VACCINE PREVENTABLE DISEASE SURVEILLANCE

Regional Epidemiology and Surveillance Unit CaLaBaRZon

What are Vaccine Preventable Diseases?

Universal Child and Mother Immunization Goals in 1986 Presidential Proclamation No. 6 s 1986

Polio Measles Tetanus

Diptheria Pertussis Tuberculosis

Priority diseases for elimination and eradication

What are the VPD Disease Eradication/ Elimination Goals?

Global Polio Eradication Eradicate wild poliovirus worldwide. Measles Elimination Stop the transmission of endemic measles virus Target Measles Incidence: <1/ 1, 000, 000 population

Neonatal Tetanus Elimination Achieve and maintain <1 NT case per 1,000 live births in every municipality / city every year

What is Vaccine Preventable Disease Surveillance?

An integrated surveillance for Acute Flaccid Paralysis (AFP), Measles, Neonatal Tetanus (NT) and Adverse Event Following Immunization (AEFI) Intensive and case-based Follows the same structure, framework and reporting flow of the Philippine Integrated Disease Surveillance and Response One of the strategies: to achieve elimination of measles and NT to sustain polio-free status

ACUTE FLACCID PARALYSIS

Case Definition

Any child under 15 years of age with sudden onset of floppy paralysis, OR A person of any age in whom poliomyelitis is suspected by a physician.
Acute: sudden onset of paralysis. Usually the interval from the onset (first sign of muscle weakness to inability to move the affected limb/s) takes 3-4 days but may extend to two weeks. Flaccid: is the loss of muscle tone of the affected limb(s) giving it a floppy appearance (as opposed to spastic or rigid) Paralysis: is the reduced or loss of ability to move the affected limb(s)

What are the Differential Diagnosis used to Detect AFP Cases?

Poliomyelitis
Guillain-Barre

Syndrome (GBS) Myelitis (i.e Transverse myelitis, Potts disease) Traumatic neuritis Other disease as long as AFP is manifested

Case Investigation

Verify if the case satisfies the case definition for AFP

Case Investigation
If If the answer to ALL 5 questions is YES,
IMMEDIATELY: Facilitate complete case investigation. Collect 2 stool specimens Secure a photocopy of the patients medical chart and laboratory test results Notify your next higher next higher level

Stool collection, storage and transport guidelines

1. Collect 2 stool specimens, adults thumb size; if the stool is watery, fill up (or at least 5 ml) of the specimen collection container. 2. Collect within 14 days from onset of paralysis 3. Collect 24-48 hrs apart 4. Place each specimen in a standard leak proof container 5. Keep in refirgerator at 4-8 C (do NOT FREEZE) 4. Properly label specimens with the name of the patient, date of collection and specimen number.

Stools should reach RITM within 3 days after collection.

What is an AFP Hot Case

a child with AFP below 5 years old, has less than 3 doses OPV, had fever at onset of asymmetrical floppy paralysis All AFP cases with poliovirus isolate regardless of type is considered a hot case until the Regional Polio Reference Laboratory completed Intratypic Differentiation (ITD) showing the type of isolate is sabinlike or vaccine-strain (e.g. live attenuated poliovirus in OPV) All hot cases must be IMMEDIATELY reported to RESU and NEC for appropriate and immediate action

In essence, what we really want to prove is that

None of the AFPs are due to polio.

Requirements for EPM Classification

Immediate reporting of AFP case to the RESU/PESU/CESU Properly fill up the Case Investigation Form Complete history of the AFP case with the chief complaint as inability to move the extremities or paralysis and the vaccination status of the case Basic neurological examination on admission or consult ( Deep Tendon Reflex, Sensory, Motor) 2 stool samples collected 24 to 48 hours apart taken within 14 days from onset of paralysis

Poliovirus travels! - by land - by sea - by air

And everybody can be a carrier!

MEASLES

Standard Measles-Rubella Case Definition

Suspected Case
Any individual, regardless of age, with the following signs and symptoms:
fever (38C of more, or hot to touch); and

Maculo-papular rash (non-vesicular)

at least one of the following: cough, coryza (runny nose) or conjunctivitis (red eyes).

What are the Differential Diagnosis used to Detect Cases?

Febrile exanthems (fever and rash) Rubella Roseola infantum (exanthema subitum) Dengue Scarlet fever Mononucleosis Meningococcemia Other viral exanthems

Case Investigation

Verify if the case satisfy the case definition for Measles-Rubella

MEASLES-RUBELLA LAB CONFIRMATION

Laboratory confirmation is very important in measles elimination since clinical diagnosis is not sufficient to confirm measles infection Documenting measles virus genotype through viral isolation serves as evidence of measles elimination status
Serum sample collection remains the GOLD STANDARD for confirming suspect cases under surveillance.

Blood Specimen Collection

Collect 3-5 cc blood from the patient, at first contact or between 4 28 days after onset of rash. Centrifuge at low speed (1,000-1,500 rpm for 5 minutes) to separate serum from the clot within the following 24 hours. Discard supernate. Decant the serum into a properly labeled cryovial. Avoid mixing red blood cells with the serum as these hemolyze during storage. Store cryovial in the refrigerator at 20C/freezer.

MEASLES-RUBELLA LAB CONFIRMATION

NPS and/or OPS for Virus Isolation collect NPS and/or OPS samples for virus isolation within 1-3 days from rash onset. PCR and genotyping are best done on viral isolates Viral isolation is significant to provide isolates that can be genotyped. Genotype data confirm whether the transmission of indigenous measles strains has been stopped. This will certify if the country has achieved the measles elimination goal

NEONATAL TETANUS

Standard NT Case Definition

Suspected Case

Any neonatal death from 3 28 days of age in which the cause of death is unknown, OR Any neonate reported as having suffered from neonatal tetanus from 3 to 28 days of age and not investigated.

Confirmed Case Any neonate that sucks and cries normally during the first 2 days of life, and becomes ill from 3 to 28 days of age and develops both an inability to suck and diffuse muscle rigidity (stiffness), which may include trismus, clenched fists or feet, continuously pursed lips, and/or curved back (opisthotonus), OR A neonate from 3 to 28 days of age diagnosed as a case of tetanus by a physician.

The case classification of NT is based solely on clinical criteria and does not require laboratory confirmation

Note: The date of birth is considered as the first day of life

Neonatal Tetanus Case Investigation

Verify if the case satisfies the case definition for Neonatal Tetanus

ADVERSE EVENT FOLLOWING IMMUNIZATION

Adverse Event Following Immunization

A medical incident that takes place after an immunization, causes concern, and is believed to be caused by immunization.

Types of AEFI
Common/ Minor Reaction Serious/ Rare Reaction - Hospitalized - Causes Disability - Death - Life-Threatening

Note: Only serious AEFIs, clustering of minor AEFIs and other severe and unusual events are submitted to the next higher level.