Routine Vaccines/Immunization of children in India during Coronavirus (COVID-19) Pandemic/lockdown.

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Author: Gauri Kshirsagar

” In view of the risks associated with the disruption of routine immunization activities, the INDIAN ACADEMY OF PEADIATRIC Advisory Committee on Vaccines & Immunization Practices (ACVIP) recommends the continuation of routine immunizations, especially the primary vaccine doses, to be administered in the first year.”

Away from the attention being showered on development of vaccines to tackle Covid-19, there is concern that routine immunisation programmes to protect children around the world, are being left behind. Primary immunisation in the first year of a child’s life should not be delayed as it protects against diseases including pneumonia, diarrhoea, meningitis, whooping cough and measles. During the lockdown period, people are scared to visit a hospital due to the risk of getting Covid-19. And in addition to that, OPDs (out patient departments) are closed in many hospitals.

Since the primary focus of public health has been in preparedness and containment of COVID 19 pandemic in the country and all other preventive health activities have been relegated to the background. A decreased demand for vaccination may also occur because of physical distancing requirements or community reluctance. The likelihood of outbreaks of vaccine preventable diseases (VPDs) such as measles may increase as a result of disruption of immunization services, even for brief periods. The importance of continued immunization activities is further emphasized by the observation that during the 2014-2015 Ebola outbreak, the increased number of deaths caused by measles, malaria, HIV/AIDS and tuberculosis attributable to health system failures, exceeded deathsfrom Ebola itself. A modelling study done by the scientists at the London School of Hygiene and Tropical Medicine on the impact of suspending routine immunization sessions to prevent the spread of COVID 19 and further deaths due to COVID 19 in Africa, has shown that for each COVID 19 death prevented, there would be as many as 34 – 1274 future deaths due to diseases including measles, yellow fever, polio, meningitis, pneumonia and diarrhea.
Hence the question arises: Should my child still get routine vaccines during the COVID-19 pandemic?

According to UNICEF while COVID-19 is disrupting our daily lives, the short answer is YES, do try to get your child vaccinated where services are available. It is important that children and babies keep their vaccinations up to date because they protect them from serious diseases. It means that when your children can return to interacting with other children, they’ll have protection from some other diseases too.

If you are unsure of whether or not your immunization service is still running as usual, please check with your health care provider. Because the COVID-19 situation is changing every day, you might find your health care providers will be adjusting their way of providing care as things change. If you cannot get to a clinic when your child’s next vaccinations are due, make a note somewhere to try again as soon as the services resume.
According to IAP (Indian Academy of Pediatrics) Prevention (including immunizations) and management of communicable diseases is considered as an “Essential Medical service”.
There is no documented risk of immunizing a well-child during the COVID 19 Pandemic. COVID 19 is an evolving disease and hence we need to monitor strictly for any increased AEFI.
Following are the guidelines mentioned by IAP:

  1. Vaccinate newborns in maternity set up, before discharge. BCG, OPV and Hepatitis B vaccines are to be administered.
  2. Prioritize primary vaccination series: DPT, Hep B, Hib, OPV/IPV, Rotavirus vaccines, PCV, Influenza, Varicella and MR/MMR. Avoid postponing these vaccines.
  3. Prioritize pneumococcal and Influenza vaccine to vulnerable groups. Healthcare personnel should be upto date in their age appropriate vaccinations.
  4. Typhoid conjugate vaccines may be clubbed with the influenza vaccine at 6 months or MR/MMR at 9 months.
  5. Inactivated JE vaccines (where applicable) should be administered at 1 year.
  6. Hepatitis A vaccines and HPV vaccines may be postponed to a later date if logistic issues of ransport, etc., exist. They may be administered after the priority vaccines have been given.
  7. Multiple vaccines can be administered in the same session without fear of any increased adverse effects.
  8. Boosters may be postponed to a later date, if logistic issues of transport, etc. exist.
  9. If a child is in a healthcare facility for any reason, this opportunity should be utilized foradministering any eligible vaccine.
  10. Mass immunization activities: In view of social distancing measures all Mass Vaccination Campaigns may be postponed.
  11. Catch Up vaccination: The vaccine provider should track of cohorts of children who have missed the
  12. vaccine and immunize them, when conditions become favorable. If a child is in a healthcare facility for any reason, and eligible for immunization, utilize this opportunity for administering any eligible vaccine.
  13. Children from homes where COVID 19 confirmed or suspected are present, should be immunized only after the quarantine period is over.

References

  1. Guiding principles for immunisation activities during Covid 19 pandemic, 26 Mar 2020. WHO/2019- nCoV/immunization services/2020.1
  2. Enabling delivery of Essential Health Services during the Covid 19 outbreak, Guidance note, MOHFW, 25 Mar 2020
  3. Suk et al. Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015. Emerging Infectious Diseases. 2016; 22(6):1106- 1108.
  4. CDC Information for Health care providers, Maintaining Child health Immunisations during Covid 19.
  5. https://www.cdc.gov/vaccines/schedules/hcp/schedulechanges.html, accessed 16-4-2020.
  6. Ministry of Home Affairs order: 40-3/2020-DM-I(A), 15 Mar, 2020. https://www.mha.gov.in/sites/default/files/MHA%20order%20dt%2004.2020%2C%20with%20Revised%20Consolidated%20Guidelines_comp ressed%20%283%29.pdf, last accessed 16-4-2020.
  7. Guidance on routine immunisation services during COVID 19 pandemic in the WHO European Region, 20 Mar 2020.

*DISCLAIMER: Do discuss the vaccine in detail with your paediatrician before making a decision. This article is only for information and discussion.


*Thanks a lot for visiting my blog. Please do ‘★ LIKE’ the post if you found it to be useful.Your comments, suggestions, criticism and all opinions are very much appreciated. Please do write your queries in the Reply/comments section and I will try to get back to you asap.


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