Objectives
- General: Strengthen laboratory capacity toward measles elimination.
- Specific:
- Enhance measles case-based surveillance.
- Improve detection of rubella through measles surveillance.
- Evaluate immunization activities on measles and rubella control.
- Establish dried blood spot (DBS) and nasopharyngeal swab (NPS) as laboratory confirmation methods.
- Implement standards in collection, handling, storage, and transport of DBS and NPS samples.
Scope and Coverage
- Applies to entire health sector: public and private health facilities at national and local government levels involved in disease surveillance and response.
Definitions and Abbreviations
- Case Investigation Form (CIF): Standard epidemiological reporting form.
- Cluster: Two or more suspected measles cases within 7-21 days and geographically or epidemiologically linked.
- Contacts: Persons living or in close contact with case during infectious period (5 days before to 5 days after rash onset).
- Disease Reporting Unit (DRU): Health facilities like hospitals, labs, ports, rural health units.
- Epidemiologically-linked case: Suspected measles case linked to lab-confirmed case.
- Immunoglobulin M (IgM): Antibody confirming measles infection.
- Measles and rubella surveillance units defined (PESU, RESU).
- Suspected measles case defined by fever, rash, and symptoms like cough or conjunctivitis.
Policies
- Targets 90% measles mortality reduction and 95% immunization coverage of infants.
- Follow-up Supplemental Immunization Activities (SIAs) every 3-4 years recommended.
- Case-based surveillance with laboratory testing essential.
- Regional action plans and resolutions endorse measles elimination by 2012.
- Control of congenital rubella syndrome prioritized through MR/MMR vaccines.
- WHO-UNICEF strategy includes high immunization coverage, a second immunization opportunity, enhanced surveillance, and proper clinical management.
Implementing Mechanism: Laboratory Procedures
- Laboratory confirms suspected measles by serology (anti-measles IgM), molecular detection, or virus isolation.
- Serum IgM testing remains the gold standard; one serum specimen to be collected from all suspected cases within 28 days of rash onset.
- Alternative specimen: Dried Blood Spot (DBS) used where serum collection or specimen storage is difficult.
- Oropharyngeal/Nasopharyngeal swabs collected within 5 days of rash onset for virus isolation, especially in clusters.
- Sample collection protocols vary by cluster size to optimize viral isolation.
- Viral isolation differentiates indigenous vs imported measles transmission.
Roles and Responsibilities
- Research Institute for Tropical Medicine (RITM): receives and tests specimens, builds lab capacity, collaborates with WHO.
- National Epidemiology Center (NEC): oversees surveillance implementation, technical support, specimen logistics, data management.
- Centers for Health Development (CHD): regional coordination, investigation, specimen management, lab result dissemination.
- Provincial Epidemiology and Surveillance Units (PESU), Provincial Health Office (PHO), and Rural Health Units (RHU): case coordination, data handling, specimen shipping, logistics support.
- Hospitals: investigate all suspected cases thoroughly, collect and transport specimens properly, maintain documentation.
Funding
- Laboratory and logistic expenses primarily borne by RITM with DOH and WHO support.
- Freight and handling costs borne by CHDs in accordance with government accounting rules.
Repealing Clause
- Previous orders inconsistent with this administrative order are revised, modified, repealed, or rescinded.
- Other provisions not affected remain valid.
Effectivity
- The order took effect immediately upon issuance on February 8, 2012, by Secretary of Health Enrique T. Ona, MD.