Sariling Atin Immunization Calendar
From infancy to adulthood, a better fit
By Michelle Ciriacruz
With 35 out of 1,000 Filipino children dying each year of vaccine preventable diseases, the importance of immunization is undeniable.
The Department of Health provides for this need through the Expanded Program on Immunization (EPI), which presently schedules a series of vaccinations against diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis, and hepatitis B for children.
However, because of the perennial shortage of funds, explains pediatric infectious disease specialist Dr. Lulu Bravo, it is not able to cover children beyond nine months of age.
For many years, pediatricians therefore followed what the American Academy of Pediatricians (AAP) recommended for the immunization needs of patients above nine months.
Our country's distinct epidemiological data, however, demanded a more appropriate immunization calendar, relates Dr. Bravo, which the EPI, with its very limited scope, can not serve without handicap.
Two years ago, the different medical societies interested in vaccination and childcare came together for the first Philippine National Immunization Conference.
The meeting was spearheaded by the Philippine Foundation for Vaccination (PFV), of which Dr. Bravo is the president, as the aim of PFV is to bring down morbidity and mortality through objective, ethical, and scientifically accurate communication of the benefits of disease prevention through vaccination.
"Our main goal is to promote awareness on the needed vaccines for our patients, who include not only children but also adolescents, adults, and even the elderly," Dr. Bravo fills in.
The PFV's initiative paid off with a consensus from the various medical societies and experts in infectious diseases on the immunization schedules for people of all ages and other risk groups like physicians, other health care professionals, and trainees.
The PFV, Pediatric Infectious Disease Society of the Philippines, and the Philippine Society for Microbiology and Infectious Diseases have since disseminated this calendar to various medical societies.
Dr. Bravo relates that the Philippine Pediatric Society has actually already endorsed the PFV recommendations, except that it classified typhoid as nonessential.
But Dr. Bravo points out that the World Health Organization itself recommends that countries where typhoid is endemic or high in incidence should consider typhoid vaccination.
She said that although we do not have accurate data yet on the incidence of typhoid in the Philippines, since it is very much underreported, it is evident that the disease is endemic here.
Aside from the updates and revisions on immunization made possible by the yearly conference-another one is coming up this November-PFV also concerns itself with encouraging vaccine missions as opposed to medical missions.
Dr. Bravo explains that the prevalence of medical missions might actually be detrimental to our health care delivery system instead of helping advance it. "If people just wait until the medical missions come to their area...they don't trust the health care centers (because the centers don't have medicine stocked or the people would rather wait for the medical missions to come in), then they don't trust our health care delivery," she exclaims.
What the medical missions-especially those organized by local government units (LGUs)-supply, anyway, are not effective, she also adds. "It (health care system) is not going to improve if the [LGUs] emphasize giving out drugs that are not really helpful. They're giving out antibiotics for one day or two days-it's no good! It will only increase our resistance to antibiotics."
Medical missions just mostly distribute vitamins, cold and cough preparations, and antibiotics, which recipients tend to stock rather than use immediately-only going to the hospital when their illness has gotten worse, Dr. Bravo reveals.
She points out that health care should principally emphasize prevention, since it will decrease the load in the curative aspect. Decrease in the cost of health care will therefore follow.
However, Dr. Bravo does concede that this dependence also has something to do with the inadequate supply of EPI recommended vaccines at the health care centers. She reports that hepatitis B is one of the vaccines often in short supply.
With 10 percent of Filipinos carrying the Hepatitis B virus-and mostly ignorant of their condition-the chances of more pregnant women passing on the virus to their offspring are increased. (According to Dr. Bravo, if a hepatitis B carrier gave birth, the chances of her infecting her baby is as high as 20 to 30 percent.)
To avoid virus transmission from mother to infant, the child should be vaccinated within 12 hours. This will protect it not just from the virus, but also from the likelihood of the disease developing into hepatic cancer. "If you don't give the Hepa B vaccine at birth and give it at a later date, like six weeks, the chances of the nontransmission is decreased also,' Dr. Bravo clarifies.
She also specifies: "If the mother is found to be a carrier, [the baby] should not get just the Hepa B vaccine but should also the Hepa B immunoglobulins, which can neutralize the Hepa B antigens."
Immunization is clearly one of the most effective tools in preventive medicine. However, this point is commonly bypassed in medical missions. "They forget about giving preventive aspects, only when the Department of Health's national immunization program comes in that these vaccines are given nationwide," points out Dr. Bravo.
The PFV is also in the process of promoting immunization among students, especially those in the medical, paramedical, and dental courses. Expresses Dr. Bravo: "We know they're exposed [frequently to various diseases], but nobody takes care of their preventive needs."
The Foundation, since its inception three years ago, has been collaborating with universities and other academic institutions to institute a vaccination program among enrollees, like US universities are doing with their student population-protecting their students against measles, mumps, rubella, and the varicella viruses.
Here, the PFV is asking that students should be vaccinated with these five: hepatitis A, hepatitis B, varicella, MMR, and diphtheria.
She makes it clear though that nonimmunization is not basis for nonenrollment. The students must sign a waiver stating that they knew about the school's policy and that they will be held liable in case they catch any of the mentioned infections.
More on these matters will be discussed at the third Philippine National Immunization Conference November 6 and 7. Discussions and workshops will revolve around the theme Assuring Vaccine Safety.
Special concerns are the improvement of vaccinations in childhood, combining vaccines, adolescent and adult immunization, and vaccination of pregnant women.
The scientific program also highlights the importance of immunization insurance and legislation, and the role of the media in disseminating appropriate and accurate information regarding vaccines.
"We will again be discussing-rediscussing, reviewing all our recommendations so that we will be up to date. Because every so often there will be new data. So we don't want to be static. We want to be dynamic. Every year, just like the AAP, we will review the immunization [schedules]. Whatever the consensus is, the resolutions that come out of the workshops, we will submit to the different societies," says Dr. Bravo.
Dr. Bravo, together with Drs. Alicia Tamesis, Enrique Tayag, and celebrity mother Ms. Lani Mercado-Revilla, established the PFV in 2000 to advocate continued vaccination for all against diseases endemic in the Philippines.
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