Cagayan Valley

Epidemiology Center

Lesson 3B
Vaccine-preventable Disease
(VPD) Surveillance

Disease Surveillance - Intermediate v20220616

 Objectives
At the end of this lesson, you will be able to:
• know the targets for selected VPDs
• recite the case definitions of VPDs
• identify the vital variables when gathering data from
detected VPD cases
• become familiar with the appropriate forms to be
used when investigating VPDs

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 Cagayan Valley
Epidemiology Center

Lesson 3B.01
Introduction to Vaccine-
preventable Disease (VPD)
Surveillance

Disease Surveillance - Intermediate v20220616

 What is VPD Surveillance?
• An integrated surveillance for Acute Flaccid Paralysis
(AFP), Measles-Rubella, Diphtheria, Pertussis and
Neonatal Tetanus (NT)
• Intensive and case-based
• Involves active case-finding

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 What are the VPD
Eradication/Elimination/Control Goals?
• Global Polio Eradication
• Eradicate wild poliovirus worldwide.
• Measles Elimination
• Stop the transmission of endemic measles virus
• Neonatal Tetanus Elimination
• Achieve and maintain <1 NT case per 1,000 live births in
every municipality / city every year
• Diphtheria and Pertussis
• Control of the occurrence of diphtheria and pertussis cases
, deaths and outbreaks in the country

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 What are the VPDs?

For elimination
Others
and eradication
Acute Flaccid
Diphtheria
Paralysis

Measles-Rubella Pertussis

Non-neonatal
Neonatal Tetanus
tetanus
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 VPD Case Definitions
• As soon as a case meets the case definition,
investigation should be done
• All cases should be notified to the next higher level
within 24 hours using the fastest means possible

If in doubt, it is better to report and investigate

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 Differential Diagnosis
• Diagnoses that is similar or most likely to have the
same signs and symptoms as the disease of interest
• Guide surveillance officers in detection
• Warrants further investigation

DSC/DSO should carefully take note of all the

presenting signs and symptoms of each case. It
is possible that one case can fit in more than
one case definition.

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 Case Classification
• All reported AFP cases are classified based on
virological classification and the AFP expert panel
• All suspect measles are classified based on the
laboratory results and review by the measles
national verification committee
• There is only one case classification for neonatal
tetanus
• Diphtheria and Pertussis cases are classified based on
laboratory results

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 Cagayan Valley
Epidemiology Center

Lesson 3B.02
Vaccine-preventable
Diseases for Elimination
and/or Eradication

Disease Surveillance - Intermediate v20220616

 Acute Flaccid Paralysis
• A syndrome in which there is a sudden onset of
floppy paralysis or weakness usually of the arms or
legs. Initial symptoms may include fever, fatigue,
headache, nausea, vomiting, muscle pain and
stiffness in the neck and back.
• All cases of AFP should be considered as suspected
polio cases until viral culture and the expert review
committee indicates otherwise.

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 Acute Flaccid Paralysis
• AFP is NOT a disease per se but a syndrome that can
have several causes. Viral stool culture of all AFP
cases is necessary to determine whether or not the
AFP is caused by poliovirus.
• If paralysis was clearly caused by trauma or was
present at birth, the child should NOT be considered
an AFP case.

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 Acute Flaccid Paralysis
• In essence, what we really want to prove is that:

None of the AFPs are

due to polio

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 Acute Flaccid Paralysis
Surveillance Target for 2022

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 Acute Flaccid Paralysis
Surveillance Target for 2022

Population Target Number of

Region/Province/City
(<15 years old) AFP Cases*
Region II 1,084,998 22
Batanes 6,233 1
Cagayan 364, 418 7
Isabela 453, 790 9
Nueva Vizcaya 151, 235 3
Quirino 65, 781 1
Santiago City 43, 542 1
*2/100K <15 years old population

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 Acute Flaccid Paralysis
Surveillance Process

Case ✓ Polio
investigation
and lab analysis

AFP

Community
Hospitals Non-Polio
cases Clinics AFP

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 Acute Flaccid Paralysis
Case Definition

• An AFP case is defined as a child <15 years of age

presenting with recent or sudden onset of floppy
paralysis or muscle weakness of any part of the
body due to any cause
OR
• Any person of any age with paralytic illness if
poliomyelitis is suspected by a clinician

AFP is a syndrome and not a diagnosis!

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 Acute Flaccid Paralysis
Hot Case

Less than 5 years old

Fever at onset of Asymmetric Less than 3 OPV
paralysis paralysis doses

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 Acute Flaccid Paralysis
Differential Diagnosis

• The following diseases may manifest with acute

flaccid paralysis (AFP):
• Poliomyelitis
• Guillain-Barre Syndrome (GBS)
• Myelitis (i.e. Transverse Myelitis)
• Traumatic Neuritis
• Pott’s Disease
• TB Meningitis

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 Acute Flaccid Paralysis
Differential Diagnosis

• The following diseases may manifest with acute

flaccid paralysis (AFP):
• Encephalitis
• CNS Infection
• Muscle Hypotonia
• Acute Gastroenteritis with dehydration
• Hypokalemia / Hypokalemic Periodic Paralysis (HPP)
• Other diseases, as long as AFP is manifested

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 Acute Flaccid Paralysis
Data Collection

• Data collection through:

• Filling out of the Case Investigation Form
• ensure accuracy and completeness
• Interview
• document complete contact information and exact residential
address
• Physical examination
• Is paralysis symmetrical (same on both sides) or asymmetrical
(one-sided)?
• Is the paralysis/weakness floppy?
• Is there a decrease in muscle strength?
• Is there a decrease in deep tendon reflexes?

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 Acute Flaccid Paralysis
Specimen Collection

two adult collected at both stools both stool

thumb- least 24 collected samples
sized stool hours apart within 14 arrived at
specimens days from RITM in
(at least paralysis good
5mL) onset conditions

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 Acute Flaccid Paralysis
Reporting

• All AFP cases must be reported

and investigated within 24-48
hours by the DSC within their
catchment area, using the updated
AFP Case Investigation Form.
• Stool sample collection should be
prioritized to maintain the
adequacy of the collected samples
as much as possible.

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 Acute Flaccid Paralysis
Reporting

Parts of the AFP Case Investigation Form

I. Patient information
II. Clinical data
III. Epidemiological data
IV. Immunization history
V. Laboratory data
VI. 60-day follow-up
VII. Final classification

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 Acute Flaccid Paralysis
Reporting

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 Measles-Rubella
• Measles (Tigdas, Tipdas) is an acute highly
communicable viral illness caused by the measles
virus in the genus Morbillivirus of the family
Paramyxoviridae.

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 Measles-Rubella
• Measles is characterized by a prodrome of fever,
conjunctivitis, cough, coryza, and small spots with
white or bluish white centers on an erythematous
base on the buccal mucosa known as Koplik spots
followed by maculopapular rash on the 3rd to the 7th
day beginning on the face then becoming
generalized.

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 Measles-Rubella
• It is transmitted through direct contact with nasal or
throat secretions of infected persons or by articles
freshly soiled with nose and throat secretions.
• The incubation period range from 7 to 21 days from
exposure to onset of fever and usually 14 days until
rash appears.

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 Measles-Rubella
Surveillance Target for 2022

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 Measles-Rubella
Surveillance Target for 2022
Region/Province/City Projected Population Measles target
Region II 3,727,855 37
Batanes 19, 046 0
Cagayan 1, 283, 097 13
Isabela 1, 566, 162 16
Nueva Vizcaya 503, 115 5
Quirino 206, 157 2
Santiago City 150, 278 2

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 Measles-Rubella
Case Definition

Tier Definition
Suspect Any person with fever AND maculopapular rash
(non-vesicular) AND one of the three:
• cough
• coryza (runny nose)
• conjunctivitis (red eyes)
Probable ---
Confirmed ---

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 Measles-Rubella
Laboratory Confirmation

• IgM Antibody Detection

• Serum samples for IgM antibody detection
• Dried blood spot (DBS) method
• Virus Isolation
• Nasopharyngeal swab (NPS) and/or oropharyngeal swab
(OPS) for virus isolation
• Polymerase Chain Reaction (PCR)
• Oral fluids using OraCol for PCR genotyping

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 Measles-Rubella
Reporting: 10 Core Variables

1. Case Identification 6. Date of rash onset

2. Date of Birth or Age 7. Date of notification
3. Sex 8. Date of investigation
4. Place of residence 9. Date of specimen
5. Vaccination status or collection
date of last 10. Place of infection or
vaccination travel history

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 Measles-Rubella
Reporting

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 Neonatal Tetanus
• Neonatal tetanus is an acute, often fatal disease
characterized by generalized, increased rigidity and
convulsive spasms of skeletal muscles caused by the
spore-forming bacterium Clostridium tetani.
• C. tetani spores which are the dormant form of the
organism are universally found in soil.

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 Neonatal Tetanus
• Neonatal tetanus is not transmitted from person to
person. The disease is acquired when dirt-containing
tetanus spores enter open wounds (injections,
cutting the umbilical cord) or breaks in the skin.
• The incubation period is 3 to 21 days, with an
average of 6 days.

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 Neonatal Tetanus
• It is particularly common in rural areas where
deliveries are at home without adequate sterile
procedures.
• Unclean cord care practices during delivery for
neonates and lack of tetanus antibody protection
from inadequately immunized mothers are the risk
factors for the disease

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 Neonatal Tetanus
Case Definition

Tier Definition
Clinically • Any neonate (≤ 28 days of life) that sucks and
Confirmed cries normally during the first 2 days of life and
becomes ill from 3 to 28 days of age AND
develops an inability to suck AND diffuse
muscle rigidity (stiffness) AND spasms (jerking
of the muscles), which may include trismus,
clenched fists or feet, continuously pursed lips,
and/or curved back (opisthotonus).
• Any neonate diagnosed as a case of tetanus by
a physician.

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 Neonatal Tetanus
Laboratory Confirmation

• The case classification of NT is based solely on clinical

criteria and does not require laboratory confirmation

The date of birth is considered as the first

day of life

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 Neonatal Tetanus
Reporting

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 Cagayan Valley
Epidemiology Center

Lesson 3B.03
Other Vaccine-preventable
Diseases

Disease Surveillance - Intermediate v20220616

 Diphtheria
• Diphtheria is an infectious disease spread (from
person to person) by respiratory droplets through
coughing and sneezing.
• Diphtheria usually affects the tonsils, pharynx, larynx
and occasionally other mucus membranes or skin.
• The incubation period is usually 2 to 5 days (range 1-
10 days).

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 Diphtheria
Case Definition

Tier Definition
Probable A person with an illness of the upper respiratory
tract characterized by laryngitis or pharyngitis or
tonsillitis, AND adherent membranes on tonsils,
pharynx and/or nose.
Confirmed A probable case that is laboratory confirmed or
linked epidemiologically to a laboratory-
confirmed case.

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 Diphtheria
Case Definition

• Persons with positive Corynebacterium diphtheriae

cultures who do not meet the clinical description (i.e.,
asymptomatic carriers) should not be reported as
probable or confirmed diphtheria cases.

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 Diphtheria
Laboratory Confirmation

• Isolation of Corynebacterium diphtheriae from a

clinical specimen
• Specimens for culture should be obtained as soon as
diphtheria is suspected, even if treatment with
antibiotics has already begun

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 Diphtheria
Reporting

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 Pertussis
• Pertussis or whooping cough is a highly
communicable disease of the respiratory tract caused
by Bordetella pertussis.
• The initial stage of the disease has an insidious onset
with an irritating cough that gradually becomes
paroxysmal, usually within 1–2 weeks, and lasts for
1–2 months or longer.

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 Pertussis
• It is primarily transmitted by direct contact with
airborne discharges from the mucus membrane of
infected person or by indirect contact through
articles freshly soiled with discharges of infected
persons.
• The average incubation period is 9-10 days ranging
from 6 to 20 days.

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 Pertussis
Case Definition

Tier Definition
Clinical A person with a cough lasting at least 2 weeks
Confirmed with at least one of the following:
• paroxysms (i.e. fits) of coughing
• inspiratory “whooping”
• post-tussive vomiting (i.e. vomiting
immediately after coughing) without other
apparent cause

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 Pertussis
Laboratory Confirmation

• Isolation of Bordetella pertussis, or detection of

genomic sequences by polymerase chain reaction
(PCR).
• Specimen: nasopharyngeal swab using the Reagan-
Lowe Kit.

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 Pertussis
Reporting

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 Non-neonatal Tetanus
• An acute disease caused by an exotoxin of the
tetanus bacillus, Clostridium tetani, which grows
anaerobically at the site of an injury.
• Characterized by painful muscular spasms
• History of an injury or apparent portal of entry may
be lacking.
• The incubation period usually 3–21 days, with most
cases occurring within 14 days.

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 Non-neonatal Tetanus
Case Definition

Tier Definition
Confirmed Acute onset of hypertonia AND/OR painful
muscular contractions (usually muscles of the
neck and jaw) AND generalized muscle spasms
without other apparent medical cause as
reported by a health care professional

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 Non-neonatal Tetanus
Laboratory Confirmation

• Laboratory confirmation is of little help because the

organism is rarely recovered from the site of infection
and usually there is no detectable antibody response

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 Non-neonatal Tetanus
Reporting

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 Cagayan Valley
Epidemiology Center

Lesson 3B
Vaccine-preventable Disease
(VPD) Surveillance

Disease Surveillance - Intermediate v20220616