Dr. Sheeja Sugunan, Associate Professor, SAT,
(Department of Paediatrics, Government Medical College Thiruvananthapuram)
With COVID 19 pandemic gripping the world, there have been more than 2 million cases and 1.5 lakh deaths till date. In order to decrease the spread of the disease, many countries including India announced lockdown which also leads to suspension of immunization services initially. This leads to many doubts in the minds of the common man. I would be addressing some of the common doubts in this article.
Why give immunization?
Immunization is one of the most cost-effective public health interventions leading to the prevention of millions of death due to various vaccine-preventable diseases worldwide. Currently, the National Immunisation schedule provides immunization against 13 diseases. Smallpox has been eradicated, most other vaccine-preventable diseases have shown a significant decrease in incidence and we are on the verge of eradicating polio. Many vaccine-preventable diseases have shown a resurgence in recent times like Diphtheria because of poor immunization coverage. Hence all children should receive immunization in a time-bound manner to gain protection against deadly vaccine-preventable diseases.
It needs to be understood that, when immunization coverage in a society is high, often the few unimmunized is also protected due to a phenomenon called herd effect as the disease-causing microorganisms find it difficult to spread in the community.
On the other hand when immunization coverage decreases, with each passing year the pool of unimmunized children increases, and then if someone gets infected it easily spreads in the community causing outbreaks like the recent outbreaks of Diphtheria in Malappuram and Ernakulam districts in Kerala.
Most of the diseases prevented by vaccination are serious infections causing death and long term disability including damage to the brain.
Hence every child should receive all the vaccines recommended in the immunization schedule to protect itself and prevent outbreaks in the community.
The rationale for postponing vaccination during the lockdown
Timely vaccinations are important for the kids, but unfortunately, hospitals act as amplifying centers in case of disease outbreaks and there is a risk of baby and caretaker contracting a disease from the hospital, hence it was decided to temporarily suspend vaccination.
As the country was facing lockdown the chance of baby contracting the disease from the community was also less as it was going to spend time inside the home with minimal interaction with community outside.
Moreover, a brief delay does not decrease the effectiveness of vaccines. Keeping all these points in mind the Government temporarily decided to postpone the vaccination.
The rationale for restarting vaccination during the lockdown
As the pandemic is showing no signs of slowing down it now looks like we are going to face a prolonged course. Suspending immunization for too long a period is not desirable especially as there is a risk of a resurgence of vaccine-preventable diseases.
It has been shown in the past that when routine immunization services are suspended like during the Ebola outbreak the number of persons who died of vaccine-preventable disease outnumbered the number that died due to the Ebola outbreak itself
The effect of interruption of immunization services is often reflected in the months or even years following an epidemic. Immunization being a core health service, it was decided to restart it taking all precautions to limit the risk of acquiring the disease from the community and hospital maintaining social distancing and adequate infection prevention measures.
Delay in vaccination Myths and facts
Many parents were worried about the delay in administering scheduled vaccination to their kids. They were worried if this would lead to an increased risk of infection and decreased effectiveness of the vaccine. Delay in administering vaccines does not decrease the efficacy of vaccines instead of the longer interval between vaccines instead of decreasing efficacy increases its efficacy as the baby’s immune system becomes more matured and responds better to the vaccine.
Vaccine doses and intervals
Vaccines are recommended to be taken at fixed intervals. It needs to be understood that most multi-dose vaccines like pentavac, hepatitis B, tetanus toxoid, etc do not confer protection to the baby with the 1st or second dose. The initial doses only prime the baby’s immune system.
The baby develops sufficient protective antibodies to protect itself from the disease only after the course of vaccination is completed. The earlier the baby completes the vaccine the earlier will the baby achieve protection against the disease.
Restarting vaccination schedules
Sometimes caretakers are worried about how to resume the vaccination which has been interrupted. Your doctor will advise regarding the schedule baby that needs to follow subsequently. As already mentioned the vaccine efficacy is not affected so the babies don’t need to restart vaccination from the beginning, they only need to continue from were stopped.
That means for example, if a baby had taken the 1st dose of Penta at 45th day and was supposed to take the next dose at two and half months, but could nor receive it due to lockdown. If the baby is now three months old, the baby needs to receive the second dose of vaccine as soon as possible and then take the third dose 1month after the second dose irrespective of age.
Multiple vaccines can be given on the same day without interference in efficacy. Priority should be given for primary vaccination than add on vaccines like Hepatitis A and HPV
The difference in vaccination schedules
It has often been seen that the immunization schedule of different vaccines are different in different countries and sometimes different in private and government hospitals. It often raises the question if one vaccination schedule is superior to others and if certain vaccines are being unnecessarily administered by private hospitals.
The vaccination schedule of a country depends on many factors including the disease incidence in various age groups. Most of the vaccine-preventable diseases are now rare in developed countries so they tend to administer their vaccines a little late starting at 2 months of age and keeping an interval of 2 months between vaccines.
But, unfortunately, India still sees a lot of cases of vaccine-preventable diseases at a very young age which necessitates that our children complete their vaccination schedule as early as possible so that they acquire protection against the diseases early.
The extra vaccines given in private hospitals like Pneumococcal vaccines are also important for protection against pneumonia and meningitis due to these microorganisms.
These vaccines are costly vaccines as a result of which government is finding it difficult to give it free of cost to all children.
It also needs to be known that many of these vaccines including Pneumococcal vaccines are at present being given in certain select states by the government itself and in due time all children in all states will receive these vaccines free of cost Hence if resources permit Pneumococcal vaccines should be offered to all children between 45 days to 5 years of age
Precautions while taking the baby out for vaccination
- Seek prior appointment from the doctor for vaccination.
- It is preferable to go directly to well-baby clinics rather than going to general OPD for vaccination prescriptions.
- Be on time for vaccination. Do not overcrowd and wait for your turn patiently.
- Keep the number of caretakers accompanying the baby for vaccination to the minimum preferably 1, maximum two.
- Preferably avoid taking grandparents along for vaccination especially if they are more than 60years of age as they being elderly are at increased risk of getting severe COVID infection.
- Caretakers accompanying the baby should wear masks. All children except infants should also be offered masks.
- Maintain a distance of at least 1 meter with those in the clinic.
- Do not touch unnecessary surfaces. Perform hand hygiene with hand sanitizer or wash hands with soap and water on exiting the hospital.
- Take a proper bath on returning from the hospital washing the dresses you wore with soap and water. Change and give bath to the baby also.
Responsibilities of Hospital giving vaccination
- Ensure separate areas for vaccination. It should not be administered in the general OPD or ER.
- Registration for vaccination should be arranged separately preferably near the vaccination area.
- Give appointments for patients with specified time slots.
- Ensure the facility is there to keep 1-meter distance between patients in the waiting area in immunization clinic
- All patients and caretakers should be triaged for fever and respiratory symptoms.
- Limit entry of bystanders to the well-baby clinic. Only 1 caretaker should be allowed inside
- Staff nurses should perform hand hygiene either with soap and water or hand sanitizer before and after touching each patient and wear masks and gloves.
- All staff in the immunization center should wear masks and appropriate PPE
- Any child with respiratory symptoms should be asked to show to the OPD and not wait in the well-baby clinic.
- The baby weighing scale should be cleaned with a 1% hypochlorite solution or alcohol-based disinfectant after weighing each baby.