Vaccination – Why & When?

The most effective, easy, and affordable way to prevent infectious diseases from infancy to adulthood is vaccination. The first vaccination was initiated with the Smallpox vaccine in 1796, and all countries worldwide adopted and collectively endeavoured to eradicate Smallpox from the earth. In simple terms, vaccination is a cost-effective and sustainable system. 

What is vaccination, and how does it prevent diseases?

Whenever bacteria, viruses, or parasites enter the body, the body resists and prepares antibodies against those pathogens to eliminate them. With repeated exposure, the body produces more antibodies against the invading pathogens and attempts to stop them. These antibodies also have the ability to destroy similar types of other pathogens. This forms the basis of the vaccination system.

Today, medical scientists have developed vaccines against the most severe infectious diseases. These vaccines are created by inactivating or preserving the whole bacteria or viruses or their body parts. When injected into the human body, they trigger the production of antibodies against those bacteria or viruses. With repeated injections at specific intervals, more and more antibodies are generated. These antibodies assist in fighting against the diseases caused by those bacteria or viruses.

Combination vaccines have been developed to administer many vaccines with minimal injections, reducing the pain and overall cost.

Why is it essential to vaccinate your child?

All vaccines developed by humans are designed to protect against dangerous diseases. Vaccination is the most economical and effective way to protect your child from severe illnesses.

My child is afraid of injections, and there are so many types of vaccines. Can't we avoid injections?

Assuming that if a child gets a severe illness, more injections will be required than vaccination. To reduce the pain caused by injections, scientists have developed combination vaccines that combine several injections into one. Efforts are ongoing to explore vaccination through the nose and mouth in the near future. Administering vaccines through these routes can reduce pain or make it virtually painless. Currently, Rotavirus and Polio vaccines are given orally.

Does vaccination provide lifelong protection, and why do we need booster shots?

Some vaccines provide lifelong protection against the diseases they are intended to prevent, while others require periodic administration. Booster shots are necessary to stimulate the process of antibody formation when antibody levels decline over time. The timing for booster shots has been determined through various research studies. Booster shots are given when the antibody levels decrease, motivating the body to produce more antibodies. There is a specific interval between each administration.

What precautions should we take before and after vaccination?

Remembering the vaccination date is crucial. Administering the vaccine at the right time ensures its effectiveness. Carry your vaccination card when visiting the vaccination centre, and ensure that the date is recorded. The card will also indicate when the next vaccine is due. 

If your child is unwell, postpone the vaccine until they recover completely. Some diseases may be aggravated by vaccination, and antibodies may not form efficiently. Breastfeeding half an hour before oral vaccination is a good idea. Breastfeeding during a vaccination reduces the pain of injections. 

If, for some reason, there is a delay in getting the vaccine, what should be done?

It will be good that the vaccine date is not missed unless the child is ill or the situation is beyond your control. If it has been missed, get it administered as soon as possible. Keep an interval of four weeks before the next vaccine. If the interval is extended, sometimes an extra shot may be required. Specific guidelines for such changes have been provided by IAP (Indian Academy of Pediatrics).

Can a child still get sick after getting vaccinated?

The effectiveness of each vaccine varies; some provide complete protection, while others offer partial protection. Some individuals may not respond much to vaccines. Therefore, a small percentage of children may still get sick despite vaccination. Receiving vaccines repeatedly at the right time enhances their effectiveness. The method of administration and storage of the vaccine also influences its efficacy.

Should children who have already had a disease for which a vaccine is available be vaccinated?

It’s true that antibodies develop against a disease after it occurs. However, vaccinating is still recommended because it helps produce more antibodies, enhancing the body’s ability to resist the disease.

Concerns are often raised about the side effects of various vaccines, such as infertility due to polio drops and autism due to measles. Is this true?

These are just rumours. Scientists are cautious when creating vaccines.

If my child has received all vaccines, should they still get vaccinated in public campaigns like Pulse Polio?

Yes, they should. Individual vaccination benefits individuals, and participating in public campaigns benefits the country as a whole. When vaccines are administered to all children in the country simultaneously, the chances of eliminating the disease increase. This was evident in global efforts against diseases like polio and tetanus. Recently, a united effort against COVID-19 through vaccination worldwide has proven effective.

A child should get both individual vaccines as per schedule and at public campaigns, too.

Should I opt for a painful vaccine or a painless one?

Triple antigen vaccines contain tetanus, diphtheria, and pertussis. They come in two types: painful and painless. The painful one, called whole-cell vaccine, contains a complete cell of inactive pertussis bacteria. 

It causes more reactions, pain, redness and swelling at the injection site. Occasionally, an injection-site lump may form. It may last many weeks, not requiring any treatment as it goes away with time. Fever due to the vaccine may go high, and the baby becomes excessively cranky and unhappy.

The painless one, called acellular vaccine, contains a part of the cell of inactive pertussis bacteria. It causes less pain and swelling at the injection site and fewer fever symptoms.

Both the painful and painless vaccines generate equal antibodies initially. The level of antibodies generated through an acellular vaccine reduces earlier. Some additional injections of acellular vaccine can extend its impact. This combination is available as Tdap and is administered to children and adults over 7 years of age. Administering it at regular intervals maintains the necessary antibody levels against pertussis. Tdap contains the acellular component of the pertussis bacterium. I recommend the painless vaccine.

Vaccination guidelines

In our country, vaccines are administered under two schedules: under the Universal Immunization Program of the Indian government’s NHM (National Health Mission) and according to the Indian Academy of Pediatrics(IAP). Both schedules are available on their websites. The government is providing free vaccinations for all children under its program. IAP has included all beneficial vaccines available for children on their schedule.

 Detailed information about each vaccine is available on the IAP website: 

https://iapindia.org/vaccine-information/.

The health department of the government of India and UNICEF have also provided knowledge about vaccines in detail:

Some essential vaccines and their administration schedule:

  1. Hepatitis B – It is crucial to administer this vaccine immediately after birth, whether the newborn is healthy or not. After that, doses are given at 6 weeks and 6 months. When combination vaccines are available, a first dose at birth and combined with other vaccines at 6, 10, and 14 weeks would be appropriate. The next dose can be given at 18 months or combined with other vaccines.
  2. BCG – This vaccine is for preventing tuberculosis. It is given below the left shoulder intradermally immediately after birth. If the child is unhealthy, it should be administered before discharge from the hospital. It should be given as soon as possible if it cannot be administered at birth.
  3. Polio – This is a very important vaccine. Now, it is available in two forms: oral polio drops (OPV) and injectable polio vaccine (IPV). After birth, OPV is given, followed by IPV injection with a combination vaccine at 6, 10, and 14 weeks. Booster doses should be given at 18 months and then at 5 years. Additional OPV doses are crucial under the Pulse Polio program in the country to eliminate polio from the earth.
  4. Triple Antigen – Combination vaccines for three diseases, Diphtheria, Pertussis, and Tetanus, are given at 6, 10, and 14 weeks, followed by boosters at 18 months and 5 years. There are two types: acellular and whole-cell. Both are effective, but there is some debate about their equivalence. For grownups and adults, Tdap has been developed. It is given after the age of 7 years. Now, hexavalent combination vaccines are available to protect against six diseases, with one injection containing the triple antigen, hepatitis B, HIB, and IPV.
  5. Measles, Mumps, and Rubella (MMR) – The first two injections are given at 9 months and between 15-18 months, with a booster at 5 years. In government campaigns, MR is given at 9 and 15-24 months.
  6. Typhoid – The new conjugate vaccine TCV is available to prevent typhoid. It can be given at 6-9 months or anytime later. Its effect lasts for a long time, and no booster is required.
  7. Influenza – From 6 months to 8 years of age, two injections are given in the first year with a one-month interval. After 8 years of age, an annual injection is recommended, preferably before the onset of the monsoon. Its effectiveness lasts for a year.
  8. Hepatitis A – It can be given after one year of age. The second dose is administered 6 months later. Administering the live attenuated vaccine can prevent Hepatitis A for an extended period.
  9. Pneumococcal Vaccine – Two types are available: PCV-13 and PCV-10. They are given at 6, 10, and 14 weeks, followed by a booster at 18 months. PCV 20 and PCV – 23 are for adults.
  10. Rotavirus—Three types are available: RV-1, RV-5, and RV-116E. RV-1 is given at 10 and 14 weeks, while the other two are given at 6, 10, and 14 weeks. The vaccine is highly effective in reducing the incidence of diarrhoea due to Rotavirus, but diarrhoea due to other agents can still occur. 
  11. Chickenpox—The first injection is given between 12 and 18 months of age, and the second 3 to 6 months later. Two injections are given at 12 years, 4 weeks apart. Although the vaccine doesn’t provide 100% protection, it significantly reduces the severity.
  12. Japanese Encephalitis – Three types are available: SA 14-14-2, JEEV, and JENVAC. They are administered in government campaigns at 9 months and 16-24 months. The first dose of JEEV or JENVAC is given at one year or later, and the second after four weeks.
  13. Human Papillomavirus (HPV) Vaccine – To protect sexual organs from papillomavirus infection, which may lead to cancer of the organs. Girls 9 through 14 years – two doses to be administered at an interval of 6 months, 0–6 months. The schedule recommends three doses for girls 15 years and older: 0–1–6 months for Cervarix and 0–2–6 months for Gardasil. HPV9 is licensed in a 3-dose schedule of 0-2-6 months in females 9-26 years of age and males 9-15 years of age. The ideal age for starting the vaccine is 9-10 years. HPV vaccines can be given at the same time as the Tdap vaccine. If cost is not the constraint, I recommend using HPV 9 as its effectiveness is 98 %.
  14. Meningococcal Vaccine – It is administered in countries where the bacteria causing meningitis is prevalent, especially during outbreaks. Children with low immunity status should receive the vaccine. In Western countries, it is mandatory, and children coming from abroad must be vaccinated in their home countries. MCV 4 is the preferred vaccine form. 
  15. Rabies – Rabies is a deadly disease. The vaccine is given in two ways: pre-exposure (before potential exposure to the disease) and post-exposure (after possible contact with an infected animal). All family members should get a pre-exposure rabies vaccine if a pet animal is at home. The post-exposure vaccine is given on days 0, 3, 7 and 14, 28 and a booster on day 90. If the complete course has been taken previously, only two injections are given on days 0 and 3. The pre-exposure vaccine is given on days 0 and 7. Children require a reduced dose. Please check the literature provided with the injection for guidance. If the bite is severe, the bitten child may also need immunoglobulins.

Preventive measures for other diseases:

  1. Vaccines against malaria and dengue are not yet available, but they might be in the future. We should prevent mosquito bites at any cost. Besides vaccination, ensuring prolonged breastfeeding, maintaining hygiene, and drinking boiled water can prevent many diseases caused by pollution, dirt, and contaminated water. Hands are the primary agents that transmit infections to individuals. Children should be trained to take care of their hands; at the same time, parents and other caregivers should maintain strict hand hygiene. They may become a source of infection for their babies.