Vaccinations to give your children and why – a check list
With a host of new vaccines now available, vaccination is no more the simple decision that it once was. If you’ve been part of the animated discussions at schools and playgrounds about whether to give your child a particular shot or not you’ll know exactly what I mean.
Conflicting advice from peers, elders in the family and aggressive television notices doesn’t help. What complicates matters further is when pediatricians have diverse views. ‘Doctors have different opinions and finally it’s up to mothers to decide whether or not to give the extra shots,’ says Namita Shah, mother of a nine-year old. It’s tough for parents to make these decisions and then follow through diligently, specially if they have several children, move frequently, change doctors, or are on a limited budget. How then are they to make the right decision?
First and foremost, it’s important to recognise that vaccines are good and most of them provide life-long immunity. ‘A vaccine has to be judged on whether it’s safe and effective, and those available are good, otherwise they wouldn’t be marketed,’ says Dr. Mukund Patel, pediatrician. Inspite of this, vaccines have been unintentionally placed into different categories. The Indian Academy of Pediatrics advocates more four more vaccines (see table) that those in the National Immunization Schedule and the Academy itself has placed two more under the category of ‘additional’ vaccines. Once we know why a vaccine falls into a particular category its easier to make the decision whether to take it or not.
The National Immunisation Schedule makes BCG (prevents tuberculosis), OPV (prevents Polio), DPT (prevents Pertussis, Diphtheria and Tetanus) and the Measles vaccines mandatory. All these are serious diseases except for Measles, but children with Measles can develop complications like bronchitis. These vaccines are inexpensive and are given free of cost by the government.
While the Indian Academy of Pediatrics fully supports the National Immunisation Schedule, it acknowledges that it ‘provides for only the basic minimum immunisation needs of Indian children’. ‘It is a question of affordability,’ explains Dr. Patel. ‘The government can afford certain vaccines at this period of time and individuals can afford the other vaccines.’
However, affordability can become an even larger issue if the parents feel that a vaccine is not mandatory. ‘Cost is a large contributory factor towards resistance to vaccines,’ says Dr. Nusly Pocha, family physician. Another problem – the fear of the needle – is also a factor, adds Dr. Pocha. Combine these two factors with parental lethargy and lack of exigency and vaccination dates are missed or avoided altogether.
Hepatitis B shots (three injections in all) are considered a must by pediatricians as Hepatitis B is a dreaded liver disease, more infectious than HIV. There is no guaranteed cure. MMR is also strongly recommended. It includes the Mumps and Rubella vaccine, in addition to Measles. Rubella is a dreaded disease for pregnant women as it can damage the foetus. Typhoid, an endemic water borne disease can be treated, but if it’s contracted by the child during examinations, it can turn into a parents’ worst nightmare. The vaccination process is pretty simple – a single injection. An oral typhoid vaccine is also available, although several doses are needed. The disadvantage is that the typhoid vaccine has to be repeated every three years and parents often balk at this. Doctors also do not always insist on it. ‘My doc says that as we aren’t in the high risk group, we can give it when the child is in the 9th as it protects the child during the 10th and 12th,’ says Nandini Mehta, mother of two.
The Hib vaccine kills the pathogens causing meningitis and pneumonia in infants and small children. The Hib disease is age dependant and has to be given before the age of five years, not later.
The ‘additional’ vaccines recommended by the Indian Academy of Pediatrics are for Hepatitis A and Chicken Pox. These are not serious diseases, at least not for children. However the severity of the diseases increases with age, and many pediatricians insist on vaccination for teens.
The issue of seasonality of vaccines is relevant in the case of vaccines which offer short-term protection like Typhoid or influenza vaccines. Typhoid is common in summer and the monsoons, and it’s useful to give it before the start of the ‘season’. The influenza vaccine is not easily available in India. It changes from year to year, depending on the changing viruses and many doctors doubt it’s efficacy, as it depends on whether the anti-bodies against the prevalent strain have been used in it’s manufacture.
More than anything, vaccines should be given in time, before the age at which the infection is anticipated. Cost should not matter for the educated and affluent as most of these vaccines cost a few hundred rupees or less (except for the chickenpox vaccine which costs Rs 1500/-), and are all very safe, with hardly any side-effects. ‘Side-effects are usually temporary, and rarely do they cause a severe reaction,’ points out Dr. Dr. Rahul Verma, pediatrician.
If by chance your child misses a dose, don’t worry. It makes no difference if the shot is given late and if by mistake a dose is repeated as there is no evidence that this is harmful. Dr. Patel puts thus. ‘If you can afford a particular vaccine, take it, after consultation with your doctor.’
The following charts are sourced from the Indian Academy of Pediatrics.
National Immunization Schedule
- At Birth – BCG, OPV – 0
- 6 weeks – DPT – 1, OPV –1
- 10 weeks – DPT –2, OPV –2
- 14 weeks – DPT –3, OPV –3
- 9 months – Measles
- 16 -18 months – DPT booster, OPV – 4
- 5 years – DT
- 10 years – TT
- 16 years – TT
- Pregnant women – TT ( 2 doses at 4 weeks interval
IAP Immunization Time Table
- Vaccine Age Recommended
- BCG – Birth – 2 weeks
- OPV – Birth, 6, 10, 14 weeks, 15 – 18 months, 5 years
- DPT – 6 weeks, 10 weeks, 14 weeks, 16 – 18 months, 5 years
- Hepatitis B – Birth, 6 weeks, 14 weeks / 6 weeks, 10 weeks, 14 weeks
- Hib Conjugate – 6 weeks, 10 weeks, 14 weeks, 16 – 18 months
- Measles – 9 months plus
- MMR – 15 months
- Typhoid – Above 2 years
- 2 doses of TT – Pregnant Women
- Varicella – 1 year onwards
- Hepatitis A – 2 years onwards
(Published in The Times of India in 2006)