Immunization

    

Vaccines are given to prevent diseases. However, all vaccines do not provide 100% protection, but if the disease (e.g measles) does come, the severity is likely to be lower than what it would have been without taking the vaccine.

Introduction 

In favour of immunization, it is said that 10 children die and 10 are disabled every minute in developing countries due to the 6 common vaccine preventable diseases ; such as measles, tetanus, tuberculosis, polio, diphtheria and pertussis (whooping cough).

What is the difference between Vaccination and Immunization :

Immunization is the process of protecting people against harmful infections  before they come in contact with them. It does this by using body's own natural defense system, the immune response.

Vaccination

Vaccination just means having the injection. When you are vaccinated, your body produces an immune response just as you would if you were exposed to the infection, but without having the symptoms, and this builds up the resistance to that infection.

  

The Vaccine

At Birth:
-BCG (Tuberculosis): The BCG Vaccine helps protect against Tuberculosis.

-Hepatitis B: The Hepatitis B vaccine helps protect against Hepatitis B infection
-OPV: Oral polio Vaccine (OPV) helps protect against Polio; a disease caused by virus that affects the nerves


At 6 weeks-6 months

-DTP, Hib, Hep-B, IPV

-Diphtheria: Severe respiratory illness, Tetanus: Leads to Muscle spasms, Pertussis: Whooping cough

-Hib: Hemophilus influenzae type b causes brain fever

-Hep-B: The Hepatitis B vaccine helps protect against Hepatitis B infection

-IPV: Injectable Polio Vaccine (IPV) protects against polio disease

-Pneumococcal: PCV (Pneumococcal conjugate vaccine) helps protect against Pneumococcal disease that can result in Meningitis, Sepsis, Pneumonia, etc. -Rotavirus: The Rotavirus vaccine helps protect against Rotavirus Diarrhea; a viral disease that affects the intestines.


At 6-12 months
-Influenza: The Influenza vaccine helps protect against Influenza, commonly known as the flu; a respiratory infection.

-MMR: The MMR vaccine helps protect against three viral diseases Measles, Mumps, Rubella.

-Typhoid: The Typhoid vaccine helps protect against Typhoid, a disease affecting the Gastrointestinal tract.
-Meningococcal#: The Meningitis ACWY vaccine helps protect against the A, C, W and Y types of Meningococcal disease which can affect the brain, spinal cord and can even lead to a blood infection.




At 1-2 years
-Hepatitis A: The Hepatitis A vaccine helps protect against Hepatitis A infection; a liver infection caused by Hepatitis A virus.

DTP, Hib, IPV

-Diphtheria: Severe respiratory illness, Tetanus: Leads to Muscle spasms, Pertussis: Whooping cough

-Hib: Hemophilus influenzae type b causes brain fever.

-IPV: Injectible Polio Vaccine (IPV) protects against polio disease

-Pneumococcal: PCV (Pneumococcal conjugate vaccine) helps protect against Pneumococcal disease that can result in Meningitis, Sepsis, Pneumonia, etc. -Chickenpox: The chickenpox vaccine helps protect against chickenpox characterized by typical skin rashes.

-MMR: The MMR vaccine helps protect against three viral diseases Measles, Mumps, Rubella.
-Influenza: The Influenza vaccine helps protect against Influenza, commonly known as the flu, a respiratory infection.


At 2-6 years of age
-Meningococcal#: The Meningitis ACWY vaccine helps protect against the A, C, W and Y types of Meningococcal disease which can affect the brain, spinal cord and can even lead to blood infection.

-MMR: The MMR vaccine helps protect against three viral diseases Measles, Mumps, Rubella.

-DTP, IPV: Diphtheria- Severe respiratory illness, Tetanus- Leads to Muscle spasms, Pertussis- Whooping cough

-IPV: Injectible Polio Vaccine (IPV) protects against polio disease

-Influenza (Yearly^): The Influenza vaccine helps protect against Influenza, commonly known as the flu; a respiratory infection.


At 6-18 years of age
-Tdap/Td: Tdap Vaccine helps protect against Tetanus, Diphtheria & Pertussis. Td Vaccine helps protect against Tetanus & Diphtheria.
-HPV: The HPV vaccine helps protect against Human Papilloma Virus, a virus that can cause Cervical Cancer, anal cancer and other types of cancer


Schedule according to the Advisory Committee of Vaccination & Immunization practices, 2020-21 by Indian Academy of Pediatrics
^ Annual Vaccination recommended for children up to 5 years of age

B.C.G (Bacille Calmette- Gue'rin) 

    

Tuberculosis can causes serious problems. B.C.G is a vaccine that is given to protect children from severe forms of TB. This is the only vaccination given between the layers of skin (intradermally) so healing takes over 3-4 months, and during this time  the place where B.C.G is given looks like a mosquito bite initially than like a small red swelling and occasionally like a pustule, filled with pus and one fine day it ruptures. leading to healing by a scar. It is not painful and does not cause any discomfort to the  baby during all this time and nothing should be applied to the  place either, as such things may delay healing and also may reduce the immunity. In some countries where Tuberculosis is uncommon, B.C.G may not be given, but if you are living in India for a few months or visit India frequently, then your baby should be given B.C.G.

Although doubts have been raise about its efficacy. Most expert recommend it because  B.C.G may protect child against serious types of tuberculosis affecting the central nervous system, bones and joints.

B.C.G is given over the left shoulder. After about a month, a small swelling appears at the site of an injection, which may break into an ulcer with a little watery discharge. This discharge may continue for about 6 weeks. Eventually, the ulcer heals, leaving a small permanent scar. Some children may get enlargement  of the glands in the armpits or above the clavicle (the collarbone), secondary to B.C.G. The ulcer does not require any ointment or medicinal powder. Also children who develop enlarge glands need not be started on anti-tubercular drugs. Consult your pediatrician if the glandular swelling increases and  an abscess forms.

If administration of B.C.G vaccine is delayed, your doctor will ask for the (Mantoux Test with 5 TU). If the test is positive. B.C.G is not given. If the test is strongly positive, the doctor will ask for a chest X-Ray and decide if your child  needs any treatment.

The Polio Vaccine 

     

Poliomyelitis can paralyses  parts of the body, including the throat. It can be prevented with Sabin Oral (O.P.V). Generally it is asked by the parents that  whether we should be giving pulse polio when the government does it. Pulse Polio vaccine is totally different from routine polio vaccination. Pulse polio is given whenever there is a polio threat,the government gives a "booster" immunity protection to all children less than 5 years and this should be given to  all children irrespective of their immunization before.  

The polio vaccine (o.p.v)  administered orally, is now routinely given in some hospitals at birth. This is called the zero dose.  Our government has initiated an annual pulse polio programme under which all children below 5 years are given extra doses of oral polio vaccine on the same day as an attempt to eradicate poliomyelitis from the country. There is no need to starve your child for long periods before or after the administration of oral polio vaccine. A gap of 10-15 minutes may be kept to avoid vomiting.

     

D.P.T (Triple Antigen) 

    

D.P.T (Triple antigen) is meant to protect against diphtheria, pertussis and tetanus. D.T (Dual antigen) does not have the pertussis component in it. Children above the age of 7 years are not given  D.P.T and are only given  D.T or T.T (Tetanus Toxiod)

 

Diphtheria

Diphtheria is a painful injection that blocks the throat. It can even cause death due to heart or nerve damage. It can be prevented by  Dpt vaccination.

Pertussis / Whooping Cough

Pertussis causes  a sever lasting cough, difficulty in breathing and sometimes death. But it can be prevented with D.P.T vaccination

T.T (Tetanus Toxoid) Immunization Schedule

Tetanus causes muscles spasm and sometimes death. It occur after cuts,  breaks in the skin or burns.  It can be prevented with  D.P.T vaccination.

If your child has a severe reaction following a D.P.T or if she has a history of convulsions, do discuss it with your doctor. He may consider giving her D.T in place of D.P.T to complete her immunization schedule, Quite a few children get fever a couple of hours after the D.P.T injection. The temperature is usually 102 degree Fahrenheit (38.9 %) and does not last 24 hours. A dose of paracetamol to be given soon after the injection.  This should be repeated four hours later, if required. If the fever last for more than 24 hours, your doctor will probably look for some other cause of fever. A National Immunization schedule recommends D.T at 5 years. If your doctor recommends D.P.T instead, follow his advice

.

Measles

Measles causes a red blotchy, flat rash. It can damage ears, lungs and brain. It can be prevented with Measles vaccine or M.M.R injections. Measles are reemerging as a major problems in many countries.  Please ensure your baby is well covered with measles vaccination.

Mumps

Mumps causes swelling of glands, testicles and other important organs. It can be prevented with M.M.R injection.

Rubella (German Measles)

It causes rash and fever. Woman who have Rubella early in their pregnancy are at risk of having a disabled or deaf baby. Therefore, women are planning to have a baby should have a rubella test or should take M.M.R injections.

Haemophilus Influenza

Type B causes meningitis and other childhood infections. It can be prevented with H.I.B injections.Now a days our government had made it mandatory vaccination.

Annual Flu vaccination recommended pre-monsoon for children from 6 months to 8 years.

Chickenpox (varicella)

Chickenpox causes  serious skin, eye and lung infections, and occasionally brain infection causing intellectual disability. It can be prevented with Chickenpox vaccine. The first dose of Chickenpox vaccine is recommended  after antibodies from the mother disappear in the baby's body, which is generally around 1 year. Hence the first dose of chickenpox vaccine at 1 year,, and second dose around 5 years of age for lifelong protection.

Influenza

Influenza causes fever, headache, sore throat cough and aches. It can be life threatening for some people. Protection from FLU vaccine is for a year only and it needs needs to be given every year based on the W.H.O antigen recommendation. It is highly recommended for young babies and people older than 65 years.

How Flu vaccines benefit kids and elderly?

Monsoon season brings infection such as Flu and food water contaminated diseases. Respiratory infections such as seasonal Flu and Covid 19 have overlapping symptoms and protecting children against the former will help de-congest  hospitals and avoid unnecessary testing for the later. With unlock more children stepping out to play increasing their risk of catching infections like Flu.

There is  also a higher likelihood of them bringing it back home to the grand parents or adults living with co-morbidity such as diabetes, heart disease and asthma who are more vulnerable to infections.

The vaccinations is recommended for everyone six months and older every year. It is an effective way to prevent Flu and its related complications not just for the child  but for the entire family specially elders above 65 years. And children between 6 months to 8 years.

Hepatitis A

Hepatitis A  can cause serious jaundice, and liver diseases, and for some children (and older adults) it can be fatal. 2 Doses of vaccine will protect your children  from this deadly disease. Hepatitis A vaccine is recommended  routinely even in countries like U.S.A . The second dose of the vaccine should be given  after 6 months of the first dose but before 18 months. (preferably around 12 months after birth) for life long protection.

Typhoid

Typhoid is a serious disease that causes lot of morbidity in India.  It is still an endemic disease, and one dose can prevent Typhoid in your child only  for a period of 3 years, after which they need a booster dose to protect them again. 

Pneumococcal

Pneumococcal infections  are a serious threat to children under 5 years of age or for people  above 50 years. It causes Pneumonia, meningitis ("brain fever") and a lot of other serious infections in children which can kill them or cripple them. Protect your child from this serious diseases by vaccinating with Pneumococcal Conjugate Vaccine (P.C.V) There are currently two vaccines available in the world, and this vaccination is mandatory in most  developed countries because of its benefit. The first one is called Prevenar 13 (Wyeth) and the second one is Synflorix (G.S.K) -They cost Rs  4000 . You have to choose  one of them for your baby.

Rotavirus

Rotavirus affects rich and poor equally by causing vomiting and diarrhea, hence it is called a Democratic virus. In serious cases it can cause death due to dehydration. Now a days , thanks to the vaccines, we can protect our children from this deadly virus. There are two brands of this vaccine- Rotarix (G.S.K) -2 doses and Rotateq (M.S.D) - 3 Doses  for complete immunization brand should not be interchanged once given for better protection. W.H.O. has pre-qualified  both of these vaccines for routine use.

National Immunization Schedule

Vaccine                          Age Recommended 

B.C.G                             Birth or 6 Weeks

O.P.V.                             Birth, 6, 10, 14, weeks 15-18 months

D.P.T                              Birth, 6, 10, 14, weeks 15-18 months

Hepatitis                        Birth, 6, 10, 14, weeks 15-18 months

Measles                          9 months plus.

M.M.R                           15-18 months months

D.T                                 5 years

T.T                                  10 and 16 years 

Others

H.i.b                                6, 10, 14, weeks 15-18 months

Typhoid                          2 years

H.P.V                               10 YEARS (For females)

T.T                                   2 Doses  Pregnant Women

P.C.V                              After 6 weeks

Varicella                         After 15 months

Hepatitis A                     After 18 months 

M.M.R (Measles, Mumps and Rubella)

      

M.M.R confers immunity against measles, mumps and rubella (German measles). It is given at 15 months of age. Children who have not received the measles at 9 months can be given M.M.R vaccine after their first birthday. Many doctors like to prescribe another dose of M.M.R vaccine at 12 years of age to provide added protection.

Following measles vaccine, your child may get a mild measles like illness with fever and rash after about a week. No treatment is required for this.

Hepatitis B Vaccine

   

Hepatitis B attacks liver, the virus spreads through blood to blood contact, sexual  contact and sharing needles. Hepatitis can be prevented through vaccines. This is one of the vaccines given to the baby. The first dose is given soon after birth, hence it has to be mercury free. Use only mercury free hepatitis vaccine.

Hepatitis B vaccine is given to prevent jaundice caused by Hepatitis B or Serum Hepatitis virus, which  can be passed by the infected mother to her newborn baby or from one affected member of a family to another. The common mode of infection is through contaminated needles or contaminated surgical instruments. As this diseases can cause serious liver disease, more and more doctors are now recommending this vaccine. The vaccine is given in 3 doses,  the first one given shortly after birth, the second dose one month later and the third at 6 months of age. Older children of all ages can be given the 3 doses, with an interval of one month between the first and second dose and 6 months between the first and third dose.

Immunization Card

You can download your own calendar here so that you don’t miss a single vaccination scheduled for your child. To be rest assured, you can even use free Vaccination reminder services like Immunize India App by Indian Academy of Pediatrics.

     

Your toddlers health Passport. A Vaccination Card is a ‘Health Ka Passport’ which can be obtained from your pediatrician. Parents must preserve this card as an important health document of the child and get it updated whenever they visit the doctor. Consider it like a child’s passport to good health. Using this card can help you keep track of all upcoming vaccinations for your child. For times when you might miss vaccinations which are due, it is crucial to consult your Pediatrician for Catch-up vaccination.

       

About Immunization 

• If immunization is due do not postpone it just because your child has a mild cough, cold or diarrhea. But if the child with diarrhea is given oral polio vaccine, remember to give an extra dose of oral polio vaccine at a later date of consultation with your doctor. However do not immunize the child  if she is acutely ill. Manage the illness and give the vaccine later on.
• The schedule table suggest that  D.P.T and O.P.V should be given at an interval of 4 weeks. Do stick to this routine. But if for some reason the gap between the two doses become more than 4 weeks, you do not have to repeat the whole course again. Just give the remaining dose that is due to  complete the course. In the long run doses given after a longer gap give us good protection as those given at fixed intervals. However as long as the course is not completed, your child runs a risk of getting these diseases; so avoid delaying the doses as far as possible.
• In a fully immunized child there is no need to give T.T for minor injuries. However, if she gets hurt when her DPT booster is due, the booster will give protection against tetanus as well.
• Some authority recommends five doses of oral polio (O.P.V) for the primary course instead of the 3 recommended as per the national Schedule. They feel that the child get better protection with 5 doses. Opt for the 3 doses if you are not sure whether you should or should not immunize your child. Also some doctor prefer to give 2 doses of O.P.V before starting the course of D.P.T injections in areas where and in seasons when polio is prevalent. This is based on the assumption that  if the child is carrying the polio virus in her system, any injection might precipitate a paralytic attack of polio. On the other hand, by delaying the D.P.T injections you may be exposing the child to the risk of getting whooping cough that can cause serious problems in a small baby. Here it will be practical to give O.P.V  at birth and then at 1,2,3 and 4 months, and give D.P.T  injections at 2, 3, and 4 months.
• The thigh is the better place for giving infants injections than the buttocks. Ensure that the needle used is disposable or is properly sterilized. Some children do get a nodular swelling at the site of the injection. This may remain for months without causing any problem. There is no need to apply any ointment on it.
• The vaccine are not effective if they are not preserved properly in a refrigerator or in an icebox. Without this precaution, your sense of security is false. Also note that the refrigerator should be used exclusively for storing vaccines, because frequent opening of the refrigerator for other things can effect temperature control. You have a right to ask the health worker whether this care has been taken.
• Do keep a record of all the immunizations given to your child , so that she completes the course as per schedule. Incidentally, if your child goes abroad for studies, the colleges there often want to know he detail of the vaccines your child has had.

It is important to note that the vaccine need to be stored  at a particular temperature all the times,India being a developing country id prone to power failour and power fluctuations. Please ensure that where ever you get the vaccines, they have enough power backup to protect the vaccines otherwise the vaccine may be useless.

Other up-coming vaccine is Corona Vaccine

"Most vaccines are safe , reactions are mild, benefits outweigh the risk, however, in spite of maximum care and precautions occasionally, vaccination may give rise to serious reactions."

https://madhuchhandacdmo.blogspot.com/2020/12/immunization.html