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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.


  1. 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.

  2. CDC. National poliomyelitis immunization days -- People's Republic of China, 1993. MMWR 1993;42:837-9.

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