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Immunisation in Children

Immunisation in Children

by: Dr. Mukesh Kumar
Consultant Paediatrician

Children are prone to get various infection including viral, bacterial, protozoal etc. after birth when they are exposed to external environment via multiple sources like food, water, air, insects etc. To protect our children from such infections we have vaccines against certain very important microorganisms.

These vaccines are available since birth in predefined immunisation schedule as per age of the child. Immunisation schedule are prepared in such a manner that child should get vaccinated early as well as vaccine is effective at that particular age. A child should get vaccinated at the minimum age recommended or later but not earlier as vaccine may not be as effective. If any child missed certain vaccine at recommended age it can be vaccinated up to certain age as per catch up immunisation schedule. If child is already having disease, they can develop immunity against viral illness but they still prone to bacterial infection and need to be vaccinated to prevent recurrence of infection.
Immunisation is the best way to protect our children from infectious diseases as once they acquire infection, severity of illness could be very high and even needs hospitalisation with critical care support, which leads to morbidity and mortality in some instances. Cost benefit ratio of immunisation is also very low as expenses of treatment could be quite high. Illness can also lead to loss of school days as well as failure to attend some important occasions like exams, competitive games etc.
Below mention table gives a broad idea about immunisation schedule and catch up immunisation. Detail about individual immunisation and few additional immunisations likeinfluenza, Japanese encephalitis, meningococcal meningitis, Human papilloma virus could be discussed with paediatrician on personal visit.

Age
(completed weeks/months/years)
Vaccines Comments
Birth BCG
OPV 0
Hep-B 1
Administer these vaccines to all newborns before hospital
discharge
6 weeks DTwP 1
IPV 1
Hep-B 2
Hib 1
Rotavirus 1
PCV 1
DTP:

  • DTaP vaccine/combinations should preferably be
    avoided for the primary series
  • DTaP vaccine/combinations should be preferred in
    certain specific circumstances/conditions only
  • No need of repeating/giving additional doses of wholecell
    pertussis (wP) vaccine to a child who has earlier
    completed their primary schedule with acellular
    pertussis (aP) vaccine-containing products

Polio:

  • All doses of IPV may be replaced with OPV if
    administration of the former is unfeasible
  • Additional doses of OPV on all supplementary
    immunization activities (SIAs)
  • Two doses of IPV instead of 3 for primary series if
    started at 8 weeks, and 8 weeks interval between the
    doses
  • No child should leave the facility without polio
    immunization (IPV or OPV), if indicated by the
    schedule
  • See footnotes under figure titled IAP recommended
    immunization schedule (with range) for

Rotavirus:

  • 2 doses of RV1 and 3 doses of RV5 & RV 116E
  • RV1 should be employed in 10 & 14 week schedule,
    10 & 14 week schedule of RV1 is found to be more
    immunogenic than 6 & 10 week schedule
10 weeks DTwP 2
IPV 2
Hib 2
Rotavirus 2
PCV 2
Rotavirus:

If RV1 is chosen, the first dose should be given at 10 weeks

14 weeks DTwP 3
IPV 3
Hib 3
Rotavirus 3
PCV 3
Rotavirus:

  • Only 2 doses of RV1 are recommended.
  • If RV1 is chosen, the 2nd dose should be given at 14
    weeks
6 months OPV 1
Hep-B 3
Hepatitis-B: The final (3rd or 4th ) dose in the HepB vaccine
series should be administered no earlier than age 24 weeks and
at least 16 weeks after the first dose.
9 months OPV 2
MMR-1
MMR:

  • Measles-containing vaccine ideally should not be
    administered before completing 270 days or 9 months
    of life;
  • The 2nd dose must follow in 2nd year of life;
  • No need to give stand-alone measles vaccine
9-12 months Typhoid Conjugate
Vaccine
  • Currently, two typhoid conjugate vaccines, Typbar-TCV®
    and PedaTyph® available in Indian market; either can
    be used
    of life;
  • An interval of at least 4 weeks with the MMR vaccine
    should be maintained while administering this vaccine
12 months Hep-A 1 Hepatitis A:

  • Single dose for live attenuated H2-strain Hep-A
    vaccine
  • Two doses for all inactivated Hep-A vaccines are recommended
15 months MMR 2
Varicella 1
PCV booster
MMR:

  • The 2nd dose must follow in 2nd year of life
  • However, it can be given at anytime 4-8 weeks after
    the 1st dose

Varicella: The risk of breakthrough varicella is lower if given
15 months onwards

16 to 18 months DTwP B1/DTaP B1
IPV B1
Hib B1
The first booster (4thth dose) may be administered as early as
age 12 months, provided at least 6 months have elapsed since
the third dose.

  • Currently, two typhoid conjugate vaccines, Typbar-TCV®
    and PedaTyph® available in Indian market; either can
    be used
    of life;
  • An interval of at least 4 weeks with the MMR vaccine
    should be maintained while administering this vaccine
18 months Hep-A 2 Hepatitis A: 2
nd dose for inactivated vaccines only
2 years Booster of Typhoid
Conjugate Vaccine
  • A booster dose of Typhoid conjugate vaccine (TCV), if
    primary dose is given at 9-12 months
  • A dose of Typhoid Vi-polysaccharide (Vi-PS) vaccine can be given if conjugate vaccine is not available or
    feasible;
  • Revaccination every 3 years with Vi-polysaccharide
    vaccine
  • Typhoid conjugate vaccine should be preferred over
    Vi- PS vaccine
4 to 6 years DTwP B2/DTaP B2
OPV 3
Varicella 2
MMR 3
Varicella: the 2nd dose can be given at anytime 3 months after
the 1st dose.
MMR: the 3rd dose is recommended at 4-6 years of age.
10 to 12 years Tdap/Td
HPV
Tdap: is preferred to Td followed by Td every 10 years
HPV:

  • Only 2 doses of either of the two HPV vaccines for
    adolescent/preadolescent girls aged 9-14 years;
  • For girls 15 years and older, and immunocompromised
    individuals 3 doses are recommended
  • For two-dose schedule, the minimum interval between
    doses should be 6 months
  • For 3 dose schedule, the doses can be administered at
    0, 1-2 (depending on brand) and 6 months

II. IAP recommended vaccines for High-risk* children (Vaccines under special circumstances) #:
1-Influenza Vaccine
2-Meningococcal Vaccine
3-Japanese Encephalitis Vaccine
4-Cholera Vaccine
5-Rabies Vaccine
6-Yellow Fever Vaccine
7-Pneumococcal Polysaccharide vaccine (PPSV 23)

* High-risk category of children:

  • Congenital or acquired immunodeficiency (including HIV infection),
  •  Chronic cardiac, pulmonary (including asthma if treated with prolonged high-dose oral corticosteroids), hematologic, renal (including
    nephrotic syndrome), liver disease and diabetes mellitus
  •  Children on long term steroids, salicylates, immunosuppressive or radiation therapy
  • Diabetes mellitus, Cerebrospinal fluid leak, Cochlear implant, Malignancies,
  • Children with functional/ anatomic asplenia/ hyposplenia
  • During disease outbreaks
  •  Laboratory personnel and healthcare workers
  •  Travelers
  •  Children having pets in home
  •  Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor.
    # For details see footnotes under figure titled ‘IAP recommended immunization schedule (with range)’
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