The following is a short note by Dr. Yashwant Amdekar on Vaccination needs for children forwarded to Dr. Sailakshmi of Ekam Foundation.
1. Vaccines that should be
given to all children - EPI vaccines must be given to all children and are available free of
charge through government and municipal outlets. These include BCG, DPT, OPV,
Measles – primary and booster doses. It is important not to miss booster dose
of DPT and OPV at 18 months. If child misses the opportunity, vaccine can be
given any time thereafter. In case of missed dose, previous dose need not be
repeated even if there is a long gap. HBV (hepatitis B) and HiB (bacterial hemophilus influenza vaccine) is
being introduced in phases by the government and if available free or
affordable, must be taken.
2. MMR vaccine is ideal only
when its coverage in the community is large and in which case, second dose of
MMR would be necessary anytime at next planned visit but not before 2 months.
IAP recommends it at 5 years. If MMR vaccine coverage in the community is poor,
it is better not to give MMR as there is a chance of developing natural
immunity due to pool of infection continuing in the community. In fact such an
exposure to these infections in childhood will prevent occurrence of such
disease in later life. Mumps and Rubella are likely to be harmful in later life
as against in early childhood. So, either consider two doses of MMR or no dose.
3. Rubella vaccine may be
ideal if woman has not had Rubella during childhood and is ideally given before
pregnancy. However it is not easy to know whether woman has had such an
infection early in life. In such a case, it may be ideal to offer Rubella
vaccine so as to prevent Rubella syndrome in foetal life. Alternatively MMR
vaccine can be given as it is easily available and may offer some more
protection against Mumps and Measles besides Rubella. There is no harm of
vaccine given to a woman if she has had such an infection in the past.
HPV
vaccine has some scientific benefits. Firstly as cause of cervical cancer is
known to be due to human papilloma virus (16 and 18 serotypes) infection, vaccine
is more specific against cervical cancer. Secondly, such an infection is almost
universal though only small number of infected women would go on to develop
cervical cancer. But in absence of regular screening program in our country (in
fact, such screening is not much prevalent even in western countries),
diagnosis of cervical cancer is possible only in late stage that is nearly
fatal. Worst part of this disease is the fact that it hits women in their 30’s
and 40’s and loss of mother at this age is disastrous to the family. From all
these points of view, HPV vaccine may be considered if affordable but it cannot
be recommended to be included in government program because there are more
pressing problems than HPV.
4. I would add about IPV.
With near eradication of wild polio infection in India (early January 2014,
India will be polio-free), we are all elated. However success is still far away
as there have been epidemics of polio in countries who were polio-free for many
years and this was due to either importation of wild polio virus from countries
who still continue to harbor such an infection or also caused by OPV that is
capable of developing vaccine derived polio virus besides vaccine associated
polio virus. Unfortunately such virus though not wild, is capable of causing
same degree of harm as that of wild virus. In fact, if we don’t take proper
care, polio caused by vaccine virus is likely to occur at any age including
adults and by then if most adults have lost immunity against polio, such a
disease may also be fatal and result in epidemics. So IPV is the need of the
hour and government is likely to bring IPV in routine immunization schedule for
all children in addition to OPV that may have to be continued for some more
years. But under cover of IPV, OPV will not cause any harm and over years OPV
may have to discontinued.
Finally I feel if anyone can
afford just one extra vaccine beyond EPI vaccines, it must be IPV. Far more
important is to improve coverage of EPI vaccines in the country which stands at
dismal 50% only in spite of vaccine available free to the community. We need at
least > 90% coverage to be effective in preventing pool of infection so that
even unvaccinated children would be safe as they would not have any exposure to
vaccine preventable infection.
So pass on two important messages. First - every
child must take EPI vaccines including booster dose of DPT and OPV. Second – if
possible give IPV at least one dose that can prime better immune response to
OPV and may avoid vaccine induced disease.
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