Immunization Systems Across The Globe

Abstract
A key method of reducing morbidity and mortality is childhood immunization, yet in 2003
only 69% of Filipino children received all suggested vaccinations. Data from the 2003
Philippines Demographic Health Survey were used to identify risk factors for non- and
partial-immunization. Results of the multinomial logistic regression analyses indicate that
mothers who have less education, and who have not attended the minimally-recommended
four antenatal visits are less likely to have fully immunized children. To increase
immunization coverage in the Philippines, knowledge transfer to mothers must improve.
Kalinga health workers set to

hold measles immunization
BY: GERALDINE G. DUMALLIG
Thursday 30th of January 2014
2 0 0 0 0
Kalinga health workers to conduct measles immunization

By Geraldine G. Dumallig
TABUK CITY, Kalinga, Jan. 30 (PIA) Health workers in the province are set
conduct measles immunization among 9 to 11 months old children as part
of the continuing program to eliminate measles in the country.
According to Minda Bawalan, Measles Program Coordinator of the Provincial
Health Office (PHO), Kalinga provincial governor Jocel Baac recently issued a
directive to all mayors in the province to facilitate the activity through their
respective health departments especially that reports of outbreak had been
recorded in Manila.
Bawalan said that the directive is not a mass vaccination but it must cover all
9 to 11 months old and the defaulters or missed children up to eight years of
age.
Six to eight months old babies are included as regularly done and the health
worker must have to give them another shot when they reach nine to 11
months, she said.
Provincial Epidemiologist and Surveillance Unit (PESU) provincial coordinator
Jose Pardito Jr. said that for January, the province has 12 suspected cases
which were submitted to the Department of Health Research Institute for
Tropical Medicine (DOH-RITM) for validation. At present, there is no confirmed
case yet.
In 2012, the PESU reported four suspected cases but DOH-RITM test results
yielded negative.
According to Pardito, the public especially parents play an important role in

preventing any outbreak or acquisition of said deadly disease.
He said that based on records, several children are still considered defaulters
in some areas of province due to negligence of parents to bring their children
to the health center.
If you love your children protect them and sacrifice a day just to bring them
to the nearest health center for immunization, he said.
Mass immunization is scheduled in June during the Measles-Rubella
Supplemental Immunization Activity or MR-SIA. (JDP/GGD- PIA CAR, Kalinga)
- See more at: http://news.pia.gov.ph/index.php?article=191391053291#sthash.IONMBlrU.dpuf
CDC writes reports and articles in order to share knowledge and contribute to the improvement of
immunization systems across the globe. Recent reports and articles are organized by topic below.
Note: Linking to a non-federal site does not constitute an endorsement by HHS, CDC, or any of its
employees of the sponsors or the information and products presented on the site.
Current Research
Hepatitis B expanded
Mao, B., et al., Prevalence of Chronic Hepatitis B Virus Infection after Implementation
of a Hepatitis B Vaccination Program among Children in Three Provinces in Cambodia.
Vaccine, 2013.
Organization, W.H., Progress Towards Meeting the 2012 Hepatitis B Control
Milestone: WHO Western Pacific Region, 2011 . Wkly Epidemiol Rec, 2011. 86(19): p. 180188.
Sobel, H.L., et al., Implementing a National Policy for Hepatitis B Birth Dose
Vaccination in Philippines: Lessons for Improved Delivery. Vaccine, 2011. 29(5): p. 941-5.
Soeung, S.C., et al., Using Data to Guide Policy: Next Steps for Preventing Perinatal
Hepatitis B Virus Transmission in Cambodia. Vaccine, 2012. 31(1): p. 149-53.
Wallace, A.S., et al., Timing of Hepatitis B Vaccination and Impact of NonSimultaneous Vaccination with DTP Vaccine Following Introduction of a Hepatitis B Birth
Dose in the Philippines. Journal of Public Health Policy, 2012. 33(3): p. 368-381.
Immunization
Also called: Vaccination
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Shots may hurt a little, but the diseases they can prevent are a lot worse. Some are even life-threatening.
Immunization shots, or vaccinations, are essential. They protect against things like measles, mumps,
rubella, hepatitis B, polio, diphtheria, tetanus, and pertussis (whooping cough). Immunizations are
important for adults as well aschildren.
Your immune system helps your body fight germs by producing substances to combat them. Once it
does, the immune system "remembers" the germ and can fight it again. Vaccines contain germs that have
been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to
respond and thus build immunity.
Before vaccines, people became immune only by actually getting a disease and surviving it.
Immunizations are an easier and less risky way to become immune.
NIH: National Institute of Allergy and Infectious Diseases
Immunization of Children
Immunization of Children Research Papers discuss the issue of childhood vaccination in terms of
economics and the impact of the ability of the public health system to give the right vaccines to
all that should have them.
The vaccination of children has recently become a topic of controversy and enhanced interest.
On the one hand, as authors have noted, the public is being barraged with news stories
concerning the safety of some of the vaccines in use. On the other hand, the possibility that the
country may undergo attacks by bioterrorists is adding a new sense of urgency with respect to
having adequate supplies of vaccines for both children and adults on handand adequate means
of distribution in place--if the worst should happen. This paper will discuss certain issues related
to the question of how efficient our system of providing vaccinations can be when our public
health system is economically over-burdened. The paper adopts, as its primary bias, the notion
that, with respect to the matching of available public health resources with the demands made on
the public health system, we are currently confronted with what is essentially a zero sum game.
That is to say, in a world of competing health care demands and stressedhealth care funding, the
resources that are devoted to one of these demands, e.g. the vaccination of children, must be
taken from other public health areas. This paper will attempt to determine if the magnitude of
public health system resources devoted to childhood immunization will likely be adequate over
the long term and, in the event of catastrophe, would likely be able to protect the child
population from epidemics.
We should begin by noting that, recent stories about
the dangers of certain forms of childhood vaccination
notwithstanding, there is no doubt that there is a long
and growing list of safe and effective vaccines that,
from the standpoints of parents, children, and
epidemiology, should be administered. Vaccination,
in fact, has a long history. An author has noted that it
was speculated about in ancient times, that by 1700
immunization was a recognized phenomenon, and that an English physician named Jenner
practiced inoculation in the latter half of the 18th century. While many writers and many studies
indicate that vaccination is not without risks and is not always foolproof ], it is no accident that
in the section on pediatrics in the authoritative Merck Manual a sub-chapter on immunizations
stands near the front of that section.
Children's Vaccines: Research on the Risks for Children and Possible

Neurological Consequences
In this very comprehensive and extensive section on vaccines - and children's

vaccines in particular - we hope to continually update you in a balanced
manner regarding the many new studies and controversies regarding
childhood vaccinations and the possible risks of vaccines, especially
concerning developmental delays and neurometabolic disorders in children.
We will discuss and review the theories and data surrounding vaccine risks
and complications, central nervous system (CNS) pathology, brain damage,
demyelination issues, vaccine-induced neuropathies, public policy concerns,
the mercury and thimerosal controversy, autoimmunity, and the possible
relationship or link between childhood vaccinations and autism spectrum
disorders. Please feel free to jump to the "Quick Index on Children's Vaccines"
for the entire scope of this material.
To date, this section contains information on the following vaccines:
DPT Vaccine: Combined Diphtheria, Pertussis (Whooping

cough) and Tetanus
Rubeola Vaccine (Measles)
MMR Vaccine: Combined Measles, Mumps and Rubella (German,
or "three-day" measles)
Hepatitis B Vaccine
Polio Vaccine
Pneumococcal Pneumonia Vaccine
Hemophilus Meningitis Vaccine
Rotavirus Vaccine
Recent vaccine research data, clinical trials, standards for pediatric
immunization practices and recommendations of independent organizations
are cited. Resources and links to additional literature, materials and opinions
regarding children's vaccines are also provided.
Overview of Vaccine Information

o Introduction to Children's Vaccines
o How Could Children's Vaccines Cause Damage?
o Early Studies on Vaccine Risks and Complications
o New Research Studies on Children's Vaccines Related to Autism
The DPT Vaccine
o DPT Vaccine and Brain Damage

o DPT Vaccine and Autism
o DPT and Vaccine-Induced Neuropathies
Diagnosis of Post-Vaccinal CNS Pathology
Vaccine-Induced Demyelination
Auto-Immunity, Vaccines and Autism
Database of Vaccine Injury
Children's Vaccines and Mercury
o Origins of the Mercury / Vaccine Controversy

o Mercury Neurotoxicity in Children
o Thimerosal and Neurotoxicity
o Is There a Link Between Exposure to Mercury and Autism?
o Ethylmercury and the DPT Vaccine
o Testing for Mercury Toxicity in Children
The MMR Vaccine
o MMR Vaccine and Autism

o MMR Vaccine and Other Complications
Other Vaccination Concerns
'
o Concern About Vaccine Adjuvants

o Immunological Consequence of Vaccines
o Vaccination During Pregnancy and Risks for Autism

The Rubeola (Measles) Vaccine
o The Rubeola Vaccine, Measles and Autism

o The Risks of Not Vaccinating Children for Measles
Conflict of Interest and Vaccine Development
The Hepatitis B Vaccine
o Hepatitis B Vaccine: The Risks

o Hepatitis B: The Disease
o Available Data on the Safety of Hepatitis B Vaccines
Information on Other Vaccines
o Polio Vaccine
o Pneumococcal Pneumonia Vaccine
o Hemophilus Meningitis Vaccine
Appendix 1: Schedule for Routine Immunizations
Appendix 2: Standards for Pediatric Immunization Practices
Appendix 3: Decline of Number of Vaccine-Preventable Cases over Time
Appendix 4: Childhood Immunizations
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The Burden of Suffering

Description of Preventive Measures
Evidence of Effectiveness
Children's Vaccines & Public Policy Considerations
Recommendations of Other Groups
Rationale Statement
Recommendations of the American College of Preventive Medicine
See Also Our New Section:

Mercury in Children's Vaccines
Children's Vaccines and Autism
Introduction to Children's Vaccines
The question of vaccine-related damage provokes tremendous controversy.

Conventional opinion holds that vaccines are good, and that those who
question vaccination are bad. Two potentially conflicting values operate in this
controversy first, the desire to eliminate disease, and, second, the desire of
parents to protect their children from damage. Children's vaccines pose risk.
Diseases pose risk. How do we balance the risks from disease with the risk
from vaccines? Unfortunately, few studies of the long term risks of vaccines
exist. Parents are struggling to make hard decisions in a medical climate of
antagonism for even questioning routine and extensive vaccination. Public
health laws propose enforced vaccination. Where does the answer lie?
[ Return to "Quick-Index" of Overview of Children's Vaccines and the Possible Risks to Children ]
How Could Children's Vaccines Cause Damage?
No vaccine is perfectly safe. An adverse event can be said to be caused by a

vaccine (i.e., a true reaction) if it is associated with a specific laboratory
finding and a specific clinical syndrome or both. Alternatively, a clinical or
epidemiological study is needed to find out whether the rate of a given
syndrome in vaccinated individuals exceeds that expected among
unvaccinated controls.
Immune panels and other laboratory tests, medical histories, and the
supporting medical literature support a causal association, with increased
risks among those children who are sick or have recently been sick. Anecdotal
reports, such as those suggesting the onset of autism after MMR vaccine, are
important in pointing toward possible relationships, which further investigative
work can clarify.
Vaccination may damage children in several ways. Live or attenuated virus
vaccination can actually produce the infection that the vaccine is supposed to
prevent. For example, live polio should never be administered to a child who
comes in contact with an HIV patient, for the attenuated virus can "leap" to the
HIV patient and produce polio. Reports exist of normal parents who have
developed polio from the viral vaccine given to their children.
A second mechanism of damage comes from neurotoxic materials found

sometimes in vaccines. Thimerosal is the most widely discussed, since it
contains mercury. The amount is small. Each vaccine is equivalent to the
amount of mercury found in a 6 oz. Can of tuna fish. Nevertheless, some
argue that even these levels may be important in a vulnerable child.
The third, and probably the most important theory of vaccine damage, relates
to allergic reactions and the development of an auto-immune response,
stimulated by the vaccine and its adjuvant. Vaccines always contain
adjuvants, which are substances known to amplify the body's response to the
vaccine. These adjuvants are known to sometimes cause allergic and autoimmune responses on their own.
We refer interested readers to the Centers for Disease Control and Prevention
(CDC) web sites for estimates of disease prevented by vaccines. On-going
debate rages over the benefits of vaccine for protection of the public and for
prevention of the disease, versus the risk to individuals who receive the
vaccine for vaccine-related complications. The question of whether or not a
society can force its members to undergo individual risks (complications of
vaccination) for the greater public good (disease prevention) is an important
part of this question. The Center for Disease Control (as its name implies)
represents one answer to these questions, while the National Vaccine
Information Center (NVIC) champions the rights of individual families to refuse
vaccines. The NVIC makes a very important, sometimes neglected point:
"Vaccination is a medical procedure which carries a risk of injury or death. As
a parent, it is your responsibility to become educated about the benefits and
risks of vaccines in order to make the most informed, responsible vaccination
decisions."
A similar statement can be made about any medical procedure. There area
also possible, but unproven links between MMR vaccine and juvenile diabetes
multiple vaccines and autism, and OPV and Gulf War syndrome. Time and
further research will tell if these proposed relationships are real
Early Studies on Vaccine Risks and Complications
The history of studies on the risks of vaccines began in 1922 when a smallpox
vaccination program caused an outbreak of encephalitis, with a secondary
result of Guillain-Barre Syndrome, an ascending paralysis ending in death.
The polio virus produces a breakdown of the myelin sheath, called
poliomyelitis, which results in paralysis. Encephalitis, whether caused through
disease or as a result of vaccination, can cause demyelination of the nerves.
For more information, see The Mechanism of Encephalitic Damage from
Vaccines. General paralysis is rare in regions where no organized vaccination
of the population exists. It is impossible to deny a connection between
vaccination and the encephalitis which sometimes follows it. [Reference: Wise
RP, Kiminyo KP, Salive ME. Hair Loss After Routine Immunizations. J Am Med
Assoc 1997; 278: 1176-8.]
In 1935, Thomas Rivers discovered "experimental allergic encephalomyelitis,"
or (EAE). Until then, it was assumed that encephalitis was caused by a viral or
bacterial infection of the nervous system. Rivers was able to produce brain
inflammation in laboratory monkeys by injecting them repeatedly with extracts
of sterile normal rabbit brain and spinal cord material which made it apparent
that encephalitis was an allergic reaction. EAE can explain the association of
allergies and autoimmune states with encephalitis.
In 1947, Isaac Karlin suggested that stuttering was caused by "delay in the
myelinization of the cortical areas in the brain concerned with speech." In
1988, Dietrich and others, using MRI imaging of the brains of infants and
children from four days old to 36 months of age, found that those who were
developmentally delayed had immature patterns of myelination.
In 1953 it was realized that some children's diseases - measles in particular showed an increased propensity to attack the central nervous system. This
indicated a growing allergic reaction in the population to both the diseases
and the vaccinations for the diseases.
In 1978, British researcher, Roger Bannister, observed that the demyelinating
diseases were getting more serious "because of some abnormal process of
sensitization of the nervous system."
Some investigators believe that this increased sensitization of the population
is being enhanced by vaccination programs.
New Research Studies Studies on Children's Vaccines, Especially Related to

Autism
This new section contains additional up-to-date information that is relevant to

the controversial theory that there may be a link between children's
vaccinations and the dramatic increase in autism's prevalence. The CDC
(Centers for Disease Control) and the FDA (Food and Drug
Administration) both oversee the entire childhood vaccination schedule and its
implementation and safety in the United States, and both of these government
institutions, along with the asserted independence of the IOM (Institute of
Medicine) have continually insisted that there is absolutely no link between
children's vaccines and autism and that mercury in children's vaccines has
essentially been eliminated because of that concern.
This section includes the examination of many recent research studies and
provides information from the CDC and FDA websites that are not easily
accessible to the general public but are published here either through these
agencies lack of website security - meaning that this information was at one
time (and may still be) posted by these government agencies but was not
intended for public consumption - or has come from transcripts of actual
CDC/FDA meetings relating to these matters which were obtained through the
Freedom of Information Act that appear to contraindicate their public
statements.
Our assessment is that the FDA and CDC and other government agencies are
acutely aware that there very well may be (and we wish to indicate here that
"maybe" is the operative and important qualifier) a connection between
children's vaccines and autism spectrum disorders or other neurological and
Developmental Disorders, including PDD-NOS and Mitochondrial Disorders
(sometimes referred to as "Mitochondrial Disease").
What appears to be happening is that that there is continually more recent
research that is showing that there might be a connection between childhood
vaccinations and autism spectrum disorders. On a continuum with that, it
appears that the FDA and the CDC wish to suppress this published research
and that they choose to conduct studies that are not capable of finding
causality between children's vaccines and autism and instead fund studies
that are not capable of or are not designed to find causality. According to
some well-respected resources in these government agencies, they have an
understandable concern that if it was revealed that there might be a
connection between autism (or other developmental disorders) and children's

vaccines, such concern could lead to concerned parents to withdraw their
children from the sometimes mandatory Schedule for Routine Vaccinations,
and that could then lead to epidemic or even pandemic cases of other
childhood diseases such as Measles and Diphtheria, for which immunization
has proved to be very beneficial and without significant risk.
While our position has always been to not persuade our readers to favor one
choice as opposed to another, but rather to provide information that will help
them make a balanced and individual choice, we also note that parents who
refuse to have their children immunized are being blamed for an increase in
communicable childhood diseases (such as measles) and are thus perhaps
significantly putting the rest of the population at risk. This only makes the
controversy about children's vaccines more divisize than it already is, which is
in not in one's best interest.
Our new section is perhaps highlighted by the testimony via an exclusive CBS
interview of Dr. Bernadine Healy, the former Director of the National Institutes
of Health (NIH) regarding this vaccine controversy. In this interview, Dr. Healy
says, "I think the government, or certain health officials in the government, are
- have been too quick to dismiss the concerns of these families without
studying the population that got sick. I haven't seen major studies that focus
on - three hundred kids, who got autistic symptoms within a period of a few
weeks of a vaccine. I think that the public health officials have been too quick
to dismiss the hypothesis as irrational, without sufficient studies of causation. I
think that they often have been too quick to dismiss studies in the animal
laboratory, either in mice, in primates, that do show some concerns with
regard to certain vaccines and also to the mercury preservative in vaccines.
The government has said, in a report by the Institute of Medicine - and by the
way, I'm a member of the Institute of Medicine. I love the Institute of Medicine
- but a report in 2004 - it basically said, 'Do not pursue susceptibility groups.
Don't look for those patients, those children, who may be vulnerable'. I really
take issue with that conclusion. The reason why they didn't want to look for
those susceptibility groups was because they're afraid if they found them however big or small they were - that that would scare the public away. First of
all, I think the public's smarter than that; the public values vaccines. But, more
importantly, I don't think you should ever turn your back on any scientific
hypothesis because you're afraid of what it might show!"
This new section is fairly complex in that there is a great deal of information
presented in a small space. In order to guide you to your specific area of
interest, here are some links to just a few of our new subsections:
Leading NIH Director Dr. Bernadine Healy Says Children's
Vaccines-Autism Link Is Worthy of Study
Government Concedes Vaccine/Autism Link - The Court Papers:
Poling vs. Secretary of HHS, Full Text
Vaccines & Autism, by Dr. Sanjay Gupta, CNN Chief Medical
Correspondent, on His Meeting with Dr. Bernadine Healy
Vaccines Past and Present: Autism and Immunizations, Stephanie
Cave, M.D. | Presentation at Autism 2002 Conference
Burton Calls for Criminal Penalties for Any Government Agency
that Knew About the Dangers of Thimerosal in Vaccines
CDC and FDA Secret Simpsonwood Meeting: Probable Link
Between Thimerosal and Neurodevelopmental Disorders
Infant Vaccines Produce Autism Symptoms in New Primate Study
by University of Pittsburgh Scientists
FDA's Answers to the Questions: Which Vaccines Still Contain
Thimerosal? What Are the Thimerosal-Free Vaccines?
Mitochondrial Disorder? Government Concedes Vaccine-Autism
Case in Federal Court, David Kirby, Huffington Post
Autism and Mercury Testimony Before Congress by Stephanie
Cave, M.D. Congressman Dan Burton
Fighting the Autism-Vaccine War, Bernadine Healy, M.D., U.S.
News & World Report, in Health - Brain and Behavior
Court Report on General Causation: Thimerosal Exposure,
Neuroinflammation, and the Symptoms of Regressive Autism
Written and overseen by Lewis Mehl-Madrona, M.D., Ph.D.

Associate Professor of Family Medicine and Psychiatry
Department of Family Medicine / University of Saskatchewan College of Medicine
Previously
Coordinator for Integrative Psychiatry and System Medicine
Program in Integrative Medicine / University of Arizona College of Medicine
Clinical Program Director, Continuum Center for Health and Healing,
Beth Israel Hospital / Albert Einstein School of Medicine
Medical Director
Center for Complementary Medicine / University of Pittsburgh Medical Center
Hosted and maintained by The Healing Center On-Line 2001 - 2009

Can J Infect Dis. 2004 Mar-Apr; 15(2): 7374.
PMCID: PMC2094964
Joanne Embree, MD FRCPC

Author information Copyright and License information
In 1998, the Lancet published a manuscript, written by Wakefield et al (1), that detailed 12
children who were referred to the gastroenterology clinic of the Royal Free Hospital and
School of Medicine in London, United Kingdom, with what was described as chronic
enterocolitis and regressive developmental disorder. Following a description of the
extensive investigation of the cause of these children's medical illness, the authors
hypothesized that the administration of the measles-mumps-rubella (MMR) vaccine could
precipitate chronic inflammatory bowel disease that would then lead to autism. This
hypothesis was announced to both the medical and scientific worlds and the general public
via a press conference, at which time warnings were given that the combination MMR
vaccine should not be given to young children because of the risk of development of this
condition. Public and scientific controversy ensued. As a result, the number of children
receiving measles immunization in the United Kingdom plummeted from a 92% to 95%
before the announcement to estimates of 60% to 80% coverage depending upon the region
and groups studied, and the extent of ongoing local press coverage of the story. The effect
was felt elsewhere, including Canada, because pediatricians, family practitioners, public
health nurses and other health care providers were questioned by worried parents about
whether it was safe to have their children immunized with this vaccine. Whether
immunization rates fell in Canada to the same extent as estimated in the United Kingdom is
not known but, fortunately, is not thought to be likely. The debate triggered the allocation of
significant amounts of funds targeted to conduct studies to confirm or refute the hypothesis,
as well as formal investigations and scientific reviews by various expert panels (2-7). By
2001, the scientific and medical community had generally concluded that there was no
evidence to support the hypothesis and had published recommendations that MMR
immunization programs should be continued (7,8). However, the issue continued to be
debated in both the medical literature and the lay press resulting in a chronically poor
uptake of measles and measles-containing vaccinations.
In February 2004, the results of a four-month investigation by reporters were announced in
the British press related to concerns that, as a result of an undisclosed significant conflict of
interest on the part of Dr Wakefield, the results published were questionable. The
investigation has generated an accusation that Dr Wakefield had received a relatively large
amount of money to find evidence of an association between receipt of immunization and
the development of autism in a significant proportion of the children described in the
manuscript, as part of legal action being taken by the parents of those children against the
company that manufactured the MMR vaccine. The editor of the Lancet has indicated that,
as a result of the investigation, the nondisclosure of this funding was of concern. Had the
editors been aware of the funding issue at the time, it would have had affected their
assessment of the data and conclusions drawn and would have affected the decision to
publish the manuscript. Understandably, this has generated a call for a formal investigation
of the circumstances surrounding the generation of the data and publication of the
manuscript to answer the question, "How did this happen?" Some, if not all, of Dr
Wakefield's collaborators have indicated that they were unaware of the contract and
payment related to the legal cases. Fortunately, true science has actually prevailed. Dr
Wakefield's hypothesis had not stood the tests of time, other scientists did not confirm his
results. Some of his original collaborators had already begun to express doubt concerning
the conclusions, and his hypothesis had generally been discounted before this story broke in
the news.
The issue of disbelief of the published results of immunization studies because of alleged
conflict of interest is not new. Opponents to vaccines and immunization programs have used
these allegations for the past several years to discredit research results that support the
safety and effectiveness of immunization. As a result, researchers who investigate the safety
and efficacy of vaccines and official bodies that make recommendations related to
immunization have become extremely careful to ensure that all potential or perceived
conflicts of interest are openly declared so that the conclusions made can be evaluated
appropriately. In situations where a true conflict of interest exists, the results may be
assessed in making decisions but the opinions of the researchers are usually not sought. The
same standards would be expected of any researcher, regardless of the expected results of
their research. As such, Dr Wakefield had an obligation to disclose any financial
arrangements or other conflicts of interest that could have influenced his interpretation of
his findings. What should happen now? Obviously, an inquiry is in order. Millions of dollars
have been spent and children's lives have likely been unnecessarily put at risk due to the
consequences of measles as a direct result of the publicity associated with thisLancet paper.
Would the same widespread consequences to measles immunization programs worldwide
have occurred if there had been a disclosure that the study had been funded, in part,
through an investigation to confirm a position taken in a legal action? Probably not.
There has been at least one positive aspect as a consequence to all of this controversy. The
problems related to the diagnosis and treatment of autism has gained international
attention. Determining the cause of autism has become a priority. How unfortunate it is that
the money spent trying to determine whether MMR caused autism had not been spent
studying more productive avenues of research.
Recently, another manuscript detailing the results of research concerning the cause of
autism has generated extensive press coverage in Canada, partly because of the reputation
of the universities with which the authors were associated. In conversations with the press,
relating to the well publicized, advanced on line publication of the manuscript in Molecular
Psychiatry (9), Dr Deth's comments reflected his belief that his results were supportive of
the argument that thimerosal in vaccines causes autism (9). Questions were immediately
raised by the press and public about the safety of the influenza vaccines provided for
children in Canada, because they contain thimerosal in small amounts. The manuscript
describes a very complex study involving many basic science experiments using neurological
cancer cell lines. Generalization of these laboratory results as an explanation of events in the
human central nervous system of a child is tenuous at best. They are not sufficient to
support the statements made related to thimerosal as the cause of autism. In reviewing the
manuscript, I am unable to determine how the study was funded. In view of the controversy
surrounding the previous Lancetpublication, authors and publishers would be well advised
to ensure that relevant information concerning the sources of funding and potential
conflicts of interest are published in association with the results of their studies.
Go to:
References
1. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoidnodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children.Lancet 1998;351:63741. [PubMed]
2. Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine:
No epidemiological evidence for a causal association.Lancet 1999;353:2026-9. [PubMed]
3. Kaye JA, del Mar Melero-Montes M, Jick H. Mumps, measles, and rubella vaccine and
the incidence of autism recorded by general practitioners: A time trend
analysis.BMJ 2001;322:460-3.[PMC free article] [PubMed]
4. Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR immunization
coverage in California.JAMA 2001;285:1183-5. [PubMed]
5. Taylor B, Miller E, Lingham R, Andrews N, Simmons A, Stowe J. Measles, mumps, and

rubella vaccination and bowel problems or developmental regression in children with
autism: Population study.BMJ 2002;324:393-6. [PMC free article] [PubMed]
6. Fombonne E, Chakrabarti S. No evidence for a new variant of measles-mumps-rubellainduced autism.Pediatrics 2001;108:E58. [PubMed]
7. Halsey NA, Hyman SL; Conference Writing Panel. Measlesmumps-rubella vaccine and
autistic spectrum disorder: Report from the New Challenges in Childhood Immunizations
Conference convened in Oak Brook, Illinois, June 12-13,
2000.Pediatrics 2001;107:E84. [PubMed]
8. Infectious Diseases and Immunization Committee, The Canadian Pediatric Society.
Measles-mumps-rubella vaccine and autistic spectrum disorder: A hypothesis only.Paediatr
Child Health 2001;6:387-9.[PMC free article] [PubMed]
9. Waly M, Olteanu H, Banerjee R, et al. Activation of methionine synthase by insulin-like
growth factor-1 and dopamine: A target for neurodevelopmental toxins and thimerosal.Mol
Psychiatry2004;9:358-70. [PubMed]
Articles from The Canadian Journal of Infectious Diseases are provided here courtesy of Pulsus Group
Vaccine Safety and the Importance of

Immunization
More than two centuries have passed since the first successful vaccine for smallpox was developed.
We've come a long way since. Today's vaccines are among the 21st century's most successful and
cost-effective public health tools for preventing disease and death. Thanks to immunizations,
debilitating and often fatal diseases like polio, that were once common, are now only distant memories
for most Americans.
Currently there are vaccines available to protect children and adults against at least 17 diseases,
which cause serious afflictions such as paralysis, loss of hearing, infertility and even death.
Diphtheria (cdc.gov)
Hepatitis A (cdc.gov)
Hepatitis B (cdc.gov)
Haemophilus Influenzae Type B (cdc.gov) (Hib)
Human Papillomavirus (cdc.gov) (HPV)
Influenza (cdc.gov) (Flu), DOH Seasonal Influenza home

page
Measles (cdc.gov)
Meningococcal (cdc.gov)
Mumps (cdc.gov)
Pertussis (cdc.gov)
Pneumococcal (cdc.gov)
Polio (cdc.gov)
Rotavirus (cdc.gov)
Rubella (cdc.gov)
Shingles (cdc.gov) (Herpes Zoster)
Tetanus (cdc.gov)
Varicella (cdc.gov) (Chickenpox)
From infants to senior citizens, timely immunizations are one of the most important ways for you to
protect yourself and others from serious diseases and infections. If you're a parent, the New York
State Department of Health, the CDC and the American Academy of Pediatrics all recommend that you
keep your children up-to-date with the recommended vaccination schedule. It's also important for
adults to be sure that they've received all the vaccinations recommended for adults (PDF, 70KB, 2pg.).
Certain groups of people may need special vaccinations. For example, first-year college students living
in dorms should be immunized against meningitis. Travelers going abroad to foreign countries where
diseases that aren't common in the United States exist, such as typhoid fever and yellow fever, may
need additional vaccines before their trips. Measles, rubella, mumps and polio also may be a risk
during foreign travel.
The New York State Department of Health's Bureau of Immunization is here to help you find reliable
information on vaccines and immunizations. Our goal is to help reduce the likelihood of vaccinepreventable diseases by making sure children, seniors and everyone in between receive the vaccines
they need. The Bureau's mission is to assure that:
All children have access to vaccines;
Health care providers are aware of immunization standards

of practice;
The latest recommendations on new vaccines are available to

health care providers;
Health care providers and the public have up-to-date

answers to vaccine questions.
If you have a question about vaccinations and you live in the five boroughs of New York City Bronx, Brooklyn, Manhattan, Queens or Staten Island - please call the New York City Department of
Health and Mental Hygiene's Immunization Hotline at 347-396-2400 or visit their website for more
information.
Immunization, Vaccines and Biologicals

Immunization, Vaccines and Biologicals
Vaccines and diseases
Global Vaccine Action Plan
WHO policy recommendations
National programmes and systems
Monitoring and surveillance
Quality, safety and standards
Research and development
Resource materials
Newsroom
Implementation research in immunization

What is implementation research?
Many definitions exist for operations and implementation research. These two terms
are often used interchangeably or at least overlap in their scope. The term
translational research is sometimes used to define research required to inform policy
decisions or introduce vaccines or other products. Here, implementation research is
defined as that area of research devoted to understanding the bottlenecks around
introduction and scaling up implementation of a proven public health intervention and
finding practical solutions to overcome such barriers or constraints.
Why the need to accelerate immunization implementation research?

With the launch of the GAVI Alliance in 2000, the worlds poorest nations had an
opportunity to access vaccines that hitherto were unavailable to them. With GAVIs
support, most countries have added hepatitis B and Haemophilus influenzae type b
vaccines, and are now introducing rotavirus and pneumococcal vaccines as well. In
addition, several countries have developed plans to introduce human papillomavirus
vaccine. Vaccines of particular relevance to certain regions, such as conjugate
meningococcal A and yellow fever in Africa, and Japanese encephalitis in Asia, are now
included in many national immunization programmes in these regions.
However, immunization programmes in many countries face challenges, not only to
introduce new vaccines, but to achieve and sustain high coverage for those already in
the programme. Such challenges are not only technical but also include managerial,
systems, socio-behavioural, financial, and communications bottlenecks. Immunization
Implementation research identifies these challenges to enable the use evidence-based
policies and practices, be it to introduce a new vaccine or to scale up coverage of
existing vaccines in national immunization programmes.
WHO activities in immunization implementation research

WHOs key role is to set the agenda and priorities for implementation research related
to vaccines and vaccination. To this end, an ad hoc Technical Working Group is
developing a global prioritized immunization implementation research agenda. The
main strategy of the Organization is to provide the leadership to bring together
research donors, research communities and national immunization programmes to
solve local problems with local solutions. The WHO Initiative for Vaccine Research
(IVR), in close collaboration with partners, will provide technical assistance to
strengthen country capacity to carry out implementation research, monitor and map
implementation research activities, and provide a platform for researchers to share
their results and examine their relevance to global immunization policies and
practices.
More information on implementation research activities
Immunization schedules
Health economics
Cholera study
Recommended reading: Vitamin A for measles in children

Measles is caused by a virus and possible complications include pneumonia. Measles is a major cause of death in children
in lowincome countries and is particularly dangerous in children with vitamin A deficiency. Eight studies involving 2574
participants were included in this review and we found that there was no significant reduction in mortality in children
receiving vitamin A. However, vitamin... more
A.D.A.M. Medical Encyclopedia.
Measles
Rubeola
Last reviewed: August 1, 2012.
Measles is a very contagious (easily spread) illness caused by a virus.
Causes, incidence, and risk factors

The infection is spread by contact with droplets from the nose, mouth, or throat of an infected person.
Sneezing and coughing can put contaminated droplets into the air.
Those who have had an active measles infection or who have been vaccinated against the measles
have immunity to the disease. Before widespread vaccination, measles was so common during childhood
that most people became sick with the disease by age 20. The number of measles cases dropped over
the last several decades to almost none in the U.S. and Canada. However, rates have started to rise
again recently.
Some parents do not let their children get vaccinated because of unfounded fears that the MMR vaccine,
which protects against measles, mumps, and rubella, can cause autism. Large studies of thousands of
children have found no connection between this vaccine and autism. Not vaccinating children can lead to
outbreaks of a measles, mumps, and rubella -- all of which are potentially serious diseases of childhood.
Symptoms
Symptoms usually begin 8 - 12 days after you are exposed to the virus. This is called the incubation
period.
Symptoms may include:
Bloodshot eyes
Cough
Fever
Light sensitivity (photophobia)
Muscle pain
Rash
o
Usually appears 3 - 5 days after the first signs of being sick
May last 4 - 7 days
Usually starts on the head and spreads to other areas, moving down the body
Rash may appear as flat, discolored areas (macules) and solid, red, raised areas
(papules) that later join together
Itchy
Redness and irritation of the eyes (conjunctivitis)
Runny nose
Sore throat
Tiny white spots inside the mouth (Koplik's spots)
Signs and tests
Measles serology
Viral culture (rarely done)
Treatment
There is no specific treatment for the measles.
The following may relieve symptoms:
Acetaminophen (Tylenol)
Bed rest
Humidified air
Some children may need vitamin A supplements. Vitamin A reduces the risk of death and complications in
children in less developed countries, where children may not be getting enough vitamin A. People who
don't get enough vitamin A are more likely to get infections, including measles. It is not clear whether
children in more developed countries would benefit from supplements.
Expectations (prognosis)
Those who do not have complications such as pneumonia do very well.
Complications
Complications of measles infection may include:
Bronchitis
Encephalitis (about 1 out of 1,000 measles cases)
Ear infection (otitis media)
Pneumonia
Calling your health care provider

Call your health care provider if you or your child has symptoms of measles.
Prevention
Routine immunization is highly effective for preventing measles. People who are not immunized, or who
have not received the full immunization are at high risk for catching the disease.
Taking serum immune globulin 6 days after being exposed to the virus can reduce the risk of developing
measles, or can make the disease less severe.
References
1. Mason WH. Measles. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson
Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 238.
Review Date: 8/1/2012.
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington
School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix,
Inc.
A.D.A.M., Disclaimer
Copyright 2013, A.D.A.M., Inc.
Measles outbreak in the Philippines
Wikimedia Commons
Robert HerrimanInfectious Disease Examiner
November 13, 2009

The Philippine Department of Health (DOH) has noted a dramatic increase of measles
cases in the area of the Western Visayas (the island of Panay). Iloilo had the most cases
in the region with 33 of the 41 cases. There have been no fatalities from this outbreak.
There were no cases of measles in Iloilo in all of 2008.
This vaccine preventable disease is one of the leading causes of mortality in children
worldwide.
Measles or rubeola, is an acute highly communicable viral disease that is characterized
by Koplik spots in the cheek or tongue very early in the disease. A couple of days later a
red blotchy rash appears first on the face, and then spreads, lasting 4-7 days. Other
symptoms include fever, cough and red watery eyes. The patient may be contagious
from four days prior to the rash appearance to four days after rash appearance.
The disease is more severe in infants and adults. Complications from measles which is
reported in up to 20% of people infected include; seizures, pneumonia, deafness and
encephalitis.
Dr. Renilyn Reyes, Center for Health Development regional coordinator for the
Expanded Program for Immunization blames the resurgence of measles in the Western
Visayas area on the accumulation of the susceptibles or poor vaccination coverage.
The DOH is attempting to get local levels of government to actively participate in the
measles elimination program.
The vaccine is being given for free at local health centers.
February 26, 2014
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Measles News and Research

Measles is a highly contagious, serious disease caused by a virus. It remains a leading cause
of death among young children globally, despite the availability of a safe and effective
vaccine. An estimated 197 000 people died from measles in 2007, mostly children under the
age of five.
Measles is caused by a virus in the paramyxovirus family. The measles virus normally
grows in the cells that line the back of the throat and the lungs. It is a human disease not
known to occur in animals.
Further Reading
Measles
Measles Symptoms
Measles Causes
Measles Diagnosis
Measles Prevention
Measles Treatment
Measles History
Viewpoints: Finding a plan for 'tinkering with DNA'; fact-checking claims of ACA losses;
pediatricians' fears of retail clinics
The manipulation of human genes could lead to profound advances in our ability to cure or prevent terrible
diseases. But in some cases, it might also mean introducing genetic material that could be passed from one
generation to the next, changing the human gene pool in a manner that could inadvertently harm peoples'
health. [More]
New approach for delivering vaccines and for stimulating body's immune system to attack
tumors
Many vaccines, including those for influenza, polio, and measles, consist of a killed or disabled version of a
virus. However, for certain diseases, this type of vaccine is ineffective, or just too risky. [More]
International study examines link between infections and ischemic stroke in children
Common infections are associated with a significantly higher chance of stroke in children, but routine
vaccinations may help decrease risk, according to preliminary research (abstract 39) presented at the
American Stroke Association's International Stroke Conference 2014. [More]
NPS MedicineWise urges parents to ensure that children's vaccinations are up to date
Following a recent spate of measles cases being reported in a number of Australian states, NPS
MedicineWise is reminding parents to check whether their childrens immunisations are up to date before
they head back to school next week. [More]
Idiopathic pulmonary fibrosis (IPF) and herpesvirus saimiri: an interview with Elazar
Rabbani, Chief Executive Officer of Enzo
Pulmonary fibrosis is a condition where fibrotic or scarred tissue progressively develops in the lungs. In
some cases the particular cause is known but in others it remains unknown and is given the term
idiopathic. [More]
Longer reads: Hospice drains Medicare; false Obamacare 'horror stories;' growing up
without vaccines
Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not
finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less. But over the
past decade, the number of "hospice survivors" in the United States has risen dramatically, in part because
hospice companies earn more by recruiting patients who aren't actually dying, a Washington Post
investigation has found. Healthier patients are more profitable because they require fewer visits and stay
enrolled longer (Peter Whoriskey and Dan Keating, 12/26). [More]
WSU researchers discover how Nipah virus employs burglary-ring-like teamwork to

infiltrate human cell
A team of scientists from Washington State University has discovered how one of the planet's most deadly
known viruses employs burglary-ring-like teamwork to infiltrate the human cell. [More]
Marker for inflammatory bowel disease linked to bipolar disorder

Researchers have found evidence that the gastrointestinal tract plays a role in the inflammatory pathology of
bipolar disorder, suggesting the need to consider dietary modification and anti-inflammatory treatment for
some patients. [More]
Imported measles poses a threat to health security

Experts report that measles still poses a threat to public health in the U.S, despite vaccination having
successfully eliminated the endemic since the 1960s. [More]
Measles still poses threat to domestic and global health security

Fifty years after the approval of an extremely effective vaccine against measles, one of the world's most
contagious diseases, the virus still poses a threat to domestic and global health security. [More]
IDSA released new guideline for vaccination of immunocompromised hosts

A new guideline released Thursday by the Infectious Diseases Society of America (IDSA) notes that most
people with compromised immune systems are especially vulnerable to illness and should receive the flu
shot and other vaccinations. [More]
Typhoon survivors in Tacloban vaccinated against measles and polio

Children in Tacloban the city hit hardest by Typhoon Haiyan were vaccinated against measles and polio in
the first phase of a mass campaign by the Government of the Philippines with support from UNICEF, the
World Health Organization, and other partners. They also received Vitamin A supplements to help improve
their immunity against infections. [More]
Viewpoints: Senate should reconsider treaty on protections for people with disabilities; HHS
treading wrong way on payments for bone marrow donors
About a year ago the Senate fell five votes short of ratifying an international treaty that would improve
protections for the disabled. It was an ignoble spectacle as the opponents rebuffed Bob Dole, a former
colleague and disabled veteran, who came to the Senate floor to lobby for it. [More]
Vaccination campaign launched to prevent outbreaks of measles and polio in Philippines

WHO and the Philippine Department of Health have launched a vaccination campaign to prevent outbreaks
of measles and polio among survivors of Typhoon Haiyan (Yolanda). [More]
Measles-containing vaccines administered at 12-5 months of age associated with reduced

risk of fever, seizures
Children receiving measles-containing vaccines at 12-15 months of age have a lower increased risk of fever
and seizures than those who receive them at 16-23 months of age, according to a new Kaiser Permanente
study published in JAMA Pediatrics. [More]
WHO and the Philippine Department of Health have launched a vaccination campaign to
prevent outbreaks of measles and polio among survivors of Typhoon Haiyan (Yolanda).
"Large numbers of non- or under-vaccinated children are at risk of contracting and
spreading infectious diseases such as measles - particularly in congested areas where the
homeless are now living," says Dr Julie Hall, WHO Representative in the Philippines.
"Measles can be deadly, especially in young children."
Worst hit areas targetted

The campaign targets children in areas hardest hit by the disaster - starting with the
evacuation centres in the city of Tacloban and at receiving centres in Cebu, where evacuated
families are finding temporary shelter. Children under 5 years old are being vaccinated
against polio and measles and given Vitamin A drops to boost their immune systems.
"Our system is shaken but not broken."
Enrique Ona, Philippine Secretary of Health
"Our system is shaken but not broken," said Philippine Secretary of Health, Enrique Ona.
"With the support of partners, vaccinations have been re-launched at a vital time."
WHO worked with the Department of Health to finalize plans and procure all
necessaryvaccines and supplies to carry out the campaign and set up immunization stations.
A team of 20 volunteer nurses is deploying to Tacloban this weekend to support local healthcare workers.
WHO and partners procure vaccines and set up "cold chain"

WHO is working with partners to arrange for the delivery of vaccines using gas-powered and
generator-powered fridges, freezers, vaccine-cases, cold boxes and ice packs for affected
areas that have lost power. This "cold chain" is necessary to keep the vaccines from being
spoiled. USAID has sent 6 solar-powered refrigerators to Tacloban.
Mass immunization and vitamin A supplementation are immediate health priorities following
natural disasters in areas with inadequate coverage levels. Contagious diseases
like measles spread quickly when people are living in unsanitary and overcrowded
conditions.
As young children are most at risk, the initial phase of the campaign targets children 6
months to 5 years old in regions most severely affected by the disaster. The campaign will
be extended to children up to 15 years old if resources allow.
Source: The World Health Organization
Published on Wednesday, 23 March 2011 10:22

Written by Manila Bulletin
Hits: 271
ILOILO CITY, Philippines (PNA) The Department of Health (DOH) will conduct
a supplemental immunization activity against measles on April 4 to May 4 with the
imminent outbreak of the virus nationwide.
DOH Regional Director Dr. Ariel Valencia said the agency targets to achieve a 95 percent
coverage.
In a press briefing , Valencia said the campaign is a critical action to
stop the continuing spread of measles virus in the country. Western Visayas ranked
fourth in the number of recorded cases of measles in the country, after National Capital
Region, Region III and Region IV-A.
He said the agency has confirmed a number of reported measles cases throughout the
country.
DOHs "Iligtas sa Tigdas ang Pinas" targets to immunize 17 million children
aged from nine months old to seven years, or equivalent to 19.58 percent of the total
population, with measlesrubella vaccines.
Dr. Renilyn Reyes, DOH Western Visayas immunization officer, said the Philippines had
committed to eliminate measles in 2012, the target year agreed upon with other
countries in the Western Pacific Region.
The country conducted immunization campaigns in 1998, 2004 and 2007 and achieved
a 95percent coverage in each round, however, even if we have a
high coverage, outbreaks may still occur for the next five to 10 years, Reyes
said.
No vaccine gives 100 percent immunization. Also, there are unreachable areas
especially in the far-flung places while other areas do not believe in the benefits of
immunization due of cultural beliefs, she explained.
She said outbreaks occur when there is an accumulation of susceptible individuals
vaccinated and unvaccinated children. But, with the campaign and with the
latest measles-rubella vaccine, the four measles strains found in the country shall be
neutralized, she added.
Reyes said that the child should be vaccinated at least twice to boost immunization and
enable them to reach a 95 percent protection. Regardless of the immunization
status, the children shall be immunized again. There is no overdose in this vaccine,
she said.
Following the month-long immunization activity, the agency shall conduct a close
monitoring of measles cases in the region for the next three months. This is to ensure
that no cases of measles shall occur and that the agency could immediately act if there
is any, Reyes said.
As of Sunday, Western Visayas has recorded 12 cases of measles two in Iloilo
Province, six in Roxas City, three in Antique, and one in Iloilo City.
source: Manila Bulletin
http://mb.com.ph/articles/310801/doh-starts-measles-immunization-drive
Expanded Program on Immunization (Philippines)

From Wikipedia, the free encyclopedia
The Expanded Program on Immunization (EPI) in the Philippines began in July 1979. And, in 1986, made a
response to the Universal Child Immunization goal. The four major strategies include: [1]
1. sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities;
2. sustaining the polio-free country for global certification;
3. eliminating measles by 2008; and
4. eliminating neonatal tetanus by 2008.
Contents
[hide]
1 Routine Schedule of Immunization
2 Routine Immunization Schedule for Infants
3 General Principles in Infants/Children Immunization
4 Tetanus Toxoid Immunization Schedule for Women
5 Care for the Vaccines
6 References
Routine Schedule of Immunization[edit]

Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is
done monthly in barangay health stations, quarterly in remote areas of the country.
Routine Immunization Schedule for Infants[edit]

The standard routine immunization schedule for infants in the Philippines is adopted to provide maximum
immunity against the seven vaccine preventable diseases in the country before the child's first birthday. The
fully immunized child must have completed BCG 1, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2,
HB 3 and measles vaccines before the child is 12 months of age. [2]
Vaccine
Bacillus
CalmetteGurin
DiphtheriaPertussisTetanus
Vaccine
Oral Polio
Vaccine
Minimum
Age
at 1st Dose
Birth or
anytime
after birth
Numbe
r
Dose
of
Doses
1 dose
6 weeks old 3 doses
6 weeks old 3 doses
0.05
mL
0.5
mL
2-3
drops
Minimum
Interval
Between
Doses
none
Route
Site
Reason
BCG given at earliest

possible age protects
Right deltoid
the possibility of TB
Intradermal region of the
meningitis and other TB
arm
infections in which
infants are prone[3]
Upper outer
6 weeks(DPT
portion of
An early start with DPT
1), 10 weeks Intramuscula the thigh,
reduces the chance of
(DPT 2), 14
r
Vastus
severe pertussis.[4]
weeks (DPT 3)
Lateralis (LR-L)
4 weeks
Oral
Mouth
The extent of protection

against polio is
increased the earlier the
OPV is given.
Keeps the Philippines
polio-free.[5]
Hepatitis B
Vaccine
Measles
Vaccine
At birth
9 months
old
3 doses
0.5
mL
1 dose
0.5
mL
4 weeks
interval
none
(not MMR)
An early start of
Hepatitis B vaccine
reduces the chance of
being infected and
becoming a carrier.[6]
Upper outer Prevents liver cirrhosis
portion of
and liver cancer which
Intramuscula the thigh,
are more likely to
r
Vastus
develop if infected with
Lateralis (R- Hepatitis B early in life.
[7][8]
L-R)
About 9,000 died of
complications of
Hepatitis B. 10% of
Filipinos have Hepatitis
B infection[9]
Upper outer
Subcutaneou portion of
s
the arms,
Right deltiod
At least 85% of measles

can be prevented by
immunization at this
age.[10]
General Principles in Infants/Children Immunization[edit]
Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months or
as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe to vaccinate
a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has
already been vaccinated against measles.[11]
If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be
resumed using minimal intervals between doses to catch up as quickly as possible. [12]
Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg per day), minor
infections with low fever (below 38.5 Celsius), diarrhea, malnutrition, kidney or liver disease, heart or lung
disease, non-progressive encephalopathy, well controlled epilepsy or advanced age, are not
contraindications to vaccination. Contrary to what the majority of doctors may think, vaccines against
hepatitis B and tetanus can be applied in any period of the pregnancy.[13]
There are very few true contraindication and precaution conditions. Only two of these conditions are
generally considered to be permanent: severe (anaphylactic) allergic reaction to a vaccine component or
following a prior dose of a vaccine, and encephalopathy not due to another identifiable cause occurring
within 7 days of pertussis vaccination.[14]
Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. A
sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single
vial or ampoule of freeze-dried vaccine.[15]
The only way to be completely safe from exposure to blood-borne diseases from injections, particularly
hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) is to use one
sterile needle, one sterile syringe for each child.[16]
Tetanus Toxoid Immunization Schedule for Women[edit]

When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect
women against tetanus, but also prevent neonatal tetanus in their newborn infants. [17]
Vaccine
TT1
TT2
TT3
TT4
TT5
Minimum
Age/Interval
At 20th weeks AOG
At least 4 weeks later
At least 6 months later
At least 1 year later
Percent
Protected
0%
Duration of Protection
protection for the mother for the first delivery
infants born to the mother will be protected from neonatal
80%
tetanus
gives 3 years protection for the mother
95%
tetanus
99%
tetanus
gives lifetime protection for the mother
99%
all infants born to that mother will be protected
In June 2000, the 57 countries that have not yet achieved elimination of neonatal tetanus were ranked and the
Philippines was listed together with 22 other countries in Class A, a classification for countries close to maternal
and neonatal tetanus elimination.[18]
Care for the Vaccines[edit]

To ensure the optimal potency of vaccines,a careful attention is needed in handling practices at the country
level. These include storage and transport of vaccines from the primary vaccine store down to the end-user at
the health facility, and further down at the outreach sites. [19] Inappropriate storage, handling and transport of
vaccines wont protect patients and may lead to needless vaccine wastage. [20]
A "first expiry and first out" (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its
expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to
expiring. Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health
facilities and plotted to monitor break in the cold chain. Each level of health facilities has cold chain equipment
for use in the storage vaccines which included cold room, freezer, refrigerator, transport box, vaccine carriers,
thermometers, cold chain monitors, ice packs, temperature monitoring chart and safety collector boxes. [21]
References[edit]
1.
Jump up^ Public Health Nursing in the Philippines. Manila, Philippines: National League of
Philippine Government Nurses, Inc. 2007. p. 141. ISBN 978-971-91593-2-2.
2.
Jump up^ "Six Out of Ten Children 12 to 23 Months Are Fully Immunized". Final Results from the
2002 Maternal and Child Health Survey (National Statistics Office). 2003-06-02. Retrieved 2007-05-11.
3.
Jump up^ Puvacic, S.; Dizdarevi, J; Santi, Z; Mulaomerovi, M (February 2004). "Protective
effect of neonatal BCG vaccines against tuberculous meningitis". Bosnian Journal of Basic Medical
Sciences 4 (1): 469. PMID 15628980.
4.
Jump up^ "Immunisation". Dialogue on Diarrhoea Online (30): 16. 1987. Retrieved 2007-05-11.
5.
Jump up^ Centers for Disease Control and Prevention (CDC) (2001-10-12). "Public Health
Dispatch: Acute Flaccid Paralysis Associated with Circulating Vaccine-Derived Poliovirus --- Philippines,
2001".Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention) 50 (40): 874
5. PMID 11666115. Retrieved 2013-10-31.
6.
Jump up^ Ni, Y. H.; M.H. Chang, L.M. Huang, H.L. Chen, H.Y. Hsu, T.Y. Chiu, K.S. Tsai, and D.S.
Chen (2001-11-06). "Effects of Universal Vaccination for Hepatitis B". Annals of Internal Medicine 135 (9):
796800. PMID 11694104. Retrieved 2007-05-12.
7.
Jump up^ "A Look at Each Vaccine: Hepatitis B Vaccine". Vaccine Education Center. The
Children's Hospital of Philadelphia. Archived from the original on 2007-06-29. Retrieved 2007-05-11.
8.
Jump up^ Chang, MH; C.J. Chen, M.S. Lai, H.M. Hsu, T.C. Wu, M.S. Kong, D.C. Liang, W.Y.
Shau, D.S. Chen (1997-06-26). "Universal hepatitis B vaccination in Taiwan and the incidence of
hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group". The New England Journal
of Medicine 336 (26): 18551859. doi:10.1056/NEJM199706263362602. PMID 9197213.
9.
Jump up^ Salazar, Tessa R. (2004-05-24). "Cancer Preventable Says US Doctor" (PDF). The
Philippine Daily Inquirer. Archived from the original on 2007-02-21. Retrieved 2007-05-11.
10.
Jump up^ Orenstein, WA; L.E. Markowitz, W.L. Atkinson, A.R. Hinman (May 1994). "Worldwide
measles prevention". Israel Journal of Medical Sciences 30 (56): 46981. PMID 8034506.
11.
Jump up^ "Measles (Catch Up Campaigns) - Toolkit for Volunteers". Health Initiative 2010. African
Red Cross & Red Crescent. Archived from the original on 2007-04-15. Retrieved 2007-05-12.
12.
Jump up^ Zimmerman, Richard Kent (2000-01-01). "Practice Guidelines - The 2000 Harmonized
Immunization Schedule". American Family Physician. Retrieved 2007-05-12.[dead link]
13.
Jump up^ "Management of the Traveler: Vaccination". Travel Medicine. Portal de Sade Pblica.
1997. Retrieved 2007-05-12.
14.
Jump up^ "General Recommendations on Immunizations" (PDF). Epidemiology & Prevention of

Vaccine-Preventable Diseases--The Pink Book 10th Edition. Centers for Disease Control and Prevention.
2007-02-14. Retrieved 2007-05-12.
15.
Jump up^ Department of Vaccines and Biologicals (December 2000). "WHO Recommendations
for Diluents" (PDF). Vaccines and Biologicals Update (World Health Organization). p. 3. Retrieved 2007-0512.
16.
Jump up^ Hoekstra, Edward. "Immunization: Injection Safety". UNICEF Expert Opinion (UNICEF).
Retrieved 2007-05-12.
17.
Jump up^ "Tetanus - The Disease". Immunization, Vaccines and Biologicals. World Health
Organization. Retrieved 2007-05-12.
18.
Jump up^ "Maternal and Neonatal Tetanus" (PDF). UNICEF. November 2000. Retrieved 2007-0512.
19.
Jump up^ "Temperature Sensitivity of Vaccines" (PDF). Immunization, Vaccines and

Biologicals (World Health Organization). August 2006. Retrieved 2007-05-12.
20.
Jump up^ "Handle Vaccines with Care". British Columbia Center for Disease Control. Archived
from the original on 2007-10-07. Retrieved 2007-05-12.
21.
Jump up^ Expanded Program on Immunization Manual. Manila, Philippines: Department of

Health, Philippines. 1995.
Health in the Philippines
It seems the time is ripe for revamping immunization program in Philippines;

otherwise, measleswould go on killing up to 6,000 children, annually. This claim by the World
Health Organization pulls out a serious issue.
In the year bygone, measles has played havoc with thousands of lives in Philippines
repeatedly raising questions over its immunization program. However, it wont be wrong
to say that measles has proved scourge not only for Philippines but for many
countries as well. And this is despite the fact that measles is a vaccine-preventable
disease, which is still known for being one of the major reasons behind deaths,
especially in the developing nations.
Keeping in view the current measles situation in Philippines, WHOs decision not to
declare it a measles-free country unless its each village vaccinates at least 95
percent of its children, sounds good. This decision would indeed create some sort of
pressure over Philippines health officials to reach this target, which would one way of
the other help achieve it the target of measlesfree Philippines.
Published on Monday, 12 April 2010 09:59

Written by EDUARDO GONZALES, MD
Hits: 164
Measles is an infectious viral disease. It is highly contagious, so highly contagious that

practically no one who has had no immunization against the measles virus can go
through life without getting afflicted with the disease.
The measles virus is transmitted by inhalation of airborne droplets from nasal or throat
secretions of infected persons, direct contact with nasal or throat secretions or urine,
and contact with articles freshly soiled with nasal or throat secretions.
The usual presenting sign of measles is fever that appears eight to 13 days after entry
of the virus into the body. The fever is typically accompanied by non-specific respiratory
tract symptoms that include cough, sore throat and runny nose. Sometimes redness of
the eye and photophobia (sensitivity of the eyes to light) also occur. Three to seven
days after the start of the illness, the blotchy red skin rashes that characterize measles
emerge. The skin rashes first appear on the face then spread throughout the body in a
matter of days.
A person with measles is communicable from the onset of fever to four days after the
appearance of the skin rashes.
There is no specific treatment for measles. In well-nourished children, the disease is
rarely serious, subsiding spontaneously in one to two weeks. But in poorly nourished
children, the disease often complicates. The more common serious and often fatal
complications of measles are pneumonia, diarrhea and encephalitis (inflammation of the
brain).
Although there is no treatment for measles, there is a very effective way of preventing
it. This is with the use of the measles vaccine. Indeed, and this is in answer to your
question, it is possible to eliminate the disease completely from the country by
immunizing a certain percentage of the population with the vaccine. In fact, the
Philippines has already attempted to do this. In 1998, our Department of Health
(DoH) embarked on a countrywide measles elimination program called The
Measles Elimination Campaign that aimed to eradicate measles in the
Philippines by the year 2008.
The first phase of that 10-year program, dubbed "Catch Up Measles Campaign,"
involved a month-long countrywide vaccination of children who are nine months to
below 15 years of age. The well-conducted campaign was completed in April 1999 and
reached more than 96 percent of the targeted children. The campaign was an
unqualified success. The number of reported cases of the disease went down from an
average of 12,000 (with 3,000 deaths) per annum before the start of the campaign to
just 3,000 in 1999.
The second-phase of the program, dubbed Ligtas Tigdas was
conducted in February 2004. As in the first phase, free measles vaccines were
given, but this time only to all children between nine months and eight years of age.
We now know that our efforts to completely eradicate measles by 2008 have not been
that successful because late last year an outbreak of the disease occurred in the
Visayas and in the latter half of February 2010 measles outbreak was reported in six
areas in the Philippines, including Metro Manila. Health Secretary Esperanza Cabral said
that an outbreak of measles was declared in Tondo, Manila; Las Pias City;
Dasmarinas, Cavite; San Francisco town in Quezon Province; and Balabagan town in
Lanao del Sur. A total of 570 cases of measles have been recorded since February with
children aged one to nine as its common victims.
Dr. Renilyn Reyes, Center for Health Development regional coordinator for the Expanded
Program for Immunization blames the resurgence of measles in the Western Visayas
area on the accumulation of the susceptibles or poor vaccination
coverage.
To stem the outbreak, the DOH has sent health workers to different parts of the country
to conduct immunization services against measles.
source: Manila Bulletin
http://mb.com.ph/articles/251139/a-primer-measles
WHO reports three new MERS-CoV cases and two deaths
FDA approves GlaxoSmithKline avian flu vaccine
Children in Philippines receive vaccines against polio, measles

Published on December 3, 2013 by Bryan Cohen
More than 30,000 children are being targeted as part of a vaccination

campaign in Tacloban, Philippines, the city hit hardest by Typhoon Haiyan, the World Health Organization recently
announced.
The government of the Philippines, WHO and the U.N. Childrens Fund joined with other partners to vaccinate
children against polio and measles. The vaccination drive, which is targeting children under the age of five in all the
typhoon-affected areas, will also provide vitamin A supplements and screen children for malnutrition.
The children of Tacloban need all the protection they can get right now, Angela Kearney, the UNICEF coordinator for
the emergency response in Tacloban, said. Disease is a silent predator, but we know how to prevent it and we will do
everything that we can.
UNICEF bought more than $2 million worth of vaccines to replenish in-country stocks being used for the campaign.
WHO and UNICEF are also helping the country to re-establish its broken cold chain, which is used to keep vaccines
at the proper temperature.
WHO and UNICEF staff hand-carried supplies from Manila to Tacloban, coordinated teams to give the vaccines and
trained them on how to do it under these difficult circumstances, Julie Hall, the WHO representative in the
Philippines, said. It is virtually unprecedented that within two-and-a-half weeks of a disaster of this scale, with this
level of devastation and these logistical challenges, that a mass vaccination campaign is already rolling out.
This story filed in Vaccine Development, World Health Organization and tagged Measles, polio, vaccine
development, World Health Organization . Bookmark the permalink.
WHO reports three new MERS-CoV cases and two deaths
DoH 7 conducts immunization in Bohol

Manila Bulletin Tue, Feb 4, 2014
Loon, Bohol -- Following the confirmed cases of chikungunya and measles here, the Region 7 office
of the Department of Health has sent a team to conduct vector management and mopped up
immunization in this town.
Of the 12 samples sent to the Research Institute of Tropical Medicine last December, half tested
positive with chikungunya while one was confirmed with rubella, also known as German measles.
Renan Cimafranca, chief of DOH 7 Regional Epidemiology and Surveillance Unit, bared that while
they are waiting for the results of the second batch of samples sent to RITM they have already
conducted immunization and integrated vector management in the five adjacent barangays of Loon
last week.
Said barangays are Catagbacan Handig, Catagbacan Sur, Catagbacan Norte, Poblacion and Pundol
where the DoH7 team treated their mosquito nets with chemicals that can kill minute insects.
Low volume of spraying and fogging were also done.
Cimafranca disclosed that since September last year chikungunya cases have been recorded here.
However, the cases have reportedly increased after the October 15 earthquake and the successive
rainy days during the last quarter of 2013 and early this year.
The RESU 7 official explained the uncollected debris and rubble after the earthquake have possibly
stored stagnant waters, making them a potential breeding sites of the mosquitoes.
Chikungunya is a viral disease transmitted to humans by infected mosquitoes.

It causes fever and severe joint pain.
Other symptoms include muscle pain, headache, nausea, fatigue and rashes which is also common
among those who have measles.
The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue
is common.
For the immunization, DoH 7 has identified a health center for those who have yet to be vaccinated.
Barangay health workers were the ones assigned to identify those eligible to undergo the vaccination.
Within this week, Cimafranca also added they are expected to visit the nearby town of Calape
following the 11 reported cases of possible chikungunya and measles.
Moreover, he urged the residents in the area to avoid storing water in uncovered containers as this is
crucial in preventing the spread of the mosquitos population.
Measles
Published on Friday, 10 January 2014 09:03
Written by Reiner Gloor
Hits: 52
IN 2015, countries will be delivering their final report on the progress they made in
achieving the Millennium Development Goals (MDGs).
The MDGs focusing on poverty reduction, universal primary education, gender equality,
environmental sustainability, partnership for development and health-related goals form
part of the priority deliverables by governments by the target date.
Since the adoption of the global action plan in 2010, countries reported important
progress specifically in health-related MDGs. High in the agenda is the goal to reduce by
two thirds the mortality rate of children under five.
Children are often among the vulnerable groups that require protection from health
threats including possibly fatal or debilitating diseases.
Until today, one of the leading causes of death of young children is measles. This,
despite the availability of a vaccine against the disease.
Another rash-causing disease is rubella, also called German measles. It is different from
measles which is also called rubeola. German measles is a contagious disease usually
mild in children but it may have serious consequences in pregnant women.
The World Health Organization (WHO) said that about 430 children died every day due
to measles in 2011 -- about 18 deaths every hour.
The figures were far more staggering prior to massive vaccination in 1980. An estimated
2.6 million children perished each year due to measles at that time.
In the Philippines, the Department of Health (DoH) recently declared a measles outbreak
in some parts of Metro Manila following the deaths of 21 children. The number of cases
is feared to peak in summer.
In response, health workers have begun a house-to-house immunization campaign to
prevent the spread of the disease.
The DoH Expanded Program on Immunization provides measles vaccine for free, along
with vaccines for polio, childhood tuberculosis, rotavirus, pneumonia, and diphtheria,
pertusis, and tetanus, among others.
A massive immunization campaign was also undertaken in Yolanda-ravaged provinces
as thousands of children seek shelter in evacuation centers. The damage to health
infrastructure, lack of access to nutritious food, and overcrowding in temporary shelters
increase the risk of a measles outbreak.
Infectious diseases easily spread in evacuation centers due to close contact or exposure
to other sick people. Coughing, sneezing, or having direct contact with infected nasal or
throat secretions usually spreads the virus.
The Philippines is not alone in the battle against measles. The US Centers for Disease
and Control said that measles is also a common disease in many parts of the world
including Europe, the Pacific, Africa, other parts of Asia, and the United States.
It said that measles is a respiratory disease caused by a virus. The measles virus
normally grows in the cells that line the back of the throat and lungs.
The virus, the WHO said, remains active and contagious in the air or on infected
surfaces for up to two hours. An infected person could transmit the virus from four days
prior to the onset of the rash to four days after the rash erupts.
One of the first symptoms of measles is high fever, which lasts for four to seven days.
This could be accompanied by a runny nose, cough, red and watery eyes, and small
white spots inside the cheeks.
After several days, a rash becomes evident -- first on the face and upper neck before
reaching the hands and feet. The rash usually lasts for five to six days and then goes
away.
Measles could potentially be fatal among poorly nourished young children, those with
insufficient vitamin A, or whose immune systems have been weakened. Pregnant
women who would get infected are also at risk of severe complications.
At risk for complications are unvaccinated children under the age of five, pregnant
women, or adults over the age 20. Complications include blindness, encephalitis (an
infection that causes brain swelling), severe diarrhea, dehydration, ear infections, or
pneumonia.
People who recover from measles are immune for the rest of their lives.
There is still no antiviral treatment for the measles virus but complications could be
avoided through good nutrition, adequate fluid intake, and treatment for dehydration.
For the eye and ear infections as well as pneumonia, antibiotics are prescribed.
The WHO said that routine measles vaccination for children, combined with mass
immunization campaigns in countries with high case and death rates, are key public
health strategies to reduce global measles deaths. Curbing measles would also
significantly contribute to the global goal of reducing mortality among very young
children.
source: Business World
http://www.bworldonline.com/weekender/content.php?id=81746
Measles Outbreak
The Importance of Vaccines
By Vincent Iannelli, M.D.
Updated January 18, 2012
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Since many of the diseases that our children recieve vaccines against, like measles and polio, aren't
very common in the United States anymore, many parents wonder why their children still need these
vaccines.
A recent measles outbreak in Alabama helps to illustrated why these diseases, until they are globally
eradicated, are still a threat. According to the CDC, 'Measles remains a common disease in many
countries of the world, including some developed countries in Europe and Asia.'
In this outbreak, an infant who had recently returned from the Philippines, where measles cases have
been increasing in recent years, exposed on young unimmunized children in a daycare. Altogether, 10
other children and 2 adults developed measles from this exposure.
All of the children were under 12 months old, and so were therefore too young to get their first MMR
vaccine and get protection. Because of the high rate of MMR vaccination among their contacts though,
including 679 people, no one else got measles. Of the two adults who became infected, one had been
immunized and the other had not ever received an MMR vaccine.
In today's global society, it is easy to see how easily these diseases can be introduced back into the
United States, and it helps to illustrate the importance of keeping your children's immunizations
current.
It also shows how important it is that measles should be included in the 'differential diagnoses for
febrile rash illnesses in infants, particularly among those with recent travel to endemic areas.'
Vaccination : Should vaccination

be done in schools?
An ounce of prevention is worth a pound of cure .

Benjamin Franklin may not have lived long enough to witness the first
successful smallpox vaccination in 1796. But his famous adage is perhaps
best proven by the significance of vaccination today as one of the most costeffective health investments. By building immunity to diseases, immunization
prevents a great deal of needless suffering, disability and even death. In 2002
alone, the World Health Organization estimates that immunization averted
about two million deaths. WHO further notes that immunization reduces
contagion, eases the burden on health-care systems, and saves money that
can be used for other health services.
Children who have not received these vaccinations by the time they reach
grade four must be given a chance to catch-up with their immunization
requirements during middle school and high school. Middle and high school
students may also receive the HPV, meningococcal, and pertussis vaccines,
while the pneumococcal and influenza vaccines may be given to high-risk

children.
However, immunizing middle and high school students poses several
challenges. Because they do not seek preventive health care, they have lower
chances of getting catch-up immunization, and a low chance of being
immunized with the new vaccines. Also, the need to administer multiple doses
for some vaccines may be a potential barrier for adolescents. Thus, Dr. Bibera
recommends that physicians make every visit an opportunity to vaccinate the
child.
Parents refusal to vaccinate their school-age children poses another barrier.
According to a study published in the Archives of Pediatric and Adolescent
Medicine, many parents are concerned that vaccines might harm their
children. Most of these parents believed that vaccines were neither safe nor
effective, and had a low level of trust in the government. Also, many of the
parents did not believe that the vaccine preventable diseases are that severe,
or that their children were susceptible to them. In ending her lecture, Dr.
Bibera challenged vaccine advocates to involve the school and to educate
parents in order to increase immunization coverage among children.
Vaccination is a proven method for preventing and eliminating diseases. Such
a benefit cannot go overlooked in a developing country like the Philippines,
where illness takes too great a toll on human life and productivity, and where
people simply cannot afford to be sick. Partnerships among parents,
educators, and health care professionals can go a long way in making sure
our children are immunized against disease.
Immunization in the Philippines
Since the Expanded Immunization Program started in the 1980s, the
Philippines has achieved comparatively high levels of immunization against
the vaccine preventable diseases (VPD). The program initially covered six
VPDs: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles.
Hepatitis B was later included in the program. In 1996 and 1997, the program
achieved an all-time high: 90% coverage of fully immunized children.
Sadly, however, the numbers of fully immunized Filipino children have declined
since then, reaching only 69.8% in 2003 (see table). The Department of
Health warns of the danger in this decline in immunization coverage, noting

that the gains in morbidity and mortality reduction recorded for the different
vaccine-preventable diseases need to be sustained to pursue disease
elimination goals in the next six years. There is thus a need again to increase
the rates of immunization among children nationwide.
Partnership with schools is one way of reaching and immunizing more Filipino
children This was the message stressed by University of the Philippines
College of Medicine professor Dr. Cecilia Maramba, and by University of the
East Medical School professor Dr. Gyneth Lourdes Bibera at the recentlyconcluded 8th Philippine National Immunization Conference, held last
November 8-9, 2007 at the Hyatt Hotel Manila. Dr. Maramba
discussed Vaccination Issues at School Attendance, while Dr. Bibera
delivered a lecture entitled Vaccinate Before You Graduate: Grade School
and High School Immunization Requirements.
Compulsory vaccination?
Many countries, including the United States, Australia, and the United
Kingdom have enacted laws to help ensure universal immunization among
their children. In the US, state laws require children to receive vaccinations
against certain infectious diseases before they can enter day care or
preschool. This practice is rooted on the fact that school-aged children were
the main group affected by measles in the 1950s to the 1970s, and that the
schools were the major site of transmission. Today, students who have not
completed their vaccinations by the first day of school will not be allowed to
attend classes until these requirements are met. The cost of vaccines are
included in the parents insurance coverage, while a Vaccine for Children
program ensures vaccination for children of uninsured parents. However, Dr.
Maramba noted that for school-based immunization programs to be
successful, a reliable supply of safe and effective vaccines must be available,
and most people must be willing to be vaccinated.
The US school laws on compulsory vaccination have been lauded by Dr.
Walter Orenstein, Director of the National Immunization Program at the
Centers for Disease Control and Prevention. According to Dr. Orenstein, the
school laws establish a system for immunization that works year in and year
out, regardless of political interest, media coverage, changing budget

situations, and the absence of vaccine preventable disease outbreaks to spur
interest.
Meanwhile, the United Kingdom uses a system of incentives to encourage
general practitioners to do their best in immunizing children in their care. In the
UK, physicians receive a fee for each child immunized, plus other fees for
meeting targets. On the other hand, missing targets can seriously affect the
stability of the practice. This puts pressure on doctors to ensure that children
are fully immunized with all the recommended vaccines. Dr. Maramba notes
that the United Kingdom reports very high rates of immunization(with 85% of
children 2 years old and below) and 93% of children 2 and below immunized
against diphtheria, tetanus, polio, pertussis, haemophilus influenzae type B
and meningitis C.
The US model of compulsory vaccination, and the UK model of incentives for
GPs help ensure high vaccination coverage rates and prevent outbreaks of
vaccine preventable diseases. Both models invest heavily in educating the
public about vaccines.
Vaccination among Filipino School Children
In the Philippines, Extended Program for Immunization (EPI) vaccines such as
DPT, OPV, Hepatitis B and measles are given free to children less than 1 year
old. Children one year old and above may get their immunizations in private
clinics.
However, immunizations are not required for school attendance. Private
schools oblige parents to submit proof of immunizations for enrolling students,
but do not require them to update the childrens immunizations. Some schools
vaccinate their students, while in others, school physicians merely advise
students to complete their immunizations. In the US and UK, school
immunization requirements and GP incentives act as safety checks that make
sure children are completely immunized. Without such safety checks, it is
difficult to follow up on the children who do not get their vaccinations.
Dr. Maramba stressed the importance of investing in the education of all
stakeholders. There is a need to support laws and actions that require EPI
vaccination before school entrance. At the same time, private schools should
be encouraged to require age appropriate vaccinations prior to school

entrance.
Catch-up immunization in the middle and high school
One dose of BCG 2 doses of Varicella
5 doses of DPT/DaPT 2 doses of Hepatitis A
5 doses of OPV/IPV 3 doses of Hepatitis B
2 doses of MMR 4 doses of Hib
SOURCES:
Bibera, GLG. Vaccinate before you graduate: Grade school and high school
immunization requirements. Lecture delivered at the 8th Philippine National
Immunization Conference, November 8-9, 2007.
Maramba, CC. Vaccination Isssues at School Attendance. Lecture delivered at
the 8th Philippine National Immunization Conference, November 8-9, 2007.
WHO Media centre. Immunization against diseases of public health
importance. Fact sheet N288. March 2005
- See more at: http://www.asianhospital.com/health-digest/vaccination-shouldvaccination-be-done-in-schools/#sthash.83jLFb0z.dpuf
Measles
From Wikipedia, the free encyclopedia
Measles
Classification and external resources
A child showing a classic 4-day measles rash.
ICD-10
B05
ICD-9
055
DiseasesDB
7890
MedlinePlus
001569
eMedicine
derm/259 emerg/389ped/1388
MeSH
D008457
Measles, also known as morbilli, English measles, or rubeola (and not to be confused
with rubella or roseola) is an infection of the respiratory system caused by a virus, specifically
a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, singlestranded, negative-sense RNA viruses. Symptoms include fever, cough, runny nose, red eyes and a
generalized, maculopapular, erythematous skin rash, the symptom for which measles is best known.
Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either
directly or through aerosol transmission), and is highly contagious90% of people without immunity sharing
living space with an infected person will catch it.[1] An asymptomatic incubation period occurs nine to twelve
days from initial exposure.[2] The period of infectivity has not been definitively established, some saying it lasts
from two to four days prior, until two to five days following the onset of the rash (i.e. four to nine days infectivity
in total),[3] whereas others say it lasts from two to four days prior until the complete disappearance of the rash.
The rash usually appears between 2-3 days of having measles. [4]
Contents
[hide]
1 Signs and symptoms

1.1 Complications
2 Cause
3 Diagnosis
4 Prevention
5 Treatment
6 Prognosis
7 Epidemiology
8 History and culture
8.1 History
8.2 Recent outbreaks

8.2.1 The Americas
9 References
10 External links
Signs and symptoms[edit]
Skin of a patient after 3 days of measles infection.
Presentation of Koplik's spots on the third pre-eruptive day, indicative of the beginning onset of measles.
The classical signs and symptoms of measles include four-day fevers [ the 4 D's ] and the three Cs
cough, coryza (head cold), and conjunctivitis (red eyes)along with fever and rashes. The fever may reach up
to 40 C (104 F). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles, but are
not often seen, even in real cases of measles, because they are transient and may disappear within a day of
arising.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash
that begins several days after the fever starts. It starts on the back of the ears and, after a few hours, spreads
to the head and neck before spreading to cover most of the body, often causingitching. The measles rash
appears two to four days after the initial symptoms and lasts for up to eight days. The rash is said to "stain",
changing color from red to dark brown, before disappearing. [5]
Complications[edit]
Complications with measles are relatively common, ranging from mild and less serious complications such
as diarrhea to more serious ones such aspneumonia (either direct viral pneumonia or secondary bacterial
pneumonia),[6] otitis media,[7] acute encephalitis (and very rarely SSPEsubacute sclerosing panencephalitis),
[8]
and corneal ulceration (leading to corneal scarring).[9] Complications are usually more severe in adults who
catch the virus.[10] The death rate in the 1920s was around 30% for measles pneumonia. [11]
Between the years 1987 and 2000, the case fatality rate across the United States was 3 measles-attributable
deaths per 1000 cases, or 0.3%.[12] Inunderdeveloped nations with high rates of malnutrition and
poor healthcare, fatality rates have been as high as 28%. [12] In immunocompromised patients (e.g. people
with AIDS) the fatality rate is approximately 30%.[13]
Cause[edit]
Measles
Measles virus electron micrograph
Virus classification
Group:
Group V ((-)ssRNA)
Order:
Mononegavirales
Family:
Paramyxoviridae
Subfamily:
Paramyxovirinae
Genus:
Morbillivirus
Species:
Measles virus
Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the
genus Morbillivirus within the familyParamyxoviridae. Humans are the natural hosts of the virus; no other
animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close
personal contact or direct contact with secretions.
Risk factors for measles virus infection include the following:
Children with immunodeficiency due to HIV or AIDS,[14] leukemia,[15] alkylating agents, or corticosteroid
therapy, regardless of immunization status[16]
Travel to areas where measles is endemic or contact with travelers to endemic areas [16]
Infants who lose passive antibody before the age of routine immunization [16]
Risk factors for severe measles and its complications include the following:
Malnutrition[16][17]
Underlying immunodeficiency[16]
Pregnancy[16][18]
Vitamin A deficiency[16][19]
Diagnosis[edit]
Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's
(cough, coryza, conjunctivitis). Observation ofKoplik's spots is also diagnostic of measles.[20][21]
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive
measles IgM antibodies[22] or isolation of measles virus RNA from respiratory specimens.[23] In patients
where phlebotomy is not possible, saliva can be collected for salivary measles-specific IgA testing.[24] Positive
contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The
contact with any infected person in any way, including semen through sex, saliva, or mucus, can cause
infection.[21]
Prevention[edit]
Rates of measles vaccination worldwide
Measles cases reported in the United States.
Measles cases reported in England andWales.
In developed countries, children are immunized against measles by the age of 18 months, generally as part of
a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than
this because sufficient antimeasles immunoglobulins (antibodies) are acquired via the placenta from the mother
during pregnancy may persist to prevent the vaccine viruses from being effective. [citation needed] A second dose is
usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates
have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or
similar setting is often met with a local vaccination program, in case any of the people exposed are not already
immune.[citation needed] Adverse reactions to vaccination are rare, with fever and pain at the injection site being the
most common. Life threatening adverse reactions occur in less than one per million vaccinations (<0.0001%). [25]
In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be
given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not.
[26]
The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with
antiretroviral drugs can increase its effectiveness.[27] Measles vaccination programs are often used to deliver
other child health interventions, as well, such as bed nets to protect against malaria, antiparasite medicine and
vitamin A supplements, and so contribute to the reduction of child deaths from other causes. [28]
Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in
northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio
vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles
rose significantly, and hundreds of children died.[29] This could also have had to do with the aforementioned
other health-promoting measures often given with the vaccine.
Claims of a connection between the MMR vaccine and autism were raised in a 1998 paper in The Lancet, a
respected British medical journal.[30] Later investigation by Sunday Times journalist Brian Deer discovered the
lead author of the article, Andrew Wakefield, had multiple undeclared conflicts of interest,[31] and had broken
other ethical codes. The Lancet paper was later fully retracted, and Wakefield was found guilty by the General
Medical Council of serious professional misconduct in May 2010, and was struck off the Medical Register,
meaning he could no longer practise as a doctor in the UK. [32]
The GMC's panel also considered two of Wakefield's colleagues: John Walker-Smith was also found guilty and
struck off the Register; Simon Murch "was in error" but acted in good faith, and was cleared. [33] Walker-Smith
was later cleared and reinstated after winning an appeal; the appeal court's finding was based on the panel's
conduct of the case, and gave no support to the MMR-autism hypothesis, which the official judgement
described as lacking support from any respectable body of opinion. [34] The research was declared fraudulent in
2011 by the BMJ.[35] Scientific evidence provides no support for the hypothesis that MMR plays a role in causing
autism.[36]
The autism-related MMR study in Britain caused use of the vaccine to plunge, and measles cases came back:
2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records
began in 1995.[37] A 2005 measles outbreak in Indiana was attributed to children whose parents refused
vaccination,[38] as was another outbreak in 2008 in San Diego.[39] Centers for Disease Control and
Prevention (CDC) reported that the three biggest outbreaks of measles in 2013 are attributed to clusters of
unvaccinated people due to their philosophical or religious beliefs. As of August 2013, three pockets of
outbreak, New York City; North Carolina and Texas contributed to 64% of the 159 cases of measles occurred in
16 states. This high number makes it on track to be the most cases since measles was considered eliminated
in USA in 2000.[40][41]
Treatment[edit]
There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and
supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as
they may be developing complications.
Some patients will develop pneumonia as a sequela to the measles. Other complications include ear
infections, bronchitis, and encephalitis.[42] Acute measles encephalitis has a mortality rate of 15%. While there
is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis,
and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen, or acetaminophen (paracetamol) to reduce fever and
pain and, if required, a fast-acting bronchodilator for cough. As for aspirin, some research has suggested a
correlation between children who take aspirin and the development of Reye's syndrome.[43] Some research has
shown aspirin may not be the only medication associated with Reye's, and even antiemetics have been
implicated,[44] with the point being the link between aspirin use in children and Reye's syndrome development is
weak at best, if not actually nonexistent.[43][45] Nevertheless, most health authorities still caution against the use
of aspirin for any fevers in children under 16.[46][47][48][49]
The use of vitamin A in treatment has been investigated. A systematic review of trials into its use found no
significant reduction in overall mortality, but it did reduce mortality in children aged under two years. [50][51][52]
Prognosis[edit]
The majority of patients survive measles, though in some cases complications may occur, which may include
bronchitis, andin about 1 in 100,000 cases[53]panencephalitis, which is usually fatal.[54] The patient may
spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to
complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles
virus infection. It typically occurs two days to one week after the breakout of the measles exanthem and begins
with very high fever, severe headache, convulsions and altered mentation. A patient may become comatose,
and death or brain injury may occur.[55]
Epidemiology[edit]
Disability-adjusted life year for measles per 100,000 inhabitants in 2002.

no data
10
1025
2550
5075
75100
100250
250500
500750
7501000
10001500
15002000
2000
In 2011, the WHO estimated that there were about 158,000 deaths caused by measles. This is down from
630,000 deaths in 1990.[56] Death occurs, in developed countries, in about 1 in 1,000 cases (.1%). In
populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%.
In cases with complications, the rate may rise to 2030%. [57] Increased immunization has led to a 78% drop in
measles deaths which made up 25% of the decline in mortality in children under five. [58]
Even in countries where vaccination has been introduced, rates may remain high. In Ireland, vaccination was
introduced in 1985. There were 99,903 cases that year. Within two years, the number of cases had fallen to
201, but this fall was not sustained. Measles is a leading cause of vaccine-preventable childhood mortality.
Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in
the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention
(CDC), the United Nations Foundation, UNICEF and the WHO. Globally, measles fell 60% from an estimated
873,000 deaths in 1999 to 345,000 in 2005.[28] Estimates for 2008 indicate deaths fell further to 164,000
globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region. [59]
In 200607 there were 12,132 cases in 32 European countries: 85% occurred in five countries: Germany, Italy,
Romania, Switzerland and the UK. 80% occurred in children and there were 7 deaths. [60]
Five out of six WHO regions have set goals to eliminate measles, and at the 63rd World Health Assembly in
May 2010, delegates agreed a global target of a 95% reduction in measles mortality by 2015 from the level
seen in 2000, as well as to move towards eventual eradication. However, no specific global target date for
eradication has yet been agreed to as of May 2010.[61][62]
On January 22, 2014, the World Health Organization and the Pan American Health Organization declared and
certified Colombia free of the measles while becoming the first Latin American country to abolish the infection
within its borders.[63][64]
History and culture[edit]

History[edit]
The Antonine Plague, 165180 AD, also known as the Plague of Galen, who described it, was
probably smallpox or measles. The disease killed as many as one-third of the population in some areas, and
decimated the Roman army.[65] Estimates of the timing of evolution of measles seem to suggest this plague was
something other than measles. The first scientific description of measles and its distinction from smallpox
and chickenpox is credited to the Persian physician Rhazes (860932), who published The Book of Smallpox
and Measles.[66] Given what is now known about the evolution of measles, this account is remarkably timely.
16th century Aztec drawing of someone with measles
Measles is an endemic disease, meaning it has been continually present in a community, and many people
develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating.
In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two
years later, measles was responsible for the deaths of half the population of Honduras, and had
ravaged Mexico,Central America, and the Inca civilization.[67]
In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.
[68]
During the 1850s, measles killed a fifth of Hawaii's people.[69] In 1875, measles killed over 40,000 Fijians,
approximately one-third of the population.[70] In the 19th century, the disease decimated
the Andamanese population.[71] In 1954, the virus causing the disease was isolated from an 11-year old boy
from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture.[72] To
date, 21 strains of the measles virus have been identified.[73] While atMerck, Maurice Hilleman developed the
first successful vaccine.[74] Licensed vaccines to prevent the disease became available in 1963.[75] An improved
measles vaccine became available in 1968. [76]
Recent outbreaks[edit]
Main article: Measles outbreaks in the 21st century
Maurice Hilleman's measles vaccine is estimated to prevent 1 million deaths every year.[77]
In 2007, a large outbreak in Japan caused a number of universities and other institutions to close in an attempt
to contain the disease.[78][79]
Approximately 1000 cases of the disease were reported in Israel between August 2007 and May 2008 (in sharp
contrast to just some dozen cases the year before).[citation needed] Many children in ultra-Orthodox Jewish
communities were affected due to low vaccination coverage.[80][81] As of 2008, the disease is endemic in
the United Kingdom, with 1,217 cases diagnosed in 2008, [82] and epidemics have been reported
in Austria, Italy and Switzerland.[83]
On February 19, 2009, 505 measles cases were reported in twelve provinces in northern Vietnam,
with Hanoi accounting for 160 cases.[84] A high rate of complications, including meningitis and encephalitis, has
worried health workers,[85] and the U.S. CDC recommended all travelers be immunized against measles. [86]
On 1 April 2009, the disease broke out in two schools in North Wales. Ysgol John Bright and Ysgol Ffordd
Dyffryn, two schools in Wales, had the outbreak. every pupil was checked for the currency of their vaccination
status.
Beginning in April 2009 there was a large outbreak of measles in Bulgaria, with over 24,000 cases including 24
deaths. From Bulgaria, the strain was carried to Germany, Turkey, Greece, Macedonia, and other European
countries.[87]
Beginning in September 2009, Johannesburg, South Africa reported about 48 cases of measles. Soon after the
outbreak, the government ordered all children to be vaccinated. Vaccination programs were then initiated in all
schools, and parents of young children were advised to have them vaccinated. [88] Many people were not willing
to have the vaccination done, as it was believed to be unsafe and ineffective. The Health Department assured
the public that their program was indeed safe. Speculation arose as to whether or not new needles were being
used.[89] By mid-October, there were at least 940 recorded cases, and four deaths. [90]
In early 2010, there was a serious outbreak of measles in the Philippines with 742 cases, leaving four
unvaccinated children dead in the capital city of Manila.[91]
As of May 2011, over 17,000 cases of measles have so far been reported from France between January 2008
and April 2011, including 2 deaths in 2010 and 6 deaths in 2011. [92] Over 7,500 of these cases fell in the first
three months of 2011, and Spain, Turkey, Macedonia, and Belgium have been among the other European
countries reporting further smaller outbreaks.[93] The French outbreak has been specifically linked to a further
outbreak in Quebec in 2011, where 327 cases have been reported between January and June 1, 2011, [94] and
the European outbreaks in general have also been implicated in further small outbreaks in the USA, where 40
separate importations from the European region had been reported between January 1 and May 20. [95]
Some experts stated that the persistence of the disease in Europe could be a stumbling block to global
eradication. It has proven difficult to vaccinate a sufficient number of children in Europe to eradicate the
disease, because of opposition on philosophical or religious grounds, or fears of side-effects, or because some
minority groups are hard to reach, or simply because parents forget to have their children vaccinated.
Vaccination is not mandatory in some countries in Europe, in contrast to the United States and many Latin
American countries, where children must be vaccinated before they enter school. [87]
In March 2013, an epidemic was declared in Swansea, Wales, UK with 1,219 cases and 88 hospitalizations to
date.[96] A 25-year-old male had measles at the time of death and died from giant cell pneumonia caused by the
disease.[97] There have been growing concerns that the epidemic could spread to London and infect many more
people due to poor MMR uptake,[98] prompting theDepartment of Health to set up a mass vaccination campaign
targeted at one million school children throughout England.[99]
In late 2013, it was reported in the Philippines that 6,497 measles cases occurred which resulted in 23 deaths.
[100]
The Americas[edit]
Indigenous measles was declared to have been eliminated in North, Central, and South America; the last
endemic case in the region was reported on November 12, 2002, with only northernArgentina and
rural Canada, particularly in Ontario, Quebec, and Alberta, having minor endemic status. [101] Outbreaks are still
occurring, however, following importations of measles viruses from other world regions. In June 2006, an
outbreak in Boston resulted after a resident became infected in India.[102]
Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the
United States to the CDC,[103][104] the most reported by this date for any year since 2001. Of the 64 cases, 54
were associated with importation of measles from other countries into the United States, and 63 of the 64
patients were unvaccinated or had unknown or undocumented vaccination status. [105] By July 9, 2008, a total of
127 cases were reported in 15 states (including 22 in Arizona),[106] making it the largest U.S. outbreak since
1997 (when 138 cases were reported). [107] Most of the cases were acquired outside of the United States and
afflicted individuals who had not been vaccinated. By July 30, 2008, the number of cases had grown to 131. Of
these, about half involved children whose parents rejected vaccination. The 131 cases occurred in seven
different outbreaks. There were no deaths, and 15 hospitalizations. Eleven of the cases had received at least
one dose of measles vaccine. Children who were unvaccinated or whose vaccination status was unknown
accounted for 122 cases. Some of these were under the age when vaccination is recommended, but in 63
cases, the vaccinations had been refused for religious or philosophical reasons.
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External links[edit]
Wikimedia Commons has
media related to Measles.
WHO.int'Initiative for Vaccine Research (IVR): Measles', World Health Organization (WHO)
Measles FAQ from Centers for Disease Control and Prevention in the United States
Case of an adult male with measles (facial photo)
Clinical pictures of measles
Virus Pathogen Database and Analysis Resource (ViPR): Paramyxoviridae
Thursday, February 27, 2014 21:49:41 GMT
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January 28, 2014, 7:04 AM
Philippines Works to
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By Cris Larano
European Pressphoto Agency
Spanish medical volunteer Manuel Pardo Rius (R), 33, and Pablo Carreno Tormo (L), 34, administer a measles
vaccine to a young typhoon victim during the WHO-UNICEF vaccination program inside the damaged San Antonio
church in the super typhoon devastated town of Basey, Samar province, on Nov. 28.
MANILAHow would a walk-in freezer benefit millions of infants in the Philippines?

Think vaccines, those shots given to young children to protect them from debilitating,
even killer diseases, such as polio, measles, mumps and rubella.
Why a freezer? Freezers help store vaccines, most of which must be kept at certain
temperatures and protected from light to ensure their potency and effectiveness,
according to the U.S. Centers for Disease Control and Prevention, or CDC.
That means vaccines need to be properly stored during immunization programs, like the
one the Philippines is currently rolling out in Manila.
Agence France-Presse/Getty Images
A mother holds her child as she receives a measles vaccine at the Department of Health (DOH)
headquarters in Manila, on Jan. 21.
On Wednesday the Philippine governments Research Institute for Tropical Medicine, or

RITM, will get new walk-in freezer, which will be used to store vaccines for various
viruses, measles included.
The institute, located south of Manila, has been undertaking research on infectious and
tropical diseases and producing vaccines since its establishment in 1981. The nearly
$90,000 freezer was bought using a grant from Japan and will be used to store vaccines
developed by RITM as well as vaccines needed for both the Manila vaccination program
and a national immunization program for measles and polio run by the Department of
Health.
Set to start in September, the national program is targeting 13 million children between
nine months and four years of age. The Philippines conducts a nationwide immunization
every three years, but past programs have not reached their full targets due in part to
urban migration and parents who chose not to have their children vaccinated.
The 2011 program only reached around 85% of the target population, the health
department said.
That has led to a resurgence in cases of measles, which spiked starting last November.
The outbreak killed more than two dozen children in 2013 and pushed the government to
begin a 12-day measles vaccination program in and around Manila on Jan. 23.
Measles, a highly contagious viral disease and a leading cause of death among young
children, can largely be prevented with available vaccines.
The World Health Organization, or WHO, estimates as many as three million deaths are
averted because of vaccination every year though nearly 23 million infants worldwide
still miss out this basic immunization.
Poor storage is another problem, since it can reduce the potency of the vaccines,
requiring repeat dosages. Measles vaccines are less vulnerable to temperature changes
than others, but according to the CDC, It is better not to vaccinate than to administer a
dose of vaccine that has been mishandled.
In addition to the new freezer for RITM, Sure Chill, a U.K.-based company that has
developed a cooling technology for use in medical refrigerators, is in the process of
delivering up to 200 vaccine refrigerators to all parts of the Philippines. The fridges,
which can go without power for up to 10 days, are part of a $500,000 order from the
United Nations Childrens Fund, or UNICEF, and are being used to support a vaccination
program initiated following Typhoon Haiyan, which hit the Philippines in November.
The Philippines is frequently impacted by storms and other natural disasters that cut off
electricity. Many areas devastated by Typhoon Haiyan went for weeks without power,
making it difficult for health workers to carry out immunizations needed to prevent the
spread of diseases that break out following disasters due to poor sanitation.
After the vaccination program is completed, UNICEF will transfer the fridges to the
Filipino Ministry of Health to be installed in local health facilities.
childhood diseases,
cold storage,
Featured,
measles vaccination campaign,
Philippines,
World Health Organization
Measles, Mumps, and Rubella (MMR) Vaccine

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The measles, mumps, and rubella (MMR) vaccine is one of the recommended childhood vaccinations.
The three-in-one vaccine protects against three potentially serious illnesses. In most states, proof of the
MMR vaccine is required for children to enter school. But if you are an adult who has not had the
vaccination or the diseases, it may be important for you to receive the MMR shot, too.
What Are Measles, Mumps, and Rubella?
Measles, mumps, and rubella are viral diseases. All have the potential to be very serious.
Measles is characterized by fever, cough, runny nose, conjunctivitis (pinkeye), and a red, pinpoint rash
that starts on the face and spreads to the rest of the body. If the measles virus infects the lungs, it can
cause pneumonia. Some older children infected with the virus suffer from encephalitis (inflammation of
the brain), which can cause seizures and permanent brain damage.
The mumps virus usually causes swelling in the salivary or parotid glands, just below the ears, giving the
appearance of chipmunk cheeks. Before the development of the mumps vaccine, mumps was the most
common cause of meningitis(inflammation of the lining of the brain and spinal cord) and
acquired deafness in the U.S. In men, mumps can infect the testicles, which can lead to infertility.
Rubella is also known as German measles. In children, rubella infection causes a mild rash on the face,
swelling of glands behind the ears, and in some cases swelling of the small joints and a low-grade fever.
Most children recover quickly from rubella with no lasting effects. If a pregnant woman gets rubella,
however, the results can be devastating. If she is infected during the first trimester of pregnancy, there is a
great chance her child will have a birth defect such as blindness, deafness, a heart defect, or mental
retardation.
Who Should and Shouldn't Get the MMR Vaccine
MMR is given in two shots, typically during childhood. Children should receive the first shot between 1215 months and the second between 4-6 years of age.
If you're not sure if you have had the diseases or the vaccines (prior to 1971 it was given in three
separate shots), you can get the MMR vaccine as an adult. You should speak to your doctor about the
vaccine if:
You were born after 1956 (if you were born during or before 1956, you are presumed to be
immune, because many children had the diseases then).
You work in a medical facility.
You are planning to or may become pregnant.

You should not receive the shot if:
You experienced a severe allergic reaction following the first MMR shot.
You are allergic to gelatin or neomycin.
You may be pregnant or are planning to become pregnant in the next four weeks. (The vaccine is
safe if you are breastfeeding.)
Your immune system is suppressed because of cancer drugs, corticosteroids, orAIDS.
MMR Risks and Side Effects
Most people who receive the MMR vaccine have no problems from it. Some experience minor soreness
and redness at the injection site or fever.
Other possible side effects are less common. They include:
Fever (1 in 5 children)
Rash (1 in 20)
Swollen glands (1 in 7)
Seizure (1 in 3,000)
Joint pain/stiffness (1 in 100 children; more common in adults, particularly women)
Low platelet count/bleeding (1 in 30,000)
Encephalitis (1 in 1 million)
Despite speculation and considerable publicity, there is no evidence that MMR vaccine causes autism.
The potential benefits of the vaccine far outweigh its potential risks.
Measles (rubeola, hard measles, red measles)

Last Reviewed: January 2012
Sarampin - Medline Plus Informacin de Salud para Usted
What is measles?
Measles is a highly contagious viral disease that can be very serious or even fatal. It begins with a
fever that lasts for a couple of days, followed by a cough, runny nose, and conjunctivitis (pink eye). A
rash starts on the face and upper neck, spreads down the back and trunk, then extends to the arms
and hands, as well as the legs and feet. After about five days, the rash fades in the same order it
appeared. Serious complications of measles include pneumonia and encephalitis (inflammation of the
brain).
Who gets measles?

As a result of widespread immunization, the measles virus does not circulate in the United States. All
reported cases of measles in the United States have been brought in from other countries, usually
Europe and Asia. Travelers leaving the United States should be immune to measles. Although measles
is usually considered a childhood disease, it can be contracted at any age by a person who never had
the disease or been vaccinated. Unvaccinated individuals are 22 times more likely to get measles than
are who those who have two measles vaccines, usually given as measles, mumps and rubella vaccine
(MMR).
How is measles spread?

Measles is highly contagious. The measles virus lives in the mucus in the nose and throat of infected
people. When they sneeze, cough or talk, droplets spray into the air and the droplets remain active
and contagious on infected surfaces for up to two hours.
What are the symptoms of measles?

Measles symptoms generally appear in two stages. In the first stage, which last two to four days, the
individual may have a runny nose, cough and a slight fever. The eyes may become reddened and
sensitive to light while the fever gradually rises each day, often peaking as high as 103 to 105F.
Koplik spots (small bluish white spots surrounded by a reddish area) may also appear on the gums
and inside of the cheeks. The second stage begins on the third to seventh day and consists of a red
blotchy rash lasting five to six days. The rash usually begins on the face and then spreads downward
and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from
head to extremities. Other symptoms include weight loss, diarrhea and enlarged lymph glands
throughout the body.
How soon do symptoms appear?
Symptoms usually appear in ten to 12 days, although they may occur as early as seven or as late as
18 days after exposure.
When and for how long is a person able to spread measles?

An individual is able to transmit measles from four days prior to and four days after rash onset.
What are the complications associated with measles?

Complications occur in up to 30 percent of all cases and are more common in those younger than five
and older than 20 years of age. Pneumonia occurs in up to six percent of reported cases. Encephalitis
(inflammation of the brain) may also occur. Other complications include middle ear infection, diarrhea
and seizures. Infection of the mother during pregnancy has been associated with an increase in lowbirth weight infants, premature labor, miscarriage and birth defects.
What is the treatment for measles?

There is no specific treatment for measles.
Does past infection make a person immune?

Yes. Immunity acquired after contracting the disease is usually permanent.
Is there a vaccine for measles?

Measles-containing vaccine is recommended for anyone born on or after January 1, 1957, who does
not have a history of physician-diagnosed measles or a blood test confirming measles immunity.
Individuals should receive 2 doses of MMR (measles, mumps, rubella) vaccine for maximum
protection. The first dose should be given at 12 to 15 months of age. The second dose should be given
at four to six years of age (age of school entry) at the same time as the DTaP and polio booster doses.
MMR vaccine is recommended for all measles vaccine doses to provide increased protection against all
three vaccine-preventable diseases: measles, mumps and rubella. Unprotected persons can get the
vaccine at any age.
In New York State, measles immunizations are required of all children enrolled in pre-kindergarten
programs and schools. Healthcare personnel and college students are also required to demonstrate
immunity against measles.
Does the MMR vaccine cause autism?

There is no evidence to support that measles-mumps-rubella vaccine (MMR) cause autism.
What can be done to prevent the spread of measles?

Maintaining high levels of measles immunization in the community is critical to controlling the spread
of measles. Infected individuals should be excluded from work or school during their infectious period.
Measles-containing vaccine should be provided to susceptible contacts within 72 hours of exposure.

Immune Globulin (IG) can be given to susceptible persons within six days of exposure.
Expanded Program on
Immunization Nursing Roles &
Responsiblities
Posted on July 27, 2012 by Maye Serrano R.N. in Community Health Nursing with 1 Comment
Because of the global burden on child morbidity and mortality,

last 1976 the Expanded Program on Immunization shortly known as EPI was developed. It primarily focuses on reaching the
bright goal of Fully Immunized Child (FIC) and to improve the rate for Child Protected at Birth (CPAB) in the country.EPI was
established to ensure the access of infant and children (0- 12months old) to the recommended vaccines which in return could
prevent the seven common diseases, i.e.:tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis or whooping cough, measles
and hepatitis.
According to DOH, the specific goals for the Expanded Program on Immunization are:
1. To immunize all infants/children against the most common vaccine-preventable diseases.

To make sure that all children in the country are Fully Immunized Child (FIC), the Department of Health utilizes several
strategies such as the Reaching Every Barangay or REB strategy adapted from WHO-UNICEFs Reaching Every District (RED)
strategy, Supplemental Immunization Activity (SIA) to reduce the rate of missed children or drop outs from routine
immunization, and also through a strengthened disease surveillance.
The routine schedule for immunization is every Wednesday, which is done monthly in every bagangay health stations and
quarterly in far flung areas.
Vaccine
BCG
(Bacillus
CalmetteGuerin)
Dose
Route
Site
0.05ml
Intradermal
Right
deltoi
d of
the
arm
Min.
Age at
1stdose
Birth
or
anyti
me
after
birth
No.
of
Dos
es
1
Min.
Interv
al
betwee
n
Doses
Reason
It is
given the
earliest
possible
to protect
the child
from TB
meningiti
s and
other
forms of
TB
infection.
DPT
(Diphtheri
a,
Pertussis,
Tetanus)
OPV
(Oral
Polio
Vaccine)
HBV
(Hepatitis
B
Vaccine)
Measles
0.5ml
2 drops
depending
on
manufacturer
s
instructions
0.5ml
0.5ml
Intramuscul
ar
Oral
Intramuscul
ar
Subcutaneo
us
Uppe
r
outer
portio
n of
thigh
Mout
h
6
weeks
6
weeks
Uppe
r
outer
portio
n of
thigh
Outer
part
of the
upper
arm
At
birth
9
month
s
4
weeks
4
weeks
6
weeks
interva
l from
1stdose
to
2nd dos
e and
B
weeks
interva
l from
2nddose
to
3rd dose
It reduces
the
chance
from
severe
pertussis.
The
extent of
protectio
n from
polio is
increased
if given
earlier. It
keeps the
Philippin
es poliofree.
It reduces
the
chance of
being
infected
and
becoming
a carrier;
prevents
an
individua
l from
having
liver
cirrhosis
and liver
cancer.
At least
85% of
measles
can be
prevented
at this
age.
A child is said to be a Fully Immunized Child if he receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HBV
and one dose of Measles before his first birthday.
2. To sustain the polio-free status of the Philippines.

As one concept in the eradication of disease initiative is to sustain the country from being polio- free for global
certification. The Polio Eradication Project was established last 1992. It has gained high regard in implementing its core
advocacy, achieving 92% of its routine coverage and happy to say that the country has maintained to be polio- free since October
2000.
Being polio- free is never an assurance for cases, so there is still an on-going polio mass immunization for children aging 6 weeks
up to 59 months old in high risk areas in the country for neonatal tetanus.
3. To eliminate measles infection.

Last 2011 the DOH conducted the 4th mass Measles Rubella Campaign nationwide. The theme, Iligtas sa Tigdas ang
Pinas lead the campaign last April to June 2011. All children with ages 9 months up to 8 years were given with one dose of
Measles-Rubella Vaccine (MR). They utilized Supplemental Immunization strategy and Rapid Coverage Assessment (RCA) to
make sure that there is no missed child for the campaign.
Reports from the RCA tell that in general, 97.6% were vaccinated with MR in all randomly selected barangays.
4. To eliminate maternal and neonatal tetanus

Pregnant women are also the target of this program. Tetanus Toxoid (TT) is given not only to protect the mother from tetanus
during childbirth but also to prevent the occurrence of neonatal tetanus.
TT (0.5ml) is given intramuscularly at the deltoid region of the upper arm. The following schedule for injection should be
followed to attain the ideal percentage of protection for both the mother and the infant.
Vaccine
Min. Age/ Interval
TT1
As early as possible during

pregnancy
Percent
Protected
Duration Protection
Infants: Protected from neonatal

tetanus
TT2
TT3
TT4
TT5
80%
Mother: 3 years protection
95%
Infant: Protected from neonatal

tetanus
Mother:5 years protection
99%

tetanus
Mother: 10 years protection
99%

tetanus
Mother: Lifetime immunity
5. To control diphtheria, pertussis, hepatitis b and German measles.

The recent combination of DPT, Hepatitis B and HIB or Haemophilus Influenza Type B is being continuously given to control
the rate of cases of these diseases. One disease that is prevented by giving this recent vaccine for children is purulent meningitis
which causes acute inflammation of the epiglottis- leading to suffocation in infants and small children.
6. To prevent extra pulmonary tuberculosis among children.

Part of the ENC or Essential Newborn Care Package is the giving of BCG and Hepatitis B at birth in compliance to R.A. 10152
or the Mandatory Infants and Children Health Immunization Act of 2011.
In adherence to eradication of common preventable disease, vaccines should be well taken care and stored accordingly to
maintain its potency. Vaccines are very sensitive substances to heat and cold temperatures. It is also a NO-NO for spoilage thus
proper handling, transporting and storing should be put into consideration.
The policy of FEFO or First Expiry First Out guarantees that all vaccines are used prior to its expiry dates. That is why
vaccines should be properly labelled with its expiry dates and they should be organized accordingly.
On the other hand, the temperature of storage should be monitored twice a day (early in the morning and in the afternoon) and
plotted in a temperature monitoring chart. The purpose is to determine if there is a break in the cold chain.
Characteristics of Vaccines
Type and Form of Vaccine
Storage Temp.
Most Sensitive to Heat
OPV (Live Attenuated)
Measles (freeze dried)

-150C to -250C (freezer)
Least Sensitive to Heat
DPT and Hepatitis B Vaccines
D Weakened toxin
P Killed Bacteria
T Weakened toxin
BCG (freeze dried)
Tetanus Toxiod
+20C to +80C
(body of the refrigerator)
Nursing Roles and Responsibilities
Maintain a master list of eligible children for immunization.

Administer immunization following the protocols in right administration of vaccines (right dose, right route, right
schedule and interval, and proper utilization of cold chain).
Infuse proper aseptic technique and infection control (one syringe: one child and proper disposal of syringes)
Provide health teachings regarding EPI i.e. scheduled immunization activity to enhance the awareness of community
and motivate them to adhere with the campaigns.
Conduct visits in the community to assess their needs and to identify cases of EPI diseases.
Have an updated record of children who had received immunization and the like and report cases if there is.
search terms found:
oral polio vaccine nursing responsibilities

role of nurse in pulse polio
doh epi
doh epi schedule
epi philippines doh
expanded program on immunization doh
RN notes TT vaccine
responsibilities of community nurse for immunization
pentavalent vaccine route and dosage in the philippines
Nursing responsibility of polio vaccine
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About Maye Serrano R.N.

A dedicated registered nurse who loves to view life as a revolving conundrum with spectacles of light and an aspiring
writer who wants to share her expertise and experience in the nursing profession. She had pursued continuing
education specializing in Psychiatric Nursing but had her practice on MNCHN.
View all posts by Maye Serrano R.N.
Kalinga health workers set to

hold measles immunization
BY: GERALDINE G. DUMALLIG
Thursday 30th of January 2014
2 0 0 0 0
Kalinga health workers to conduct measles immunization

By Geraldine G. Dumallig
TABUK CITY, Kalinga, Jan. 30 (PIA) Health workers in the province are set
conduct measles immunization among 9 to 11 months old children as part
of the continuing program to eliminate measles in the country.
According to Minda Bawalan, Measles Program Coordinator of the Provincial

Health Office (PHO), Kalinga provincial governor Jocel Baac recently issued a
directive to all mayors in the province to facilitate the activity through their
respective health departments especially that reports of outbreak had been
recorded in Manila.
Bawalan said that the directive is not a mass vaccination but it must cover all
9 to 11 months old and the defaulters or missed children up to eight years of
age.
Six to eight months old babies are included as regularly done and the health
worker must have to give them another shot when they reach nine to 11
months, she said.
Provincial Epidemiologist and Surveillance Unit (PESU) provincial coordinator
Jose Pardito Jr. said that for January, the province has 12 suspected cases
which were submitted to the Department of Health Research Institute for
Tropical Medicine (DOH-RITM) for validation. At present, there is no confirmed
case yet.
In 2012, the PESU reported four suspected cases but DOH-RITM test results
yielded negative.
According to Pardito, the public especially parents play an important role in
preventing any outbreak or acquisition of said deadly disease.
He said that based on records, several children are still considered defaulters
in some areas of province due to negligence of parents to bring their children
to the health center.
If you love your children protect them and sacrifice a day just to bring them
to the nearest health center for immunization, he said.
Mass immunization is scheduled in June during the Measles-Rubella
Supplemental Immunization Activity or MR-SIA. (JDP/GGD- PIA CAR, Kalinga)
- See more at: http://news.pia.gov.ph/index.php?article=191391053291#sthash.IONMBlrU.dpuf
Abstract
Children in the Asia Pacific region are still suffering from certain vaccine-preventable
diseases. The current study surveyed the national immunization programs and vaccine
uptake of traditional and newly developed vaccines in 12 countries in this area. The results
showed children in most countries were well protected from conventional vaccinepreventable diseases, while immunization programs for certain diseases such as poliovirus
or measles should be strengthened in certain countries. Protection against pneumococcus,
rotavirus, and human papillomavirus infections were obviously inadequate in most of the
countries in the region. Promoting coverage of newly developed vaccines will benefit a great
number of children in this area.
Prevention of measles, rubella, congenital rubella syndrome, and

mumps, 2013: summary recommendations of the Advisory
Committee on Immunization Practices (ACIP).
McLean HQ1, Fiebelkorn AP, Temte JL, Wallace GS; Centers for Disease Control and
Prevention.
Author information
Abstract
This report is a compendium of all current recommendations for the prevention of measles, rubella,
congenital rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the
Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all
existing ACIP recommendations that have been published previously during 1998-2011 (CDC. Measles,
mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella
syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices
[ACIP]. MMWR 1998;47[No. RR-8]; CDC. Revised ACIP recommendation for avoiding pregnancy after
receiving a rubellacontaining vaccine. MMWR 2001;50:1117; CDC. Updated recommendations of the
Advisory Committee on Immunization Practices [ACIP] for the control and elimination of mumps. MMWR
2006;55:629-30; and, CDC. Immunization of healthcare personnel: recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR 2011;60[No. RR-7]). Currently, ACIP recommends
2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15
months and the second dose administered at age 4 through 6 years before school entry. Two doses are
recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or
other post-high school educational institutions, healthcare personnel, and international travelers) and 1
dose for other adults aged 18 years. For prevention of rubella, 1 dose of MMR vaccine is recommended
for persons aged 12 months. At the October 24, 2012 meeting, ACIP adopted the following revisions,
which are published here for the first time. These included: For acceptable evidence of immunity,
removing documentation of physician diagnosed disease as an acceptable criterion for evidence of
immunity for measles and mumps, and including laboratory confirmation of disease as a criterion for
acceptable evidence of immunity for measles, rubella, and mumps. For persons with human
immunodeficiency virus (HIV) infection, expanding recommendations for vaccination to all persons aged
12 months with HIV infection who do not have evidence of current severe immunosuppression;
recommending revaccination of persons with perinatal HIV infection who were vaccinated before
establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine
once effective ART has been established; and changing the recommended timing of the 2 doses of MMR
vaccine for HIV-infected persons to age 12 through 15 months and 4 through 6 years. For measles
postexposure prophylaxis, expanding recommendations for use of immune globulin administered
intramuscularly (IGIM) to include infants aged birth to 6 months exposed to measles; increasing the
recommended dose of IGIM for immunocompetent persons; and recommending use of immune globulin
administered intravenously (IGIV) for severely immunocompromised persons and pregnant women
without evidence of measles immunity who are exposed to measles. As a compendium of all current
recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and
mumps, the information in this report is intended for use by clinicians as baseline guidance for scheduling
of vaccinations for these conditions and considerations regarding vaccination of special populations. ACIP
recommendations are reviewed periodically and are revised as indicated when new information becomes
available.
PMID:
23760231
[PubMed - indexed for MEDLINE]
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Evaluation of immunization coverage within the Expanded

Program on Immunization in Kita Circle, Mali: a cross-sectional
survey
Abdel Karim Koumar12*, Drissa Traore1, Fatouma Haidara3, Filifing Sissoko1, Issa Traor4, Skou
Dram5, Karim Sangar5, Karim Diakit5, Brhima Coulibaly1, Birama Togola1 and Aguissa Maga5
*Corresponding author: Abdel K Koumarkoumareak@buroticservices.net.ml

Author Affiliations
Facult de Mdecine de Pharmacie et d'Odonto Stomatologie, Universit de Bamako, Bamako, Mali
Institut Africain de Formation en Pdagogie, Recherche et Evaluation en Sciences de la Sant (IAFPRESS)
- Quartier du Fleuve - Bamako, BP 05 Koulouba, Mali

Centre de Sant de Rfrence de la commune V, Bamako, Mali
Centre de Sant de Rference de la commune V du cercle de Kita, Mali
Direction Rgionale de la Sant de Kayes, Mali
For all author emails, please log on.

BMC International Health and Human Rights 2009, 9(Suppl 1):S13 doi:10.1186/1472-698X-9-S1-S13
The electronic version of this article is the complete one and can be found online
at:http://www.biomedcentral.com/1472-698X/9/S1/S13
Published:
14 October 2009
2009 Koumar et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction
in aided the original work is properly cited.
Abstract
Background
In 1986, the Government of Mali launched its Expanded Program on Immunization (EPI) with the goal of
vaccinating, within five years, 80% of all children under the age of five against six target diseases:
diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and measles. The Demographic and Health Survey
carried out in 2001 revealed that, in Kita Circle, in the Kayes region, only 13% of children aged 12 to 23
months had received all the EPI vaccinations. A priority program was implemented in 2003 by the Regional
Health Department in Kayes to improve EPI immunization coverage in this area.
Methods
A cross-sectional survey using Henderson's method (following the method used by the Demographic and
Health Surveys) was carried out in July 2006 to determine the level of vaccination coverage among children
aged 12 to 23 months in Kita Circle, after implementation of the priority program. Both vaccination cards and
mothers' declarations (in cases where the mother cannot make the declaration, it is made by the person
responsible for the child) were used to determine coverage.
Results
According to the vaccination cards, 59.9% [CI 95% (54.7-64.8)] of the children were fully vaccinated, while
according to the mothers' declarations the rate was 74.1% [CI 95% (69.3-78.4)]. The drop-out rate between
DTCP1 and DTCP3 was 5.5%, according to the vaccination cards. The rate of immunization coverage was
higher among children whose mothers had received the anti-tetanus vaccine [OR = 2.1, CI 95% (1.44-3.28)].
However, our study found no difference associated with parents' knowledge about EPI diseases, distance
from the health centre, or socio-economic status. Lack of information was one reason given for children not
being vaccinated against the six EPI diseases.
Conclusion
Three years after the implementation of the priority program (which included decentralization, the active
search for missing children, and deployment of health personnel, material and financial resources), our
evaluation of the vaccination coverage rates shows that there is improvement in the EPI immunization
coverage rate in Kita Circle. The design of our study did not, however, enable us to determine the extent to
which different aspects of the program contributed to this increase in coverage. Efforts should nevertheless
be continued, in order to reach the goal of 80% immunization coverage.
Abstract in French
See the full article online for a translation of this abstract in French.
Abstract in French
See Additional file 1 for a translation of the abstract to this article in French.
Additional file 1. Abstract in French.
Format: PDF Size: 71KB Download file
This file can be viewed with: Adobe Acrobat Reader
Background
Vaccination is the most effective means of combating disease. Vaccines exist for a great many dangerous
infectious diseases. The introduction of vaccines, particularly among children, has led to significant
reductions in morbidity and mortality from these diseases, thereby lowering the infant mortality rate.
However, in sub-Saharan Africa, despite the availability of these vaccines and efforts on the part of
governments and their partners to make them accessible, the mortality rate for children under the age of
five remains among the highest in the world [1]. In 1974, the World Health Organization (WHO) launched the
Expanded Program on Immunization (EPI) to make vaccines available to all children worldwide [2]. In Mali the
government launched its EPI in 1986 with the goal of vaccinating, within five years, 80% of all children under
the age of five against six target diseases: diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and
measles. After many years, this goal is far from being reached [3,4], and in 2006, the infant mortality rate
was 119 per 1 000 and child mortality, 217 per 1,000 -- both rates still among the highest in the world[5].
Fifteen years after the EPI's inauguration, the 2001 Demographic and Health Survey (DHS-III)[6] revealed
that, according to vaccination records or mothers' declarations, only 32% of children between the ages of 12
and 23 months had received all the EPI vaccinations. This poor performance was even more striking in the
Kayes region in the northwest area of the country, including Kita Circle (a circle being an administrative
district), where only 13.6% of children aged 12 to 23 months had been fully vaccinated.
The DTCP1 to DTCP3 drop-out rate in the Kayes region was among the highest in Mali (60%); in other regions
of the country the rate ranged from 12% to 50% (DHS-II, DHS-III) [7]. The very great disparity between the
routine data (which allows health personnel of the Kayes region to plan EPI activities based on "coverage
rates" of around 70%) and DHS data (with rates of fully vaccinated children being under 15%, without taking
into consideration whether they were correctly vaccinated), must have shaken the convictions of health
personnel in the Kayes region, and especially those of the regional authorities. In fact, the administrative
authorities based themselves largely on the results from the National Immunization Days (NID), which have a
rate of coverage of more than 90% [7]. For these reasons, in 2003, the Regional Department of Health in
Kayes developed a priority program to improve the EPI's rate of immunization coverage.
This priority program had seven main components:
1. The creation of community health centres (CSCom - Centres de sant communautaire) for each 5 000
habitants. Each CSCom was provided with the human and material resources required to carry out
vaccination sessions within a radius of 15 km. Before the implementation of this program, vaccination units
at times had to vaccinate children within a radius of 100 km.
2. The creation of a health committee within each village. Each committee was composed of two villagers
(one male and one female) who were called "intermediaries". They received training on the EPI (targeted
diseases and vaccinations schedule) and were provided with a register allowing them to record all pregnant
women in the village, all births, all children between the ages of 0 and 5, and the vaccination calendars for
these children. These intermediaries were in regular contact with vaccination teams, which allowed them to
know the dates of vaccination sessions and thereby inform villagers in advance. Upon the arrival of
vaccinators, the intermediaries would accompany them in the village, and would thereby know, at the end of
the vaccination session, which children were missing. When vaccinators left, they would enquire about the
reasons why children had missed the vaccination session and plan for them to attend the following one. This
was known as the active search for missing children.
3. The purchase of a motorcycle, its maintenance, and the purchase of fuel for the vaccination team.
4. The purchase of a 4 4 vehicle, its maintenance, and the purchase of fuel for the supervision team.
5. The purchase of equipment for, and maintenance of, the cold chain.
6. The purchase of vaccination cards.

7. The regular payment of per diems for the training and supervision sessions.
This priority program was mainly financed by the Global Alliance for Vaccines and Immunization (GAVI). Here,
we report on the results of an evaluation of the vaccination coverage rate three years after the
implementation of the priority program in the Kayes region. We did not, however, evaluate the priority
program itself.
Methods
Location of the study
The study took place in Kita Circle, which was selected as representative of the Kayes region. Kita Circle is
located in the southwest part of the Kayes region and has a land area of 35 250 km 2. It has an estimated
population of 338 551 people distributed among 330 villages regrouped into 33 communes, of which 2 are
urban and 31 rural. The circle is served by a railway line linking it to Bamako and Kayes, at distances of 186
and 307 km, respectively. At the time of the study, the circle had only regional roads and rural tracks; there
were no asphalt roads. In addition to its connection to the telephone network, the circle had seven local radio
stations as well as traditional methods of communication. The national television covered approximately 30%
of the circle's territory.
As in the rest of the country, the EPI vaccines are administered according to the calendar set out by WHO [8]:
Polio 0 and BCG in the first 15 days after birth; DTCP1, DTCP2, and DTCP3 at, respectively, 6, 10, and 14
weeks after birth; measles and yellow fever, at nine months of age. The viral hepatitis B and haemophilus
influenzae type B vaccines, introduced more recently into Mali's EPI, are administered in combination and at
the same time as DTCP1, DTCP2, and DTCP3.
Outline of the study

The survey was carried out in July 2006 in three health areas of the circle (Djidjan, Fladougou, and Kasaro)
and was focused on children between the ages of 12 and 23 months. The WHO protocol developed by
Henderson [9] for evaluating EPI immunization coverage was used; the same method was used in the DHS-III
in 2001. With this method, to be accurate within 10% with a margin of error of 5% would require surveying
210 children per health area. For greater accuracy, we surveyed around 250 children per health area. In each
health area, children were selected using a random sampling; sample size was proportional to the population
size. For each child selected, information on the vaccination card and statements made by the person
responsible for the child during an individual guided interview were noted. There is a discrepancy between
data taken only from the vaccination cards and those based also on the mothers' statements. Thus, if we
exclude the mother as a source of information, 4% of the children are considered to be only partially, rather
than fully, vaccinated. The rate of fully vaccinated children thus becomes 26% instead of 30% [6].
Mothers' statements are subject to bias because they:
might be subjected to historical biases;
do not allow us to know if the vaccination was carried out at the right time;
and therefore, do not allow us to properly study dropouts.
In addition, illiterate mothers often cannot tell the difference between the EPI vaccinations and those of the
NID, nor the differences among the various antigens.
Nevertheless, including them helps minimize the underestimation of immunization coverage that occurs
because of lost vaccination cards. Given the biases related to the choice of one method over the other, it was
decided to use the same definition as in the official reports of the DHS, which use both information from
vaccination cards and mothers' declarations. Children were eligible if they had been residents for at least six
months and if their parents consented to their participation in the study. Thirteen pairs of trained supervisors
who spoke French well and at least one local language (Malinke, Khassonk, Bambara, Sonink, and Peul)
carried out the interviews with the mothers using a questionnaire that was validated after pre-testing.
Supervision was ensured by three physicians.
For each child, in addition to the data on the vaccination card, the following information was gathered: i)
parents' knowledge about the diseases covered by the EPI; ii) distance from the health centre; iii) prenatal
consultations and whether the mother was vaccinated against tetanus during pregnancy; and iv) socioeconomic status, determined by the number of meals per day and whether the family possessed a radio
and/or a television. Parents were also questioned about the reasons for non-vaccination or for dropping out
between DTCP1 and DTCP3 (child having received DTCP1 but not DTCP3). Data collected on the
questionnaires were coded and copied into Epi Info version 6 [10]. Analyses were carried out in SPSS version
12.0. The rate of immunization coverage was estimated as the proportion of children who had been fully
vaccinated against the six diseases of the EPI, with a confidence level of 95% using the method of Fleiss [11]
and a cluster effect of two [12]. Pearson's chi-square test was used to compare the proportions. Ratings
ratios were calculated to assess the association between full immunization coverage and the other
dimensions studied (parents' knowledge of EPI diseases, distance from health centre, prenatal consultations
and mother's vaccination against tetanus during pregnancy, socio-economic status). A child is considered
fully vaccinated if all EPI vaccines against the six targeted diseases were received.
Results
The numbers of children surveyed in each health area were: 252 in Djidjan, 250 in Fladougou, and 248 in
Kasaro, for a total of 750 children, of whom 378 (50.4%) were male.
Proportion of children vaccinated, by antigen

Immunization coverages by antigen and by health area are presented in Table 1. Total immunization
coverages for BCG, DTCP1, DTCP2, and DTCP3 were above 90%, while coverage for measles was 70.5%.
Table 1. Proportion of children having received the various EPI antigens according to vaccination cards, by
health area (2006).
Proportion of children fully vaccinated

The immunization coverage levels observed are presented in Table 2. The rate of children fully vaccinated
according to the mothers' declarations was highest in the Djidjan health area (78.2%), followed by Fladougou
(76.4%) and Kasaro (67.7%). The rate of fully vaccinated children according to vaccination cards was highest
in the Fladougou health area (63.2%), followed by Djidjan (58.3%) and Kasaro (58.1%). In the three health
areas combined, the rate of fully vaccinated children according to the statements of those responsible for
them was higher, at 74.1% [CI 95% (69.3-78.4)], than it was according to the vaccination cards, at 59.9% [CI
95% (54.7-64.8)].
Table 2. Proportion of fully vaccinated children according to the mothers' declarations and the vaccination
cards, by health area (2006).
DTCP1 to DTCP3 drop-out rate
If we rely on the vaccination cards held by the families, the rate of drop-out between DTCP1 and DTCP3 was
significantly lower in Djidjan, at 2.8%, than in Fladougou (7.6%) and Kasaro (6%).
Factors associated with full vaccination

The associations between full vaccination and the factors studied are presented in Table 3. Among the
factors studied, only the mother's vaccination status during pregnancy was associated with full vaccination
of the child [OR = 2.18, CI 95% (1.44-3.28)]. On the other hand, there was no link between full vaccination
and the other factors, particularly the mother's education, prena-tal consultations, parents' knowledge about
the EPI diseases, the child's sex, distance from the health centre, or socio-economic status.
Table 3. Vaccination status and associated factors (2006).
Reasons for non-vaccination and for dropping out according to those

responsible for the children
The reasons for non-vaccination and for dropping out, according to those responsible for the children, are
presented in Figure 1. The reason most often mentioned was insufficient information (63.3% of respondents),
followed by a lack of money to buy the card or for travel (8.9%). Parents' refusal was mentioned by 4% of
those responsible for children to explain non-vaccination or dropping out, while 2.4% cited unwelcoming
reception and an overly long wait time.
Figure 1. Reasons for child's non-vaccination or dropping out, according to the

mothers' declarations.
Discussion
As shown in Tables 1 and 2, the rate of fully vaccinated children according to declarations of those
responsible for them improved considerably between 2001 and 2006. Indeed, according to our study, this
rate went from 13.6% in 2001 in the Kayes region to 74% in the three health areas of Kita. The studies
carried out as part of the DHS-III in 2005 in the six communes of Bamako show rates of fully vaccinated
children, according to the declarations of the person responsible for the child, ranging from 76.2% to
86.5% [13-18]. In Kita Circle, this increase in coverage can in part be explained by the fact that before 2003,
a large part of the population (around 15%) lived between 15 and 100 km of the nearest vaccination centre,
resulting in various transportation issues. Now, however, with the implementation of the priority program,
the population lives within 15 km of a CSCom, and thus of vaccination centres. At the same time, it is also
postulated that other aspects of the priority program, including the active search for missing children,
contributed to this increase.
The rate of fully vaccinated children according to vaccination cards has also improved markedly between
2001 and 2006: going from 5% in 2001 in the Kayes region (according to the DHS-III) to 60% (according to
our study). This rate was between 60% and 72.6% in the six communes of Bamako in 2005 [13-17].
According to the DHS-III in 2001 [8], immunization coverage was twice as great in urban settings, particularly
in Bamako (52%), as in rural ones (24%). Our study, however, shows an increase in coverage rates in the
three health areas of Kita Circle (all rural areas) to levels similar to those of Bamako. There is, therefore, a
reduction of inequities in vaccination coverage between the rural zone of Kita and the capital city. Again, this
increase in the vaccination coverage rate in the three health areas of Kita is likely linked to the priority
program formulated and implemented in Kita Circle and financed mainly by GAVI. The lower rate for measles
coverage is likely due to problems in the stock supply of measles vaccines in the region a few months prior
to this study, as explained by the doctor in charge of the region.
Our study has also demonstrated that the probability that children will be vaccinated rises when the mother
herself is vaccinated against tetanus, a finding that mirrors those of other authors[19,20]. We did not find
any significant differences in rates of immunization coverage that could be related to the sex of the child or
to the socio-economic status of the family, as reported in earlier studies [19,20]. In this case, the absence of
any difference could be explained by the presence, as part of the priority program, of two intermediaries in
each village who follow up on children who do not attend a vaccination session and plan for them to attend
the following one, regardless of the children's sex or socio-economic status. It should be noted, however, that
the fact that socio-economic status did not have any influence on vaccination coverage rates might be due
to the inaccuracy of the indicators we used to measure socio-economic status.
While our initial hypothesis was that drop out rates were influenced by lack of money to pay for vaccination
cards and poor reception by health personnel, the study showed that parents mention those reasons in less
than 10% of drop-out cases, while they blame insufficient information 60% of the time. The observation that
persons responsible for children most often mentioned insufficient information as the primary reason for nonvaccination or dropping out is not surprising and confirms the work of other authors [18,19,21,22]. However,
these declarations contradict the other results of our study, which found that the level of knowledge of the
EPI did not influence the vaccination coverage rate. These contradictory findings deserve a more detailed
qualitative study in order to determine the real reasons behind non-vaccination or dropping out.
Figure 1 demonstrates that health personnel were held accountable for non-vaccination or dropping out in
2.4% of the cases in this study, particularly because of unwelcoming reception or overly long wait times. In
other studies, the main reason given for dropping out was the long wait time [13-17]. In our questionnaire,
however, we did not differentiate between reasons for non-vaccination and reasons for dropping out.
All the reasons provided for non-vaccination or dropping out underscore the need to give priority to providing
information and raising the awareness of populations, even if earlier studies have demonstrated the limited
efficacy of Information, Education, and Communication (IEC) sessions in health facilities [19,20]. However,
the absence of any significant differences with respect to mother's education, prenatal consultations,
parents' knowledge about the EPI diseases, child's sex, distance from the health centre, or socio-economic
status is a reflection of the limitations of our study. These include: the insufficient strength of our sample; the
lack of control groups; and the lack of an experimental design to actually evaluate the priority program.
If insufficient information is indeed confirmed to be a key factor in other contexts as well, further questions to
be addressed by other studies could include:
What are the factors that influence vaccination coverage in areas with active search for missing children
versus those areas without it?
What are the best strategies for raising awareness among illiterate people, to persuade them to have their
children vaccinated without the need for the active search for missing children?
Among the eight circles of the Kayes region of Mali, our study looked only at Kita Circle. We selected Kita
Circle because it had the lowest rates of immunization coverage in a region that, itself, had the lowest
immunization coverage in the country. Even if there is no reason a priori to believe that immunization
coverage in the other circles would be lower than in Kita Circle, it would be interesting to confirm this by an
evaluation in one or more of these circles.
The increase in immunization coverage from 13.6% in 2001 in the whole region of Kayes to 74% in our study
three years after implementation of the priority program demonstrates that it is possible, by using
appropriate strategies, to significantly improve immunization coverage in the country. In this case, it would
appear that decentralization of health activities has indeed contributed to an increase in coverage, but this
needs to be coupled with the mobilization of appropriate resources (as was the case here with the support of
GAVI) if objectives are to be attained.
Conclusion
Three years after the implementation of the priority program (which included decentralization, the active
search for missing children, and deployment of health personnel, material and financial resources), our
evaluation of the vaccination coverage rates shows that there is improvement in the EPI immunization
coverage rate in Kita Circle. The design of our study did not, however, enable us to determine the extent to
which different aspects of the program contributed to this increase in coverage. Efforts should nevertheless
be continued, in order to reach the goal of 80% immunization coverage, and, as the study identified, notably
through better information to parents.
List of abbreviations used

DHS-II: Demographic and Health Survey, 2nd edition; DTCP: Diphtheria, tetanus, pertussis, poliomyelitis;
DHS-III: Demographic and Health Survey, 3rd edition; IEC: Information, Education and Communication; WHO:
World Health Organization; EPI: Expanded Program of Immunization; TV: Television; CI: Confidence interval;
OR: Odds ratios; BCG: Bacillus Calmette-Gurin; GAVI: Global Alliance of Vaccines and Immunization.
Competing interests
They authors declare they have no competing interests.
Authors' contributions
AKK contributed to the design of the study, supervision of the surveys, and the writing of the manuscript; FS
contributed to the supervision of the survey. IT, SD, KS, and KD participated in supervising the survey and
writing the report. AM participated in writing the report. DT, FH, and AD contributed to writing the analysis
and the manuscript.
Acknowledgements
This work was carried out with the aid of a grant from the International Development Research Centre (IDRC),
Ottawa, Canada, as part of the Canadian International Immunization Initiative Phase 2 (CIII2). This initiative is
a project of the Global Health Research Initiative (GHRI). We wish to thank Slim Haddad, Pierre Fournier, and
Marta Feletto of the Centre de recherche de l'Universit de Montral for their support to the conduct of this
study, and Donna Riley for translation of the manuscript. We also thank the Kayes Regional Department of
Health for their logistical and administrative support. We extend our gratitude to the parents of the children
surveyed for participating in the study, and also to the local authorities for their support.
This article is published as part of BMC International Health and Human Rights Volume 9 Supplement 1,
2009: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. The
Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants. The full contents
of the supplement are available online athttp://www.biomedcentral.com/1472-698X/9?issue=S1.
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Immunization Systems Across The Globe

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Immunization Systems Across The Globe

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Abstract

Kalinga health workers set to

Kalinga health workers to conduct measles immunization

According to Pardito, the public especially parents play an important role in

- See more at: http://news.pia.gov.ph/index.php?article=191391053291#sthash.IONMBlrU.dpuf

Children's Vaccines: Research on the Risks for Children and Possible

In this very comprehensive and extensive section on vaccines - and children's

DPT Vaccine: Combined Diphtheria, Pertussis (Whooping

Overview of Vaccine Information

o DPT Vaccine and Brain Damage

o Origins of the Mercury / Vaccine Controversy

o MMR Vaccine and Autism

o Concern About Vaccine Adjuvants

o Vaccination During Pregnancy and Risks for Autism

o The Rubeola Vaccine, Measles and Autism

o Hepatitis B Vaccine: The Risks

The Burden of Suffering

See Also Our New Section:

Introduction to Children's Vaccines

The question of vaccine-related damage provokes tremendous controversy.

How Could Children's Vaccines Cause Damage?

No vaccine is perfectly safe. An adverse event can be said to be caused by a

A second mechanism of damage comes from neurotoxic materials found

Early Studies on Vaccine Risks and Complications

New Research Studies Studies on Children's Vaccines, Especially Related to

This new section contains additional up-to-date information that is relevant to

connection between autism (or other developmental disorders) and children's

Written and overseen by Lewis Mehl-Madrona, M.D., Ph.D.

Hosted and maintained by The Healing Center On-Line 2001 - 2009

Joanne Embree, MD FRCPC

5. Taylor B, Miller E, Lingham R, Andrews N, Simmons A, Stowe J. Measles, mumps, and

Vaccine Safety and the Importance of

Haemophilus Influenzae Type B (cdc.gov) (Hib)

Human Papillomavirus (cdc.gov) (HPV)

Influenza (cdc.gov) (Flu), DOH Seasonal Influenza home

Shingles (cdc.gov) (Herpes Zoster)

Varicella (cdc.gov) (Chickenpox)

All children have access to vaccines;

Health care providers are aware of immunization standards

The latest recommendations on new vaccines are available to

Health care providers and the public have up-to-date

Immunization, Vaccines and Biologicals

Implementation research in immunization

Why the need to accelerate immunization implementation research?

WHO activities in immunization implementation research

More information on implementation research activities

Recommended reading: Vitamin A for measles in children

A.D.A.M. Medical Encyclopedia.

Measles is a very contagious (easily spread) illness caused by a virus.

Causes, incidence, and risk factors

Light sensitivity (photophobia)

Usually appears 3 - 5 days after the first signs of being sick

May last 4 - 7 days

Redness and irritation of the eyes (conjunctivitis)

Tiny white spots inside the mouth (Koplik's spots)

Signs and tests

Viral culture (rarely done)

The following may relieve symptoms:

Encephalitis (about 1 out of 1,000 measles cases)

Ear infection (otitis media)

Calling your health care provider

Measles outbreak in the Philippines

Robert HerrimanInfectious Disease Examiner