Republic ofthe Philippines Department of Health OFFICE OF THE SECRETARY ADMINISTRATIVE ORDER NOV 02 2011 No. 2011 = OOI® SUBJECT: Implementing Guidelines on Influenza and Pneumococcal Immunization for Indigent Senior Citizens I RATIONALE Influenza and pneumococcal disease together are responsible for hospitalizations, deaths and is a substantial disease burden worldwide. Most of the serious complications of these diseases occur among the elderly and other people with underlying chronic medical conditions In most countries, majority of the cases of influenza occurs in the elderly. Observational studies from Europe, America and Asia have established that immunizing the elderly not only prevents direct outcomes of influenza infection and complications including hospitalization and death, but also direct outcomes, such as death from other causes or acceleration of the worsening condition of their health status. Meta-analyses of 20 cohort studies conducted between 1965 and 1991 add further support for the value of influenza immunization in the elderly, demonstrating prevention of respiratory illness by 56%, pneumonia by 53%, and hospitalization by 50% and death by 68%. Immunization is strongly recommended by the World Health Organization (WHO) and many national health authorities. The WHO estimates that more than 1.6 million people die from pneumococcal infections every year. It remains a major cause of mortality worldwide. Elderly subjects are most affected, with an incidence rate of 40 per 100,000 for people aged 80 ~ 85 years. Age- related impairment of the immune system and other defense mechanisms often compounded ith decrease physical activity and poor nutrition increase the risk of severe pneumococcal sease in the elderly. Immunization remains the best preventive tool as the growing issue of antibiotic resistance often hampers treatment. In recognition of this tool, a growing number of countries and health bodies now recommend pneumococcal immunization of elderly and atcrisk groups. Immunization with the 23-valent polysaccharide vaccine protects from invasive pneumococcal infections. WHO recommends the use of pneumococcal polysaccharide vaccine for the elderly and other at-risk groups'. In February 2010, President Gloria Macapagal-Arroyo signed into law Republic Act (RA) No. 9994, otherwise known as the “Expanded Senior Citizens Act (ESCA) of 2010”. It ‘World Health Organization. Pneumococcal Vs ‘Weekly Epidemiological Rec, 2003; 78 (14): 11049. ‘Buildiag 1, San Lararo Compound, Rizal Avenue, Ss. Cray 1003 Manila © Trunk Line 6SI-0000 Direct Line: 71-9802 to (3 Fax: 743-1829 « URL: ii ohvh -mll:osedoh zo. Vvis an act granting additional benefits and privileges to senior citizens, further amending RA ‘No. 7432, otherwise known as “An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for Other Purposes”. Pursuant to Article 11, Section 4 of RA 9994, the Department of Health (DOH) is mandated to procure pneumococcal and influenza vaccines to be administered for free to indigent senior citizens in communities who are recipients of the Department of Social Welfare and Development's National Household Targeting System for Poverty Reduction (DSWD - NHTS-PR) of the country. Senior citizens in government-run residential homes and facilities shall likewise be entitled to free immunizations under these Rules. To ensure an effective and efficient management of routine immunization for the indigent senior citizens in all health units, government-run residential homes and facilities, this guideline is hereby developed. Consultations with the Health and Well-being of Older Persons (HWOP), Expanded Program for Immunization (EPI), National Epidemiology Center (NEC), National Center for Health Promotion (NCHP) and their regional/provincial and municipal counterparts will be done to warrant the successful implementation of this guideline. Likewise, coordination with other government offices like the DSWD and the Office for Senior Affairs (OSCA), other Non-Governmental Organizations like the Coalition of Citizens for the Elderly (COSE), National Federation of Senior Citizens’ Associations of the Philippines (NFSCAP), and Confederation of Older Persons Association of the Philippines (COPAP) among others will be done. SCOPE AND COVERAGE ‘This order shall apply to all Centers for Health Development (CHD) of the DOH, city/municipal health centers, government ~ managed centers/tesidential institutions for senior citizens and other institutions providing immunization services for indigent senior citizens nationwide. Ill. PROGRAM GOAL 1. To reduce the morbidity and mortality of indigent senior citizens against pneumonia and influenza diseases. 2. To reduce transmission of resistant strains and pneumococcal resistance to antimicrobial drugs among indigent senior citizens. IV. DEFINITION OF TERMS For purposes of this Order, the following terms shall have the following definitions based on the Implementing Rules and Regulations of RA 9994 SENIOR CITIZEN OR ELDERLY - refers to any Filipino citizen who is a resident of the Philippines, and who is sixty (60) years old or above. It may apply to senior citizens with “dual citizenship” status provided they prove their Filipino citizenship and have at least six (6) months residency in the Philippines. INDIGENT SENIOR CITIZEN — refers to any elderly who is frail, sickly, or with disability, and without pension or regular source of income, compensation or financial assistance from his/her relatives to support his/her basic needs, as determined by the DSWD. in consultation with the National Coordinating and Monitoring Board (NCMB).RESIDENTIAL CARE FACILITY ~ refers to a facility that provides twenty four (24) hour residential care s 's operated for the purpose of promoting the well-being of abandoned, neglected, unattached or homeless senior citizens. The facility may be run by government or non-stock non-profit organization and is accredited by the DSWD to serve a minimum of 10 clients. V. GENERAL GUIDELINES ‘The DOH shall procure pneumococcal and influenza vaccines starting CY 2011 onwards and administer for FREE a yearly dose of influenza vaccine and a single dose of pneumococcal vaccine to all indigent senior citizens. ‘The DOH shall calculate the pneumococcal and influenza vaccines based on the list of indigent senior citizens in the NHTS-PR of the DSWD, in residential care facility (ex: government-run residential facilities and in DSWD-accredited non-governmental home care facilities), as stipulated under the RA 9994. Only health workers trained and skilled at giving injections are authorized by the DOH to give immunizations in designated city/municipal health centers, government- run residential facilities and DSWD-accredited non-governmental home care facilities for senior citizens, VI. IMPLEMENTING GUIDELINES 1 ‘Target setting A. Age Group Al. All indigent senior citizens 60 years of age and above should receive the following vaccines: One (1) dose of pneumococcal vaccine throughout his/her lifetime ii, One (1) dose of fluenza vaccine every year A2. An indigent senior citizen who has received a penumococcal vaccine the last 5 years and was < 60 years of age at the time of immunization should receive another dose of pneumococcal vaccine. ‘A3. An indigent senior citizen who has received a pneumococcal vaccine ‘when he/she was 60 years old and above at the time of immunization is not required to receive another dose of pneumococcal vaccine. B. Geographical coverage BI. All indigent senior citizens 60 years old and above living in residential care facilities and in the communities identified. B2. All personnel and staff employed in residential care facilities. Vaccination of these employees against these diseases will ensure protection because they are constantly in contact with the senior citizens,C. Immunization Schedule Routine immunization activity will commence as soon as the vaccines are made available at the City/Municipal Health Centers. 2. Immunization Strategy -based (i.e. residential care facility, city/municipal health center) ition strategy shall be the main strategy with a catch-up/mop-up ‘vaccination to track those who were listed but did not come to the facility for vaccination or vace was temporarily deferred due to sickness. DOH hospitals will be alternative sites for immunization. B. Preparatory activities 4 weeks before the date of immunization 1. Make a line list of target beneficiaries i. List the name of all indigent senior citizens 60 years of age and above living in residential care facilities, including all personnel and staff employed in the above residential care facilities. Use the Master List for Indigent Senior Citizen Recording Form (Annex 1). ii, List the name and address of all indigent senior citizens 60 years old and above living in communities based on the NHTS- PR of DSWD. Use the Master List for Indigent Senior Citizen Recording Form (Annex 2). 2. Orient the target beneficiaries regarding when, where, how, what to do for the upcoming immunization acti 3. Vaccine Information A. Type of Vaccine 1. Pneumococcal Polyvalent Vaccine 25 micrograms/0.5 mL (polysaccharide from each capsular type) in 0.5 pre-filled syringe. Itis an inactivated vaccine containing twenty-three (23) killed pneumococcal strains. 2. Influenza Polyvalent Vaccine 0.5 mL vial + pre-filled syringe diluent or 0.5 mL suspension in a pre-filled syringe or ampule. It contains three (3) killed influenza viruses. 3. The CY 2011 supply of both the pneumococcal and influenza vaccines are in pre-filled syringe preparation. However, in future procurements, formulations may change as long as it is in the latest edition of the Philippine National Drug Formulary. B. Dosage 1, The standard dosage is 0.5 mL Pneumococcal Polyvalent Vaccine and is given once in his/her lifetime. There is no need to re-vaccinate mn)unless he/she has received pneumococcal vaccine in the last 5 years and was < 60 years old at the time of vaccination. 2. The standard dosage is 0.5 mL Influenza Polyvalent Vaccine and is given every year because influenza viruses change from year to year. Route of Administration Simultaneous administration of pneumococcal and influenza vaccines is safe and effective during the same immunization schedule but at different sites muscle — pneumococcal vaccine intramuscularly; Right deltoid muscle — influenza vaccine intramuscularly), It is not recommended, however, to mix the 2 vaccines in one (1) syringe before injection. Vaccine Distil ution, Storage and Handling. 1. Pneumococcal and Influenza vaccines procured by the DOH shall be stored at the Research Institute for Tropical Medicine (RITM). An allocation list of vaccines shall be submitted by the National Health and Well-being of Older Persons (HWOP) Program focal person to RITM for delivery and distribution to the different CHDs. The delivery and distribution of these vaccines shall follow the mechanism used by the EPI 2. The CHD - HWOP will prepare the distribution list for the provincial/municipal/city health care centers based on the total estimated indigent senior citizens residing in residential care facilities and in communities. 3, Pneumococcal and influenza vaccines shall be stored at temperatures between +2° to +8°C. Both vaccines should not be allowed to freeze. Influenza vaccines supplied by DOH comes with a “Vaccine Vial Monitor” (VVM). On the other hand, pneumococcal vaccine does not have a VVM. VVM should be regularly read before using the vaceine. 4, Proper labeling of pneumococcal and influenza vaccines shall be done e.g. name of vaccine, expiry date, ete 5. Safe injection practices shall be strictly observed in the administration and disposal of these vaccines. Disposal of used syringes and needles LE All vaccination teams shall be provided with a safety collector box (SCB) to dispose the used vial/syringes, cotton and other immunization wastes. 2. All health facilities shall identify areas for the temporary storage of the filled-SCB until its final waste disposal as recommended in the EPI. 3. The Sanitary Inspector (SI) shall ensure that such immunization wastes shall be finally disposed in the recommended waste disposal method.Contraindications Senior citizens coronary heart disease, chronic obstructive pulmonary disease, diabetes mellitus, dementia, stroke, malnutrition, chronic liver disease, chronic renal disease, use of immunosuppressive drugs because of cancer can still be given pneumococcal and influenza vaccines. There are no contraindications for the administration of pneumococcal and influenza vaccines, The only absolute contraindication to influenza vaccine is a known history of allergy to eggs and egg products (egg proteins), chicken feathers, vaccine component antibiotics such as neomycin or polymy:xin, latex gloves, or those currently taking steroids. For a senior citizen who has fever, signs of acute illness like cough, or any flu-like illness or other pertinent signs and symptoms of an acute infection at the time of immunization, postponement of immunization is advised until the senior citizen has fully recovered from his/her acute illness. Thus, a quick health assessment by the health worker is required before administration of the vaccines. Possible mild and adverse events The risks from pneumococcal and influenza vaccines are similar to most inactivated vaccines, although not everybody gets them. Mild Events: Injection-site abscess ~ occurrence of a fluctuant or draining fluid-filled lesion at the site of injection with or without fever. Lymphadenitis (includes supporative lymphadenitis) - occurrence of either: at least one lymph node, 1.5 em in size (one adult finger width) or larger; or a draining sinus over a lymph node. Severe local reaction — redness and/or swelling centered at the site of injection and one or more of the following: swelling beyond the nearest joint; pain, redness and swelling of more than 3 days duration; or requires hospitalization, ‘These reactions usually begin soon after the immunization, can last from 1 ~2 days to 1 week after immunization and spontaneously disappear without treatment. The risk of any vaccine causing life threat 1g allergic reactions to the vaccine is extremely small. Although very rare, any one of the following signs has to be watched out for. Central Nervous System (CNS) Adverse Events: ‘Acute paralysis such as Guillain Barre Syndrome (GBS) ~ acute onset of rapidly progressive, ascending, symmetrical flaccid paralysis, without fever at onset of paralysis and with sensory loss. Encephalopathy ~ is an acute onset of major illness temporarily linked with immunization and characterized by any two of the following three 64Summary Table: conditions: seizures; severe alteration in level of consciousness lasting for 1 day or more; and distinct change in behavior lasting 1 day or more, ‘© Encephalitis — is characterized by encephalopathy and signs of cerebral inflammation and, in many cases, CSF pleocytosis and/or virus isolation. © Meningitis - acute onset of major illness with fever, neck stiffness/positive meningeal signs (Kernig, Brudzinski). Symptoms may be subtle to similar to those of encephalitis. Seizures ~ lasting for several minutes to more than 15 minutes and not accompanied by focal neurological signs or symptoms. Febrile seizures or afebrile seizures. Onset is usually 0 to 2 days. Other Adverse Events: © Anaphylactoid Reaction (acute hypersensitivity reaction) ~ exaggerated acute reaction, occurring within 2 hours after immunization, characterized by one or more of the following: (1) wheezing and shortness of breath due to bronchospasm; (2) laryngospasm/laryngeal edema; (3) one or more skin manifestations, e.g. hives, facial edema, or generalized edema. * Neuritis ~ dysfunction of nerves supplying the arm/shoulder without other involvement of nervous system. A deep steady, often severe aching pain in the shoulder and upper arm followed by weakness and wasting in arm/shoulder muscles. Sensory loss maybe present, but is less prominent. May present on the same or the opposite site to the injection and sometimes affects both arms. Onset is usually 2 to 28 days. © Hypotensive-hyporesponsive episode (shock collapse) ~ sudden onset of paleness, decrease level or loss of responsiveness, decrease level or loss of muscle tone (occurring within 24 hours of vaccination), The episode is transient and self-limiting «Persistent screaming — inconsolable continuous crying lasting at least 3 hours accompanied by pitched screaming. Onset 0 to 24 hours. ‘© Sepsis ~ acute onset of severe generalized illness due to bacterial infection and confirmed by positive blood culture. © Thrombocytopenia — platelet count of 100,000 cells or less per mm*. Onset is 15 to 35 days, * Toxic shock syndrome — abrupt onset of fever, vomiting and watery- diarrhea within a few hours of immunization, often leading to death wi 24 to 48 hours. If these adverse events do occur, hours after the immunization. is usually within a few minutes to a few It is important to seek consult with a doctor, and inform him/her about the reaction, the date and time it happened, and when the vaccination was given. Appropriate medical treatment and supervision are readily available in case of anaphylactic reactions. ‘CHARACTERISTICS VACCINE TYPE, Pneumococcal Polyvalent Vaccine Influenza Polyvalent Vaccine “Temperature Storage 32 to 48°C FE 10 +8°C VM label Without VVM label With VVM label Preparation 05 mL vial + pre-filled syringe diluent (IM) or 0.5 mL suspension in a pre-filled syringe or ampule 25 micrograms/0.5 mL (polysaccharide from each capsular type) in 0.5 mL. pre- filled syringe “4‘CHARACTERISTICS VACCINE TYPE | Standard Dosage (pef person) Pneumococcal Polyvalent Vaccine 0.5 mL given once in the senior citizen’s lifetime Influenza Polyvaient Vaccine (0.5 mL given every year Route of Administration Intramuscular, left (L) deltoid muscle Tntramuscular, right (R) deltoid muscle ‘Contraindications T. Absolute contraindication’ Known history of allergy tor > vaccine components > antibiotics such as neomycin or polymyxin > Latex gloves Currently taking systemic steroids | cep products (egg. proteins), chicken Known history of allergy to eggs and feathers | Known history of allergy to: > vaccine components, > antibiotics such as neomycin or polymyxin > Latex gloves Currently taking systemic steroids 72, Precautionary measures Currently with an acute infection at the time of immunization (ex. fever, signs of acute illness like cough or any flu-like illness) ‘Currently with an acute infection at the time of immunization (ex. fever, signs of acute illness like cough or any flustike illness) Mild events after | > Injection-site abscess immunization > Lymphadenitis, including supporative lymphadenitis >severe local reactions | ‘These reactions usually begin soon after the immunization, can last for 1 — 2 days to 1 week after immunization and spontaneously disappear without _| treatment, ‘Adverse events after | CNS adverse events immunization > Acute paralysis (ex. Guillain Barre Syndrome) | > Encephalopathy | > Encephalitis | > Meningitis > Seizures ] Other adverse events > Anaphylactoid reaction (acute hypersensitivity reaction) > Neuritis > Hypotensive-hyporesponsive episode (shock collapse) > Persistent screaming. | > Sepsis > Thrombocytopenia | > Toxic shock syndrome These reactions usually begin within a few minutes to a few hours after the _ immunization. BRING PATIENT TO THE NEAREST HOSPITAL. 4, Calculation of Pneumococcal and Influenza Vaccine Needs Data required: A. ‘Total number of indigent senior citizens in residential care faci total number of personnel in residential care facilities. B. ‘Total number of indigent senior citizens residing in all municipé the NHTS-PR of the DSWD.The formula is as follows: ‘Annual vaccine required = A + B MULTIPLIED BY wastage factor (based on vaccine vial preparation). 1. wastage factor of 1.1 or 10% (single dose vaccine vial) 2. wastage factor of 1.25 or 20% (multi-dose vaccine vial) 5. Vaccine Administration ‘A. Vaccines shall cover all indigent senior citizens 60 years old and above living in: 1. residential care facilities for indigent senior citizens 2. in the community based on the NHTS-PR of the DSWD B. The City/Municipal/Provincial Health Officer and CHD shall plan the immunization schedule for the residential care facility and for the community for senior citizens. C. — Vaccinator teams that will be assigned to immunize senior citizens in residential care facilities shall get their vaccine allocation for the day in the CHO/MHO where the above center/residential institution is located. The vaccinator team shall get the vaccines and place it in a standard vaccine carrier prior to the immunization schedule. D. Remaining unused vaccines after immunization schedule shall be retumed to the CHO/MHO at the end of the day and shall be used first in the next immunization. 1, Depending on the vaccine preparation, the follo undertaken: ing steps are to be a. Forany vaccine without VVM Any unopened vaccine vial that needs to be returned back to the health facility for storing shall be marked ‘X? if first time to be taken out. This ‘X’ marked vaccine should be allocated for use on the following day. ii In case this unopened vaccine vial marked ‘X’ was not again utilized at the end of the day and needs to be returned back to the health facility, marked this vaccine as ‘XX’ and shall be used first the following day. 6. Recording and Reporting Forms A. The following are the recording and reporting forms that shall be used every i ity.1. Master List for Indigent Senior Citizens Recording Form 2. Form 1A: Residential Care Facilities for Senior Citizens Summary Reporting Form 3. Form IB: City/Municipal Level Summary Reporting Form Form 2: Provincial Level Summary Reporting Form 5. Form 3: Center for Health Development Summary Reporting Form Master List for Indigent Senior Citizen Recording Form shall be used by the vaccination team to record all vaccines to indigent senior citizens. This Master List for Indigent Senior Citizen Recording Form shall be kept at the facility (City/Municipal Health Units and residential care facilities). Form 1A: Residential Care Facilities for Senior Citizen Summary Reporting Form shall be used by all residential care facilities for senior citizens. A member of the vaccination team shall accurately and completely fill-up this summary form. The form will be submitted every 1* week of January of the succeeding year to the C/MHO where the said facility is located. Form 1B: City/Municipal Level Summary Reporting Form shall be used by all C/MHOs. A C/MHO staif member shall accurately and completely fill-up this summary form. This form will be submitted every 2 week of January of the succeeding year to the PHO, together with the immunization coverage of the city/municipality using the formula below. Immunization Coverage of Municipality ‘X* = 1. Number of senior citizens given pneumococcal vaccine X 100 ‘Number of target senior citizens 2. Number of senior citizens given influenza vaccine X 100 Number of target senior citizens Form 2: Provincial Level Summary Reporting Form shall be used by all PHOs. A PHO staff member shail accurately and completely fill-up this summary form. This form will be submitted every 3" week of January of the succeeding year to the CHD together with immunization coverage of the province. Immunization Coverage of Province ‘X= 1. Number of senior citizens given pneumococcal vaccine X 100 ‘Number of target senior citizens 2. Number of senior citizens given influenza vaccine X 100 ‘Number of target senior citizens Form 3: Center for Health Development Summary Reporting Form shall be used by all CHDs. The CHD shall collate all the reports from the provinces ‘and accomplish the CHD Summary Report Form. This form will be submitted every 4" week of January of the succeeding year to the National Center for Disease Prevention and Control together with the regional immunization coverage and their provincial immunization coverage. 10 a7. Surveillance of Events following Immunization (AEF) Ay: ‘The pneumococcal and influenza vaccines have been in use worldwide for more than 20 years and outcomes of trials have suggested that both pneumococcal and influenza vaccines are safe and immunogenic vaccines. However, a vaccine, like any medicine, could cause an adverse event, such as fa severe allergic reaction but the risk of any vaccine causing serious harm, or death, is extremely small. All minor and serious adverse events following immunization should be properly documented (using the AEFI form). Report both minor and serious adverse events following immunization using the protocol of AO No. 2010-0017: Guidelines in Surveillance and Response to Adverse Events Following Immunization. Appropriate medical intervention of any AEFI should be instituted immediately using protocol of AO No. 2010-0017: Guidelines in Surveillance and Response to AEFI. VIL IMPLEMENTING MECHANISMS. ‘A. Roles and Responsibilities 1, Department of Health a, Health and Well-being of Older Persons Program (HWOP) focal person, ‘National Center for Disease Prevention and Control 1. Coordinates. with the EPI Manager in the development of immunization policies and guidelines. 2. Coordinates and supervises the overall immunization activi 3. Coordinates with NEC for any reported AEFI cases. 4, Prepares the vaccine allocation list. 5. Ensures timely distribution of pneumococcal and influenza vaccines to the CHDs. 6. Sets-up a speakers bureau. 7. Orients Regional HWOP coordinators and other stakeholders on the immunization activity. 8. Conducts monitoring visits, in coordination with the regional HWOP to the LGUs. 9. Analyzes and feedbacks the accomplishment reports of the immunization activity. 10. Reproduce and distribute Master List of Indigent Senior Citizen Recording Form by CY 2012. National Center for Health Promotion 1. Develop and implement a communication plan in relation to the immunization activities for the indigent senior citizens in close coordination with NCDPC. 2. Develop and implement the national AEFI risk communication plan, including myths, misconceptions and rumors. ul3. Develop prototype leaflets/brochures/messages/advisories, Frequently ‘Asked Questions (FAQs) targeting different audiences in coordination with NCDPC. 4. Assist the sub-national levels to develop and implement their respective risk communication plan, including monitoring and evaluation tools. 5. Monitor and evaluate implementation of communication plan at all levels and provide feedback to all stakeholders. c. National Epidemiology Center 1. Oversee the design and implementation of AEFI surveillance. 2. Assist NCDPC in the development of post-vaccination monitoring operational plan and recording form for minor events. 3. Provide AEFI surveillance information for policy and program use. 4. Coordinate AEFI surveillance activities with FDA both at the national and regional levels. 5. Provide quality control of the AEFI reporting system. 4. Centers for Health Development e Regional HWOP, in coordination with the EP!, RESU and HEPO regional coordinators and other stakeholders, shall: a, Develop an immunization plan. b, Conduct training of health workers. c. Ensure the timely distribution of vaccines tothe Provincial/City Health Office and to the final immunization points (residential care facilities for indigent senior citizens and RHU). d. Conduct supervisory and monitoring visits to the LGUs. e. Ensure timely submission of accomplishment reports to the Central Office. Reproduce and distribute Master List for Indigent Senior Citizen Recording Form for CY 2011 g Reproduce and distribute Summary Reporting Forms 1A, 1B, 2 and 3. h. Translate and print leaflets/key messages/Frequently Asked Questions (FAQs) in the local language for dissemination. Coordinate the Regional DSWD and other non- governmental senior citizens’ organizations on the implementation of the immunization plan. Document AEFI surveillance and response activities. Submit report of AEFI cases and minor events following immunization. eo Clinically manage and report all AEFI cases. Provide AEFI investigation team with medical records of immunization cases. 122. Local Government Unit (Province/City/Municipality) a, Submit annual updated list of senior citizen residents in residential care facilities. b. Conduct micro-planning and orientation of health workers. c. Ensure that the vaccines are given to the targeted eligible population - in« senior citizens. Implement immunization activity. Conduct inventory and monitoring of vaceines. Allocate funds for the procurement of cotton and other supplies. Provide funds for the traveling and incidental expenses for the health workers during the conduct of immunization campaign. h. Ensure timely submission of accomplishment reports from the city/municipality to the province and the CHD. Mobilize human resources during the conduct of the activity. j. Report and conduct initial AEFI investig 3. Partner Agencies (Department of Social Welfare and Development) a. Submit annual updated list of indigent senior citizens disageregated according to age breakdown (60-69 years old; 70-79 years old; 80-89 years old and 90- 99 years old), including the name and address based on the NHTS-PR to DOH. b. Submit annual updated list of senior citizen residents in DSWD-managed residential institutions. c. Support immunization efforts of the DOH. 4. Private Sectors/Professional Organizations and Societies (Philippine College of Geriatric Medicine, National Center for Geriatric Health, etc) a. Support and assist immunization efforts of the DOH (ex. vaceination teams). b, Provide technical assistance, c. Member of speaker's bureau. 5. Senior Citizens’ Organizations a, Provide assistance and support to immunization efforts of DOH by issuing memorandum to its members. b. Collaborate with the local health offices in validating the NHTS-PR list of indigent senior citizens. c. Disseminate information and advocacy. VII. EFFECTIVITY ‘The order shall take effect immediately. ENRIQUE T. ONA, MD Secretary of HealthANNEX I MASTER LIST OF INDIGENT SENIOR CITIZENS | 60 YEARS OLD AND ABOVE NAME OF RESIDENTIAL INSTITUTION: DSWD Managed |LGU-Run Centers JDSWO-accredited NGO centers MUNICIPALITY OF: PROVINCE/CITY: REGION:TCL > 60 y.o. Masterlist of INDIGENT SENIOR CITIZENS 60 YEARS OLD and ABOVE w e 7. oe o wi w w oo wo} oare | osca lcouptere AooRESs cit you recs] Oo yuna iso ae te owing Pease check oro (iy nareronen _ rr ein oy tne owe) (rims vee om | Narenuaaeinta) | qu | Moute Neves iy, Is a i - = _ g _ P {| le | le = = Ne TO ORR ae TTR SORE CRT STO OE Ds CHRP, RSH ROREENY IOS wae Hs a aT eS “oegowmnn’ on wacera aen we permanant ages Sree, faptcabe——s oH ras Pope “THT PORE owe Sinn one bia) 2 =Instructions in Accomplishing Master List for Indigent Senior Citizen Recording Form Column No. Instruction Remarks Q) Date of Birth Write the date of birth following the Month-Day-Year (mm/dd/yy) format. ‘Thus, write ‘March 30, 1950° as: 03/30/51 GB) OSCA If senior citizen has an OSCA ID, write down the OSCA ID no. no OSCA ID no,, refer | | to OSCA | office for ID | issuance @) ‘Name of Senior Citizen Write the complete name of the patient, with the Family Name of the senior citizen first, followed by his/her Given Name and Middle Initial. Thus, write the senior citizen's name ‘Juan R. Dela Cruz’ as: Dela Cruz Juan R. Family Name Given Name Middle Initial (6) Gender Write the letter ‘M’ for male; *F” for female (6) Complete Address Write the House Number, Street, Barangay, City or Municipality where the senior citizen resides. ‘Thus, write the senior citizen’s address as: 14A__ Mabini St. Brgy. Norte, House No. Street Barangay Ifthe address has no House No. and Street Name, write the name of the Barangay, City or Municipality and the Province. Leave blank the spaces intended for the house no. and street name. Brgy. Norte House No. Street Barangay a Date of Registration | Write the date of date the senior citizen was assessed followii | Month-Day-Year (mm/dd/yy) format. the Thus, write ‘May 30, 2011” as: 05/30/11Column | Instruction | Remarks No. : a | (8) | Did you receive influenza vaccination this year? Write the letter if yes; ‘N° ifno (9) Did you receive pneumococcal vaccination in the last 5 years? Write the letter *Y” if yes and write the year the vaccine was given; Write the letter “N’ iftno Thus, write Y 2004 (10) | Do you have a history of allergy to the following: —_ Put a (V) mark at the appropriate column (10A — 10E if senior citizen has an allergy. Ifno allergy, leave it blank. (11) _ | Are you currently taking systemic steroids? Write the letter Y* if yes and ‘N’ if no. (12) | Do you have fever today or 3 days prior? | Write the letter “Y° if yes and ‘N’ if no, (13) _| Do you currently have an acute infection (ex. cough, flu-like illness) today or 3 days prior? Write the letter “Y” if yes and ‘N’ if no. (14) | Remarks: Write any of the following remarks after assessing the senior citizen: ~ eligible for ) both pneumoccoccal and influenza vaccination (there are no “YES’ answers in columns 8 ~ 13) ) pneumococcal vaccine only (there is a ‘YES” answer in column 8 and *NO’ in column 9) ©) influenza vaccine only (there is a “NO” answer in column 8 and ‘YES* in column 9) ~ not eligible for both vaccines a) there are “YES’ answers in both columns 8-9, and ») there is any “YES” answer in columns 10-11 = defer vaccination to a later date (there is any *YES’ answer in columns 12 13) If senior citizen in the master list is nowhere to be found: = transferred residence - died| Column Tnstruction Remarks No. ‘Columii (15) —to be filled up if senior citizen is eligible for vaccination (ISA) _ | Initial Pneumococcal Polyvalent vaccine | Simultaneous | administration (15A.1) | Write the date the pneumococcal vaccine was given following the Month- | of Day-Year (mm/dd/yy) format. pneumococcal and influenza Thus, write ‘May 30, 2011” as: 05/30/11 vaccines is safe | during the same (15A.2) | Write the letter *R’ if the vaccine was injected in the right arm or immunization vaceine was injected in the left arm schedule but at different sites | (5B) | Initial Influenza Polyvalent Vaccine (Left and Right deltoid muscle). (15B.1) | Write the date the influenza vaccine was given following the Month-Day- Year (mm/dd/yy) format. ‘The Right (R) deltoid muscle Thus, write ‘May 30, 2011” as: 05/30/11 immunization site for (15B.2) | Write the letter ‘R” if the vaccine was injected in the right arm or “L’ ifthe | pneumocecocal | vaccine was injected in the left arm, vaceine; The Left (L) deltoid muscle | immunization | or 3 days prior? | Write the letter ‘Y” if yes and ‘N’ ifn. | ie for influenza | vaccine. Columns (16) to (20) — to be filled up if senior citizen is eligible for vaccination for next year. (16) | Date of Registration Ifthere are new enrollees (new Write the date of date the senior citizen was assessed following the 60 years old; ‘Month-Day-Year (mm/dd/yy) format, start from column 2 up to | ‘Thus, write ‘April 10, 2012" as: 04/10/12 column 15 | (7) _| Did you receive influenza vaccination this year? Write the letter “Y” if yes; *N’ iffno (18) | Do you have fever today or 3 days prior? Write the letter *Y” if yes and *N’ if no. (9) | Do you currently have an acute infection (ex. cough, flu-like illness) todayInstruction Remarks Column No. ‘ (20) _| Remarks: Write any of the following remarks after assessing the senior citizen: = eligible for influenza vaccination (there are no ‘YES’ answers in columns 17-19) not eligible for influenza vaccination (there is a ‘YES’ answer in column 17 = defer vaccination to a later date (there is any ‘YES’ answer in columns 18-19) If senior citizen in the master list is nowhere to be found: = transferred residence - died (21) | Influenza Polyvalent Vaccine There is no need to indicate Write the date the influenza vaccine was given following the Month-Day- the site of Year (mm/dd/yy) format. injection since | there is only 1 | Thus, write ‘April 10, 2012" as: 04/10/12 vaccine to be __| given ‘Columns (22) to (27) — to be filled up if senior citizen is eligible for vaccination for next year. Write any of the following remarks after assessing the senior citizen: = eligible for influenza vaccination (there are no ‘YES’ answers in columns 23-25) = not eligible for influenza vaccination (there is a ‘YES’ answer in column 23) (22) | Date of Registration if there are new enrollees (new Write the date of date the senior citizen was assessed following the 60 years old; Month-Day-Year (mm/dd/yy) format. start from column 2 up to Thus, write ‘April 10, 2012" as: 04/10/12 column 15 (@3)_| Did you receive influenza vaccination this year? Write the letter *Y” if yes; ‘N’ ifno (24)__| Do you have fever today or 3 days prior? ~ — Write the letter *Y” if yes and ‘N’ if no (@3)_| Do you currently have an acute infection (ex. cough, fluke llness) today or 3 days prior? Write the letter *Y” if yes and N (26) | Remarks. 7Remarks | Column Instruction No. _ _ (26) | =” defer vaccination to a later date (there is any “YES" answer in columns 24-25) If senior citizen in the master list is nowhere to be found: = transferred residence (27) _| Influenza Polyvalent Vaccine a There is no need to indicate Write the date the influenza vaccine was given following the Month-Day- _ | the site of Year (mm/dd/yy) format. injection since there is only 1 Thus, write “June 5, 2013" as: 06/05/13, vaccine to be givenANNEX IC MASTER LIST OF INDIGENT SENIOR CITIZENS 60 YEARS OLD AND ABOVE NAME OF RHU: MUNICIPALITY OF: PROVINCEICITY: REGION:TCL > 60.0. Masterlist of INDIGENT SENIOR CITIZENS 60 YEARS OLD and ABOVE ma] a m ae 7 ws hte e408 wo.| oare | osca | “MEGEN"” loenoerconrtere cones or anmi (Fond Namen OO ein aoa cae) | wou | 2 Pesim|vesson]| Semermoaeia | gun, | Moen ocer| toe so 0) rom)“ si She eat.) cen vice | | ‘products | products | gover: Tits OSCR a ae TSS AT ITS STS CST OTRO, PO Ca RITA a TW eB COT ‘Hvar te OSCAID numb “lteporoment ten eases aon we pamarant aac 05a" caefapealewm] a] ar a a a ‘Yessy intuerza| (a ate Region IrsveneePelywset \vaccna lVacane Date iver toa cuen “28 Dat den |vaconao ianateivst Tenmneleiiist todeotenaynn| “ert | deters | eonInstructions in Accomplishing Master List for Indigent Senior Citizen Recording Form Column Instruction Remarks No. | @)_ | Date of Birth | Write the date of birth following the Month-Day-Year (mm/dd/yy) format. | | Thus, write ‘March 30, 1950° as: 03/30/51 @ | osca [Ifsenior | | citizen has If senior citizen has an OSCA ID, write down the OSCA ID no. | no OSCA | ID no., refer to OSCA | office for ID | issuance @__ | Name of Senior Citizen Write the complete name of the patient, with the Family Name of the senior en first, followed by his/her Given Name and Middle Initial. | Thus, write the senior citizen’s name ‘Juan R. Dela Cruz’ as: Dela Cruz Juan R. Family Name Given Name Middle Initial (5) | Gender Write the letter ‘M’ for male; ‘F” for female |__| Complete Address Write the House Number, Street, Barangay, City or Municipality where the senior citizen resides. Thus, write the senior citizen's address as: t. Bray. Nort, Barangay | Ifthe address has no House No. and Street Name, write the name of the Barangay, City or Municipality and the Province. Leave blank the spaces intended for the house no. and street name. Brey. Norte House No. Street Barangay (7) __ | Date of Registration | Write the date of date the senior citizen was assessed following the Month-Day-Year (mm/dd/yy) format. | Thus, write ‘May 30, 2011” as: 05/30/11Remarks Write any of the following remarks after assessing the senior citizen = eligible for a) both pneumoccoceal and influenza vaccination (there are no ‘YES’ answers in columns 8 — 13) 'b) pneumococcal vaccine only (there is a *YES? answer in column 8 and ‘NO’ in column 9) | ©) influenza vaccine only (there is a ‘NO’ answer in column 8 and ‘YES? | in column 9) = not eligible for both vaccines a) there are ‘YES* answers in both columns 8-9, and b) there is any ‘YES’ answer in columns 10 ~ 11 - defer vaccination to a later date (there is any ‘YES’ answer in columns 12 - 13) If senior citizen in the master list is nowhere to be found: | - transferred residence | - died Column Instruction No. ae \ (8). | Didyou receive influenza vaccination this year? Write the letter *Y” if yes; "N’ iffno (9) | Did yow receive pneumococcal vaccination in the last 3 years?) | | | | Write the letter “Y" if'yes and write the year the vaccine was given; | | Write the letter ‘N’ if no | | Thus, write ¥ 2004 | (10) | Do you have a history of allergy to the following: Put a (V) mark at the appropriate column (10A ~ 10E if senior citizen has an | allergy. Ifno allergy, leave it blank. (1) | Are you currenily taking systemic steroids? Write the letter ‘Y” if yes and ‘N’ ifno. | (13) | Do you have fever today or 3 days prior? | } Write the letter “Y’ if yes and °N’ ifno. (3) _| Do you currently have an acute infection (ex. cough, fluclike Wines) today or 3 | days prior? Write the letter “Y* if yes and ‘N’ ifno. (4) Remarks: ]‘Column’ Instruction Remarks No. = : ‘Column.(15) = to be filled up if senior citizen is eligible for vaccination _ (15A)_| Initial Pneumococcal Polywalent vaccine Simultaneous administration (15A.1) | Write the date the pneumococcal vaccine was given following the Month- | of Day-Year (mm/dd/yy) format. pneumococcal and influenza Thus, write ‘May 30, 2011° as: 05/30/11 vaccines is safe during the same (154.2) | Write the letter ‘R’ if the vaccine was injected in the right arm or *L? if the | immunization vaccine was injected in the left arm. schedule but at | different sites (ISB) | Initial Influenza Polyalent Vaccine (Left and Right deltoid muscle). (15B.1) | Write the date the influenza vaccine was given following the Month-Day- Year (mm/dd/yy) format. The Right (R) deltoid muscle Thus, write ‘May 30, 2011” as: 05/30/11 ~immunization site for (15B.2) | Write the letter ‘R’ if the vaccine was injected in the right arm or ‘L’ ifthe | pneumocecocal vaccine was injected in the left arm, vaccine; The Left (L) deltoid muscle — immunization | site for influenza vaccine. Columns (16) to (20) ~ to be filled up if senior citizen is eligible for vaccination for next year. (16) | Date of Registration If there are new enrollees (new Write the date of date the senior citizen was assessed following the 60 years old; Month-Day-Year (mm/dd/yy) format. start from | column 2 up to ‘Thus, write ‘April 10, 2012" as: 04/10/12 column 15 (7) | Did you receive influenza vaccination this year? Write the letter °Y” if yes; ‘N’ ifno (18) _ | Do you have fever today or 3 days prior? | Write the letter ‘Y’ if yes and ‘N’ if no. (19) | Do you currently have an acute injection (ex. cough, flu-like Wine: or 3 days prior? Write the letter *Y” if yes and ‘N’ ifn.E = Instruction Remarks Column No. (20) | Remarks Write any of the following remarks after assessing the senior citizen: - eligible for influenza vaccination (there are no “YES? answers in columns 17-19) ~ not eligible for influenza vaccination (there is a ‘YES* answer in column 17 ~ defer vaccination to a later date (there is any *YES* answer in columns 18-19) If senior citizen in the master list is nowhere to be found: > transferred residence - died (21) _ | Influenza Polywalent Vaccine There is no need to indicate | Write the date the influenza vaccine was given following the Month-Day- | the site of | Year (mm/dd/yy) format. ijection since | there is only 1 | ‘Thus, write ‘April 10, 2012” as: 04/10/12 vaccine to be | given [Columns (23) to 27) to be filled up if senior citizen is eligible for vaccination for next year. (22) | Date of Registration if there are new enrollees (new Write the date of date the senior citizen was assessed following the 60 years old; | Month-Day-Year (mm/dd/yy) format. start from column 2 up to __| Thus, write ‘April 10, 2012" as: 04/10/12, column 15 (@3)__ | Did you receive influenza vaccination this year? Write the letter °Y” if yes; ‘N° ifno (24) _| Do you have fever today or 3 days prior? Write the letter *Y” if'yes and ‘N’ ifn. 23) | Do you currently have an acute infection (ex. cough, fluclike illness) today or 3 days prior? | Write the letter *Y" if yes and ‘N’ if no. | | _ | (26) | Remarks: | | Write any of the following remarks after assessing the senior citizen: + eligible for influenza vaccination (there are no ‘YES? answers in | columns 23-25) | = not eligible for influenza vaccination (there is a *YES’ answer in column 23)~ Instruction Remarks ‘Colurn No, ee Z (26). | = defer vaccination to a Tater date (there is any VES" answer in ‘columns 24-25) If senior citizen in the master list is nowhere to be found: | - transferred residence - died L = @7)_| Influenza Polywalent Vaccine There is no need to indicate Write the date the influenza vaccine was given following the Month-Day- | the site of Year (mm/dd/yy) format. injection since | there is only 1 Thus, write June 5, 2013” as: 06/05/13 j vaccine to be | givenFORM 1A: INDIGENT SENIOR CITIZENS SUMMARY FORM (one sheet per residential home) NAME OF RESIDENTIAL HOME FOR SENIOR CITIZEN Calendar Year. (J JL JE See! {oswo managed [] Leu-Run Centers DSWD Accredited NGO COMPLETE ADDRESS: Number of bes capacty rn HEAD OF AGENCY: Currant number of SC residents: (1 11 111 GOVERNMENT/NGO-RUN CENTERIRESIDENTIAL INSTITUTION SUMMARY REPORTING FORM PNEUMOCOCCAL VACCINE AGE GROUPING TOTAL NUMBER 160 - 68 years old: [ 70-78 years old: BO 89 years old: INFLUENZA VACCINE GIVEN [7100 years old & above: TOTAL: TOTAL NUMBER OF EMPLOYEES: tei NUMBER OF EMPLOYEES GIVEN PNEUMOCOCCAL VACCINE: nie NUMBER OF EMPLOYEES GIVEN INFLUENZA VACCINE 1FORM 18: INDIGENT SENIOR CITIZENS SUMMARY FORM (one sheet per cityimunicipality) MUNICIPALITYICITY: 1. DSWD-managed Residential ins Calendar Year: PROVINCE: ‘AGE GROUPING, PNEUMOCOCCAL VACCINE GIVEN | — INFLUENZA VAGEINE GIVEN, [60~ 69 years old 100 years old & above: total Ti 2. LeUstun Centers/Residential Institutions for Senior Citizens: “AGE GROUPING 160 - 89 years ola: TOTAL NUMBER PNEUMOCOCCAL VACCINE GIVEN | INFLUENZA VACGIN O78 yeais old [80-86 years ol: [90 - 88 years old 00 years old & above” ‘Sub-fotal a} 3. DSWD accredited NGO Centers/Resi idential Ins ns for Senior Citizens: "AGE GROUPING “TOTAL NUMBE! PNEUMOCOCCAL VACCINE GIVEN | — INFLUENZA VEGGINE GWEN [80-69 yoars old 70 78 years old (80-88 years old (60- 88 years old TOO years old & above ‘Sub-Total It I DOT 4, Number of indigent senior citizens in community: (NHTS of DSWD) [__AGE GROUPIN TOTAL NUMBER él a PREUNOCOCGAL WAC [60-69 years ola. tif TT 0-78 years old (a0 80 years |80 - 98 years oid i { Ch TOO years old & above: ‘Sub-total: ial SUMMARY/JAGGREGATE TOTAL NDIGENT SENIOR CITIZEN IM MUNIZED AGAINST PNEUMONIA AND INFLUENZA AGE GROUPING (60-69 years old. ‘PNEUMOCOCCAL VACCINE GIVEN | INFLUENZA VAC [70 75 years-old [80 89 years oid: [90 - 89 years old. "100 years old & above: (Grand Total:FORM 2: INDIGENT SENIOR CITIZEN IMMUNIZATION SUMMARY FORM (one sheet per province) Calendar Year. PROVINCE 4, DSWO-managed Residential Institutions for Senior Citizens: (GE GROUPING: TOTAL NUMBER | PREUMOCOSCAL VACCINE GIVEN | INFLUENZA VACCINE GI LCT 70 78 years old: 150 89 years ols. [90 - 80 years ola. 100 years old & above: [ Sub-total 2. LGU-run Centers/Residentialinsttution’s for Senior Citizens: "AGE GROUPING |60 - 69 years ala: “TOTAL NUMBER | PNEONOCOCCAT VACCINE GWVEW | NFLUENZR VAGGINE SER CALLA ane! [70 78 years-old [8080 years old [90 68 years old FTOD years old & above: me CLL if 3, DSWD accredited NGO Centers/Rosident ((_AGE GROUPING $f Senior Citizens: PREUNOCOCCAT TOT [BO=B5 years oid [70-76 years old. {80-89 years old {9089 years old [fot years old & above: [Sub-Totar 4. Number of indigent senior citizens in ct sommunity: (NHTS of DSWO) {__AGE GROUPING TOTAL NUMBER [ PNEUMOCOCCAL VACOINE GIVEN [ INFLUENZA VACCINE GIVEN] (60-6 years ol (70 78 years old (a0 - 89 years [S008 years [00 years old & above: ‘Sub-total: 1 It fit ht ie it SUMMARYIAGGREGATE "TOTAL NDIGENT SENIOR CITIZEN IMMUNIZED AGAINST PNEUMONIA AND INFLUENZA SE GROUPING: TOMBE | PREUNCICOCAL VACCINE GIVEN | INFCUERZA- VACCINE GIVER] (60-69 years 70-79 years ol [g0- 89 years old [20 - 89 years ol: 100 years old & above: [Grand Total:FORM 3: INDIGENT SENIOR CITIZEN IMMUNIZATION SUMMARY FORM (one sheet par Center for Heath Development) CENTER FOR HEALTH DEVELOPMENT: 4. DSWD-managed Residential Insttutionis for Senior Ctizens: AGE GROUPING TOTALNUMBER | PNEUMOCOCCAL VACCINE GIVEN |80 89 years ole i 0-79 years old [80 89 years ois [90-88 years ofc 00 years old & above: ‘Sub- torah 2. LGU-run Centere/Residental institution's for Senior Citizens AGE GROUPING [60 - 69 years old [70-78 years old [80 88 years old 3, DSWD accredited NGO Centers/Resid 160 -68 years old OG years old & above’ [Sub-Tozar: 4, Number of indigent senior citizens in community: (NHTS-PR of DSWO) E CROUPING \60 - 89 years old [70-78 years old [30 89 years old [90 99 years old 100 years off & above: ‘Sub-Total SUMMARVIAGGREGATE a TOTAL NDIGENT SENIOR CITIZEN IMMUNIZED AGAINST PNEUMONIA AND INFLUENZA AGE GROUPING 160 - 66 years old [70-78 years old, [50 88 years old — a= [20 SB years old 1 tf FOO years oid & above: rand Total: PNEUMOCOCCAL VACCINE GIVEN| INFLUENZA VACCINE GIVEN Ty