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National Immunization Days and Status of Poliomyelitis Eradication -- Philippines, 1993
The Western Pacific Regional Committee of the World Health
Organization (WHO) resolved in 1988 to eradicate poliomyelitis in
the region by 1995. Despite intensified surveillance for acute
flaccid paralysis (AFP), reported cases of poliomyelitis decreased
from 5485 in 1989 to 1909 in 1992. Of the five countries in the
region that continue to report endemic poliomyelitis (Cambodia,
People's Republic of China, Laos, Republic of the Philippines, and
Vietnam), reported incidence is lowest in Philippines, which also
was the first country in the region to undertake national
immunization days (NIDs) with oral poliovirus vaccine (OPV); in
addition, other vaccines were administered at vaccination posts by
trained health workers. This report assesses the impact of
Philippines' first NID, which was initiated as part of its
poliomyelitis eradication efforts, and summarizes progress toward
eradication of poliomyelitis in Philippines.
In 1992, Philippines achieved vaccination coverage of 92% with
three doses of OPV by age 1 year by routine vaccination delivery.
Eight of the 47 reported AFP cases in Philippines that year were
classified as confirmed poliomyelitis based on standard WHO
criteria (1) -- three based on isolation of wild virus, four based
on
residual paralysis at 60 days, and one because of loss to
follow-up.
To accelerate the eradication of poliomyelitis, the official
commitment to conduct NIDs annually during a 3-year period was made
on March 3, 1993, by the President of Philippines. Following
intensive planning efforts that focused on technical and logistical
issues, social mobilization, and recruitment of volunteers,
Philippines' NID -- the first NID in Asia -- was conducted on April
21;
a second round of vaccinations was conducted on May 19. An
estimated 400,000 volunteers and 15,000 Philippines Department of
Health staff worked at approximately 64,000 vaccination posts. All
children aged 0-59 months were targeted to receive one dose of OPV
in each of two rounds; an estimated 9.2 million children were
vaccinated in each round. Each child aged 12-59 months also was
targeted to receive 200,000 international units (IU) of vitamin A.
In addition, approximately one third of vaccination posts
administered additional vaccines recommended by WHO's Expanded
Program on Immunization (EPI) to eligible persons based on review
of their vaccination records; these vaccines included measles
vaccine, bacille Calmette-Guerin vaccine, and diphtheria and
tetanus toxoids and pertussis vaccine for young children and
tetanus toxoid for women aged 15-44 years.
To estimate vaccine coverage achieved during the NIDs,
standard 30-cluster EPI coverage surveys were conducted in June
1993 in one randomly selected province in each of Philippines' 15
regions. A total of 3123 children aged less than 5 years were
evaluated. Estimated OPV coverage was 89.6% (95% confidence
interval {CI}=88.9%-90.0%) for round one and 90.9% (95% CI=89.8%-
92.0%) for round two. In traditionally hard-to-reach areas with
ongoing civil strife, estimated OPV coverage was 83%. For
injectable vaccines, coverage was substantially lower: 21% of
targeted children received measles vaccine, and 39% of mothers
received tetanus toxoid. Seventy-five percent of children aged 12-
59 months received 200,000 IU of vitamin A during the second round.
This nationwide effort received resources and other assistance
from government and nongovernment agencies, including Rotary
International, which supplied approximately half of the OPV.
Assistance also was provided by professional societies, other civic
organizations, churches, schools and universities, and private
business firms. An extensive media campaign featured popular
television and radio entertainers, and private amateur radio groups
facilitated logistics and communications in remote areas. Similar
preparations are under way for the 1994 NIDs on February 16 and
March 16.
Reported by: M Costales, MD, A Benegas, MD, J Ducusin, MD, C
Lucman, MD, P Ubial, MD, L Agripa, Maternal and Child Health Svc,
Philippines Dept of Health, Manila. Expanded Program on
Immunization Unit, Western Pacific Regional Office, World Health
Organization, Manila, Philippines. Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases; Polio
Eradication Activity, National Immunization Program, CDC. Editorial Note
Editorial Note: NIDs in which OPV is administered during two rounds
to all young children, regardless of previous vaccination history,
are now an integral component of strategies recommended by WHO to
achieve global eradication of poliovirus transmission by the year
2000. This is one of two approaches that supplement routine
vaccination with four doses of OPV (at birth and at ages 6 weeks,
10 weeks, and 14 weeks). The second approach is to conduct
house-to-house, two-dose supplemental vaccination of those children
living in areas considered at high risk for poliovirus
transmission. In addition to an effective surveillance system for
investigation and reporting of AFP, this combination of routine and
supplemental vaccination strategies has been instrumental in
eradicating poliomyelitis from the Western Hemisphere, where the
last case of poliomyelitis resulting from wild poliovirus was
confirmed in a 2-year-old child in Peru in August 1991.
Of the five countries in the Western Pacific Region with
endemic poliomyelitis, four (China, Laos, Philippines, and Vietnam)
have adopted the strategy of NIDs. The successes in Philippines and
China (2) reflect the high levels of political support engendered
during the extensive planning for and conduct of the NIDs and the
multisectoral involvement of public and private partnerships formed
in countries in this region.
References
Expanded Program on Immunization, World Health Organization.
Poliomyelitis section. In: Report of the Combined Research and
Development Group and technical consultative meeting of the
Expanded Programme on Immunization. Geneva: World Health
Organization, Expanded Program on Immunization, 1993:12-3;
publication no. WHO/EPI/GEN/93.20.
CDC. National poliomyelitis immunization days -- People's
Republic
of China, 1993. MMWR 1993;42:837-9.
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