Implementation of School-Based Dengue Vaccination Program

March 28, 2016

DepEd Memorandum No. 50, s. 2016

IMPLEMENTATION OF SCHOOL-BASED DENGUE VACCINATION PROGRAM

To:

Bureau and Service Directors
Regional Directors
Schools Division Superintendents
Public and Private Secondary Schools Heads
All Others Concerned

1. Dengue virus is one of the leading causes of illness in the Philippines. The country ranks fourth in the number of dengue cases among the ten ASEAN nations. It has been estimated that the direct medical cost of dengue is around 345 million dollars or 16 billion pesos annually. Dengue indeed poses not only a public health burden but also significant economic and social implications in the country.

2. The Department of Health (DOH) and the Department of Education (DepEd) since 2013 have implemented the School-Based Vaccination in both elementary and secondary schools in the country. Measles, Rubella, Tetanus, and Diptheria Vaccines have been provided for free and will be provided every August to Grade 1 and Grade 7 learners nationwide.

3. This year, the School-Based Immunization (SBI) will be expanded to include dengue vaccination. This initiative is deemed as a more effective, sustainable, and cost effective strategy to reduce the increasing number of cases of dengue among the school age population in the country.

4. For Calendar Year 2016, the SBI Dengue Vaccination will be provided to all Grade 4 learners, nine years old and above, currently enroled in public elementary schools in the National Capital Region (NCR), Regions III and IV-A (CALABARZON). The vaccine will be given in three doses (0-6-12 months interval) using the Food and Drug Administration (FDA) approved tetravalent vaccine.

5. Enclosed are the implementing guidelines for the Program and the DOH Department Memorandum No. 0096, s. 2016 entitled Guidelines in the School-Based Immunization of Tetravalent Dengue Vaccine.

6. Regional directors, school division superintendents, and other school officials are enjoined to provide full support in the conduct of the said activity. School health personnel are expected to coordinate with DOH regional and provincial health officers for the implementation and conduct of the school-based vaccination program. This activity shall be monitored by the DOH and by the DepEd, central, regional and division offices.

7. Parental consent must be secured prior to the conduct of the vaccination.

8. For more information, all concerned may contact Ms. Girlie G. Azurin, Senior Education Program Specialist, School Health Division, Bureau of Learners Support and Services, Department of Education Central Office at telephone no. (02) 632-9935 and Dr. Clarito U. Cairo Jr. Medical Officer IV, Infectious Disease for Prevention and Control Division, Disease Prevention and Control Bureau, Department of Health at telephone no. (02) 651-7800 local 2354.

9. Immediate dissemination of this Memorandum is desired.

BR. ARMIN A. LUISTRO FSC
Secretary


(Enclosure No. 1 to DepEd Memorandum No. 50, s. 2016)

IMPLEMENTING GUIDELINES ON THE IMPLEMENTATION OF DENGUE VACCINES TO GRADE 4 STUDENTS

I. TARGET COVERAGE

All Grade 4 students, 9 years old and above currently enrolled in public elementary schools in NCR, Region 3 and Region 4.

II. GENERAL GUIDELINES

  1. All 9 years old and above students enrolled in Grade 4 public schools shall be vaccinated with 3 doses (0-6-12 months interval) of the Dengue tetravalent vaccine.
  2. Vaccination shall start from April 2016 until June 2017.
  3. School-based vaccination shall be a FREE routine service to be administered by the health center service providers and the school health personnel.
  4. There shall be no case of suspension, grounding, or reprimand in case of dengue vaccination refusal or failure to complete the dosage.
  5. Only students with parental/guidance consent shall be vaccinated.
  6. DOH shall provide the necessary vaccines and other immunization logistics (e.g. N/S, epinephrine, safety collector boxes, consent forms, immunization cards, recording and reporting forms) following the routine system of the distribution of the immunization logistics.
  7. Department of Education (DepEd) shall determine the most appropriate timing of the immunization sessions for the schools, inform teachers/parents/students of the vaccination, provide support human resource for vaccination, and enjoin each eligible student to undergo vaccination and appropriately refer missed students for vaccination.
  8. The Local Government Units (LGUs) health personnel (MDs. Nurses, midwives, volunteers) shall lead the vaccination in collaboration with schools, hospitals and other partners within the catchment areas.
  9. As part of the vaccination activity, schools of beneficiary regions will be included in the passive and active surveillance of adverse reactions during the implementation of the program.

III. SPECIFIC GUIDELINES

A. Vaccination Strategy

1. Strategy:

  • School-based, classroom per classroom
  • Rolling-phase

2. Timelines:

  • 3 months-long per round
  • From 2016 up to 2017

3. Number of Rounds:

3 Rounds to coincide with the required 3 doses for complete immunization:

  • Round 1 (Dose 1): Year 2016 -April, May, June
  • Round 2 (Dose 2): Year 2016 – October, November, December
  • Round 3 (Dose 3): Year 2017 – April, May, June

B. Target Vaccination of Dengue Vaccines

1. Nine (9) years old and above students enrolled in Grade 4 public schools shall be vaccinated with the 1st dose of the dengue vaccine, 0.5ml, subcutaneous, (SC) at the LEFT deltoid arm. Succeeding doses shall follow the recommended vaccination schedule:

First Dose : At time of visit with the health worker at school

Second Dose : At least 6 months after the 1st dose

Third Dose : At least 6 months after the 2nd dose

NOTE: Health workers must ensure that those who received the dengue vaccine first dose shall be given the 2nd dose after 6 months and the 3rd dose 6 months after the 2nd dose

2. All clinic/ Grade 4 teachers/school nurses shall issue a notification letter to all students on the vaccine and dates to be received.

3. Clinic/school nurses/teachers shall list all the enrolled students in Grade 4 using the Recording Form 1 (Master list of Grade 4).

4. Follow-up of Deferred Students:

  • Teacher-in-charge shall follow-up the deferred students but willing to be vaccinated and refer to the catchment health facility.
  • Students who will be referred and vaccinated at the health facility shall be accompanied by the school nurse and shall be included in the accomplishment report.

5. Grade 4 students less than 9 years old shall not be given the dengue vaccine.

6. All vaccinators shall conduct a quick health check status of every eligible student before vaccination.

Ask if the students had/hasACTION REQUIRED
FeverDefer vaccination until child is well.
Refer for medical management.
Set a definite date for the vaccination.
Cough
Rashes
Headache
Received any vaccines for the last 1 month
Resident/enrolled in schools in San Pablo City, LagunaDo not give the dengue vaccine.
Recipient of blood products for the last 3 months
Taking corticosteroids or chemotherapy
Pregnant or Breastfeeding

C. Dengue Tetravalent Vaccine (Dengvaxia)

  1. Live, attenuated vaccine contains 4 dengue virus serotypes-1,2,3, and 4
  2. 5-dose per vial (multi-dose), suspension for SQ injection
  3. NOVVM label
  4. Indicated for use to children and adults from 9 years to 45 years old

D. Vaccine Storage and Transport

  1. DOH shall provide the Dengue tetravalent vaccines to Regions III, IVA and NCR.
  2. Dengue Tetravalent vaccines shall be stored at +2°C to +8°C .
  3. During immunization session, Dengue tetravalent vaccines shall be transported and stored using the WHO recommended vaccine carriers with pre-conditioned ice-packs.
  4. Opened Dengue tetravalent vaccines shall be discarded 6 hours of reconstitution or at the end of the immunization period following the recommended disposal of the biological wastes.
  5. Excess unopened Dengue tetravalent vaccines brought in school shall be marked with a bar (/) before returning to the refrigerator for storage. The bar mark shall indicate the vaccine vial was out from the refrigerator and shall be prioritized for use in the next immunization session.

E. Immunization Safety

  1. Special precautions must be instituted to ensure that blood-borne diseases are not transferred to other persons. This shall include:
  2. Always use the auto-disabled syringe (AD) in all immunization sessions
  3. Do not pre-fill syringes.
  4. Do not recap needles.
  5. Dispose used syringes and needles in safety collector box.
  6. Proper disposal of safety collector boxes with used immunization wastes through the recommended appropriate final disposal for hazardous wastes.
  7. Use of aspirating needles and pre-filling of syringes are strictly prohibited.
  8. Used needles and syringes, empty vaccine vials, used cotton balls are considered infectious and shall be disposed in the recommended appropriate disposal of infectious wastes.

F. Recording and Reporting

  1. For each level of vaccination schedule, an appropriate recording and reporting forms shall be completed and submitted from the service delivery point to the next higher administrative level.
  2. Accomplishment Reports shall be submitted by the DOJ Regional Offices to the DOH National Office 2 weeks every after each round.

G. Adverse Event Following Immunization

  1. Fear of injections resulting to fainting has been commonly observed in school immunization. Thus it is recommended that the vaccination sites are situated in areas not conspicuous to the students. Immunization session shall be conducted after these eligible students have taken their snacks/food to rule-out fainting secondary to hypoglycemia.
  2. Adverse Events after the receipt of the vaccines, even if it is not clear that the vaccine caused the adverse events should be reported following the existing DOFI Issuance Administrative Order No. 2010-0017, “Guidelines in Surveillance and Response to Adverse Events Following Immunization (AEFI).
  3. However, a line list of the minor reactions shall be recorded and submitted to gather information on the various AEFI rates for the Philippines setting.

Download: DM 50, s. 2016 – Implementation of School-Based Dengue Vaccination Program

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