Know about vaccines and vaccination
Schedule:
Age | Vaccine |
| Birth | BCG (Bacille Calmette Guerin) |
| OPV-0 (Oral Polio Vaccine) | |
| 6 wks | OPV-1 |
| DPT-1 (Diphtheria Pertussis Tetanus) | |
| Hepatitis B 1st | |
| 10 wks | OPV-2 |
| DPT-2 | |
| Hepatitis B 2nd | |
| 14 wks | OPV-3 |
| DPT-3 | |
| 7.5 mths | Hepatitis B 3rd |
| 9 mths | Measles |
| 15 mths | MMR ( Measles Mumps Rubella) |
| 16-24 mths | OPV – DPT-1st Booster |
| 3 yr | Typhoid |
| 4 yr | Chicken pox |
| 5-6 yrs | OPV – DT-2nd Booster |
| 10 yrs | Tetanus Toxoid |
| Typhoid | |
| 16 yrs | Tetanus Toxoid |
| Typhoid |
RESCHEDULING:
- Acute febrile illness: Immunization is postponed for acute illness with high fever. However it should not be postponed for minor illnesses like colds and coughs.
- Unknown immunization status: Consider child susceptible and immunize.
- Lapse in routine immunization schedule: This does not interfere with routine immunization response. It is unnecessary to repeat doses.
- Prior anaphylactoid (severe allergic reaction) reaction to same or related vaccine: Defer immunization till skin testing is performed.
When are live viral vaccines (like Polio or MMR) not to be given?
- Immunodeficiency: Babies infected with HIV should receive MMR vaccine, as the risk of measles far outweighs the risks of the vaccine. Immunodeficient children living with immunodeficient persons can be given killed polio vaccine (IPV). Hospitalized children should not be given OPV because of possibility of transmission of the vaccine virus to an immunosuppressed infant.
- Immunosuppressed children: those receiving radiation, steroids or cancer chemotherapy. However children on alternate day steroids, low or moderate doses or those on short-term steroid usage (asthmatics) can be immunized in the routine way.
- Pregnancy: Pregnant women should not receive live viral vaccines. However it is permissible to give the same to their household contacts.
Common side-effects of Vaccines:
The incidence and severity of side effects is far exceeded by the risks and damages of the diseases against which vaccines afford protection. Some of the common vaccines that manifest side-effects are –
1) Pertussis (DPT/ DT): Symptoms occur within 48-72 hours of injection.
- mild fever
- irritability
- persistent screaming
- collapse
2) MMR: Temperature of 39.40C (1030F) or more may develop between 6th and 10th day of injection and last for 1-2 days. Transient rashes and arthralgias may occur.
3) Haemophilus influenzae type B (HiB): Mild local reactions (erythema, swelling) may occur and usually resolve within 24 hours. Systemic reactions are rare.
- OPV: Minute risk of producing poliomyelitis
- IPV: Mild local reactions only
Natural Immunity:
Natural immunity is what a child gets either through the mother or by exposure to the organism concerned. Children who have incurred the natural disease of Pertussis (whooping cough), Measles, Mumps, Rubella develop lifelong immunity and need not be given the vaccine. However, it must be kept in mind that receipt of the vaccine will cause no harm.
Simultaneous administration:
Most mothers wonder which vaccines can be given with others and which can not be? DPT, OPV/IPV, MMR, HiB can be given simultaneously without any problem but they should be given at different sites. Hepatitis B vaccine can also be given together with OPV/ DPT
The use of the HiB vaccine alongwith diphtheria toxoid does not reduce immunity to diphtheria
BCG vaccine: (Baccile - Calmette - Guerin)
This is a live attenuated vaccine, to be given at birth as protection against Tuberculosis. It is given intradermally in the deltoid region of the left arm.
You may forget that your baby was given the vaccine as the reaction to it comes up after 6 wks. This is in the form of a swelling, which will burst with another 8-10 days. This heals slowly leaving behind a permanent, tiny, round scar upto 8mm in diameter, indicating successful vaccination. Boosters are generally not given. If BCG does not take with 1st attempt, re-vaccination is indicated. Generally given at Government or Municipal dispensaries.
Do’s & Don’ts:
- Do not rub the site of vaccination
- Do not apply hot fomentation at the site
- Report to your doctor in case swelling appears in armpit or neck
There had been some controversy regarding effectiveness of BCG. The controversy has ended and all of you must give BCG.
DPT vaccine:
Commonly known as triple vaccine; this is a combined vaccine for ‘D’iphtheria, ‘P’ertussis (Whooping cough) and ‘T’etanus.
It should be started 6-8 weeks after birth. Three doses have to be taken at 4 weeks interval followed by 2 booster doses at 1.5 and 5 yrs of age.
It is given intramuscularly on the anterolateral aspect of thigh.
DPT vaccine is not recommended after 6-7 yrs of age, as the ‘P’ component causes complications like prolonged convulsions, infantile spasms, and encephalitis. DT is recommended for children beyond this age. DT should also be used for the following –
- A child having convulsions within 3 days of receiving the vaccine.
- Reaction to first dose.
- Persistent screaming within 72 hrs of injection.
- Hyperpyrexia
You should:
- Give Paracetamol in case there is fever
Apply ice locally to relieve pain
Polio vaccine:
Two types of vaccine available – oral and injectable; oral one is preferred in India. It is a live attenuated vaccine. Oral vaccine is preferred as it provides both systemic & gut immunity.
The vaccine should be started at 6 wks of age. WHO recommends a ‘zero’ dose at birth. The schedule is as follows:
- At birth – zero dose
- 1st dose – 6 wks
- 2nd dose – 10 wks
- 3rd dose – 14 wks
- 4th dose – 18 wks
- 5th dose – 22 wks
- 1st booster – 1.5 yrs
- 2nd booster – 4-5 yrs
Precautions:
- Do not administer hot liquids, food, and breast milk half an hour prior to and after vaccination.
- Contrary to popular belief it can be given when child has cold, cough and mild fever. High fever or major systemic disease is a contraindication.
Mothers commonly ask that when we have given all the vaccines on time, should we participate in the PULSE-POLIO Programme?
The answer is an absolute YES! Your participation is a MUST for eradication of polio from this country. Mass immunization on a gigantic scale was responsible for global eradication of Small Pox. Pulse Programme ensures that ALL children in community have the protection against Polio. Secondly 1-2 more doses will always be beneficial and will never harm your child. Remember if we have to have our country and then this world FREE OF POLIO – only your child can make it happen by joining Pulse Polio Drive
Know more about Pulse Polio Immunization
HiB vaccine:
H. influenzae b infection occurs in first two years of life. Infection with Hemophilus influenzae B (HiB) in children less than 24 mths of age does not confer immunity and they have to be immunized.
This vaccine is often referred to as the Hib vaccine. The vaccine is given intramuscularly or subcutaneously either in the buttock or in the thigh. Children over 2 yrs can receive the vaccine in the arm. The schedule is –
Below 6 months – 3 doses at 1-2 month interval followed by a booster at 12 months
Between 6 -12 months – 2 doses 1-2 month interval followed by a booster at 12 months
Above 12 months – 1 dose
Pneumococcal vaccine:
The pneumococcal polysaccharide vaccine protects against 23 types of pneumococcal bacteria.
Infants and toddlers may have a poor or unpredictable antibody response; hence the vaccine is not recommended for children under two years of age.
Who should get the vaccine?
- Anyone over 2 years of age who has a long term health problem such as: Heart disease, Lung disease, Liver disease, Diabetes, Sickle cell disease, Alcoholism
- Anyone over 2 years of age who has a disease or condition that lowers the body’s resistance to infections, such as: Certain cancers, Kidney disorders, HIV infection/AIDS, Organ transplant, Damaged spleen or no spleen.
- Anyone over 2 years of age who is taking any medicines or treatment that lowers the body’s resistance to infection such as: Long term steroids, Cancer drugs, Radiation treatment
Hepatitis A vaccine:
Another entrant of 1999. It is an inactivated vaccine recommended for children above one year of age.
0.5 ml of vaccine is given intramuscularly in the antero-lateral part of the thigh in infants and 1 ml in the deltoid region in adults. There are two regimes Two doses (720 units each) are given at 6 mths interval. A booster dose has to be taken 6-12 months after the first dose.
Hepatitis B vaccine:
Quite an expensive vaccine but recommended, as children who get the infection are more prone to get chronic hepatitis and Liver cancer in later years.
It induces 90% protection against hepatitis B virus infection and adverse effects are minimal, consisting mainly of soreness at injection site.
All newborns should be administered the vaccine.
HBsAg status of mother | First dose | Second dose | Third dose |
Negative | 0-2 days | 1-2 months | 6-18 months |
Positive or Unknown | As soon as possible after birth | 1 month | 6 months |
If your child is unimmunised at whatever age, Hepatitis B vaccine is strongly recommended. Two schedules have been recommended:
Regular Schedule | Rapid Schedule |
| Any elected date | As soon as possible |
| 4 weeks later | 4 weeks after first |
| 6 weeks after first | 8 weeks after first |
| Booster 5 years later | 12 months after first |
| 10 years thereafter | 8 years thereafter |
Infants who did not receive a dose of the vaccine at birth should receive three doses by 18 months of age. The minimum interval between first two doses is 1 month and next two doses is 3-4 months.
The vaccine can be given together with other vaccines but should not be mixed in the same syringe. It can be given 1 or more inches apart in the same thigh or deltoid.
Chicken Pox vaccine:
Available in India since 1999. Important vaccine as Chicken Pox usually strikes in Feb/March. Many students have jeopardized their career plans due to Chicken pox just before their board exams. It is a live attenuated vaccine, which can be given from the age of 12 mths onwards.
From age of 1-12 yrs, only one dose is required; above this age two doses are given at an interval of 6-10 wks. The vaccine is given sub-cutaneously. A measles virus containing vaccine can be given at the same time, if not then an interval of atleast one month should be kept between the two.
Side effects: Fever, rash, headache, fatigue, paresthesia.
Meningitis vaccine: (meningococcal)
Meningococcal meningitis most commonly occurs under 5 yrs of age.
This vaccine is recommended for children above 2 yrs of age as it can’t produce an adequate immune response in children below that age. Immunity with this vaccine lasts for 3 yrs and boosters are advised every 3 yrs.
MMR:
It is a live attenuated vaccine, which simultaneously gives protection against Mumps, Measles, and Rubella.
The vaccine is first diluted with sterile water and given sub- cutaneously on the upper part of arm or anterior thigh.
This vaccine can be given between 18-24 mths of age and is generally given 6 months after the 1st Measles dose given, where it acts as a booster.
Rubella:
It is a live attenuated vaccine.
Age: 15 months.
It is given in a single dose of 0.5-ml sub- cutaneously. It is strongly recommended in pre-pubertal girls as Rubella is one of the commonest cause of 1st trimester abortions.
Measles vaccine:
Measles – the largest killer of children in 1-3 age group before the advent of vaccine. It took us a long time to convince our patients (of all religions) about the need for Measles vaccine as the all-powerful myth associating Measles as ‘darshan’ of Goddess Durga. It is a live attenuated vaccine.
The reconstituted (available as powder) vaccine is administered in a single dose of 0.5 ml. Injection is given sub-cutaneously.
Age: It should be given as close to the age of 9 months as possible, as before this age the vaccine is rendered ineffective due to maternal antibodies in the infant’s circulation and after this age many children will have been exposed to the risk of infection. However if the child is malnourished the vaccine can be given at 6-8 months as the risk of infection in such children is very high. The child should then receive a second dose at 15-18 months of age.
Immunity develops 11-12 days after vaccination.
Typhoid vaccine:
Even though not a part of Universal Immunisation Programme, the child must be protected against Typhoid. You may ask why? Many a children have missed their final exams or fared badly as Typhoid commonly strikes between Jan to March. Also the Typhoid causing bacteria is becoming resistant to the commonly used antibiotics.
The vaccine is available in injectable and oral form.
The INJECTABLE vaccine cannot be given below two years of age because of low immune response. It is given intramuscularly or sub-cutaneously. Two doses are required at an interval of 4-6 wks. Booster doses should be taken every 3 yrs.
The ORAL vaccine is a live vaccine available as capsules. It is recommended after 6 yrs of age. 3 capsules have to be taken on days 1,3 and 5, one hour before meals with cold or lukewarm water or milk. Boosters are required every 3 yrs.
Rabies Vaccine:
Three types of vaccine are available:
- Nervous tissue vaccines – These are derived from nervous tissue of animals. These are not used nowadays due to their side effects – paralysis.
- Duck embryo vaccines – These do not have the side effects like above.
- Cell culture vaccines – These are of two types:
- Human diploid cell vaccine (HDCV)
- Purified chick embryo vaccine (PCEV)
The vaccine most commonly used is the PCEV. One ml of the vaccine is given intramuscularly in the arm (under no circumstances should it be given in the buttocks). The schedule depends upon the grade of exposure.
| Exposure Grade | Type of Exposure | Immunization Schedule | |
| Contact with a rabid/suspected rabid animal | Contact with an inoculated animal | ||
| 1 | Touching/feeding animals with no contact with their saliva; patient’s skin is undamaged | Touching; skin intact | No immunization necessary. But if in doubt one inj. is to be given on days 0, 3, 7, 14, 30 and a booster on day 90 |
| 2 | Animal has nibbled or licked exposed skin of the patient ; contact with saliva, superficial, non- bleeding, scratches made by the animal with the exception of scratches on the head, neck, scapular region, arms, hands | Touching; skin damaged | Immediately start immunization as above. Also give concomitant prophylaxis with human rabies immunoglobulin (readymade antibody) If the animal later proves to be non rabid then the schedule continues with injections on day 7,28, 365 |
| 3 | All bites; bleeding scratches; all scratches on the head, neck, scapular region, arms, hands; contact of mucus membrane with saliva as in licking. | Contact of saliva with mucus membrane or fresh skin wound. | Immediate administration of immunoglobulins. If the animal later is non rabid give injections on day 0,7,28 ,365 |
If your child has already taken the vaccine once, and is re- exposed following schedule is to be followed –
Interval between vaccine and re-exposure | Schedule |
Less than a year | One injection on day 0 and 3 |
1-5 years | On day 0, 3, 7 |
More than 5 years | Full course |