Parent’s Guide to Childhood Vaccinations/Immunizations
Dr. Mallikarjuna Swamy, DNB (Pediatrics), Fellowship in Neonatology; mallikarjuna78@gmail.com
Parents are constantly concerned about the health and safety of their children and they take many steps to protect them. These preventive measures range from child-proof door latches to child safety seats. In the same respect, vaccines work to safeguard children from illnesses and death caused by infectious diseases.
Though Dhanvantri, the father of Indian Medicine, spoke of preventing certain infectious diseases through immunization, the first successful vaccine in the modern era was developed by Edward Jenner in 1796 when he used cowpox inoculation (vaccination) to protect against Smallpox. Since then many other vaccines have been developed in rapid succession.
Protection from preventable diseases, disabilities and death through immunization is the birth right of every child. As parents, we want to do everything we can, to keep our babies from getting sick. In this article you will learn about:
· Diseases that are prevented by Vaccines (Part 1)
· The Vaccines available and their Schedule flexibility, Special Circumstances (Part 2)
· How to prepare for a doctor’s visit that includes vaccinations, and what to expect during and after the visit, along with frequently asked questions (Part 3)
The Greek work "immune" means "to be protected".
· It’s true that newborn babies are immune to many diseases because they have antibodies they got from their mothers. However, the duration of this immunity may last only a month to about a year. Further, young children do not have maternal immunity against some vaccine-preventable diseases, such as whooping cough.
· Immunizing individual children also helps to protect the health of our community, especially those people who are not immunized.
Diseases that can be prevented with routine childhood vaccination, and a brief description of each disease (in alphabetical order):
Diphtheria | Influenza (Flu) | Pertusis (Whooping Cough) | Rubella |
Hepatitis A | Measles | Pneumococcal Disease | Tetanus |
Hepatitis B | Mumps | Polio | Tuberculosis |
Hemophilus influenza type b | Meningococcus Infection | Rotavirus infection | Varicella (Chickenpox) |
1. Diphtheria
Diphtheria is caused by bacteria that live in the mouth and throat of an infected person and cause a sore throat, fever and chills. If diphtheria is not properly diagnosed and treated, the bacteria can produce a toxin that causes serious complications such as heart failure and paralysis. It is spread from person to person through sneezing, coughing, or even breathing.
2. Hepatitis A
Hepatitis A virus causes liver disease, which can result in fever, loss of appetite, fatigue, stomach pain, vomiting, and yellow skin or eyes (jaundice). Hepatitis A virus is found mainly in bowel movements, and is spread by personal contact or through contaminated food or water.
3. Hepatitis B
Hepatitis B virus also causes liver disease. It is spread through contact with blood and other body fluids. Hepatitis B infection can cause muscle or stomach pains, diarrhea or vomiting, yellow skin or eyes (jaundice) or loss of appetite and fatigue. People usually recover after several weeks, but some of them become “chronically infected.” These people can spread the disease to others through unprotected sex, sharing needles, or other exposures to blood. Chronically infected people often suffer from cirrhosis (scarring of the liver) or liver cancer. A mother who is chronically infected with hepatitis B virus is very likely to infect her baby at birth.
4. Hemophilus Influenza type b (Hib) infection
Hib bacteria are spread through the air by coughing, sneezing and breathing. They can cause meningitis, pneumonia, inflammation of the throat, arthritis, and other problems. Before there was a vaccine for it, Hib disease was the leading cause of bacterial meningitis in children younger than 5. Some of these children suffered permanent brain damage, and few even died.
5. Influenza (Flu)
Flu is a seasonal illness, occurring mainly during the winter. It causes fever, sore throat, cough, headache, chills and muscle aches, and can lead to sinus infections, pneumonia, inflammation of the heart, and death.
6. Measles
Measles virus causes a rash all over the body, fever, runny nose and cough. It may also present with an ear infection, pneumonia, encephalitis, and some may even die. Measles is extremely contagious, and is spread through the air by coughing, sneezing, and even breathing.
7. Mumps
Mumps is a relatively mild disease, causing swelling of the cheeks and jaw due to inflammation of the salivary glands, fever and headache. It can lead to meningitis and occasionally to encephalitis or deafness or death. It is spread from person to person through the air by coughing, sneezing and even breathing.
8. Meningococcus infection
Meningococcus bacteria accounts for 30-40% cases of meningitis in children up to the age 15 years. It is the only bacterium capable of causing large scale epidemics of meningitis. It spreads through the air by coughing, sneezing and breathing.
9. Pertusis (Whooping Cough)
Pertussis, caused by bacteria can look like a common cold at first, but after 1 or 2 weeks a child with pertussis is overcome with coughing spells so violent that they interfere with eating, drinking, and even breathing. Pertussis can lead to pneumonia, seizures, encephalopathy (brain infection), and death. It spreads through the air from person to person.
10. Pneumococcus infection
After Hib disease began to decline, thanks to Hib vaccine, pneumococcal disease became the most common cause of bacterial meningitis in children under 5. Caused by a bacteria and spread through the air, pneumococcal disease also causes ear infections, pneumonia, blood infections, and death.
11. Polio
Polio virus spreads through air by coughing, sneezing and breathing. Though few patients recover to some extent, most are left with permanent leg paralysis and other neurological sequel.
12. Rota Virus
Rotavirus causes gastroenteritis (diarrhea and vomiting) in babies and young children.
13. Rubella (German Measles)
Rubella, caused by the rubella virus presents with swollen glands in the back of the neck, a slight fever, rash on the face and neck, and sometimes arthritis-like symptoms in the joints. It is usually spread through the air.
However, the greatest danger from rubella is to unborn babies. If a woman gets rubella early in her pregnancy, there is an 80% chance her baby will be born deaf or blind, with a damaged heart or small brain, or mentally impaired. This is called Congenital Rubella Syndrome, or CRS. Miscarriages are also common among women who are infected with rubella during pregnancy.
14. Tetanus (Lock Jaw)
Tetanus is different from other vaccine-preventable diseases in that it does not spread from person to person. Children (and adults) become infected when the bacteria enter through breaks in the skin – usually cuts or puncture wounds. About 3 weeks after exposure, a child might get a headache, become cranky, and have spasms in the jaw muscles. The bacteria can then produce a toxin that spreads through the body causing painful muscle cramps in the neck, arms, legs, and stomach.
15. Tuberculosis
Mycobacterium Tuberculosis bacteria spreads through air by coughing/sneezing. It can affect lungs, blood, brain, and almost all parts of the body.
16. Varicella (Chicken Pox)
The main symptom of chickenpox is an itchy rash all over the body, usually along with fever and drowsiness. It spreads from person to person through the air, or through contact with fluid from the rash. Chickenpox is usually mild, but it can cause skin infections and encephalitis.
A pregnant woman who gets chickenpox either in early pregnancy or around the time of delivery can infect her baby. Some of these babies will die if not treated quickly.
After a person recovers from chickenpox, the virus stays in the body and can re-emerge years later to cause a painful condition called shingles.
The Vaccines available and their Schedule flexibility, Special Circumstances
Routine childhood vaccines that protect children from these 15 diseases:
· BCG (Bacillus Calmette Guerin): Protects against Tuberculosis
· DTwP(Whole Cell Pertusis)/DTaP (Acellular Pertusis): Protects against Diphtheria, Tetanus & Pertussis
· Td: Tetanus with reduced Diphtheria component
· Tdap: Tetanus with reduced Diphtheria and acellular Pertusis component.
· MMR: Protects against Measles, Mumps & Rubella
· HepA: Protects against Hepatitis A
· HepB: Protects against Hepatitis B
· Hib: Protects against Haemophilus influenzae type b
· Flu: Protects against Influenza
· PCV7 & PCV 13 (Pneumococcal Conjugate Vaccine): Protects against Pneumococcal
disease
· Polio (OPV - Oral/IPV - Injectable): Protects against Polio
· RV: Protects against Rotavirus
· Varicella: Protects against Chickenpox
Current status of combination vaccines:
1. Combination vaccines can be used to decrease the number of pricks being given to the baby and to decrease the number of clinic visits. The manufacturer's instructions should be followed strictly whenever "mixing" vaccines in the same syringe prior to injection.
2. During pregnancy, the interval between the two doses of TT should be at least one month.
3. We should continue to use OPV till we achieve polio eradication in India.
IPV can be used additionally for individual protection.
4. OPV must be given to children less than 5 years of age at the time of each supplementary immunization activity.
5. Please discuss with your Pediatrician for options available on combination vaccines.
Immunization Schedule Recommended by Indian Academy of Pediatrics 2011
Age (completed weeks/ months/years) | Vaccines |
Birth | BCG OPV0 HepB 1 |
6 weeks | DTwP1/DTaP1 OPV1*/ OPV1 + IPV1 Hib1 HepB2 Rotavirus 1 *# PCV 1 |
10 weeks | DTwP2/ DTaP2 OPV2*/ OPV2 + IPV2 Hib 2 Rotavirus 2 PCV 2 |
14 weeks | DTwP3/ DTaP3 OPV3*/ OPV3 + IPV3 Hib3 Rotavirus 3 HepB3** PCV 3 |
9 months | Measles |
12 months | Hepatitis A 1 |
15 months | MMR1 Varicella PCV booster |
16 to 18 months | DTwP B1/ DTaP B1 OPV4*/ OPV4 + IPVB1 Hib B1 |
18 months | Hepatitis A 2 |
2 years | Typhoid 1# |
5 years | DTwP B2 / DTaP B2 OPV5 MMR2$ Typhoid 2 Varicella 2 $$ |
10 to 12 years | Tdap/Td& HPV^ |
* OPV alone if IPV cannot be given
*# Rotavirus vaccine (2/3 doses depending on the brand at 4-8 weeks interval)
** The third dose of Hepatitis B can be given at 6 months
$ The second dose of MMR vaccine can be given at any time 4-8 weeks after the first dose
$ $ Varicella (2nd dose may be given any time 3 months after the 1st dose)
# Typhoid revaccination every 3 years
& Tdap preferred to Td, followed by repeat Td every 10 years
^ Only females, three doses at 0, 1-2 (depending on brands) and 6 months (Human Papilloma Virus Vaccine)
Indian Academy of Pediatrics recommended vaccines for Adolescents
(10 Years to 18 Years)
Vaccine | Schedule |
Tdap/Td & | 10 years |
HPV^ | 10 to 12 years |
& Tdap preferred to Td, followed by repeat Td every 10 years (Tdap to be used once only)
^ Only females, three doses at 0, 1 or 2 (depending on the vaccine used) and 6 months
IAP Recommendations for Catch up Immunization in Adolescents
Vaccine | Schedule |
MMR | 2 doses at 4-8 weeks interval@ |
Hepatitis B | 3 doses at 0, 1 and 6 months# |
Hepatitis A | 2 doses at 0, 6 months (prior check for Anti HAV IgG may be cost effective) ## |
Typhoid | 1 dose every 3 years ** |
Varicella | 2 doses at 4-8 weeks interval |
@ One dose if previously vaccinated with one dose
#, ## Combination of Hep B and Hep A may be used in 0, 1, 6 schedule
** A minimum interval of 3 years should be observed between 2 doses of typhoid vaccine
IAP Recommendations for Adolescent Immunization in Special Circumstances
Vaccine | Schedule |
Influenza Vaccine | One dose every year |
Japanese Encephalitis Vaccine | Catch up up to 15 years @ |
PPSV23 (Pneumococcal) Vaccine | 2 doses 5 years apart * |
Rabies Vaccine (0, 3, 7, 14, 28 day) | As soon as possible after exposure |
@ Only in endemic area as catch up; * Maximum number of doses – Two
IAP Recommendations for Adolescents travelers
All age appropriate vaccines should be completed before travel, in addition to those
listed below
Vaccine | Place of travel | Dose Recommended |
Meningococcal Vaccine | USA / UK /endemic areas Saudi Arabia and Africa # | 2 doses 4-8 weeks apart |
Yellow fever ^ | Yellow fever endemic zones** | 10 days before travel |
Oral Cholera vaccine | Endemic Area or area with an outbreak | 2 doses 1 week apart |
Japanese B encephalitis | Endemic Areas for JE | Single dose (upto 15 years) |
Rabies Vaccine (Pre exposure Prophylaxis) | For adolescents going on trekking | 0, 7, 28 |
# Quadrivalent vaccine for those travelling to the US and Bivalent (A+C) or Quadrivalent for those travelling to the UK
^ Mandatory for all travellers to yellow fever endemic zones as per International Health Regulations.
** The list of endemic countries can be obtained http://www.nc.cdc.gov/travel/yellowBookCh4-
YellowFever.aspx currently available only at select government controlled centres in India.
Immunization in Special Circumstances
· Immunization in Preterm (born before 37weeks)/Low birth weight (<2500gm) infants
In principle, all vaccines may be administered as per schedule according to the chronological age irrespective of birth weight or period of gestation. BCG and birth dose of OPV can be safely and effectively given to low birth weight / preterm babies after stabilization and preferably at the time of discharge.
All other childhood vaccines may be given as per usual schedule. Since preterm, low birth weight babies have increased susceptibility to infections, vaccines such as Pneumococcal conjugate vaccines, Rotavirus and Influenza should be offered if resources permit.
· Children receiving oral corticosteroids in high doses (prednisolone > 2 mg/kg/day or
for those weighing more than 10 kg, 20 mg/day or its equivalent) for > 2 weeks should not receive live virus vaccines until the steroids have been discontinued for at least one month.
· Immunization in children with history of allergy:
a. Children with history of serious egg allergy should not receive Influenza and Yellow fever vaccines but can safely receive other vaccines including Measles and MMR vaccines.
b. First time immunization with any vaccine is contraindicated in children with history of serious hypersensitivity/ anaphylaxis to any of vaccine components.
c. Children who have had a serious hypersensitivity reaction/ anaphylaxis to a particular vaccine must never receive it again.
d. In any case all children should be watched for at least 15 minutes after vaccination for allergy.
· Immunization during illness:
a. Vaccination can be given during minor illness such as upper respiratory tract infections and mild diarrhea.
b. All immunizations need to be postponed only during serious illness.
· Lapsed immunization/ preponed immunization:
a. There is no need to restart a vaccine series regardless of the time that has elapsed.
b. Immunizations should be given at the next visit as if the usual interval had elapsed and the immunization scheduled should be completed at the next available opportunity.
c. The two/multiple vaccines can be given either together or at least 4weeks of time gap between the two. (Never before 4weeks). (Exception: BCG & Measles/MMR should not be given on the same day)
· Interchangeability of brands: There is sufficient data that brands of Hib, Hep B and Hep A may be safely interchanged with no compromise on immunogenicity and efficacy.
How to prepare for a doctor’s visit that includes vaccinations, and what to expect during and after the visit, along with FAQs (Part 3)
Before the Immunization Visit
a. If you have a vaccination record card for your baby, take it along so the provider can mark the vaccines given.
b. If she/he is getting her/his first vaccination(s), ask for a card. This record could come in handy later to show that your child has had the vaccinations necessary to get into school, or if you move or switch doctors.
During the Immunization Visit
a. Many providers/doctors like to keep a child in the clinic for observation for about 15 or 20 minutes after getting vaccines, in the unlikely event of an allergic reaction or in case the child becomes dizzy or faints.
b. If your baby has a moderate or severe cold or other illness, you might be asked to postpone vaccinations until he gets better.
c. Be sure that any vaccinations that are given get recorded in your baby’s shot record.
After the Immunization Visit
a. Sometimes your child will have a fever or a sore leg or arm (where the injection was given) after an immunization visit. You can give your child a prescribed pain reliever to reduce any pain or fever that might follow vaccinations. Giving the child plenty of fluids to drink can also help reduce a fever (in non-breast fed infants or babies who are in the process of weaning). A cool, wet washcloth over the sore area can help relieve pain.
b. If your baby cries for 3 or more hours without quitting, if he seems limp or unresponsive, if he starts having seizures (convulsions), or if you are worried at all about how your baby looks or feels, call your provider/doctor right away.
c. A severe allergic reaction to a vaccine is very unlikely, but if one were to occur, be ready to respond to it:
ü If an allergic reaction occurs, it will usually happen within a few minutes to a few hours after the vaccination.
ü Signs of a severe allergic reaction can include difficulty breathing, dizziness, swelling of the throat, hives, fast heartbeat, hoarseness or wheezing.
ü If your baby shows these signs, call a doctor and get him to a doctor right away.
ü Be ready to tell the doctor when the reaction occurred, what vaccinations were given, and when.
Frequently Asked Questions on Vaccines
· Can vaccines harm my child?
Any medicine can cause a reaction, even aspirin. Vaccines are no exception.
· Will vaccines harm my child?
Probably not. Most children won’t have any reaction at all to a given vaccine. For those who do, most reactions are very minor . . . a sore leg, a slight rash, or a mild fever that goes away within a day or two.
Some children have moderate reactions like a high fever, chills, or muscle aches.
· Why do children need so many doses of certain vaccines?
Most vaccines require at least 2 doses.
With inactivated (killed) vaccines, each dose of vaccine contains a fixed amount of disease antigen (virus or bacteria). Immunity is built in phases with each dose boosting immunity to a protective level.
Live vaccines are different, in that the antigen in the vaccine reproduces and spreads throughout the body. One dose produces satisfactory immunity in most children. But a second dose is given to assure immunity, because not all children respond to the first one.
· Can a child get a disease even after being vaccinated?
It isn’t very common, but it can happen. About 1% to 5% of the time, depending on the vaccine, a child who is vaccinated fails to develop immunity.
· Can a child actually get the disease from a vaccine?
Almost never. With inactivated (killed) vaccines, it isn’t possible. A dead virus or bacteria, or part of a virus or bacteria, can’t cause disease.
With live vaccines, some children get what appears to be a mild case of disease (for example what looks like a measles or chickenpox rash but with only a few spots). This isn’t harmful, and can actually show that the vaccine is working.
A vaccine causing full-blown disease would be extremely unlikely. One exception is the live oral polio vaccine, which could very rarely mutate and actually cause a case of polio.
· Why does the government require children to be vaccinated to attend school?
The mission of a public health system, as its name implies, is to protect the health of the public – that is, everybody. Remember that vaccines protect not only the person being vaccinated but also people around them. Immunization laws exist not only to protect individual children, but to protect all children.
· Can’t so many vaccines overwhelm a child’s immune system?
There may not be consensus over exactly how many germs a baby’s immune system can handle at a time, but it is considerably more than they will ever get from vaccines. After all, this is the immune system’s job. From the day a baby is born, her immune system is busy dealing with the thousands of germs she is exposed to as part of daily life. As one doctor put it, “Worrying about too many vaccines is like worrying about a thimble of water getting you wet when you are swimming in an ocean.”
To summarize: “When you vaccinate your child, you are not just protecting her. You are also protecting her friends and schoolmates and their families; and you are also protecting her children, her grandchildren, and all future generations.”
Some useful websites to know regarding Vaccinations in detail
