. The following shall be conducted to monitor operations, vaccine
accomplishment and vaccine utilization:
 1. The UHC-HSC Technical Office shall convene a weekly virtual meeting every
Wednesday afternoon or as deemed necessary to monitor the progress,
bottlenecks, and other concerns on the bOPV roll-out.

Rapid Convenience Monitoring (RCM) form (Annex C) through peer-to-peer

strategy shall be done starting on the third month of implementation or March
2024, and quarterly thereafter to monitor for routine immunization. The
Central and Regional oversight teams may also conduct site monitoring
activities.

G. Surveillance and Reporting of Adverse Events Following Immunization (AEFI)

L. All detected AEFIs both minor and serious, shall be reported to the nearest
health facility. The existing DOH guidelines on AEFI surveillance and
response under Administrative Order No. 2023-0007 “Revised Omnibus
Guidelines on the Surveillance and Management of Adverse Events Following
Immunization (AEFI)” shall be observed for this purpose;

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 compliance.

By Authority of the Secretary of H

D, MHA, MSN, FPSMS, FPCHA

Undersecretary of Health
Public Health Services Cluster
Annex B. Accomplishment Form. As of Month/Day/Year

Barangay/PHV Stock on 0-11 MONTHS 12-23 MONTHS 24-59 MONTHS

Total D Gi
Municipality/ Prevince/ hand (in 0-59 Month
(0- ‘onthsol)) % of bOPY doses utilized
Region doses) Accomplishment Accomplishment Target Accomplishment

Submitted by: Approved by:

Public Health Nurse/Midwife Municipal/ City Health Officer
2
of
Annex C, Rapid Convenience Monitoring

Bivatent Oral Pollo Vaccine immuntzetion

for
Rapid Conventence Monitoring (RCM) FORM.
REGION:,__ CITY/ MUNICIPALITY:__,

not
NAME OF HEALTH
CENTER: BARANGAY:

Bip
PUROK/ZONE: Date of ROM:,

Enter number of children in eoch category for columns ato g

Method verification of vaccination: immuniration Cord

-___
DOPY Vaccination status

Cofchiéren Bet children

CRMOs 2459005
Method of 8 vl children who NOT recelve Menveccineted, enter reeton
Souree of information on
pare eritcation vaccine ORS Wrerunization (record
presentin present in (record code number trom ise
code nuenber from the Bst
house heute . below)
below)
Imeuniestion Card |0 +23 M01) 24-59 Mos

6 ’ ¢ ¢ e i 2
i

‘4

10

TOTAL

IMop-up

[Note: Any
Needed: YES___
Ln
Purok/Zone with 2 or more “Missed” children sholl conduct @
mop-up

REASONS FOR BEING UNVACCINATEO

feted all Bat apply for the Hr)

Code Reasons SOURCE REORMAT TION:

eee
Code Reasons soone
1 Parent wan sbsent/ away from home Code
z
Ce cee ee ee 30
31
Cock of trust in the vareinator
Child just recovered from Miness 0+ just }
Rago

nen acne
. nv
enperees, cischaged from the hospital the pareovearegiver
streamnet/ Yerpauin

we
=

4 Ould ateeady hay complete routine vaccination, extra

wae ofthe campaign ; fnewones
{pevne dove

;
fone cesar,
sed
penta refuted
33
44
Veceine team did rot vist
Cid wasa frome diferentarea
6
2
Socal Mecha (F8, Twitter,
Barangay officials
ete)
tadne perceives to tobe not ett lective, of low-quality
fi or on
25 Child was acutely sick or not feeling well
8 ne
expiry
36 Go not know/ dechnad be respond
8
9
Relstives/ neighbours
Onhers (specity}
7 Chart lg a nenboen sad parents bellewsd that her/his child is t00
17 Outright refusal
yourgte be given vaccination
Badd was akeeady eaccinetes by pravete apninst advised by
MAO, 1 Other (specityy:,

‘BrirateMO, thus parental connglvar refvsed: Agoladt religious belats

9 Recuher parzonal babelh or maconcestions of the perent of

caregiver on vorcination

RCM TEAM MEMBERS (Name and Agency)

1,

2
3.
Annex D: SEIR Operational Guidelines

A. To enhance the processing efficiency of vaccination linelist data, the following

measures have been implemented for the Catch-Up Immunization:
1. Deployment of dedicated domains in the country’s
major group of islands and
select regions and their corresponding Uniform Resource Locator (URLs):
a. For Metro Manila: https://seir-ncr.doh.gov.ph
b. For CALABARZON, please access https://seir-calabarzon.doh.gov.ph
c. For Ilocos, Cagayan Valley, Central Luzon, Bicol, MIMAROPA and
CAR
please access: https://seir-luzon.doh.gov.ph
d. For Eastern, Central and Western Visayas, please access
https://seir-visayas.doh.gov.ph '
For Zamboanga Peninsula, | Northern Mindanao, Davao,
SOCCSKSARGEN, CARAGA
Autonomous
and Ministry of Health — Bangsamoro
Region in Muslim Mindanao, please access:
https://seir-mindanao.doh.gov.ph

2. As an additional step, we have restricted access to these domains. They shall

ONLY
be accessible by the Municipal Health Office (MHO) for Independent
Component Cities and by the City Health Offices for Highly Urbanized Cities
within the designated region.

3. Accounts approved in 2023 have been migrated to the newly developed

domains and may login to their designated domains. ONLY newly hired
staff,
authorized to access these domains, should proceed with registration.

B. Submission Process
1, Encoders of Rural Health Units/Health Centers and
reporting units must do the
following prior to encoding:

a. Review the SEIR Manual, watch the video tutorials, and read the
Frequently Asked Questions (FAQs) all found in the SEIR domains.
b. Download and use the prescribed SEIR Prescribed Template V5
accessible in the downloads page of each of the SEIR domain. The
template uses Microsoft Excel for data entry. Below are the necessary
it:
activities needed to be done before using

e Microsoft Excel, a third-party software utilized by SEIR for mass

data collection even without internet access, has a crucial function.
However, it's important to note that this application adopts the date
and time settings of the device being used by the encoder.
Therefore,
any discrepancies in the date and time settings format can lead to
errors during data uploading in SEIR. As a reminder, please ensure
the following steps are completed before encoding in the linelist
template:
 © Go
to the settings of your laptop/desktop unit.
o Select the “Time & Language” option and select
“Language and Region” option.
© Choose Philippines as the default country and select
English (US) as
the regional format.

o Expand theselection under the “Regional format” and

choose mm/dd/yyyy as the default format of the system.
(please watch the Instructional video for Encoders or
read the manual on the SEIR website).

c. Completeness of Data and Compliance to the SEIR Data Standards

A maximum of 500 rows/records should be encoded per linelist.
All fields with an asterisk (*) are considered required. Failure to
populate any of these fields will result in failure of uploading.
Almost all fields are with drop down options. ONLY use the options in
the drop-down lists. Using options not available in the drop-down lists
will result in failure of uploading.

Both the “Permanent Address and Place of Vaccination” are using the
Philippine Standard Geographic (PSG) codes of the PSA. Each column
for these sections is dependent from the previous column. You have to
choose using this sequence: region, province, city/municipality and
barangay.

The “REASON_FOR_REFUSAL/DEFERRAL”
you have selected either Defer/Refuse
is
ONLY required if
under the “Action Taken”
column. Failure to select an option under this column when selecting
Defer/Refuse will result in failure to upload.

The
ONLY
“DEFERRAL_DATE_OF NEXT_VISIT (MM/DD/YYYY)”
required if you have selected “Defer” under the “Action Taken”
is
column. Populating this field when selecting either Vaccinate/Refusal
under the “Action Taken” column wiil result in failure of upload.
The SEIR will always check the data indicated in the “Place of
Vaccination” section (PLACE OF VACCINATION REGION; PLACE
OF VACCINATION PROVINCE; PLACE OF VACCINATION
MUNI_CITY; PLACE OF VACCINATION BARANGAY) SEIR will
not accept the data uploaded
if
it detected that the data encoded
of Vaccination” section is not under the
in
the “Place
jurisdiction of the account you
same
are using. This is to ensure that the accomplishment of the
collected.
is correctly
region

Prior to uploading the encoders must check the above-mentioned

details to lessen the time spent in
correcting the
linelist uploaded.
 d. Proper Copying and Transferring of data in the SEIR Linelist Excel
template
© DO NOT “drag down” cells to copy data. This will cause
alterations to fields with reference codes. The safest way to copy
is
to select the desired cells and selecting paste option “Paste Values”.
© When copying massive amounts of data from one template to another,
always double check if the copied cells are pasted correctly to the
target cells. Each column of the template has a specific set of values
that SEIR validates. Improper formatting will result in failure of
uploading.

e ’ All health facilities shall encode their accomplishment on a daily basis

and shall submit them to their respective CHO/MHO daily. A File
naming convention must be adopted to prevent confusion in uploading
linelists by the users: LGU_BRGYname_date) (ex. xd
Manila_Brgy1_05032024).
2. MHO and CHO
SEIR accounts:
to
do the following prior to logging in to their respective

a. Review the SEIR Manual, watch the video tutorials, and read the
Frequently Asked Questions (FAQs) all found in the SEIR domains.
b. The system always downloads a linelist result immediately after
uploading a linelist. Use this as a guide for correcting the errors you are
encountering when uploading:

"INVALID VACCINATION DATE!" - Invalid vaccination date

encoded in the linelist should follow (mm/dd/yyyy) format.
e "INVALID
-
DEMOGRAPHIC DATA!, INVALID DATE OF
BIRTH" Invalid birthdate encoded in the linelist should follow
(mm/dd/yyyy) format.
e "INCOMPLETE VACCINATION DATA!" Failed to populate one
(1) or more required fields.
© "Invalid Vaccination Data, This Data doesn't belong to this User
Data Coverage!"- the "Place of Vaccination” columns, specifically
the Province and City of the record you are uploading is not under
the scope of your account. You can only upload records with the
same province and city of your account under the "Place of
Vaccination" columns.
® "Invalid Vaccination Data, Incorrect permanent address!" - Check
the columns under the "Permanent Address". The region, province,
city and barangay should be under the same coverage.
® "Invalid Vaccination Data, Kindly verify Row Data for Vaccinated
vs Refusal/Deferral Data!" - Must populate the "Reason for
refusal/deferral" column if the selected option under the “Action
Taken" tab is either "Deferred/Refused".
¢ “Import Failed”
- Intermittent internet connection during uploading
of the data. All records with this in the remarks should be collated
and reuploaded again.
 c. MHO/CHO shall upload all received linelists from the health facilities
under their jurisdiction and upload them in SEIR on or before the Ist
Monday
of the Following Month (i.e., March 4, 2024 for February 2024;
April 1, 2024 for March 2024, etc.). All data uploaded during the time
period will reflect as the accomplishment of the region that will be
reflected in the dashboard managed by the Epidemiology Bureau.

3. Provincial Health Offices, CHDs, and MOH-BARMM

will be granted solely
viewing accessto the linelist data submitted by their corresponding MHOs and
CHOs. To maintain ari organized and efficient record- keeping
process, it is
advisable to follow a linear submission approach from RHUs/HCs
(encoding)
to MHO/CHO (uploading), then to PHOs and CHDs/MOH-BARMM
(viewing). This method. ensures a streamlined tracking of records, minimizing
the risk of duplicating work,