Vaccinations for a healthy child

Reviewed on : 27 April 2016

For a baby, nothing can be as safe and secure as the mother’s womb. During the entire pregnancy, the fetus lives in a sterile environment in the uterus, but once the baby is delivered, he or she is completely on his or her own. With the first breath, the immune system of the baby has get on with the job of fighting new dangers in the form of virus, fungi and bacteria and start developing antibodies against these pathogens present in its environment.

As the baby grows, the immune system continues to strengthen itself. Pathogens however will always be ready to attack at the first sign of a weakness. To help newborns fight some of the stronger and more dangerous microbes soon after they are born, vaccinations need to be administered. These antigenic materials, on being administered into the body, help the baby in quickly building up a strong defence against specific infections and diseases.

Vaccinations are administered at different ages starting from day 1  till the child is 15 years old. Some vaccines must be administered over multiple doses while others are one time shots. Over a period of 2 years, the baby is given up to 12 vaccines. It is important that the parents keep a track of the schedule for vaccination that is prescribed by their child’s doctor.

Vaccines usually contain a small amount of specific virus or bacteria or their weakened toxins which are sufficient to trigger the defence mechanism in the baby’s body to start producing antibodies to fight them, without causing a full blown disease. These antibodies then become available to protect the baby when there is an exposure to the same virus or bacteria in higher concentrations sufficient to cause a full manifestation of the disease.

Various Types of Vaccines

Live Attenuated vaccines – These are the most common vaccines, which are developed by weakening the live virus or bacteria. Except for cases where the immune system is already compromised, these vaccines are highly effective.

Inactivated vaccines – These vaccines are derived from the disease microbes that have been killed using chemicals. They produce a weaker immune response but are more stable as compared to live attenuated vaccines. They might also require booster shots to retain their effect over long periods.

Toxoid vaccines – This type of vaccine is derived from the deactivated toxin found in the bacteria or virus. It is used in cases where the illness or disease is caused by the toxin released by the virus or bacteria. Scientists therefore do not have to use the whole bacteria to develop a vaccine. When the immune system is exposed to this toxin, it learns to fight against the toxin.

Subunit vaccines – Subunit vaccines can be developed by deconstructing the actual microbe or by using genetic engineering techniques in a laboratory. These contain only parts of the microbe that stimulate the immune system. With this kind of vaccine, the risk of a temporary reaction in the body is reduced even further than with other types of vaccines.

Conjugate vaccines – These types of vaccines help the immune system identify the bacteria hidden behind a special coating and develop antibodies against it.

Recommended Schedule for Vaccination

Hepatitis B vaccine – The first dose of this vaccine should be given to a newborn within 12 hours of birth and before he or she is discharged from the hospital. The second dose is usually administered when the child is 6 weeks old and the final dose is ideally given at the age of 6 months (but not before 24 weeks and not less than 16 weeks after the previous dose). This vaccine assumes added importance when the mother of the newborn already has hepatitis B. An additional intermediate dose may be administered to such high risk children.

Though, the combination vaccine for hepatitis A and B is generally considered good, it should not be given to children under the age of 1 year, as in rare cases, they might have an allergic reaction to it. Parents of such children should opt for a dose only after proper consultation with their doctor.

Bacillus Calmette–Guérin (BCG) – This vaccine is also administered to a newborn shortly after birth and is used to provide protection against tuberculosis, an infectious disease which often affects the lungs. Children suffering from HIV/AIDS should not be given this vaccine.

Polio vaccine – The Oral Polio Vaccine (OPV) uses a mix of live but weakened polio virus of all three types and was the exclusively recommended vaccination against polio in India till recently. As per new guidelines it is now recommended to use a combination of OPV with Inactivated Polio Vaccine (IPV), which contains inactivated strains of all the three types of polio virus and must be administered through intramuscular injection by a trained healthcare worker. Being not a “live” vaccine IPV, unlike OPV, has no risk of vaccine associated polio paralysis. It is however much more expensive than OPV.

The first dose of OPV is to be given at birth followed by three doses of IPV at 6 weeks, 10 weeks and 14 weeks. The next 2 doses of OPV are then to be administered at 6 months and 9 months. The booster dose of IPV should be administered at 16-18 months but only after 6 months have elapsed since the last IPV dose. The final dose of OPV is to be administered at 4 to 6 years. OPV is to be used only when IPV administration is not feasible for any reason. The World Health Organisation (WHO) recommends that all children should be vaccinated against polio for achieving effective eradication.

DTP vaccine – The DTP vaccine is for protection against diphtheria, tetanus and pertussis (whooping cough). It is administered at 6, 10 and 14 weeks, with two booster doses one each at 16-18 months and 4-6 years.

Tetanus Toxoid vaccine – Tdap should be administered at 10-12 years followed by the Td vaccine every 10 years for continued protection. It is designed to protect the body against tetanus, which can cause convulsions and severe muscle spasms. In case of an injury which leaves an open wound that is hard to clean, an emergency tetanus shot is highly recommended.

MMR vaccine – This vaccine is targeted at measles, mumps, and rubella. The first dose should be administered when the child is 9-month-old and the second dose at the age of 15 months.

Varicella vaccine – For protection against chickenpox and to prevent the contagious infection caused by varicella-zoster virus, the first dose of the vaccine is given when the child is 15-month-old, with a booster shot at the age of 4 to 6 years.

Haemophilus influenza vaccine – Also called the Hib vaccine, it is now recommended for administration at 6, 10 and 14 weeks with a booster shot at 16-18 months.

Rotavirus vaccine – It is used for protection against rotavirus infection which is the most common cause for severe diarrhea in small children. It is administered in 3 doses for RCV5 at 6, 10 and 14 weeks or only 2 doses for RCV1 at 10 and 14 weeks.

Pneumococcal conjugate vaccine (PCV) – Is used to provide protection against diseases caused by the bacterium streptococcus pneumoniae and administered at 6,10 and 14 weeks with a booster dose at 15 months.

Typhoid vaccine – Provides protection against typhoid and should be administered at the age of 9-12 months, while maintaining a gap of min. 4 weeks with the administration of MMR vaccine. A booster dose at 2 years is recommended.

Hepatitis A vaccine – A single dose at 12 months is sufficient if using the live, weakened H2 strain vaccine. In case of use of a vaccine with the killed virus, a second dose, after the first dose at 12 months, is advised at 18 months.

It is important to ensure that vaccination is undertaken only at properly equipped centers where the vaccines are stored under prescribed conditions and the required hygiene conditions are maintained. Instances, when something has gone wrong after administering a vaccine, are rare and the efficacy of these vaccines has been proven through a large number of clinical trials. There are many government sponsored programs to encourage vaccinations and ensure that children in India have a disease free future.

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