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What are vaccines? 

Vaccines are biological products that impart immunity to the recipient. Vaccines may be live attenuated, killed or toxoids. Vaccines are administered to children to protect them from infections that could cause death or severe disability. A vaccine is made often from bacteria and viruses, but is unable to produce an infection in a normal child. However, it retains its ability to produce an immune reaction.

Vaccines are of three types:

Killed vaccines: Killed vaccines contain microorganisms that are killed by various processes. E.g. Salk vaccine for polio.

Live attenuated vaccines: These vaccines contain live microorganisms that can multiply to a limited extent in the child, but they are unable to produce an infection. They usually provide long-lasting immunity. They could, however, result in disease in people with decreased immunity, for example, those suffering from cancer, AIDS or under treatment with corticosteroids; live attenuated vaccines should be avoided in people with decreased immunity. E.g. oral polio vaccine.

Toxoids: These are bacterial toxins that have been rendered inactive, but they retain their ability to produce an immune reaction. E.g. tetanus toxoid and diphtheria toxoid.

A vaccine is made often from bacteria and viruses, but is unable to produce an infection in a normal child. However, it retains its ability to produce an immune reaction. The child produces antibodies against the organism, thus conferring protection to the child against that particular organism. For example, if a live attenuated polio vaccine is administered to the child, the child produces an immune reaction against the polio virus in the vaccine. The same antibodies also protect the child if an actual polio virus infects the child.

Most vaccines are safe in children and do not cause any complications. Mild adverse effects like local pain, fever and mild rash may be observed.  Serious complications are rarely observed with the use of vaccines. The benefits of the vaccines outweigh their risk even in the face of these rare serious complications and their continued use in children is recommended.

The Expanded Programme on Immunization (EPI) was launched in India in 1978. It aimed to cover 80% infants against six diseases, diphtheria, pertussis, tetanus, poliomyelitis, typhoid and childhood tuberculosis. The program was later expanded to cover 100% infants in 1985 and was referred to as the Universal Immunization Programme (UIP). Under this program, typhoid vaccination was discontinued and measles vaccine was added. Vaccines are administered free of cost under this program.

The Indian Academy of Pediatrics also has its list of recommendations to include some of the newer vaccines. These vaccines may be administered to the child if the parents agree and can afford the vaccine. This list includes some of the newer vaccines which have not been considered under the National Program as yet.

Here are a few essential vaccines that should be always administered to all the children. Some of the other vaccinations are optional and maybe administered depending on the risk of exposure to the condition.

Some of the commonly available vaccines used in children are listed below:

BCG (Bacillus Calmette-Guerin) Vaccine: The BCG vaccine is an anti-tuberculosis vaccine. It is a live attenuated vaccine administered to babies at birth. It is injected into the skin of the outer arm. A small swelling appears around 7 to 10 days following the injection, which then ulcerates and heals leaving a scar. The immunity conferred by the BCG vaccine is not permanent and not entirely predictable. It usually lasts for 15 to 20 years.

Polio vaccines: There are two types of polio vaccines, the oral polio vaccine and the inactivated polio vaccine. The oral polio vaccine (OPV), also called Sabin vaccine, is a live attenuated vaccine administered as 2 drops orally usually at birth and around 6, 10 an 14 weeks, and later at 1.5 years and 5 years of age. Under the ‘Pulse Polio Immunization Program’, in an attempt to eradicate the disease, it is administered in addition, twice a year to all children less than 5 years of age. The inactivated polio vaccine (IPV), also called the Salk vaccine is an injectable vaccine that is preferred in some countries in their immunization schedules.

DPT vaccine/ Triple antigen: The DPT vaccine confers immunity against three deadly diseases, diphtheria, pertusis or whooping cough and tetanus.  It is administered as an intramuscular injection into the thigh to all children at 6, 10, 14 weeks with a booster at 1.5 years of age. The vaccine is usually replaced with a Double antigen DT which contains diphtheria and tetanus toxoid at age 5. Tetanus vaccine is repeated at age 10 and 15 years. The DTaP vaccine, also known as DTPa or TDaP that causes fewer side effects compared to the DPT vaccine, is also available. However, its cost does not justify its widespread use. The Tdap vaccine is a form of the DPT vaccine that can be administered in individuals from 11 to 64 years of age.

Hepatitis B vaccine: Hepatitis B vaccine is administered as three doses at 6 weeks, 10 weeks, 14 weeks (along with the DPT vaccine) and at 6 months of age if the mother is known to be negative for the hepatitis B antigen HBsAg. If it is not known if the mother is positive or negative for HBsAg, an additional dose should be administered within 24 hours of birth. If the mother is positive for HBsAg and/or HBeAg, the baby is administered Hepatitis B Immune Globulin and hepatitis B vaccine within 24 hours of birth. Hepatitis B vaccine is included in the National Immunization Schedule of India in some districts.

MMR (Measles Mumps Rubella) vaccine: The MMR vaccine is administered to children over the age of 1 year, usually between 15 to 18 months. A second dose of MMR is administered any time 18 months following the first dose, usually given around 5 years of age.  The MMR vaccine protects the child against measles, mumps as well as German measles.  A measles only vaccine is also available, which is administered at 9 months of age.

Typhoid VaccineThe typhoid vaccine provides immunity for one to three years following the injection. However, it should not be administered to children less than two years of age. An oral typhoid vaccine is also available, which is taken as three doses in the form of capsules. The oral capsules should not be administered to children less than 5 years of age.

Hib vaccine (Hemophilus influenza type b vaccine): The Hib vaccine protects infants and children from complications like meningitis and pneumonia caused by Hemophilus influenza virus. It is administered as 3 doses at 6, 10 and 14 weeks with a booster at 15-18 months.

Chicken pox vaccine/ Varicella vaccine: Chicken pox vaccine prevents the viral infection in children. It is administered as a single dose in children between the ages of 1 and 12 years. A mild form of the infection may occur following the vaccination.  Since it is not a compulsory vaccine in India, it may be administered after discussion with the parents of the child.

Pneumococcal conjugate: The pneumococcal conjugate vaccine protects children from pneumonia, meningitis and other complications caused by Streptococcus pneumonia. The vaccine is administered as three doses at 6, 10 and 14 weeks and a booster at 15 to 18 months. Currently, it is an optional vaccine in India and is given only if the parents desire.

Rota virus vaccine: The rotavirus vaccine is administered in 2 to 3 doses at 4 to 8 week intervals in infants more than 6 weeks of age. It protects infants against severe diarrheal disease caused by rotavirus. It is an optional vaccine.

Hepatitis A vaccine: The hepatitis A vaccine protects infants against hepatitis A infection. It is an optional vaccine administered in 2 doses at 6 to 12 month intervals after 18 months of age.

HPV (Human Papilloma Virus) Vaccine: The HPV vaccine prevents cervical cancer in females. The HPV virus is spread through sexual contact and is associated with the development of cervical cancer. Thus, immunizing girls against HPV before they are sexually active can help to prevent the development of cervical cancer. It is administered to girls after the age of 10 years in 3 doses at 0, 1-2 months and 6 months. 

Frequently Asked Questions: 

1. Where should I go to get my child vaccinated?

Vaccines included in the National Immunization Schedule are administered free of cost at Primary Health Centers. Other vaccines are administered by Pediatricians. The Pulse Polio Immunization is administered at specially set-up booths as well as primary health centers on the specified days.

2. Should I administer all the vaccines to my child?

Vaccines that are recommended in the National immunization schedule should be administered to all children. The additional vaccines recommended by the Indian Academy of Pediatrics are good to administer especially if you could afford them, though not compulsory.

3. What happens if a child misses to take a vaccination on time?

If a child misses a vaccination on time, missed doses can usually be administered at a later date. You would have to talk to your child’s pediatrician regarding the individual vaccine.

4. What is a cold chain?

Cold chain is the system of transporting vaccines from the manufacturer till it is administered to the child. Vaccines have to be maintained under strict temperature control during their transport to ensure that their potency is not lost.