PART 2: THE GROWING YEARS — FROM INFANCY TO ADOLESCENCE
To Immunise Or Not To Immunise
In favour of immunisation, it is said that 10 children
die and 10 are disabled every minute in developing countries due to the 6 vaccine-preventable diseases — measles, tetanus,
tuberculosis, polio, diphtheria and pertusis (whooping cough).
Those who are against immunisation say that more harm than good is done by immunisation. The latter group
includes some of the finest people I know. I have learnt a lot
from them in keeping myself and others fit. But so far, they have
not been able to convince me that children should not be
immunised at all, although it is true that in July 1999, distribution
of rotavirus vaccine for the prevention of diarrhoea due to rotavirus
was halted in the U. S. A. because of intussusception
following administration of the vaccine. Intussusception is a
serious disease of the abdomen that may need surgery.
After having considered the risk-benefit ratio, I recommend immunisation for all the children who come
under my care. But I do not refuse treatment to a child whose mother has not immunised her as a matter of
THE 6 VACCINES
BCG (Bacille Calmette-Guérin) vaccine
is meant to protect the child against tuberculosis. Although doubts have
been raised about its efficacy in the past, most experts
recommend it because BCG may protect the child against serious
types of tuberculosis affecting the central nervous system,
bones and joints.
If administration of the BCG vaccine is delayed, your
doctor will ask for a skin test (Mantoux test with 5 TU). If
the test is positive, BCG is not given. If the test is strongly
positive, the doctor will ask for a chest X-ray and decide if your
child needs treatment for tuberculosis.
The polio vaccine,
administered orally, is now routinely given in some hospitals at birth, This is called the
zero dose. If you are debating whether to immunise your child or
not, you may inform the hospital authorities that you would
not like to have the zero dose given to your baby.
DPT (also called Triple antigen) is
meant to protect against diphtheria, pertusis and tetanus. DT (also called
does not have the pertusis component in it. Children above the age of 7 years are not given DPT and are only given
DT or TT (Tetanus Toxoid). The
National Immunisation Schedule recommends DT at 5 years. If your doctor
instead recommends DPT at 5 years, follow his advice.
The table below gives the National Immunisation Schedule recommended by the Government of India.
NATIONAL IMMUNISATION SCHEDULE
Birth or 6 weeks
Birth, 6, 10, 14 weeks, 15 – 18 months
6, 10, 14 weeks, 15 – 18 months
10 and 16 years
** If given for the first time at this age, give 2 doses
at 4-week intervals
** For pregnant mothers, 2 doses of ‘M’ at 4-week
The following table gives the schedule suggested by the Indian Academy of Pediatrics
IAP IMMUNISATION TIMETABLE
|Birth to 2 weeks
|Birth, 6, 10, 14 weeks, 9 months,
15 – 18 months, 5 years
HB (Hepatitis B)
|Birth, 6 weeks, 6 – 9 months, 10 years
|6, 10, 14 weeks, 15 – 18 months, 5 years
|9 months plus
|15 – 18 months
|10, 16 years
Some Important Points About Immunisation
Do not unnecessarily delay your child’s course of vaccinations. If immunisation is due, do not postpone it just because your child has a mild cough, cold or diarrhoea. But if
the child with diarrhoea is given oral polio vaccine, remember to
give an extra dose of oral polio vaccine at a later date in consultation with your doctor.
However, do not immunise the child if she is acutely
ill, Manage the illness and give her the vaccines later on.
If your child had a severe reaction following a DPT or
if she has a history of convulsions, do discuss it with your doctor, He may consider giving her DT in place of DPT to
complete her immunisation schedule.
The schedule table suggests that DPT and OPV should be given at an interval of 4 weeks. Do stick to this
routine. But if for some reason, the gap between the 2 doses becomes
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 as good protection as those given at fixed intervals.
However, as long as the course is not completed, your child runs the
risk of getting these diseases; so avoid delaying the doses
as far as possible.
There is no need to starve your child for long periods before or after the administration of oral polio
vaccine. A gap of 10 to 15 minutes may be kept to avoid vomiting.
In a fully immunised child, there is no need to give TT
for minor injuries. However, if she gets hurt when her DPT booster is due, the booster will give protection against
tetanus as well.
Some authorities recommend 5 doses of oral polio vaccine (OPV) for the primary course instead of the 3
recommended as per the National Schedule. They feel that the child
gets better protection with 5 doses. I tend to agree with
them. Opt for the 3 doses if you are not sure whether you should
or should not immunise your child. Also, some doctors prefer to give 2 doses of OPV before starting the course of DPT
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 DPT injections, you may be exposing the
child to the risk of getting whooping cough that can cause
serious problems in a small baby. My practical advice is to give
OPV at birth and then at 1, 2, 3 and 4 months, and to give
DPT injections at 2, 3 and 4 months.
Recently, our government has initiated an annual pulse polio immunisation programme under which all children
below 5 years are given extra doses of oral polio
vaccine on the same day at 6-week intervals throughout India in an attempt to eradicate poliomyelitis from the country.
BCG is given over the left shoulder. After about a
month, a small swelling appears at the site of the 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 BCG. The ulcer
does not require any ointment or medicinal powder. Also,
children who develop enlargement of the glands need not be
started on anti-TB drugs. Consult your paediatrician if the
glandular swelling increases and an abscess forms. Reimmunisation
is to be considered in those who do not show a scar after
having had BCG.
The thigh is a better place for giving infants
injections than the buttocks. Ensure that the needle used is disposable or is
properly sterilised. 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 vaccines 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 the vaccines, because frequent opening of the refrigerator
for other things can affect temperature control. You have a right to ask the health worker whether this care has been
Quite a few children get fever a couple of hours after
the DPT injection. The temperature is usually less than
(38.9%) and does not last more than 24 hours. I
recommend a dose of paracetamol be given soon after the injection. This should be repeated 4 hours later, if required. If the
fever lasts for more than 24 hours, your doctor will probably look
for some other cause of fever.
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.
Do keep a record of all the immunisations 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 the
details of the vaccines your child has had.
MMR (Measles, Mumps and Rubella) vaccine confers immunity against measles, mumps and rubella (German
measles). It is given at 15 months of age. Children who
have not received the measles vaccine at 9 months can be given MMR vaccine after their first birthday. Many doctors
like to prescribe another dose of MMR vaccine at 12 years of age
to provide added protection.
Hepatitis B vaccine is
given to prevent jaundice caused by Hepatitis B or Serum Hepatitis virus, which can be
passed from an infected mother to her newborn baby or from one affected member of the family to another. The common
mode of infection is through contaminated needles or
contaminated surgical instruments. As this disease can cause serious
liver disease, more and more doctors are now recommending this vaccine. The vaccine is given in 3 doses; the
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
Vaccines against Chickenpox,
Hepatitis A and Haemophilus Influenza Type B are
also available. You may give them after consulting your doctor.
There are 3 different vaccines against Typhoid, namely,
- Whole cell killed vaccine (usually known as TA
- Oral typhoid vaccine, and
- Vi polysaccharide vaccine.
The TA is very cheap, but it frequently causes side
effects such as local pain and swelling and fever lasting 2 or 3 days.
The other two vaccines are expensive, but have very few
These vaccines are recommended where typhoid is widely prevalent. Injections of TA or Vi vaccine may be given
at 2 years of age, followed by subsequent doses at 3-year intervals. Oral vaccine can be given at 6 years of age
and repeated at 3 to 5-year intervals according to the manufacturer’s recommendations.
In localities where typhoid is not widely prevalent,
typhoid vaccine may be avoided. I recommend hygienic precautions for prevention of not only typhoid but also other water
and food-borne diseases like hepatitis A and diarrhoea.
Proper hand washing, boiling of water, eating fresh food and keeping food covered are some of the
measures that are
recommended to avoid such illnesses.
To conclude, I urge you to take care to keep your child healthy and follow the general principles of hygiene. Do
not depend wholly upon these vaccines. It is possible that
they might not have been stored properly; this does happen sometimes. In such cases, you may have a false sense of
Also, all vaccines do not provide cent per cent
7 March, 2016