Do you know your child’s vaccine schedule?

Ensuring that a child’s immunisations are up to date is one of the best gifts parents can give their child. Vaccines carry weakened or inactive parts of an infection-causing organism to trigger an immune response which can help achieve immunity in the long run. In other words, following the mandatory and recommended vaccine schedule reduces the risks of morbidity and mortality due to an infection.

“Immunisation is extremely important to protect children against polio, tetanus, diphtheria and the likes,” says Dr Neeraj Kumar, HOD and chief consultant, paediatrics, Motherhood Chaitanya Hospital, Chandigarh.  “A vaccine is nothing but a dead or weakened version of the disease in question. When children are exposed to the disease-causing organism in the form of a vaccine, they build antibodies that will protect them from contracting the disease if they are exposed to it,” he adds.

However, missing or delaying a vaccine from the schedule can be quite worrisome for new parents.

Shweta Venkat, a mother and an IT employee from Bengaluru recalls the time when this happened.

“We had travelled to Chennai and my daughter fell sick around that time. We waited for a week and then we got busy. We missed the vaccine date for the third dose of pentavalent which she was supposed to get on the 14th week (after birth). We were late by more than a month and we were worried.”

What to do if your child has missed a vaccine shot?

Dr Kumar says that missing a vaccine makes children vulnerable to infections and increases the risk of them contracting diseases. “The longer a vaccination is delayed, the susceptibility to infections increases. It can also put other members of the family at risk, especially elderly persons with weak immune systems,” he says.

Shweta was concerned that since they had crossed the ideal time to administer the third shot, they would have to start with the first dose again.

When should you give your child the missed vaccine shot?

Dr Kumar says that because of unavoidable circumstances if children miss a scheduled vaccination, catch-up vaccinations are administered. “There is no timeline before which a vaccine should be given after a miss. However, it is important to administer the deferred dose as soon as possible to reduce the risk of them contracting a disease. A child specialist will prepare a catch-up vaccination schedule depending on the age of the child and the pending vaccinations,” says Dr Kumar.

Vaccines are safe for children with fever or mild illness

Most new parents believe that it is not safe to vaccinate their kids while they are sick. However, this is a misconception.

Shweta too waited to get her daughter vaccinated because she was sick on the scheduled date.  But their physician enlightened her about the misapprehension and the child was administered the final dose without further delay.

According to the Centers for Disease Control and Prevention (CDC), children with a fever or mild illness can still get vaccines as a mild illness does not affect how well the body responds to a vaccine. A child with mild illness – low-grade fever, cold, runny nose or cough, an ear infection or mild diarrhoea can be vaccinated.

However, children with moderate or serious illnesses with or without fever may need to wait until they are better to get some vaccines. It could be due to a chronic health condition like cancer, a weakened immune system or a severe allergic reaction to the previous dose of vaccination. It is advised to consult a paediatrician to determine which vaccine can and cannot be given to a child.

Vaccine schedules that you need to know

Dr Rashmi Jeenakeri, consultant paediatrician and neonatologist, Apollo hospitals, Bengaluru explains the two vaccination schedules that are being followed in India. She says, “first is the National Immunisation Schedule which is the government schedule; they are mandatory vaccinations against six killer diseases – polio, diphtheria, tetanus, pertussis, Haemophilus influenza and measles. The second schedule is recommended by the Indian Academy of Paediatrics; these are optional vaccines against diseases that can cause equal morbidity in children up to the age of five.”

She adds that there are about 13 mandatory vaccines by the government of India from birth to the age of ten, of which three are oral.

Parents are sometimes confused between mandatory and optional vaccines, says Dr Kumar. “In simple terms, mandatory vaccines are those that are covered by the National Immunisation Programme. The optional vaccines are those that are recommended by health experts but not yet included in the government list because of budget constraints. Parents who can afford them should get optional vaccines for their children,” he says.

Current National Immunisation Schedule

(BCG: bacillus Calmette–Guérin; dT: diphtheria and tetanus toxoids; DTwP: diphtheria, tetanus, whole cell pertussis; fIPV: fractional-dose inactivated poliovirus vaccine; Hib: Haemophilus influenzae type b; JE: Japanese encephalitis; MR: measles and rubella vaccine; OPV: oral polio vaccine; PCV: pneumococcal conjugate vaccine)

*PCV is being introduced in a phased manner, currently only in a few states. 

**Measles is being replaced with MR vaccine in a phased manner, currently being given in most states except a few. 

***JE vaccine is given only in identified endemic districts of the country

Current Indian Academy of Pediatrics (IAP) immunisation schedule

(BCG: bacillus Calmette–Guérin; DTwP: diphtheria, tetanus, whole cell pertussis; DTaP: fIPV: fractional-dose inactivated poliovirus vaccine; Hib: Haemophilus influenzae type b; HPV: human papillomavirus vaccine; JE: Japanese encephalitis; MMR: measles, mumps and rubella vaccine; OPV: oral polio vaccine; PCV: pneumococcal conjugate vaccine; Td: tetanus, reduced dose diphtheria toxoid; Tdap: tetanus and diphtheria toxoids and acellular pertussis vaccine)

•   OPV should be given to all children till five years of age during every pulse polio immunisation day.
•   JE vaccine (12 and 13 months), cholera vaccine (12 and 13 months) and meningococcal vaccine (9 and 12 months) are advised in high-risk situations.
•   For meningococcal disease, menectra (9–24 months – 2 doses; >2 years – 1 dose) and menveo (>2 years – 1 dose) are the options

*Third dose rotavirus vaccine not necessary for RV-1

**Hepatitis A, live vaccine (1 dose), killed vaccine (2 doses)

***For annual influenza, the best time in India is April (pre-monsoon); but can be given any time of year with the most recent available influenza vaccine

****HPV only for females; for 9-14 years (2 doses), if started >15 years, then 3 doses

*****Td to be repeated every 10 years after that

Keep a record of immunisations

According to Dr Jeenakeri, parents need to maintain an immunisation record which shows a list of the vaccinations administered and due. “The only way to not miss an immunisation is by keeping a record of it. Your doctor will share a table with all the vaccines that need to be administered and will record the dates along with the due date for the next dose,” she says.

Dr Kumar says that parents should keep a track of all the vaccines that must be given as most vaccines are completed between birth and five years. “Many vaccines will be given more than once. Keeping a record will ensure that doses are not missed. Your hospital will also keep a record of this,” he says.

Will there be reactions?

Dr Jeenakeri says that normally there will be reactions to the BCG vaccine (given against tuberculosis); this tells that the vaccine is working. “In the pentavalent vaccine, the DPT (diphtheria, pertussis, tetanus) component can cause reactions in the baby. Local reactions could be redness or slight swelling on the vaccination site. The child may be slightly cranky or irritable for a day after the vaccine. There might be a mild rise in temperature; the doctor might advise giving oral paracetamol drops to the child after six, ten and 14 weeks after the vaccination. Most of the other vaccinations are tolerated well. If your child is allergic to eggs, you may see a reaction to the MMR vaccination,” she says.

Vaccine checklist

Dr Kumar gives a list of the important immunisations. These include both mandatory and recommended ones.

• BCG vaccine – To be administered at birth or soon after. It protects children against tuberculosis.
• Hepatitis B vaccine – To be given at birth, preferably within 24 hours. Total three doses.
• Polio vaccine (oral/injectable) – To be given at birth, six, ten and 14 weeks. The booster doses are given when the child is one-and-a-half and five years old.
• Pentavalent vaccine – This is given at six, ten and 14 weeks with boosters at one-and-a-half and five years. It protects the child from five diseases – diphtheria, pertussis, tetanus, hepatitis B and Hib infections. Hib is the leading cause of pneumonia and meningitis in young children.
• PCV vaccine – This is for the prevention of pneumococcal infections which cause pneumonia and meningitis in children. It is given at six, ten and 14 weeks, with a booster at 15 months.
• Rotavirus vaccine – Prevents rotavirus diarrhoea and has two/three doses given at six, ten and 14 weeks.

• MMR vaccine (measles, mumps and rubella) – Given at nine months, 15 months and five years.
• JE vaccine – For protection against Japanese encephalitis (a type of brain infection). It is recommended in states with a high incidence of this infection. It has two doses and is given after the age of one, with a one-month gap between doses.
• HPV vaccine – The HPV vaccine is used for the prevention of cervical cancer and should be administered to girls starting at the age of nine. It has two/three doses depending on the age at which it is given.
• Typhoid vaccine – It prevents typhoid infection; a single dose is given to the child between six to nine months.
• Hepatitis A vaccine – It prevents liver infection caused by the hepatitis A type of virus which is transmitted through infected water and food. It has one/two doses given at the age of one.
• Varicella (chickenpox) – It prevents a chickenpox infection. It has two doses, given after the age of one with a gap of three months.
• Tdap vaccine (tetanus, diphtheria and acellular pertussis) – It is a booster vaccine given to older children (10 years) and adults.
• Flu vaccine – It protects the child from common viral infections. It is advised to be given every year after the child turns six months. It should be especially given to children who have less immunity because of underlying issues.

What is an inoculation mark?

Have you noticed a dark coin-sized mark on your left arm? It’s called an inoculation mark. In some older people, we see two inoculation marks, but few have no marks at all.

Dr Jeenakeri explains that the mark we see is due to the BCG vaccine which is given at birth and for some people the mark fades away with time. “In the elderly people in India, you might see two inoculation marks; earlier along with the BCG, people were given smallpox vaccinations which also used to leave a mark. India is one of the countries which has now almost eradicated smallpox through wide vaccination and hence, it is no longer offered as a routine vaccination for infants today,” she says.