Status of Measles Response Immunization in Region 1

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
September 6, 2018
MCV2 Coverage,
100
Region1, 2015-2017*
90
80
70
60
50
40
30
20
10
0
2015 2016 2017

*2017 data - 4th quarter data but may be subject to change after inclusion of late reports; data source: FHSIS
September 6, 2018
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
90
80
70
60
50
40
30
20
10
0
MCV2 MCV 1
September 6, 2018
2017 NDHS Result

September 6, 2018
2017 NDHS Result
2.9 17.5
% %
decrease decrease
from 2008 from 2008
NDHS NDHS

September 6, 2018
Number of Measles Susceptibles and Population Immunity
Total
Total MCV1 Vaccine Total
Province Unimmunized Failure Measles 2018 Target Population
(2015-217) (2015- Susceptible Population Immunity
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.
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
September 6, 2018
Surveillance of
Measles and Rubella Cases

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
Epidemiologically linked A suspect case that has not been confirmed by laboratory but has
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.

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

September 6, 2018
Reported Laboratory Confirmed Measles Cases
By Province
2015 – 2018*
20
18
16 19 21 91 68
14
4 15 73 54
12
10
0
*data as of August 4, 2018

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

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

September 6, 2018
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
Calasiao Lab Confirmed 301 Yes
Lab Confirmed 232 Unknown
Dagupan City Lab Confirmed 23 None
Lab Confirmed 87 Yes
September 6, 2018
CY 2018

Lab Confirmed
and Equivocal
Pangasinan
Dagupan Lab Confirmed 10 None
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
Lab Confirmed 87 Yes
September 6, 2018
CY 2018

Lab Confirmed
and Equivocal
La Union
Agoo Lab Confirmed 54 Yes
Aringay Lab Confirmed 10 Yes
Bauang Lab Confirmed 29 Yes
Caba Lab Confirmed 59 Yes
Ilocos Norte
Currimao Lab Confirmed 15 Yes

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

September 6, 2018
Vaccination Status of Confirmed Measles
Cases (n=27)
January 1 to August 4, 2018
not eligible for

vaccination
19%
vaccinated
unknown 41%
11%
not vaccinated
30%

September 6, 2018
Department Memorandum No. 2018 - 0137

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

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

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.
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.

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.

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%

September 6, 2018
Specific Guidelines
• Vaccine
7
63
69
9468
19
19
119
Measles Rubella Mumps

September 6, 2018
Specific Guidelines
• Vaccine
Live-attenuated virus Live-attenuated virus
vaccine vaccine
5-dose vial vaccine 10-dose per vial
Lyophilized powder
requiring reconstitution Lyophilized powder requiring
with supplied diluent reconstitution with supplied
from the supplier diluent from the supplier
Safe and effective

Safe and effective

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

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

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

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

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

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

September 6, 2018
Specific Guidelines
• Vaccine Safety
– Immediate dispose
1 hourused
after reconstitution,
syringes a d diluted
needlesMCV
into the
loses 50% of its potency at 20 C and o
safety collector box100% of its potency at 37 C o
– Used needles and syringes, empty vials, used cotton

It is important to ALWAYS put the DATE
balls are considered infections
and TIME and shall be disposed in
of opening/reconstituting
the recommended vaccines
appropriate disposal of
infectious/biological wastes
Final disposal of safety collector box(es)
– It is recommended that needles
with used the vaccine be usedshould
and syringes as soon as
follow the DOH recommended
possible after reconstitution. Opened and disposal
reconstituted
for hazardous wastes under the
MCV shall be discarded 6 hours
Philippine from reconstitution
Sanitation Code or
at the end of the immunization period.

September 6, 2018
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”

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

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/Distric submitted and must send the reports to next
t 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
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
September 6, 2018
September 6, 2018
Thank you…
Maraming Salamat Po!!!!

September 6, 2018
September 6, 2018
September 6, 2018
September 6, 2018
September 6, 2018
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

September 6, 2018
September 6, 2018

Status of Measles Response Immunization in Region 1

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Status of Measles Response

Department Memorandum No. 2018 - 0137

Orientation on Ligtas Tigdas Supplemental Immunization Activity

2015 2016 2017

2015 2016 2017

MCV2 MCV 1 2017 MCV1 VS MCV2 MCV2 MCV 1

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Confirmed measles case Laboratory confirmed + epidemiologically linked measles cases

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

not eligible for

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Total Population x 10.8%

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

5-dose vial vaccine 10-dose per vial

Safe and effective

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Immunosuppressive or cancer treatment

Primary and acquired immunodeficiency

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

• Give one dose of MCV to 6-59 months

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

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

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Infants given MCV at 6-8months old are

Only infants and children that are eligible

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Do not freeze diluents. Use only diluents that

Excess unopened vaccines brought in

Protect the vaccine from the light at all times,

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

safety collector box100% of its potency at 37 C o

– Used needles and syringes, empty vials, used cotton

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

Orientation on Ligtas Tigdas Supplemental Immunization Activity

PHO/City/District shall validate all reports

All reports received every Friday shall be

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

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

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

If in one community, many unvaccinated infants and

Maraming Salamat Po!!!!

Orientation on Ligtas Tigdas Supplemental Immunization Activity

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