Department of Health What is newborn screening?

Newborn screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. Why is it important to have newborn screening? Most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. When is newborn screening done? Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for more accurate results. How is newborn screening done? Newborn screening is a simple procedure. Using the heel prick method, a few drops of blood are taken from the baby's heel and blotted on a special absorbent filter card. The blood is dried for 4 hours and sent to the Newborn Screening Laboratory (NBS Lab). How much is the fee for newborn screening? P550. The DOH Advisory Committee on Newborn Screening has approved a maximum allowable fee of P50 for the collection of the sample. When are newborn screening results available? Newborn screening results are available within seven working days to three weeks after the NBS Lab receives and tests the samples sent by the institutions. Results are released by NBS Lab to the institutions and are released to your attending birth attendants or physicians. Parents may seek the results from the institutions where samples are collected. A negative screen mean that the result of the test is normal and the baby is not suffering from any of the disorders being screened. In case of a positive screen, the NBS nurse coordinator will immediately inform the coordinator of the institution where the sample was collected for recall of patients for confirmatory testing. Who will collect the sample for newborn screening Newborn screening can be done by a physician, a nurse, a midwife or medical technologist. Where is newborn screening available? Newborn screening is available in participating health institutions (hospitals, lying-ins, Rural Health Units and Health Centers). If babies are delivered at home, babies may be brought to the nearest institution offering newborn screening. What are the disorders included in the Newborn Screening Package? 1. Congenital Hypothyroidism (CH) CH results from lack or absence of thyroid hormone, which is essential to growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within (4) weeks, the baby's physical growth will be stunted and she/he may suffer from mental retardation. 2. Congenital Adrenal Hyperplasia (CAH) CAH is an endocrine disorder that causes severe salt lose, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies may die within 7-14 days.

3. Galactosemia (GAL)GAL is a condition in which the body is unable to process galactose, the sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts. 4. Phenylketonuria (PKU)PKU is a metabolic disorder in which the body cannot properly use one of the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the body causes brain damage. 4. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def)G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency may have hemolytic anemia resulting from exposure to certain drugs, foods and chemicals. What should be done when a baby is tested a positive NBS result? Babies with positive results should be referred at once to the nearest hospital or specialist for confirmatory testing and further management. Should there be no specialist in the area, the NBS secretariat office will assist its attending physician. Disorder Screened Effects SCREENED Effect if SCREENED and treated

CH (CongenitalSevere Mental Normal Hypothyroidism Retardation CAH (Congenital Hyperplasia) Adrenal Death Alive and Normal

GAL (Galactosemia) PKU (Phenylketonuria G6PD

Death of Cataracts Alive and Normal Severe Mental Normal Retardation Severe Anemia, Normal Kernicterus

Reference: http://www.doh.gov.ph/faq/show/457.html

BCG - the current vaccine for tuberculosis World Health Organization Bacille Calmette Guerin (BCG) is the current vaccine for tuberculosis. It was first used in 1921. BCG is the only vaccine available today for protection against tuberculosis. It is most effective in protecting children from the disease. History of the vaccine Bacille Calmette Guerin (BCG) containes a live attenuated (weakened) strain of Mycobacterium bovis. It was originally isolated from a cow with tuberculosis by Calmette and Guren who worked in Paris at the Institute Pasteur. This strain was carefully subcultured every three weeks for many years. After about thirteen years the strain was seen to be less virulent for animals such as cows and guinea pigs. During these thirteen years many undefined genetic changes occurred to change the original stain of M. bovis. This altered organism was called BCG. In addition to the loss of virulence, other changes to BCG were noted. These included a pronounced change in the appearance of colonies grown in the laboratory. Colonies of M. bovis have a rough granular appearance whereas colonies of BCG are moist and smooth. Today there are several strains of BCG. BCG was first used as a vaccine to protect humans against tuberculosis in 1921. At first, cultures of BCG were maintained in Paris. Later, it was subcultured and distributed to several laboratories throughout the world where the vaccine strain called BCG continued to be maintained by continuous subculture. After many years it became clear that the various strains maintained ain different laboratories were no longer identical to each other. Indeed, it was likely that all the various strains maintained by continuous subculture continued to undergo undefined genetic changes. Indeed, the "original" strain of BCG maintained at in Paris had continued to change during the subcultures needed to

maintain the viability of the culture. To limit these continuing changes the procedures needed to maintain the strain were modified. Today, the organism is maintained in several laboratories using a "seed lot" production technique to limit further genetic variation using freeze-dried (also called lyphilized) cells so that each batch starts with the same cells. Safety After extensive tests in animals, BCG was first used as a vaccine in 1921. It was given orally to infants. Since this time the vaccine has been widely used. Today, it is estimated that more than 1 billion people have received BCG. BCG is widely used and the safety of this vaccine has not been a serious issue until recently. There is a concern that use of the vaccine in persons who are immune compromised may result is an infection caused by the BCG itself. Also, even among immune competent persons, local reactions, including ulceration at the site of vaccination may result in shedding of live organisms which could infect others who may be immune compromised. The early use of BCG was marked by a tragic accident. In Lubeck more than 25% of the approximately 250 infants who received a batch of the vaccine developed tuberculosis. It was later recognized that this batch was accidentally contaminated with a virulent strain of M. tuberculosis. BCG production and substrains The BCG vaccines that are currently in use are produced at several (seven?) sites throughout the world. These vaccines are not identical. To what extent they differ in efficacy and safety in humans is not clear at present. Some differences in molecular and genetic characteristics are known. What is not known is if the "BCG" from one manufacturer is "better" than one produced at another site. Each BCG is now know by the location where it is produced. For example, we have BCG (Paris), BCG (Copenhagen), BCG (Tice) and BCG (Montreal) among others. Reference: http://www.who.int/vaccine_research/diseases/tb/vaccine_development/bcg/en/