Overview of Expanded Immunization Programs

Hi guys, welcome back to my channel. It's Dr. Junelle. The subject at hand is community and public health. And for this video, we are going to be talking about the expanded program on immunization. So we won't be able to understand immunization without first tackling or studying the meaning of immunity and what types of immunity we have in our body. So when we say immunity, this is the condition of being protected against a particular disease. So when we say immunity, this is the ability of our body to fight against various microorganisms, various disease-causing microbes that may be present in our environment. And there are two types of immunity. The first is natural or innate, and the second one is adaptive immunity. So when we say natural or innate immunity, this is the body's inborn system to which it can protect itself in fight of infections. So once a person is born into the world, meron siya natural ability to defend itself against mga disease-causing organisms. And part of that innate immunity is seen in the image, kasama dun yung mga macrophages natin, yung mga granulocytes natin. and the different types of killer cells found in the body. There's a mast cell, there's a dendritic cell, there's a natural killer cell, etc. When we say adaptive immunity, this is built by the body or this is a result of the exposure to a disease-causing organism. So what happens is, once we're exposed to a disease, the body remembers that organism. And the body is not a body. creates soldiers specific to that disease so that the next time the body meets that disease again it can already mount a defense against it so more of that when you go to your immunocero in your third year now when we talk about adaptive immunity no yung result of being exposed to a disease. You cannot do away with talking about antigen and antibody. So, ang antigen, these are substances that causes the body to produce antibodies. On the other hand, antibodies are substances produced by the immune system and defends the body against infections. Sa madaling sabi, let's say my disease-causing organism, that is the antigen. Because the disease-causing organism, will be the one to trigger our immune system to produce antibodies. Yung sinasabi ko kanina na soldiers specific to that organism. So yung antigen, yan yung organism na magti-trigger sa ating immune system. And the soldiers are the antibodies. They defend the body against infection. At tinatandaan nila kung sino yung nag-trigger para ma-produce sila. so that that the next time that the body meets or the body is invaded by this organism again, kayang-kaya na niyang talunin. So adaptive immunity can be further divided into two. Meron tayong tinatawag na active adaptive immunity and passive adaptive immunity. And both active and passive adaptive immunity can be divided into two. Yung naturally acquired and artificially acquired. So basically, may tinatawag tayo na Naturally Acquired Active Adaptive Immunity. Medyo mahaba, it's a mouthful, but kaya natin yan. May tinatawag din na Artificially Acquired Active Adaptive Immunity. And we also have Naturally or Artificially Acquired Passive Adaptive Immunity. So para mas maintindihan natin, i-define natin yung bawat uri ng Adaptive Immunity. So first, let's talk about the Naturally Acquired. Active immunity. This results from infection, like what I discussed earlier about adaptive immunity. So let's say you have a COVID-19 infection. Your immune system will determine or will be able to detect that there is a foreign body inside. Who is the foreign body? Who is the invader? The SARS-CoV-2 virus that entered your body. So what the body will do, the body will be able to detect the foreign body or the antigen. So it will trigger the immune system. to remember the appearance of SARS-CoV-2 virus, and to create antibodies specific to COVID-19. So eventually, kapag nakabuo ka ng COVID-19 antibodies mo, matatanggal or mapapatay natin yung COVID-19 virus na yan na nasa loob. And the next time you encounter a COVID-19 infection again, mas madali na for the body to kill the virus kasi meron na siyang pondo or meron na siyang nakreate ng mga soldiers or antibodies from a previous infection. So kapag naturally nangyari, na-infect ka, nag-create ka ng antibodies, naturally acquired active immunity siya. The second is your artificially acquired active immunity. So paano naman nangyari ito? This is through the injection of antigen or mga vaccines natin. So please remember that. When you ask in the exam, what type of immunity does your vaccines give you? Correct answer, artificially acquired active immunity. Why active if it's a vaccine? Because what we give in vaccines is a copy of the microorganism, a copy of the disease-causing microorganism. But... Ang goal natin is not so that the person can develop the disease, but only to trigger the immune system to produce antibodies against the real microorganism so that when the body is invaded by that real microorganism, kahit hindi pa niya namimit yun before, meron ka ng panlaban against it. Kasi ang namit ng body mo ay isang copy of that microorganism before. So again, giving a person a vaccine is giving them a copy of that microorganism. But the goal is not to produce illness, but only to trigger the immune system to produce antibodies against the real microorganism. So, what's included in those vaccines, of course, are our tetanus vaccine, our measles vaccine. tuberculosis vaccine no and then later on aralin ati ng meaning ng mga ito attenuated killed recombinant DNA when we say passive immunity naman may dalawang uri ulit no natural acquired passive immunity and artificially acquired when we say naturally acquired passive immunity this happens through transplacentral or via the colostrum What is colostrum again? This is the first milk of the pregnant. mom or a newly delivered mother. So what happens is in passive immunity, hindi na yung microorganism ang trigger. Instead, ang nakukuha mo na are the antibodies themselves. Okay? Tandaan yun. Kapag passive immunity, antibody ang nakukuha mo. So in naturally acquired passive immunity, the baby gains antibodies from the mother. And how did the mother gain those antibodies? Pwedeng natural infection, pwede rin na na-vaccine si mommy. That's why those antibodies produced by the mother will be transferred to the baby. No? Pagka panganak, natatransfer sa kanya yun. Or pagka dede niya kay mommy, natatransfer sa milk yung mga antibodies na ito. The second is artificially acquired passive immunity. And in artificially acquired passive immunity, we inject the patient with antibodies. So if we have a copy of the microorganism injected, you can also give them directly as antibodies. And this includes your anti-serum, your immunoglobulins. Anti-serum is what we use as anti-poison. If a snake bites, if it's poisoned, let's say, sea-living creatures, can you put it on a big animal antibodies to them. So when you give the body antibodies needed to fight off or prevent an infection, then this is considered artificially acquired passive immunity. It was not created by the body, thus it's called artificial and passive because you're giving antibodies. So in order for us to better remember this, this is a picture showing that there's naturally acquired active immunity. This is from your infections. We also have artificially acquired active Immunity meaning You're giving a killed or weakened copy of the microorganism to the patient. It can also be naturally acquired passive immunity. This is from maternal antibodies. And there's also artificially acquired passive immunity. And these are the antibodies themselves. Now, a lot of people who encounter this for the first time would ask, Doc, why do we need to give artificial passive? Kung kaya naman natin palang magbigay ng artificial active. Why do we have to give them antibodies if we can give them the vaccine and they can eventually produce the antibodies? Because sometimes, the production of antibodies by vaccines would take a long time. If you remember from your COVID-19, pag nabakunahan ka ng COVID-19 ngayon, it will take two weeks before you are considered immunized. Why two weeks? Because it will take two weeks for the body to create antibodies against COVID-19. So there are instances or there are situations where we cannot wait for very long for the bodies to create these natural antibodies. We need to act fast. Therefore, instead of giving them a vaccine and allowing time to produce their antibodies, we administer the antibodies or the immunoglobulins immediately. to exposed patients such as as i mentioned no when you have to wait for two weeks before you give antibodies that's not because in two minutes or in two hours your patient is dead so give the antibodies that will neutralize the poison your toxin right so that's the reason why we still have this artificially acquired passive immunity so as an exercise for us to understand natin let's say we have a medical technologist who was extracting blood from a hepatitis B patient. However, because of clumsiness or probably because may kausap siya, na-distract siya, na-needle prick niya yung sarili niya, na-tusok niya yung sarili niya with a needle that came from a hepatitis B patient. Eh, paano ba naukuwang hepatitis B? Through needle prick and through sex. So, what will happen? The virus or the hepatitis B virus will enter the body. And what will this virus do? It will replicate inside. So eventually, the body will be able to detect na merong foreign body sa loob, merong hindi nagbibilong sa loob. So it will trigger the immune system to produce antibodies. In this image, yung mga parang letter Y, ito no, So this is one letter Y, another letter Y, another letter Y. Yung mga letter Y na yan, those are your antibodies. And the green here is your virus. So yung antibodies na makikreate ng immune system mo, they will attack the virus. So para manutralize yung virus. But the problem with hepatitis B is, it is incurable. So what will the body do? Because it's long, if you wait for your natural immunity to create antibodies, you should be able to give them the antibodies immediately. So you will give them this human hepatitis B immunoglobulin. And eventually, you can also give them a vaccine. So two of these will be given to these patients. So what kind of immunity is this? Naturally acquired because... natural yung pangyayari sa patient natin. Natural tong mga antibodies na to. But also, meron din tayong binigay na immunoglobulin. So this is also an example of artificially acquired passive immunity. Pero nagbigay ka rin ng vaccine sa pasyente. So meron ka rin artificially acquired active immunity. So tatlong uri ng ano, no? ng immunity yung nakita natin sa patient natin. So, para mas ma-exercise kayo, tingnan natin tong review natin. Animal handlers get rabies vaccinations to protect themselves from potential exposure to the virus through bites or scratches. What type of immunity is this? So, vaccine, artificial. Ano ba yung vaccine natin? Active or passive? Active. So, artificially acquired active immunity. Second, plasma therapy is one of the techniques currently being tested against COVID-19. Patients who have recovered successfully from the disease donate their plasma from their blood. So what does your plasma contain? Antibodies. Okay? So yung antibodies daw na mga successfully nag-recover, ibinibigay sa iba. So this is an example of naturally acquired passive immunity. Third, a patient developed chickenpox when she was a kid. Despite having an office mate who has chickenpox now, she did not get sick. This is an example of... Na-expose siya sa sakit, diba? So, naturally acquired. And then, active immunity. And lastly, an ER personnel attended to a patient who got injured by a rusty metal. He was given tetanus antitoxin to neutralize the tetanus spasmin. So, yung antitoxin is an immunoglobulin, no? So, this is an example of it contains antibodies. artificially acquired passive immunity okay so hopefully we were able to understand that because that will be a an important part of the next parts of our discussion now when we talk about immunization this is a beneficial and cost-effective disease prevention measure napaka beneficial lang immunization guys at napaka cost-effective niya why because usually the protection is long term. if not lifetime. So imagine, ang flu vaccine, let's say, yan ay 800 pesos to 1,000 pesos in a clinic. Sa halagang 1,000 pesos, mapoprotektahan ka from flu for one to two years. So, cost-effective siya at maraming mga vaccines. Bakit cost-effective? Maraming vaccines libre. Libre sa gobyerno binibigay. So, immunization is the process of triggering the immune system against a specific disease through vaccines. It can be passive. Ang mga bakuna pwedeng passive or ang binibigay ay antibody. Pwede ring active or ang inibigay is a copy of that microorganism. Okay? So, paano ba nagsimula itong vaccine development? It started in the 18th century when smallpox was a pandemic. It was widespread. It was very deadly. and By that time, the only means of combating smallpox was a primitive form of vaccination called variolation. So ano ginagawa sa variolation? Look at this. You intentionally infect a healthy person with the matter, whether liquid or solid, taken from a patient who is sick and causing them a mild attack of the disease. Grabe no? kukuha ka ng substance from a sick person. person at in effect more unhealthy person eco cosmo namaka socket Silla so that they can be prevented from the severe symptoms no so well I'm considered Ohan come mild lamba telegram a gigging socket mo so marami mga patients who underwent variolation who actually developed the severe disease and died no so that was the only way that they could protect themselves from smallpox Until they noted that persons who suffered from cowpox, which is a relative of smallpox, only difference is kung smallpox sa tao nangyayari, ang cowpox sa cow nangyayari. It was a harmless disease that comes from cattle. And once you get cowpox or ma-expose ka sa cowpox, hindi ka na mahahawa ng smallpox. They noticed it, but no one really gave it a... Time or thought. Until in May 1796, Dr. Edward Jenner found a young dairymaid. Dairymaid meaning she works with cows all the time. He met Sarah Nelmes who had fresh cowpox lesions on her hand. So Sarah Nelmes was caught by cowpox. But again, the disease is completely harmless. On May 14, Using the matter from Sarah's lesions, her cowpox lesions, Edward Jenner infected an 8-year-old boy by the name of James Phipps, who had never had smallpox before. So, he inoculated James Phipps with the cowpox lesion. Phipps became slightly ill over the course of the next 9 days, but on the 10th day, James Phipps recovered. On July 1st, Jenner intentionally inoculated James Phipps, now with smallpox matter, but the disease never developed. So Edward Jenner was able to prove that a person who was able to build immune protection against cowpox would also be immune against smallpox. And because of this, Edward Jenner is considered the father of immunization. Many studies came after this discovery by Edward Jenner. And now we have different types of vaccines. The first is live attenuated vaccines, which is the same as what Jenner did. So Edward Jenner gave attenuated, when we say attenuated, weakened. A weakened form of the virus or the bacteria. And once the body receives this weakened or attenuated form of virus or bacteria, it will trigger the immune system to produce antibodies to the disease similar to a natural infection okay so kumbaga without causing severe symptoms nakagawa yung katawan mo ng panlaban against the disease and live attenuated vaccines would provide long-term coverage to a person thus we only need one to two doses of a vaccine On the other hand, we also have inactivated vaccines where you give a copy of the microorganism, but this microorganism has been killed through heat or chemical methods. So sa live attenuated, buhay yung virus or bacteria, pero weakened. Pero sa inactivated, patay yung bacteria or virus na ibibigay. So once you give it to the patient, yung killed version of the virus, the body will create also antibodies specific to it. However, these antibodies cannot replicate. Kung ilan yung nagawa ng katawan mo during the time of vaccination, yun na yun. That's why you generally require 3 to 5 doses. At kasama na ron yung boosters. So, in the COVID-19 vaccine, it is actually inactivated. Killed version of the vaccine. ang ibinibigay sa sa atin so that our body can create antibodies and the reason why we need boosters is because these antibodies cannot replicate okay there is only one vaccine out there na live attenuated and that is synovac okay so why do we need to give boosters to remind the body to produce these antibodies so eventually The WHO created a program about this, and they called it the Expanded Program on Immunization, or EPI. This was established in 1976, and their goal was to initially protect infants and children and mothers who may be given access to these routinely recommended vaccines. The EPI, or the Expanded Program on Immunization, includes 6 vaccine-preventable diseases, which includes here tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, and measles. In fact, in 2002, WHO estimated 1.4 million deaths among children under 5 years old. It was because of diseases that could have been prevented by routine vaccination. So, it's a waste because 1.4 million people died from a disease that we can prevent. That's why EPI is very important so that we can provide healthy lives, better futures to children and infants and even mothers. So, in the Philippines, if the WHO launched it in 1976, the Philippines began it in 1979. So, this was because of... of Presidential Decree No. 996, providing compulsory, sabi ng compulsory lahat, compulsory basic immunization for infants and children below 8 years of age. So what were the free vaccines provided in 1979? BCG, DPT, OPV, and missiles. Don't worry because malalaman natin yung meaning ng mga ito. BCG, alam nyo na yan, device for tuberculosis. DPT is for diphtheria, pertussis, and tetanus. OPV is your oral polio. vaccine, and then missiles. So basically, ito pa rin yung anim, diba? Tuberculosis, diphtheria, polio, tetanus, pertussis, and missiles. Yan pa rin yung anim na binanggit ko kanina. And EPI in the Philippines can be done through several strategies. May mga tinatawag tayo na REV strategy or reaching every barangay. Kaya nga in each barangay, meron tayong barangay health center. And As of now, from what I remember, my last visit to a barangay health center was in 2018 when I was still a medical intern. Every Wednesday, ang libreng bakuna sa mga bagong panganak at para sa mga bata. Every Wednesday yan. So we have the Reaching Every Barangay Strategy or the REV Strategy. They also have supplemental immunization activity. These are done in schools, no? pharmacies, supplemental immunization activity, or in clinics. And then we also have strengthening vaccine preventable disease surveillance. So, ito yung mga iba't-ibang strategy ng DOH para mas ma-push yung EPI in the Philippines. So, ano ba yung goals ng EPI in the country? First, to immunize all infants and children against the most common vaccine preventable diseases. Again, ano yung most common vaccine preventable diseases natin? TB, diphtheria. Pertussis, tetanus, polio, and measles. Don't forget those six. Also, we want to sustain the polio-free status of the Philippines. And we will only be able to do that by continuing to provide free oral polio vaccine to children. We want to eliminate measles infections. Still, we have measles outbreaks. Eventually, we want to eradicate this disease completely in the country. To eliminate maternal and neonatal tetanus. So actually, if a patient is pregnant, we actually give them tetanus vaccine. To control diphtheria, pertussis, hepatitis B, and German missiles. And to prevent the extra pulmonary tuberculosis among children. So basically, we also divided the six vaccine-preventable diseases into six goals. right so Let's give a description for each EPI vaccine. First, we have BCG or Bacillus Calmetguirin. So, don't forget that. I asked that before in the prelims, right? So, in BCG, we give the patient tuberculosis antigen. And this is what you see in almost all people who have peclate in the right deltoid. So, where is the right deltoid? Right shoulder. Deltoid is shoulder muscle. Okay, so remember that because by your second year, if you'll go to second year, you have anatomy and physiology. That subject is very difficult. So deltoid is shoulder muscle. And you give that at birth. And why do we have to give it? Because we want to prevent TB meningitis. Doc, isn't TB in the stomach, why is there meningitis? Yes, tuberculosis first infects the lungs, but sometimes it can travel to other organs, such as in the brain. You can have tuberculosis in the brain and that is what we call TB meningitis. So in order to prevent that, we give patients BCG at birth. We also have hepatitis B vaccine. As mentioned, this is an incurable disease. So if you have this, there is no cure for you. So in order to prevent it from happening, we give them the hepatitis B vaccine. It is an intramuscular injection, meaning we inject it in the muscles. in order to provide protection against hepatitis B. The next is oral polio vaccine or OPV. We give it in three doses. Oral po yan, hindi po yan ini-inject. Pinapatak sa bibig. Okay? And we usually give it at six weeks of life, 10th week of life, and 14th week of life. Next, we have your rotavirus. Hindi ko ito nabanggit sa six vaccines natin, but this is one of the newer additions. It's for the prevention of childhood diarrhea caused by a virus called rotavirus. And similar to your polio, it's also given orally. It's given in the mouth. And then, we have your pentavalent vaccine or our 5-in-1. So it's called Penta 5-in-1. What are these 5 diseases? First, we have your diphtheria. Diphtheria is a respiratory disease caused by a vaccine. called Cory nebacterium diphtheriae please remember that Cory nebacterium diphtheriae Okay? So more of this when you go to your third year, no? In your microbiology. You also have a vaccine against pertussis, right? Pertussis is what causes whooping cough. When they cough, there's a whoop at the end. It's like, ah, ah, ah, whoop! Something like that, right? So don't repeat it. I won't repeat it. And your pertussis is caused by a bacteria also called Bordetella pertussis. Okay? Tetanus, alam natin yan, no? This causes muscle spasm and rigidity and also death. And it's caused by a bacteria called Clostridium tetani. Okay? Clostridium tetani. We also have your Hepatitis B. Nabanggit na natin yan. Kasama rin siya sa 5-in-1. And a newer addition is your Hib. No? Or Haemophilus influenzae type B bacteria. Kaya siya Hib. H for Haemophilus, I for Influenza, and then B for Type B bacteria, which causes meningitis in newborns or in children. So basically, we have the six, no? Plus, what did we add? Your rotavirus and your Hib or Haemophilus Influenza Type B. Another vaccine here is your measles vaccine. Usually, it's given at nine months, the measles. And meron din tayong tinatawag na MMR, which is a 3-in-1 vaccine for the prevention of mumps, missiles, and rubella. Yung missiles, yan yung tigdas. It's caused by a virus called morbillivirus. Yung mumps, yan naman yung beke, na caused by a virus called rubella virus. And then rubella, which is tigdas hangin, it's caused by a virus called rubella. virus. So first year pa lang, ine-expose ko na kayo, piniprepare ko na kayo for your higher years by giving you these vaccines and these microorganisms. So as mentioned, may timing yung pagbigay ng mga EPI vaccines natin. So ang BCG, ibinibigay yan at birth. Okay? Pag hindi ka nabigyan at birth, ibibigay sa'yo yan once you start school. Okay? How many doses will be given to you? One only. During birth or before the start of school. And usually, at birth, it's given. ID means intradermal. Intradermal. And it's usually given on the right deltoid. How much? 0.05 ml or 0.05 cc. Oh my gosh, guys. I have an experience here. I was an intern already. Med... medicine intern under pediatrics. And one of my classmates mistook 0.05 to be 0.5. My gosh, ang daming niyang tinurok na BCG sa balat ng baby. So, panic kaming lahat. Even the pediatrician, parang, oh no, ang daming nabigay. So, we had to study journals, we had to read evidences, kung ano bang side effect nun kay baby. Kasi nagkamali ito si medical intern. Good enough, wala naman palang masama. So 0.05 is also correct. And you shouldn't exceed that because eventually, it might have an effect. But good enough. The baby has a good monitor. And now, she's 4 years old and very, very healthy. If you're giving a school entry, you're going to get a PCG. It will be given on the other shoulder, on the left deltoid. And more because you're bigger, which is 0.5 cc. Next is your DPT, your diphtheria pertussis tetanus. So if you will notice, karamihan na mga EPI vaccine, usually sinisimulan yan at 6 weeks. 6 weeks muna. Yun yung minimum age for the usual EPI vaccines except for your BCG. And usually for your EPI vaccines, 3 doses. Kaya babalik ka 6th week, 10th week, and 14th week. Sinabi ko yan kanina. So, ilang weeks ang interval? Apat, four weeks every vaccine na ibibigay sa'yo. So, for your DPP, usually we give it intramuscular, sa muscle tinuturok. And where can you find your vastus lateralis? Usually, we give your DPP or yung intramuscular vaccines natin sa thigh. Thigh, hita ng pasyente. Okay, bakit sa hita binibigay, dok? Bakit hindi sa shoulder? Because there is more muscle mass in the thigh as compared to the shoulder during infancy. or kapag baby ka, mas marami kang muscle sa thigh mo, specifically sa vastus lateralis muscle, as compared to the deltoid. And how much do you give? 0.5 cc. For your oral polio vaccine, oral po ito, ipinapatak sa bibig. 6 weeks minimum age, 3 doses, 4 weeks apart. You give 2 to 3 drops. Yun yung GTPS. 2 to 3 drops. No? Yan. And then your hepatitis B, kasama yan sa pentavalent natin. So same lang siya ni DPT, 0.5 cc. And then your muscles, we give it subcutaneous. Pag sinabing subcutaneous, sa fat area lang natin. It's only one dose, we give it at 9 months. And how much do we give? 0.5 cc. So this table is very important. Don't you forget to memorize this. So ano ba yung contents ng EPI vaccine natin? Your BCG is live attenuated. OPV and missiles, live attenuated. Ang diphtheria at tetanus, these are antibodies already. No? Antibodies already ang mga yan. Pertussis, inactivated. And your HEPA-B is a DNA recombinant. Meaning, may part lang ng hepatitis B DNA. na itinuturok sa patients natin, enough to cause or to trigger the immune system, but we do not give the entire virus to the patient. Now, ano yung mga contraindications? When do we not give a vaccine to a patient? Number one, if they have severe illness. Number two, kung dati naturukan sila at nag-allergy sila, we do not give the second or the third dose anymore. Or if the patient is immunosuppressed, meaning Probably, they're taking medications or undergoing chemotherapy radiation as long as the immune system is low. Why? Because the goal of vaccine is to trigger the immune system. If the immune system is suppressed and cannot be triggered, there is no point in giving the vaccine. It might develop an illness. So when they are severely ill, when they have allergies or immunosuppressed, the main reason why we do not give it to them is because instead of triggering the immune system, And they might develop the disease instead. And why do we have to, you know, grab everybody and get everybody involved in terms of vaccination? Because we want to achieve herd immunity. And what do we mean by herd immunity? It is getting the majority to be vaccinized so that the immunized individuals can provide indirect protection to the susceptible members of a population. So like in this image, no? Yung mga green, sila yung mga vaccinated. Yung mga blue, sila yung mga incompletely vaccinated. At yung mga red, sila yung mga unvaccinated. So if there are more people with the vaccine, there will be lesser chance of getting the disease. Kung walang magpapasa-pasa ng disease, the unvaccinated will have lesser chance also of getting the disease. At kung meron mga magkasakit sa unvaccinated, sila sila na lang ang magkakasakit. Okay? So, ano yung mga targets natin for the immunization program? For infancy, yung mga infant vaccines natin, given at 6, 10, and 14 weeks, dapat makomplete yan by 12 months old or before 1 year old, dapat matapos na. Yung mga school entrant vaccine, basically your BCG, dapat mabigay yan by 6 to 7 years old. At yung mga pregnant mothers na makangailangan ng tetanus vaccine, Dapat before delivery, mabigyan sila ng five. tetanus toxoid vaccines no and for ito yung mga vaccines na binibigay sa bawat isa infants of course your epi school entrance your bcg and for pregnant five tetanus toxoid shots so in studying vaccines we also have to understand yung cold chain system ano yung cold chain system it is keeping and transporting the vaccine in cold temperatures to maintain the potency of the vaccine. So, di ba? Ang laman ng vaccines natin are weakened or killed bacteria or virus. And if they are not allowed to thrive in the right environment, they could die. And if they die, how could they trigger the immune system? So, yes, alam ko may mga inactivated vaccines, dead na yun, dok, they could die. Yeah, yung potency, yung ability to trigger an immune response, yun yung iniingatan natin. So, you have to store them in the right temperatures, usually sa cold temperatures. So the cold chain system should be able to store the vaccines in good condition. Minsan tinatawag din yung cold chain system na vaccine supply chain or immunization supply chain. And actually, isa ito sa mga talagang mahalagang dapat ma-maintain especially in transporting vaccines like when we order let's say Pfizer vaccine or AstraZeneca vaccine or Moderna vaccine from abroad. and they bring it to the country in planes. Dapat! yung plane na yun may maayos na cold chain system even pagbaba ng aeroplano dapat maitransport ka agad yun mailipat agad sa cold chain system natin no? dapat hindi siya mawawala doon sa cold chain system or else mamamata yung vaccine so may iba't ibang mga requirements no? such as your OPV and missiles ang nire-require nila negative 15 to negative 25 degree celsius so sa freezer mo itatago yan We have vaccines such as DPT, Hepa-B, BCG, and your tetanus toxoid, 2 to 8 degrees Celsius only. So where will you hide that? In the refrigerator? In the body? What is the body? The one under the freezer? Not exactly the one that looks like a chiller, not there. Underneath, in the body really. Not even in the door, because the vaccine will get damaged if it's in the door. So you will hide them in your body, where the vaccine is maintained, or the temperature rather is maintained at... 2 to 8 degrees Celsius. So please also remember that we have two vaccines which are highly sensitive to heat. Pag nainitan ng kahit konti or bumaba ng kahit konti sa negative 15 degrees Celsius, pag uminit pa siya dun, mamamatay na or masisira, mapapanis na yung vaccine. That's your OPV and missiles. And the two least sensitive to heat vaccine is your BCG and tetanus toxoid. Actually, yang BCG. That's one of the things that we're taught as doctors on how to give it. So in the Philippines, aside from Presidential Decree 996, our country also issued Republic Act 10152 or the Mandatory Basic Immunization Services for Infants and Children which repealed PD 996. So what happened to RA 10152? It gave free vaccines to... infants and children only up to 5 years of age. PD-996 is 8 years old. And in RA-10152, that's where the other vaccines were included. That's where Hib or Haemophilus Influenza Type B was included, which could cause pneumonia and meningitis. That's where DPT, Hepatitis B, and Hib were combined into the pentavalent vaccine. That's where Rotavirus was added. which is an oral vaccine against diarrhea, and your pneumococcal vaccine or your pneumonia vaccine. Okay? So, ano ba yung goals or principles ng vaccination natin? So, you have to remember this so that if you are aspiring to become a doctor, and a lot of you are, you should remember this, especially when you give advice to your mga kamag-anak. So, no BCG can be given to a child who has HIV or AIDS. again HIV or AIDS immunosuppression. So hindi mo pwedeng bigyan ng BCG yan at birth. DPT dose number 2 or DPT dose number 3 is not given to a child who developed epilepsy or convulsions or shock within the 3 days na nareceive niya yung una niyang DPT. Okay? So ito yung sinasabi ko. Pag nagkaroon ng allergic reaction or nagkaroon ng adverse reaction to a vaccine. Katulad neto, binigyan daw ng DPP. If within the first three days after vaccination, baglang nag-convulsion si patient, you cannot give dose number two and number three anymore. Okay? Number three is the most commonly misunderstood and myth in vaccination. Moderate fever, malnutrition, even if you have cough, colds, diarrhea, or mildly vomiting, Hindi ibig sabihin ay hindi ka nababakunahan. Even if you have fever, even if you are malnourished, even if you have cough and colds, diarrhea, and even mild vomiting, you can be vaccinated. So sa mga tita, tito, especially sa mga babies na kasama ninyo sa bahay, sometimes sa mga mothers, minsan talaga very protective. And we can understand naman the anxiety and yung apprehensions nila. But please advise them properly, ha? Hindi contraindication ang moderate fever malnutrition, cough and colds, diarrhea, vomiting to vaccination. Okay? Next, it is safe to administer all EPI vaccines on the same day as long as you give them on different sites of the body. Anong ibig sabihin ito? Diba sinabi ko kanina? There are several vaccines that you can give at six weeks. And yes, you can give them all at the same day. Okay? So your DPT, hepatitis B, your HIV, your Rota, what else? yung mga ngayon, sila yung mga binibigay at 6 weeks, you can give them all in the same day, pero iba't-ibang sites dapat. Kaya nga ang ginawa ng government, ginawang pentavalent, diba? Magkakasama na lahat sa isang bakuna, isang turok lang, lima na. D, P, T, Hib, Hepa B. Lima na kaagad yun sa isang turok lang. So instead of giving them iba-ibang turok, yung limang yan, pinagsama-sama na nila. Next, you cannot eat 30 minutes after receiving your oral polio vaccine. Or else, you'll lose the effect of your OPV. So, if you give them a vaccine, other moms, when they give you a medicine, they'll give you a reward right away. So, if you give your OPV, you cannot give them any drink or any food after, within 30 minutes. Also, you have to ask, do you have an allergy to eggs? Before giving missiles vaccine. Actually, it's not just missiles, I don't know. Ako ay always ask for egg allergy in general. Why? Because a lot of our vaccines are developed inside an egg. Yeah. Doon natin, ginugrow yung vaccines natin in chick cells. So if you're allergic to eggs, hindi ka pwede mag-receive ng vaccine or you have to take your anti-allergy because may egg component yung vaccines natin. Kaya nga, when you are vaccinated, sasabihin sa'yo, you you cannot eat chicken, eggs, or fish first. Avoid eating fish first because it might trigger an allergic reaction. Last set of principles, measles vaccine should be given as soon as 9 months, regardless of whether other vaccines will be given on that day. So as long as it's protected for 9 months, you should be able to receive your measles vaccine. Also, there's nothing here, but I have to say that in the scenario of a measles outbreak, you can give the measles vaccine earlier than nine months but only if there is a measles outbreak number eight vaccination schedule should not be restarted from the beginning even if the interval between doses are exceeded so sabi natin diba mabibigay ang mga vaccine starting six weeks let's say four weeks lang dapat yung interval pero dahil busy si mami busy si daddy or baka baby is busy, right? We're wrong. Exceed to be six weeks, right? Yung interval, pag na-miss mo yung vaccine mo, hindi kailangan umulit mula umpisa. Itutuloy lang po yun. At sasabihan ka na please, huwag ka nang makakaligta ulit. Okay? Now, there should be a repeat BCG vaccination pag walang scar na nag-develop sa first injection. So yes, prerequisite yung scar. Prerequisite na dapat magkaroon ka ng... peklat sa balikat mo. Kasi pag hindi, uulitin yan. Because the scar is the proof of vaccination. So pag wala sila nakitang scar sayo, ulitin nila yan. Next, kung multiple vaccines ang ibibigay sa baby in a day, one needle per child lang po. Okay? One syringe, one needle per child during vaccination. We cannot use the same needle on other patients. And lastly, a child with diarrhea who is due for OPV should receive a dose of OPV during the visit but do not count the dose. Why? So sabi pag may diarrhea yung bata, pwede ka pa rin magbigay ng OPV pero hindi mo ika-count yung dose na yun meaning babalik pa ulit siya. Bakit ganun? Because in diarrhea, merong fast um intestinal motility, mabilis yung galaw ng bituka, and the OPV vaccine, baka maidumi mo lang siya. Instead of it being able to create an immune response inside the intestines, baka idumi mo lang siya. So, we have to repeat the vaccine. And that's it. That's the end of our EPI discussion. Hopefully, you were able to understand it. I will be uploading the next video in a while. Shalom!

Hi guys, welcome back to my channel. It's Dr. Junelle. The subject at hand is community and public health. And for this video, we are going to be talking about the expanded program on immunization.

So we won't be able to understand immunization without first tackling or studying the meaning of immunity and what types of immunity we have in our body. So when we say immunity, this is the condition of being protected against a particular disease. So when we say immunity, this is the ability of our body to fight against various microorganisms, various disease-causing microbes that may be present in our environment.

And there are two types of immunity. The first is natural or innate, and the second one is adaptive immunity. So when we say natural or innate immunity, this is the body's inborn system to which it can protect itself in fight of infections. So once a person is born into the world, meron siya natural ability to defend itself against mga disease-causing organisms.

And part of that innate immunity is seen in the image, kasama dun yung mga macrophages natin, yung mga granulocytes natin. and the different types of killer cells found in the body. There's a mast cell, there's a dendritic cell, there's a natural killer cell, etc. When we say adaptive immunity, this is built by the body or this is a result of the exposure to a disease-causing organism. So what happens is, once we're exposed to a disease, the body remembers that organism.

And the body is not a body. creates soldiers specific to that disease so that the next time the body meets that disease again it can already mount a defense against it so more of that when you go to your immunocero in your third year now when we talk about adaptive immunity no yung result of being exposed to a disease. You cannot do away with talking about antigen and antibody.

So, ang antigen, these are substances that causes the body to produce antibodies. On the other hand, antibodies are substances produced by the immune system and defends the body against infections. Sa madaling sabi, let's say my disease-causing organism, that is the antigen. Because the disease-causing organism, will be the one to trigger our immune system to produce antibodies.

Yung sinasabi ko kanina na soldiers specific to that organism. So yung antigen, yan yung organism na magti-trigger sa ating immune system. And the soldiers are the antibodies. They defend the body against infection.

At tinatandaan nila kung sino yung nag-trigger para ma-produce sila. so that that the next time that the body meets or the body is invaded by this organism again, kayang-kaya na niyang talunin. So adaptive immunity can be further divided into two. Meron tayong tinatawag na active adaptive immunity and passive adaptive immunity. And both active and passive adaptive immunity can be divided into two.

Yung naturally acquired and artificially acquired. So basically, may tinatawag tayo na Naturally Acquired Active Adaptive Immunity. Medyo mahaba, it's a mouthful, but kaya natin yan.

May tinatawag din na Artificially Acquired Active Adaptive Immunity. And we also have Naturally or Artificially Acquired Passive Adaptive Immunity. So para mas maintindihan natin, i-define natin yung bawat uri ng Adaptive Immunity. So first, let's talk about the Naturally Acquired.

Active immunity. This results from infection, like what I discussed earlier about adaptive immunity. So let's say you have a COVID-19 infection.

Your immune system will determine or will be able to detect that there is a foreign body inside. Who is the foreign body? Who is the invader?

The SARS-CoV-2 virus that entered your body. So what the body will do, the body will be able to detect the foreign body or the antigen. So it will trigger the immune system. to remember the appearance of SARS-CoV-2 virus, and to create antibodies specific to COVID-19. So eventually, kapag nakabuo ka ng COVID-19 antibodies mo, matatanggal or mapapatay natin yung COVID-19 virus na yan na nasa loob.

And the next time you encounter a COVID-19 infection again, mas madali na for the body to kill the virus kasi meron na siyang pondo or meron na siyang nakreate ng mga soldiers or antibodies from a previous infection. So kapag naturally nangyari, na-infect ka, nag-create ka ng antibodies, naturally acquired active immunity siya. The second is your artificially acquired active immunity. So paano naman nangyari ito?

This is through the injection of antigen or mga vaccines natin. So please remember that. When you ask in the exam, what type of immunity does your vaccines give you? Correct answer, artificially acquired active immunity.

Why active if it's a vaccine? Because what we give in vaccines is a copy of the microorganism, a copy of the disease-causing microorganism. But... Ang goal natin is not so that the person can develop the disease, but only to trigger the immune system to produce antibodies against the real microorganism so that when the body is invaded by that real microorganism, kahit hindi pa niya namimit yun before, meron ka ng panlaban against it.

Kasi ang namit ng body mo ay isang copy of that microorganism before. So again, giving a person a vaccine is giving them a copy of that microorganism. But the goal is not to produce illness, but only to trigger the immune system to produce antibodies against the real microorganism.

So, what's included in those vaccines, of course, are our tetanus vaccine, our measles vaccine. tuberculosis vaccine no and then later on aralin ati ng meaning ng mga ito attenuated killed recombinant DNA when we say passive immunity naman may dalawang uri ulit no natural acquired passive immunity and artificially acquired when we say naturally acquired passive immunity this happens through transplacentral or via the colostrum What is colostrum again? This is the first milk of the pregnant.

mom or a newly delivered mother. So what happens is in passive immunity, hindi na yung microorganism ang trigger. Instead, ang nakukuha mo na are the antibodies themselves.

Okay? Tandaan yun. Kapag passive immunity, antibody ang nakukuha mo.

So in naturally acquired passive immunity, the baby gains antibodies from the mother. And how did the mother gain those antibodies? Pwedeng natural infection, pwede rin na na-vaccine si mommy. That's why those antibodies produced by the mother will be transferred to the baby. No?

Pagka panganak, natatransfer sa kanya yun. Or pagka dede niya kay mommy, natatransfer sa milk yung mga antibodies na ito. The second is artificially acquired passive immunity.

And in artificially acquired passive immunity, we inject the patient with antibodies. So if we have a copy of the microorganism injected, you can also give them directly as antibodies. And this includes your anti-serum, your immunoglobulins. Anti-serum is what we use as anti-poison. If a snake bites, if it's poisoned, let's say, sea-living creatures, can you put it on a big animal antibodies to them.

So when you give the body antibodies needed to fight off or prevent an infection, then this is considered artificially acquired passive immunity. It was not created by the body, thus it's called artificial and passive because you're giving antibodies. So in order for us to better remember this, this is a picture showing that there's naturally acquired active immunity.

This is from your infections. We also have artificially acquired active Immunity meaning You're giving a killed or weakened copy of the microorganism to the patient. It can also be naturally acquired passive immunity. This is from maternal antibodies. And there's also artificially acquired passive immunity.

And these are the antibodies themselves. Now, a lot of people who encounter this for the first time would ask, Doc, why do we need to give artificial passive? Kung kaya naman natin palang magbigay ng artificial active. Why do we have to give them antibodies if we can give them the vaccine and they can eventually produce the antibodies?

Because sometimes, the production of antibodies by vaccines would take a long time. If you remember from your COVID-19, pag nabakunahan ka ng COVID-19 ngayon, it will take two weeks before you are considered immunized. Why two weeks? Because it will take two weeks for the body to create antibodies against COVID-19.

So there are instances or there are situations where we cannot wait for very long for the bodies to create these natural antibodies. We need to act fast. Therefore, instead of giving them a vaccine and allowing time to produce their antibodies, we administer the antibodies or the immunoglobulins immediately. to exposed patients such as as i mentioned no when you have to wait for two weeks before you give antibodies that's not because in two minutes or in two hours your patient is dead so give the antibodies that will neutralize the poison your toxin right so that's the reason why we still have this artificially acquired passive immunity so as an exercise for us to understand natin let's say we have a medical technologist who was extracting blood from a hepatitis B patient. However, because of clumsiness or probably because may kausap siya, na-distract siya, na-needle prick niya yung sarili niya, na-tusok niya yung sarili niya with a needle that came from a hepatitis B patient.

Eh, paano ba naukuwang hepatitis B? Through needle prick and through sex. So, what will happen?

The virus or the hepatitis B virus will enter the body. And what will this virus do? It will replicate inside.

So eventually, the body will be able to detect na merong foreign body sa loob, merong hindi nagbibilong sa loob. So it will trigger the immune system to produce antibodies. In this image, yung mga parang letter Y, ito no, So this is one letter Y, another letter Y, another letter Y. Yung mga letter Y na yan, those are your antibodies. And the green here is your virus.

So yung antibodies na makikreate ng immune system mo, they will attack the virus. So para manutralize yung virus. But the problem with hepatitis B is, it is incurable. So what will the body do? Because it's long, if you wait for your natural immunity to create antibodies, you should be able to give them the antibodies immediately.

So you will give them this human hepatitis B immunoglobulin. And eventually, you can also give them a vaccine. So two of these will be given to these patients. So what kind of immunity is this?

Naturally acquired because... natural yung pangyayari sa patient natin. Natural tong mga antibodies na to.

But also, meron din tayong binigay na immunoglobulin. So this is also an example of artificially acquired passive immunity. Pero nagbigay ka rin ng vaccine sa pasyente. So meron ka rin artificially acquired active immunity.

So tatlong uri ng ano, no? ng immunity yung nakita natin sa patient natin. So, para mas ma-exercise kayo, tingnan natin tong review natin. Animal handlers get rabies vaccinations to protect themselves from potential exposure to the virus through bites or scratches. What type of immunity is this?

So, vaccine, artificial. Ano ba yung vaccine natin? Active or passive?

Active. So, artificially acquired active immunity. Second, plasma therapy is one of the techniques currently being tested against COVID-19.

Patients who have recovered successfully from the disease donate their plasma from their blood. So what does your plasma contain? Antibodies.

Okay? So yung antibodies daw na mga successfully nag-recover, ibinibigay sa iba. So this is an example of naturally acquired passive immunity.

Third, a patient developed chickenpox when she was a kid. Despite having an office mate who has chickenpox now, she did not get sick. This is an example of...

Na-expose siya sa sakit, diba? So, naturally acquired. And then, active immunity.

And lastly, an ER personnel attended to a patient who got injured by a rusty metal. He was given tetanus antitoxin to neutralize the tetanus spasmin. So, yung antitoxin is an immunoglobulin, no?

So, this is an example of it contains antibodies. artificially acquired passive immunity okay so hopefully we were able to understand that because that will be a an important part of the next parts of our discussion now when we talk about immunization this is a beneficial and cost-effective disease prevention measure napaka beneficial lang immunization guys at napaka cost-effective niya why because usually the protection is long term. if not lifetime.

So imagine, ang flu vaccine, let's say, yan ay 800 pesos to 1,000 pesos in a clinic. Sa halagang 1,000 pesos, mapoprotektahan ka from flu for one to two years. So, cost-effective siya at maraming mga vaccines.

Bakit cost-effective? Maraming vaccines libre. Libre sa gobyerno binibigay.

So, immunization is the process of triggering the immune system against a specific disease through vaccines. It can be passive. Ang mga bakuna pwedeng passive or ang binibigay ay antibody.

Pwede ring active or ang inibigay is a copy of that microorganism. Okay? So, paano ba nagsimula itong vaccine development? It started in the 18th century when smallpox was a pandemic. It was widespread.

It was very deadly. and By that time, the only means of combating smallpox was a primitive form of vaccination called variolation. So ano ginagawa sa variolation? Look at this. You intentionally infect a healthy person with the matter, whether liquid or solid, taken from a patient who is sick and causing them a mild attack of the disease.

Grabe no? kukuha ka ng substance from a sick person. person at in effect more unhealthy person eco cosmo namaka socket Silla so that they can be prevented from the severe symptoms no so well I'm considered Ohan come mild lamba telegram a gigging socket mo so marami mga patients who underwent variolation who actually developed the severe disease and died no so that was the only way that they could protect themselves from smallpox Until they noted that persons who suffered from cowpox, which is a relative of smallpox, only difference is kung smallpox sa tao nangyayari, ang cowpox sa cow nangyayari.

It was a harmless disease that comes from cattle. And once you get cowpox or ma-expose ka sa cowpox, hindi ka na mahahawa ng smallpox. They noticed it, but no one really gave it a...

Time or thought. Until in May 1796, Dr. Edward Jenner found a young dairymaid. Dairymaid meaning she works with cows all the time. He met Sarah Nelmes who had fresh cowpox lesions on her hand.

So Sarah Nelmes was caught by cowpox. But again, the disease is completely harmless. On May 14, Using the matter from Sarah's lesions, her cowpox lesions, Edward Jenner infected an 8-year-old boy by the name of James Phipps, who had never had smallpox before.

So, he inoculated James Phipps with the cowpox lesion. Phipps became slightly ill over the course of the next 9 days, but on the 10th day, James Phipps recovered. On July 1st, Jenner intentionally inoculated James Phipps, now with smallpox matter, but the disease never developed.

So Edward Jenner was able to prove that a person who was able to build immune protection against cowpox would also be immune against smallpox. And because of this, Edward Jenner is considered the father of immunization. Many studies came after this discovery by Edward Jenner.

And now we have different types of vaccines. The first is live attenuated vaccines, which is the same as what Jenner did. So Edward Jenner gave attenuated, when we say attenuated, weakened.

A weakened form of the virus or the bacteria. And once the body receives this weakened or attenuated form of virus or bacteria, it will trigger the immune system to produce antibodies to the disease similar to a natural infection okay so kumbaga without causing severe symptoms nakagawa yung katawan mo ng panlaban against the disease and live attenuated vaccines would provide long-term coverage to a person thus we only need one to two doses of a vaccine On the other hand, we also have inactivated vaccines where you give a copy of the microorganism, but this microorganism has been killed through heat or chemical methods. So sa live attenuated, buhay yung virus or bacteria, pero weakened.

Pero sa inactivated, patay yung bacteria or virus na ibibigay. So once you give it to the patient, yung killed version of the virus, the body will create also antibodies specific to it. However, these antibodies cannot replicate.

Kung ilan yung nagawa ng katawan mo during the time of vaccination, yun na yun. That's why you generally require 3 to 5 doses. At kasama na ron yung boosters. So, in the COVID-19 vaccine, it is actually inactivated. Killed version of the vaccine.

ang ibinibigay sa sa atin so that our body can create antibodies and the reason why we need boosters is because these antibodies cannot replicate okay there is only one vaccine out there na live attenuated and that is synovac okay so why do we need to give boosters to remind the body to produce these antibodies so eventually The WHO created a program about this, and they called it the Expanded Program on Immunization, or EPI. This was established in 1976, and their goal was to initially protect infants and children and mothers who may be given access to these routinely recommended vaccines. The EPI, or the Expanded Program on Immunization, includes 6 vaccine-preventable diseases, which includes here tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, and measles. In fact, in 2002, WHO estimated 1.4 million deaths among children under 5 years old.

It was because of diseases that could have been prevented by routine vaccination. So, it's a waste because 1.4 million people died from a disease that we can prevent. That's why EPI is very important so that we can provide healthy lives, better futures to children and infants and even mothers. So, in the Philippines, if the WHO launched it in 1976, the Philippines began it in 1979. So, this was because of...

of Presidential Decree No. 996, providing compulsory, sabi ng compulsory lahat, compulsory basic immunization for infants and children below 8 years of age. So what were the free vaccines provided in 1979? BCG, DPT, OPV, and missiles.

Don't worry because malalaman natin yung meaning ng mga ito. BCG, alam nyo na yan, device for tuberculosis. DPT is for diphtheria, pertussis, and tetanus.

OPV is your oral polio. vaccine, and then missiles. So basically, ito pa rin yung anim, diba? Tuberculosis, diphtheria, polio, tetanus, pertussis, and missiles.

Yan pa rin yung anim na binanggit ko kanina. And EPI in the Philippines can be done through several strategies. May mga tinatawag tayo na REV strategy or reaching every barangay.

Kaya nga in each barangay, meron tayong barangay health center. And As of now, from what I remember, my last visit to a barangay health center was in 2018 when I was still a medical intern. Every Wednesday, ang libreng bakuna sa mga bagong panganak at para sa mga bata.

Every Wednesday yan. So we have the Reaching Every Barangay Strategy or the REV Strategy. They also have supplemental immunization activity.

These are done in schools, no? pharmacies, supplemental immunization activity, or in clinics. And then we also have strengthening vaccine preventable disease surveillance.

So, ito yung mga iba't-ibang strategy ng DOH para mas ma-push yung EPI in the Philippines. So, ano ba yung goals ng EPI in the country? First, to immunize all infants and children against the most common vaccine preventable diseases. Again, ano yung most common vaccine preventable diseases natin? TB, diphtheria.

Pertussis, tetanus, polio, and measles. Don't forget those six. Also, we want to sustain the polio-free status of the Philippines.

And we will only be able to do that by continuing to provide free oral polio vaccine to children. We want to eliminate measles infections. Still, we have measles outbreaks. Eventually, we want to eradicate this disease completely in the country. To eliminate maternal and neonatal tetanus.

So actually, if a patient is pregnant, we actually give them tetanus vaccine. To control diphtheria, pertussis, hepatitis B, and German missiles. And to prevent the extra pulmonary tuberculosis among children. So basically, we also divided the six vaccine-preventable diseases into six goals. right so Let's give a description for each EPI vaccine.

First, we have BCG or Bacillus Calmetguirin. So, don't forget that. I asked that before in the prelims, right? So, in BCG, we give the patient tuberculosis antigen. And this is what you see in almost all people who have peclate in the right deltoid.

So, where is the right deltoid? Right shoulder. Deltoid is shoulder muscle.

Okay, so remember that because by your second year, if you'll go to second year, you have anatomy and physiology. That subject is very difficult. So deltoid is shoulder muscle.

And you give that at birth. And why do we have to give it? Because we want to prevent TB meningitis.

Doc, isn't TB in the stomach, why is there meningitis? Yes, tuberculosis first infects the lungs, but sometimes it can travel to other organs, such as in the brain. You can have tuberculosis in the brain and that is what we call TB meningitis. So in order to prevent that, we give patients BCG at birth. We also have hepatitis B vaccine.

As mentioned, this is an incurable disease. So if you have this, there is no cure for you. So in order to prevent it from happening, we give them the hepatitis B vaccine. It is an intramuscular injection, meaning we inject it in the muscles. in order to provide protection against hepatitis B.

The next is oral polio vaccine or OPV. We give it in three doses. Oral po yan, hindi po yan ini-inject. Pinapatak sa bibig. Okay?

And we usually give it at six weeks of life, 10th week of life, and 14th week of life. Next, we have your rotavirus. Hindi ko ito nabanggit sa six vaccines natin, but this is one of the newer additions. It's for the prevention of childhood diarrhea caused by a virus called rotavirus. And similar to your polio, it's also given orally.

It's given in the mouth. And then, we have your pentavalent vaccine or our 5-in-1. So it's called Penta 5-in-1.

What are these 5 diseases? First, we have your diphtheria. Diphtheria is a respiratory disease caused by a vaccine.

called Cory nebacterium diphtheriae please remember that Cory nebacterium diphtheriae Okay? So more of this when you go to your third year, no? In your microbiology.

You also have a vaccine against pertussis, right? Pertussis is what causes whooping cough. When they cough, there's a whoop at the end.

It's like, ah, ah, ah, whoop! Something like that, right? So don't repeat it. I won't repeat it. And your pertussis is caused by a bacteria also called Bordetella pertussis.

Okay? Tetanus, alam natin yan, no? This causes muscle spasm and rigidity and also death.

And it's caused by a bacteria called Clostridium tetani. Okay? Clostridium tetani. We also have your Hepatitis B. Nabanggit na natin yan.

Kasama rin siya sa 5-in-1. And a newer addition is your Hib. No?

Or Haemophilus influenzae type B bacteria. Kaya siya Hib. H for Haemophilus, I for Influenza, and then B for Type B bacteria, which causes meningitis in newborns or in children. So basically, we have the six, no? Plus, what did we add?

Your rotavirus and your Hib or Haemophilus Influenza Type B. Another vaccine here is your measles vaccine. Usually, it's given at nine months, the measles. And meron din tayong tinatawag na MMR, which is a 3-in-1 vaccine for the prevention of mumps, missiles, and rubella. Yung missiles, yan yung tigdas. It's caused by a virus called morbillivirus.

Yung mumps, yan naman yung beke, na caused by a virus called rubella virus. And then rubella, which is tigdas hangin, it's caused by a virus called rubella. virus.

So first year pa lang, ine-expose ko na kayo, piniprepare ko na kayo for your higher years by giving you these vaccines and these microorganisms. So as mentioned, may timing yung pagbigay ng mga EPI vaccines natin. So ang BCG, ibinibigay yan at birth. Okay?

Pag hindi ka nabigyan at birth, ibibigay sa'yo yan once you start school. Okay? How many doses will be given to you?

One only. During birth or before the start of school. And usually, at birth, it's given. ID means intradermal.

Intradermal. And it's usually given on the right deltoid. How much? 0.05 ml or 0.05 cc.

Oh my gosh, guys. I have an experience here. I was an intern already. Med...

medicine intern under pediatrics. And one of my classmates mistook 0.05 to be 0.5. My gosh, ang daming niyang tinurok na BCG sa balat ng baby.

So, panic kaming lahat. Even the pediatrician, parang, oh no, ang daming nabigay. So, we had to study journals, we had to read evidences, kung ano bang side effect nun kay baby. Kasi nagkamali ito si medical intern. Good enough, wala naman palang masama.

So 0.05 is also correct. And you shouldn't exceed that because eventually, it might have an effect. But good enough.

The baby has a good monitor. And now, she's 4 years old and very, very healthy. If you're giving a school entry, you're going to get a PCG.

It will be given on the other shoulder, on the left deltoid. And more because you're bigger, which is 0.5 cc. Next is your DPT, your diphtheria pertussis tetanus.

So if you will notice, karamihan na mga EPI vaccine, usually sinisimulan yan at 6 weeks. 6 weeks muna. Yun yung minimum age for the usual EPI vaccines except for your BCG. And usually for your EPI vaccines, 3 doses.

Kaya babalik ka 6th week, 10th week, and 14th week. Sinabi ko yan kanina. So, ilang weeks ang interval? Apat, four weeks every vaccine na ibibigay sa'yo. So, for your DPP, usually we give it intramuscular, sa muscle tinuturok.

And where can you find your vastus lateralis? Usually, we give your DPP or yung intramuscular vaccines natin sa thigh. Thigh, hita ng pasyente. Okay, bakit sa hita binibigay, dok?

Bakit hindi sa shoulder? Because there is more muscle mass in the thigh as compared to the shoulder during infancy. or kapag baby ka, mas marami kang muscle sa thigh mo, specifically sa vastus lateralis muscle, as compared to the deltoid.

And how much do you give? 0.5 cc. For your oral polio vaccine, oral po ito, ipinapatak sa bibig.

6 weeks minimum age, 3 doses, 4 weeks apart. You give 2 to 3 drops. Yun yung GTPS. 2 to 3 drops. No?

Yan. And then your hepatitis B, kasama yan sa pentavalent natin. So same lang siya ni DPT, 0.5 cc.

And then your muscles, we give it subcutaneous. Pag sinabing subcutaneous, sa fat area lang natin. It's only one dose, we give it at 9 months. And how much do we give?

0.5 cc. So this table is very important. Don't you forget to memorize this. So ano ba yung contents ng EPI vaccine natin? Your BCG is live attenuated.

OPV and missiles, live attenuated. Ang diphtheria at tetanus, these are antibodies already. No? Antibodies already ang mga yan.

Pertussis, inactivated. And your HEPA-B is a DNA recombinant. Meaning, may part lang ng hepatitis B DNA.

na itinuturok sa patients natin, enough to cause or to trigger the immune system, but we do not give the entire virus to the patient. Now, ano yung mga contraindications? When do we not give a vaccine to a patient?

Number one, if they have severe illness. Number two, kung dati naturukan sila at nag-allergy sila, we do not give the second or the third dose anymore. Or if the patient is immunosuppressed, meaning Probably, they're taking medications or undergoing chemotherapy radiation as long as the immune system is low.

Why? Because the goal of vaccine is to trigger the immune system. If the immune system is suppressed and cannot be triggered, there is no point in giving the vaccine.

It might develop an illness. So when they are severely ill, when they have allergies or immunosuppressed, the main reason why we do not give it to them is because instead of triggering the immune system, And they might develop the disease instead. And why do we have to, you know, grab everybody and get everybody involved in terms of vaccination?

Because we want to achieve herd immunity. And what do we mean by herd immunity? It is getting the majority to be vaccinized so that the immunized individuals can provide indirect protection to the susceptible members of a population.

So like in this image, no? Yung mga green, sila yung mga vaccinated. Yung mga blue, sila yung mga incompletely vaccinated. At yung mga red, sila yung mga unvaccinated. So if there are more people with the vaccine, there will be lesser chance of getting the disease.

Kung walang magpapasa-pasa ng disease, the unvaccinated will have lesser chance also of getting the disease. At kung meron mga magkasakit sa unvaccinated, sila sila na lang ang magkakasakit. Okay?

So, ano yung mga targets natin for the immunization program? For infancy, yung mga infant vaccines natin, given at 6, 10, and 14 weeks, dapat makomplete yan by 12 months old or before 1 year old, dapat matapos na. Yung mga school entrant vaccine, basically your BCG, dapat mabigay yan by 6 to 7 years old.

At yung mga pregnant mothers na makangailangan ng tetanus vaccine, Dapat before delivery, mabigyan sila ng five. tetanus toxoid vaccines no and for ito yung mga vaccines na binibigay sa bawat isa infants of course your epi school entrance your bcg and for pregnant five tetanus toxoid shots so in studying vaccines we also have to understand yung cold chain system ano yung cold chain system it is keeping and transporting the vaccine in cold temperatures to maintain the potency of the vaccine. So, di ba?

Ang laman ng vaccines natin are weakened or killed bacteria or virus. And if they are not allowed to thrive in the right environment, they could die. And if they die, how could they trigger the immune system?

So, yes, alam ko may mga inactivated vaccines, dead na yun, dok, they could die. Yeah, yung potency, yung ability to trigger an immune response, yun yung iniingatan natin. So, you have to store them in the right temperatures, usually sa cold temperatures. So the cold chain system should be able to store the vaccines in good condition.

Minsan tinatawag din yung cold chain system na vaccine supply chain or immunization supply chain. And actually, isa ito sa mga talagang mahalagang dapat ma-maintain especially in transporting vaccines like when we order let's say Pfizer vaccine or AstraZeneca vaccine or Moderna vaccine from abroad. and they bring it to the country in planes.

Dapat! yung plane na yun may maayos na cold chain system even pagbaba ng aeroplano dapat maitransport ka agad yun mailipat agad sa cold chain system natin no? dapat hindi siya mawawala doon sa cold chain system or else mamamata yung vaccine so may iba't ibang mga requirements no?

such as your OPV and missiles ang nire-require nila negative 15 to negative 25 degree celsius so sa freezer mo itatago yan We have vaccines such as DPT, Hepa-B, BCG, and your tetanus toxoid, 2 to 8 degrees Celsius only. So where will you hide that? In the refrigerator? In the body?

What is the body? The one under the freezer? Not exactly the one that looks like a chiller, not there. Underneath, in the body really. Not even in the door, because the vaccine will get damaged if it's in the door.

So you will hide them in your body, where the vaccine is maintained, or the temperature rather is maintained at... 2 to 8 degrees Celsius. So please also remember that we have two vaccines which are highly sensitive to heat.

Pag nainitan ng kahit konti or bumaba ng kahit konti sa negative 15 degrees Celsius, pag uminit pa siya dun, mamamatay na or masisira, mapapanis na yung vaccine. That's your OPV and missiles. And the two least sensitive to heat vaccine is your BCG and tetanus toxoid. Actually, yang BCG.

That's one of the things that we're taught as doctors on how to give it. So in the Philippines, aside from Presidential Decree 996, our country also issued Republic Act 10152 or the Mandatory Basic Immunization Services for Infants and Children which repealed PD 996. So what happened to RA 10152? It gave free vaccines to... infants and children only up to 5 years of age. PD-996 is 8 years old.

And in RA-10152, that's where the other vaccines were included. That's where Hib or Haemophilus Influenza Type B was included, which could cause pneumonia and meningitis. That's where DPT, Hepatitis B, and Hib were combined into the pentavalent vaccine. That's where Rotavirus was added.

which is an oral vaccine against diarrhea, and your pneumococcal vaccine or your pneumonia vaccine. Okay? So, ano ba yung goals or principles ng vaccination natin?

So, you have to remember this so that if you are aspiring to become a doctor, and a lot of you are, you should remember this, especially when you give advice to your mga kamag-anak. So, no BCG can be given to a child who has HIV or AIDS. again HIV or AIDS immunosuppression. So hindi mo pwedeng bigyan ng BCG yan at birth.

DPT dose number 2 or DPT dose number 3 is not given to a child who developed epilepsy or convulsions or shock within the 3 days na nareceive niya yung una niyang DPT. Okay? So ito yung sinasabi ko. Pag nagkaroon ng allergic reaction or nagkaroon ng adverse reaction to a vaccine. Katulad neto, binigyan daw ng DPP.

If within the first three days after vaccination, baglang nag-convulsion si patient, you cannot give dose number two and number three anymore. Okay? Number three is the most commonly misunderstood and myth in vaccination. Moderate fever, malnutrition, even if you have cough, colds, diarrhea, or mildly vomiting, Hindi ibig sabihin ay hindi ka nababakunahan.

Even if you have fever, even if you are malnourished, even if you have cough and colds, diarrhea, and even mild vomiting, you can be vaccinated. So sa mga tita, tito, especially sa mga babies na kasama ninyo sa bahay, sometimes sa mga mothers, minsan talaga very protective. And we can understand naman the anxiety and yung apprehensions nila.

But please advise them properly, ha? Hindi contraindication ang moderate fever malnutrition, cough and colds, diarrhea, vomiting to vaccination. Okay? Next, it is safe to administer all EPI vaccines on the same day as long as you give them on different sites of the body. Anong ibig sabihin ito?

Diba sinabi ko kanina? There are several vaccines that you can give at six weeks. And yes, you can give them all at the same day. Okay?

So your DPT, hepatitis B, your HIV, your Rota, what else? yung mga ngayon, sila yung mga binibigay at 6 weeks, you can give them all in the same day, pero iba't-ibang sites dapat. Kaya nga ang ginawa ng government, ginawang pentavalent, diba?

Magkakasama na lahat sa isang bakuna, isang turok lang, lima na. D, P, T, Hib, Hepa B. Lima na kaagad yun sa isang turok lang. So instead of giving them iba-ibang turok, yung limang yan, pinagsama-sama na nila. Next, you cannot eat 30 minutes after receiving your oral polio vaccine.

Or else, you'll lose the effect of your OPV. So, if you give them a vaccine, other moms, when they give you a medicine, they'll give you a reward right away. So, if you give your OPV, you cannot give them any drink or any food after, within 30 minutes.

Also, you have to ask, do you have an allergy to eggs? Before giving missiles vaccine. Actually, it's not just missiles, I don't know. Ako ay always ask for egg allergy in general.

Why? Because a lot of our vaccines are developed inside an egg. Yeah.

Doon natin, ginugrow yung vaccines natin in chick cells. So if you're allergic to eggs, hindi ka pwede mag-receive ng vaccine or you have to take your anti-allergy because may egg component yung vaccines natin. Kaya nga, when you are vaccinated, sasabihin sa'yo, you you cannot eat chicken, eggs, or fish first. Avoid eating fish first because it might trigger an allergic reaction.

Last set of principles, measles vaccine should be given as soon as 9 months, regardless of whether other vaccines will be given on that day. So as long as it's protected for 9 months, you should be able to receive your measles vaccine. Also, there's nothing here, but I have to say that in the scenario of a measles outbreak, you can give the measles vaccine earlier than nine months but only if there is a measles outbreak number eight vaccination schedule should not be restarted from the beginning even if the interval between doses are exceeded so sabi natin diba mabibigay ang mga vaccine starting six weeks let's say four weeks lang dapat yung interval pero dahil busy si mami busy si daddy or baka baby is busy, right?

We're wrong. Exceed to be six weeks, right? Yung interval, pag na-miss mo yung vaccine mo, hindi kailangan umulit mula umpisa.

Itutuloy lang po yun. At sasabihan ka na please, huwag ka nang makakaligta ulit. Okay?

Now, there should be a repeat BCG vaccination pag walang scar na nag-develop sa first injection. So yes, prerequisite yung scar. Prerequisite na dapat magkaroon ka ng...

peklat sa balikat mo. Kasi pag hindi, uulitin yan. Because the scar is the proof of vaccination. So pag wala sila nakitang scar sayo, ulitin nila yan.

Next, kung multiple vaccines ang ibibigay sa baby in a day, one needle per child lang po. Okay? One syringe, one needle per child during vaccination. We cannot use the same needle on other patients. And lastly, a child with diarrhea who is due for OPV should receive a dose of OPV during the visit but do not count the dose.

Why? So sabi pag may diarrhea yung bata, pwede ka pa rin magbigay ng OPV pero hindi mo ika-count yung dose na yun meaning babalik pa ulit siya. Bakit ganun? Because in diarrhea, merong fast um intestinal motility, mabilis yung galaw ng bituka, and the OPV vaccine, baka maidumi mo lang siya.

Instead of it being able to create an immune response inside the intestines, baka idumi mo lang siya. So, we have to repeat the vaccine. And that's it.

That's the end of our EPI discussion. Hopefully, you were able to understand it. I will be uploading the next video in a while. Shalom!

Transcript for:Overview of Expanded Immunization Programs

Transcript for:
Overview of Expanded Immunization Programs