School-Based Immunization

Orientation
Population: 4,768,630
(2015)
5 Provinces
9 Cities
84 Municipalities
84 RHUs
2,020 barangays
Elementary Schools-2,092
2014-2015 Grade 1 enrolees:
Male -56,381 ;
Female - 49,460
Total: 105,841
Public Secondary Schools-355-
2014-2015 Grade 7 enrolees-
Male- 35,785 ;
Female -34,934
Total: 70,719
Objectives:

To present and orient participants on School –Based immunization

guidelines and immunization forms;
To orient the participants on School – based Deworming activities;
To orient the Health Service Providers on Inactivated Polio Vaccine
(IPV);
To finalize the number of Grade 1 and Grade 7 immunization targets
per Province/Municipalities;
To plan for the August 2015 National School-Based immunization
activity;
The Vaccine Introduction in the
Philippines (1)

2010
1992 MMR
Hepatitis B Pentavalent
1982 vaccines
Anti- (DPT-HepB-HiB)
measles vaccines
1979
vaccine
BCG, DPT
1976 TT for mom
EPI was OPV
launched
The Vaccine Introduction in the
Philippines (2)

2016 & Beyond*

2015*
Dengue
HPV
2014 Japanese Encephalitis
Cholera
IPV
2013 Dt for
PCV schoolchildren

2012 MR & Td for

adolescents
Rotavirus * For Introduction
vaccine
Flu &PPV for
Senior Citizen
 RATIONALE:
Philippines Expanded Program on Immunization (EPI) –
-focused on the provision of free vaccines for infants as their
primary series to booster doses.

Protection produced by some vaccines

 declines over time
 booster doses may be needed to ensure high levels of protection
are maintained
( ex. diphtheria, whooping cough and tetanus )
RATIONALE:
A booster dose given anytime after primary series will
-provide protection over a longer period of time.
-Also new vaccines such as the human Papillomavirus (HPV)
vaccine are more effective if delivered at a specific age.
 RATIONALE:
With the availability of newer vaccines (e.g. human papillomavirus
(HPV)) and greater attention to providing booster doses of routine
vaccines to older children (e.g. DTP, 2nd dose of measles), the School
Immunization Strategy will become even more promising.

it is important that healthcare service providers take every available

opportunity to deliver vaccines and start vaccination for the
schoolchildren and adolescents enrolled.
Department of Health (DOH) in collaborations
Department of Education (DepEd) & Department of
Interior and Local Government (DILG) & local health
units started the vaccinations among adolescents in
2013.
Three (3) vaccines introduced:

combination of Measles-Mumps-Rubella (MMR),

Tetanus-diphtheria (Td) and

Human Papillomavirus (HPV) vaccines in selected public secondary

schools only (20 poor Provinces)

MR and the Td were introduced - as an integral immunization

strategy toward the eliminations of the measles and tetanus and the
controls of the mumps, rubella and diphtheria in selected secondary
schools
Target Population

All eligible Grade 1, Grade 4 (not included this year for Region
X) and Grade 7 children enrolled in public schools nationwide
shall receive the FREE vaccines in the identified vaccination sites
or school clinics in collaboration with the local government health
centers/units.
RECOMMENDED VACCINES FOR SCHOOL CHILDREN & TEENS
IN PUBLIC SCHOOLS

Grade 1 Tetanus -diphteria (Td) vaccine

Grade 1 Measles Containing Vaccine (MCV)

Grade 4 Human Papilloma Virus (HPV)

Tetanus-diphtheria (Td) Vaccine

Grade 7 Measles Containing Vaccine (MCV) - MR

I. All school children enrolled in Grade 1, Grade 4 and Grade 7 shall be
vaccinated with the appropriate vaccines.
1.1 All eligible children (male or female) should be :

◦ a. Screened for their measles vaccination history at the time of

school entry and vaccinated if evidences show either zero or only 1
dose to ensure that these students received at least 2 MCV by
school entry.

◦ b. administered with one (1) dose of Tetanus-diphteria (Td) vaccines.

 General Guidelines:

1.2. All 9-13 years old , female school children enrolled in Grade
4 shall be vaccinated with 2- dose quadrivalent HPV following
the DOH recommended immunization schedule.( only for 20
prioritized Provinces)

1.3. All male and female students enrolled in Grade 7 regardless

of age shall be vaccinated with 1 dose each of Measles-Rubella
(MR) and Td vaccine on the same immunization session.
 General Guidelines

2. School Based vaccination shall be a FREE routine service to

be administered by the health center catchment and the
schools.
3. Only Students with parental/guardian consent shall be
vaccinated.
4. In case of zero or 1 dose or vaccination refusal or no
immunization card presented the student shall not be
suspended, grounded nor reprimanded.
 SPECIFIC GUIDELINES:
A. Vaccination for Grade 1 students by school entrance:
All Grade 1 clinic teachers/school nurses shall issue notification letter of
health services to be received by the students including immunization
upon enrolment.

All parents/guardians of the enrolled students are encouraged to bring

the immunization card within 1 month after enrolment.

Clinic teacher shall list all the enrolled students in Grade 1 using
Recording Form 1 (Masterlist of Grade 1).
 A. Vaccination for Grade 1 students by school entrance:

The teacher in-charge, clinic teachers/school nurse shall submit the

completed Recording Form to the RHU/MHO.
 students with recorded 2 doses of MCV: DO NOT VACCINATE
 Students with zero dose (0) of MCV or no immunization card:
Give the 1st dose of MCV (0.5ml Subcutaneous, Right deltoid), and
another dose at least 1 month after.
 student with only 1 dose of MCV : give the MCV dose
all students shall receive Td 0.5 ml, deep Intramuscular, left deltoid
A. Vaccination for Grade 1 students by school entrance:
 teacher in-charge shall follow up the deferred students and refer to RHU for
the MCV dose within 2 weeks after the scheduled vaccination.

students who will be referred and vaccinated at the RHU shall be

accompanied by the School Nurse and shall be included in the consolidated
accomplishment report of the RHU

Al students who receive the MCV and Td vaccines shall be recorded in
Recording Form 1.
 B. Vaccination for Grade 4, Female, 9-13 years old

 all 9-13 years old female students in Grade 4 with parental/duardian

consent shall be vaccinated with 2-doses of the quadrivalent Human
Papilloma Vaccine (HPV) in the designated immunization posts in all public
schools
 all students shall receive HPV 0.5 ml, Intramuscular Left Deltoid arm

All students who receive the first dose of HPV, shall be given the 2nd dose
after 6 months.
 all students who receive the HPV vaccine shall be recorded in Recording
Form 2
C. Vaccination for Grade 7 Students with Td and MR:

 all males and females shall be vaccinated with both MR and Td vaccine
in the designated immunization post and record in the Recording Form
3.
 students with parental consent but were missed – be followed up and
referred to RHU for the needed vaccination
 Health workers shall be sensitive in asking questions about sexual
activities.
 C. Vaccination for Grade 7 Students with Td and MR:

students who received the Td and MR vaccines, refused for vaccination

shall be recorded in the Recording Form 3.

All students shall receive the MR vaccine, 0.5 ml subcutaneous, Right-

Deltoid arm and the Td vaccine, 0.5 ml, Intramuscular, left-deltoid arm.
 Schedule, Route, Doses Required :
Grade Number of Doses
Name of Vaccine Route of Administration
level Required
Grade 1 Diphtheria-Tetanus containing 0.5 ml , IM 1
vaccine (Dt/Td) Left Arm
Measles Containing Vaccine 0.5 ml , Subcutaneous, 1
(MCV) Right deltoid
Grade 4 Quadrivalent Human Papilloma 0.5 ml, Intramuscular 2 (6 mos. After)
Vaccine (HPV) Left Deltoid arm

Grade 7 Tetanus-Diphtheria (Td) 0.5ml, IM 1

Left Arm

Measles-Rubella (MR) 0.5 ml,

Subcutaneous, Right Arm 1
Pre-vaccination Preparatory Activities/Steps
 Planning and Coordination
An immunization committee within DepEd-DOH-DILG with
memberships from other interested organizations indicating the
specific/defined roles and functions of each
agency/organization shall be organized to oversee the over-all
implementation of the vaccination in schools.

All teachers, parents, guardians and carers of these students and

other partners in school or community shall be well-informed of
the school-based immunization.
Organization of Vaccination Teams:

•The vaccination team (VT) shall be composed of a vaccinator

and a recorder. Both of them shall be oriented on the
guidelines for school-based vaccination.

Vaccinator can either be a doctor, a nurse, or a midwife.

Experiences from previous mass immunizations with an
injectable vaccine showed that 1 VT can vaccinate at least 70-
100 students per day.
 Organization of Vaccination Teams:

Assignments of vaccination team:

◦ At least 1 VT for Grade 1 students to administer Dt-containing
vaccines
◦ At least 1 VT for Grade 1 students to administer Measles -containing
vaccines
◦ At least 1 VT for Grade 4 students to administer HPV (not
included in Region X for this year)
◦ At least 1 VT for High School students to administer MR
◦ At least 1 VT for High School students to administer Td
 Organization of an Adverse Event Following Immunization (AEFI)
Team:

Fear of injections- results to fainting has been commonly observed in

school immunization.
- recommended that the vaccination sites are situated in areas not
conspicuous to the students.
- immunization session shall be conducted after recess- to rule
fainting secondary to hypoglycemia.
Organization of an Adverse Event Following
Immunization (AEFI) Team:
 Schools shall identify a medical team responsible for management
and response of any AEFI.
- coordinated with the local health unit, ( province or city) for
trained health professionals for the schedule of the immunization in
schools.
 identify and orient Referral hospital –for serious AEFIs including its
management and response.
 The existing guidelines DOH guidelines in AEFI investigation,
recording and reporting shall be used for this purpose.
 Anaphylaxis Response Kit:

The availability of protocols, equipment and drugs

necessary for the management of anaphylaxis should be
checked before each vaccination session.

 Anaphylaxis Response Kit:
anaphylaxis response kit should be on hand at all times and should contain:
adrenaline 1:1000 (minimum of three ampoules – check expiry dates)

minimum of three 1 mL syringes and 25 mm length needles (for

intramuscular [IM] injection)

cotton swabs

pen and paper to record time of administration of adrenaline

copy of adrenaline doses

copy of ‘Recognition and treatment of anaphylaxis’

 Drug, Site and Frequency of Administration: Dose Dose (Child)
Route of (Adult)
Administration
Epinephrine Repeat in every 5-15 min. as 0.5ml According to age:
1:1000, IM to needed until there is <1 year: 0.05ml
the midpoint of resolution of the anaphylaxis
the anterolateral 2-6 years: 0.15ml
aspect of the NOTE: Persisting or worsening
middle 3rd of the cough associated w/ 6-12 years: 0.3ml
thigh pulmonary edema is an
immediately important sign of epinephrine Children > 12
overdose & toxicity years: 0.5ml
NOTE:
The needle used for injection needs to be sufficiently long
to ensure that epinephrine is injected into muscle.
 Treatment Guide for Anaphylaxis:
 If the patient is conscious after the epinephrine is given, place the head
lower than the feet and keep the patient warm.
 give oxygen by facemask, if available
 transfer the patient to nearby hospital for further management, but
never leave the patient alone.
 if there is no improvement in the patient’s condition within 5 minutes,
repeat giving a dose of epinephrine ( maximum of 3 doses).
 Secure a Valid Consent:

Valid consent –voluntary agreement by an individual to a

- proposed procedure, given after sufficient, appropriate and reliable I
information about the procedure,
-including the potential risks and benefits, has been conveyed to that I
individual.
persons to be vaccinated and/or their parents/carers
should be
-given sufficient information (preferably written) on the
risks and benefits of each vaccine,
-including what adverse events are possible, how
common they are and what they should do about
them.
 Secure a Valid Consent:
For consent to be legally valid, the following elements must be present:

It must be given by a person with legal capacity, and of sufficient

intellectual capacity to understand the implications of being
vaccinated.
• It must be given voluntarily in the absence of undue pressure, coercion
or manipulation.
• It must cover the specific procedure that is to be performed.
• It can only be given after the potential risks and benefits of the
relevant vaccine, risks of not having it and any alternative options have
been explained to the individual.
 Secure a Valid Consent:
• Consent should be obtained before each vaccination, once it has been
established that there are no medical condition(s) that contraindicate
vaccination. Consent can be verbal or written.

• Should a child or adolescent refuse a vaccination for which a

parent/guardian has given consent, the child/adolescent’s wishes
should be respected and the parent/guardian informed.
Immunization Safety

The process of ensuring the safety of all aspects of immunization,

including vaccine quality, adverse events surveillance, vaccine
storage and handling, vaccine administration, disposal of sharps
and management of waste.
 Immunization Safety
Special precautions must be instituted to ensure that blood- borne diseases
are not transferred to other persons:

 Use an Auto-disable syringe in all immunization sessions.

Do not pre-filled syringes.

Do not recap needles.

Dispose used syringes and needles into the safety collector box.
 Immunization Safety:
Proper disposal of safety collector boxes with used immunization wastes
through the recommended appropriate final disposal for hazardous wastes.

 Use of aspirating needles and pre-filling syringes are strictly prohibited.

Used needles and syringes, empty vaccine vials, used cotton balls are
considered infectious and shall be disposed in the recommended appropriate
disposal infectious/biological wastes.
 Vaccine Storage, Handling and Transport of Vaccines

1. DOH shall provide the MR, HPV and Td vaccines to all

regions following the proper storage of the vaccines.

2.MR, HPV and Td vaccines shall be stored at +2⁰C to +8⁰C

during immunization session.

3.MR vaccine shall be discarded after 6 hours of reconstitution

Vaccine Storage, Handling and Transport of Vaccines
4.Td vaccine follows the multi-dose vial policy. Open vials of Td vaccine
may be used in subsequent sessions (28 days) provided the following
conditions are met.
a.Expiry date has not passed;
b.Vaccines are stored under appropriate cold chain conditions;
c.Vaccine vial septum has not been submerged in water;
d.Aseptic technique has been used to withdraw all doses;
e.Vaccine Vial Monitor (VVM) is intact and has not reached the
discard point;
f. Date is indicated when the vial was opened.
For HPV vaccines to be effective:
-be given prior to exposure to HPV.

-There is no reason to wait until a teen is having sex to offer HPV

vaccination to them.
- Preteens should receive all three doses of the HPV vaccine series
long before they begin any type of sexual activity and are exposed to
HPV.
-Also HPV vaccine produces a higher immune response in
preteens than it does in older teens and young women.
-One HPV vaccine—the quadrivalent vaccine called Gardasil—is
also for boys.
This vaccine helps prevent boys from getting infected with
the types of HPV than can cause cancers of the throat, penis
and anus.
The vaccine also prevents genital warts. When boys are
vaccinated, they are less likely to spread HPV to their
current and future partners
Recording and Reporting Accomplishment Reports

 Each level of vaccination schedule - appropriate recording and

reporting forms shall be completed and submitted from the service
delivery point to the next higher administrative level.

 flow of submission of reports- refer to the table/ attached anexes.

 Accomplishment reports shall be submitted by the DOH Regional
Offices to the DOH National Office after 2 weeks.
 Flow and Submission of Reports:
Levels of Type of Report Responsible Person To be Submitted to: Schedule of
Implementation Report
School Recording Form 1: Masterlist of Teacher/School Midwife Weekly
Grade 1 Students Nurse
Recording Form 2: Masterlist of
Grade 4 Students

Recording Form 3: Masterlist of

Grade 7 Students

RHU Consolidated Accomplishment RHU Midwife Provincial/City Weekly

Report by school per Municipality Adolescent
Coordinator
PHO/CHO Consolidated Accomlishment PHO/CHO Regional Adolescent Weekly
Report by Municipalities Adolescent Coordinator
Coordinator
RHO Consolidated Accomplishment Regional Adolescent National Adolescent After 2
Report by Provinces/ Cities Coordinator Coordinator weeks
No. of Grade 1 & Grade 7 targets for immunization in August 2015:
PROVINCE/CITY GRADE 1 GRADE 7
MALE FEMALE MALE FEMALE
Cagayan de Oro City
7,132 6,252 4,701 4,467
El Salvador City
558 533 337 309
Gingoog City
2,068 1,774 1,215 1,227
Iligan City
4,380 3,838 2,883 2,989
Malaybalay City
2,593 2,071 1,894 1,826
Oroqueita 688 702 783 769
Ozamis City 1,524 1,366 1,190 1,130
Tangub City 793 736 759 747
Valencia City 2874 2415 946 962
TOTAL: 22,610 19,687 14,708 14,426
No. of Grade 1 & Grade 7 targets for immunization in August 2015:
PROVINCE/CITY GRADE 1 GRADE 7
MALE FEMALE MALE FEMALE
BUKIDNON
10,754 9,212 5,955 6,082
CAMIGUIN
1,108 988 1,047 797
MIS. OCC
3,852 3,358 2,579 2,412
MIS. OR
9,206 8,313 7,553 7,241
LANAO DEL NORTE
8,791 7,842 3,943 3,976
TOTAL 33,711 29,713 21,077 20,508
 ROLES AND FUNCTIONS:
1. Department of Health (DOH) – provide the logistics (Needle/syringes
epinephrine, safety collector boxes, immunization card, recording and
reporting forms)

◦ a. Disease Prevention and Control Bureau (DPCB) – develop guidelines,

policies and standards for school based immunization in collaboration
with DepED.

◦ b. Epidemiology Bureau – review/revise and incorporate the official

recording and reporting forms , collect all the accomplishment reports
and AEFIs
ROLES AND FUNCTIONS:
◦ c. Health Promotion Unit- develop the advocacy, communication
plans and IEC materials for replication by the Regional Health Offices

◦ d.Bureau of Local Health Development- ensure the preparedness and

acceptance of the various local government units towards the school
vaccinations.
◦ e.Regional Health Offices- responsible for monitoring the school –
based immunization at the different public schools and ensure that
health worker at the local level be oriented about the school based
immunization.
 ROLES AND FUNCTIONS:
2.Department of Education- assist and facilitate for the implementation
of the immunization in school, issue memorandum about the activity,
inform students/parents/teachers/school clinic staff, screen students at
school entry and submit reports to the local health units.

◦ a.Health and Nutrition Bureau- ensure the complete vaccination status

of all children entering primary school.
◦ -ensure that mothers of all children with incomplete immunization be
informed of the immunization program provided by the government
 ROLES AND FUNCTIONS
a.Health and Nutrition Bureau- identify and report any case of suspected
vaccine preventable disease to the concerned local health units.
◦ - annually monitor the school lists to ensure compliance by all schools and
submit annual reports of school compliance to DOH.

3. Department of Interior and Local Government- issue a memorandum

to all the Local Chief Executive (LCE) for their active participation to the
activity.
 ROLES AND FUNCTIONS
4. Local Government Units- health personnel (MDs, Nurses, midwives ,
volunteers) lead the vaccination in collaboration with schools, hospitals
and other partners within the catchment areas.

5. Parents-Teachers Association- members shall be oriented and raise

awareness in the guidelines for school-based immunization.

6. Private Sector/Professional Organization- ensure that every

child/student received the appropriate vaccines and other child health
interventions
 THANK YOU
AND
GOD BLESS US ALL!