Right Parenting - Are vaccines essential?

The horror was not because of the immature, illogical and ignorant question - (because usually that gives us doctors a reason to show off our knowledge!) -but because just minutes ago that mother had proudly proclaimed that she was a postgraduate in immunology! I shuddered to think that if a parent having some basic knowledge about immunology had such concepts about vaccination, then what about others less informed?

With so many new vaccines, there is confusion in the minds of many parents as to how important it is to vaccinate their children. Here is an effort to clear some major queries on the subject.

Why should we vaccinate our children?

Vaccines prevent serious illnesses and don't we all know that prevention is better than cure? Vaccines don't kill immunity- rather they stimulate immunity against various infections. Vaccine is a modified product from the infective organism (like a bacteria or a virus). Giving a vaccine is like deliberately introducing a mild, insignificant infection in the body to stimulate and prime the body defenses. So when there is a real infection, the defense system is ready and waiting to combat that infection successfully.

What are the side effects of these vaccines?

Most of them occasionally have very mild and minimal side effects like some pain/ redness/ swelling at the injection site and fever. These are transient and can be easily avoided with a few doses of analgesics. Serious side effects though possible, are very rare. Don’t try and avoid vaccinating your child because you are afraid of their side-effects. Their benefits far outweigh these minor after-effects.

Can we give vaccines when the child is sick?

There is no need to avoid vaccination for minor illnesses like cold, cough or loose motions. Only when the child is running fever and looking really sick, should the vaccination be postponed.

What is the basic vaccination/ immunisation program?

There are certain vaccines, which are considered so important that universally they are included in the schedule starting after the birth. This is so because they protect against a variety of the most common but potentially life-threatening diseases at a vulnerable age group of 0-2 years.

These vaccines include OPV (against polio), DPT (against diphtheria, pertussis i.e. whooping cough and tetanus), Hib(against H.influenza type b), HBV (against Hepatitis B), measles and MMR (against measles, mumps and rubella). In most developing countries and in the UAE, BCG (against Tuberculosis) is also included in this schedule.

All over the world, these vaccines are available free of cost in government hospitals and health centers. The inclusion and timing of individual vaccines and duration between them may vary from country to country, according to the policies.

What is the Indian Academy Of Paediatrics IAP- recommended vaccination schedule?

Birth – 15 days	BCG + OPV (zero dose)+ Hepatitis B 1st Dose
6 weeks – 8 weeks	OPV1 + DPT1+ Hepatitis B 2nd dose+ + Hib 1st dose
10 weeks – 12 weeks	OPV2 + DPT2+Hib 2nd dose
14 weeks – 16 weeks	OPV3 + DPT3+Hepatitis B 3rd dose + Hib 3rd dose
9 months (completed)	Measles vaccine
15 – 18 months	1st Booster dose of OPV + DPT+ MMR vaccine
4 – 6 years	2nd booster dose of OPV + DPT
10 years	Tetanus toxoid
16 years	Tetanus toxoid

What is the latest recommended basic vaccination schedule in UAE?

At birth	BCG, HBV
2 months	OPV, DPT, Hib, HBV
4 months	OPV, DPT, Hib, HBV
6 months	OPV, DPT, Hib, HBV
12 months	MMR
18 months	OPV, OPT, Hib

Do we have to follow the exact dates in the vaccination schedule?

The dates in your vaccination schedule serve as guidelines and a few days here or there, don’t really make much difference. Yet, too much of latitude in this time-table could jumble up the timings and make the schedule go haywire.

Vaccination is all about bringing you child under the protection-net against illnesses and any delay from your side could leave him unprotected in that window-period. That’s why always try and adhere to the prescribed dates.

Is this program sufficient?

Many parents seem to think that once they complete this basic schedule of vaccination, the protection is complete. Unfortunately this is not true in the strictest of senses.

1. The basic schedule adopted by the government health policies doesn't include all the preventable diseases in the list. This is mainly because economically it's not feasible to offer these vaccines free of cost and also because, some of the excluded vaccines are for diseases, which are not so common in this region.

2. This schedule is mainly intended for the age up to 18 months and the children falling outside this limit are not covered.

What is a Booster?

Booster is not some extra-powerful vaccine injection. The immunity offered by most of the vaccines starts to wane after a few years. Booster is a repeat dose of a vaccine to ‘boost up’ the decreasing immunity.

Which vaccines are necessary as boosters in school-age children?

At the age of 5 years (or between 4 and 6 years of age), booster doses of OPV, DPT (or DT for children over 6 years), MMR and Hepatitis B are given as ‘Boosters’. Similar boosters are also given at 10 and 15 years of age.

What are the other available vaccines and are they really needed?

Apart from these basic vaccines, there are quite a few vaccines available through private medical clinics and hospitals. These include vaccines against Typhoid, Meningitis (Types A+C), Hepatitis A (common infective jaundice), Cholera, Chicken pox, Influenza, Pneumococcal infections, Yellow fever and Rabies.

Out of these, Chickenpox vaccine is now widely recognized as an essential vaccine for all uninfected persons above the age of 1 year. Some others like Influenza and Pneumococcal vaccines are helpful for patients with specific health problems. Some vaccines are necessary for persons traveling to areas where the risk of specific diseases is more or when there is an epidemic going on.

In general, for people traveling to the Indian subcontinent, vaccines against Typhoid, Meningitis and Hepatitis A are more or less essential considering the frequency of these illnesses there. The same is true for Yellow fever vaccine in case of Africa.

The anti-Rabies vaccine is usually given after an animal bite- most commonly after a dog-bite.

Aren't these vaccines expensive?

Unfortunately the cost- (in the range of 100 – 300 Dhs. in UAE) - sometimes forces the parents to shy away. Most of them try to reason it out by saying that since they themselves have done well without all such ‘new’ vaccines and since such vaccines are not included in the basic schedule, they could certainly do without them for their kids. It’s a silly logic and it’s dangerous, too.

Another factor that takes away importance from vaccination is that it is for a normal and healthy child. Parents who don't mind spending much more on treatment when their child is sick sometimes think twice before spending much less for prevention when the child is perfectly fine.

As a paediatrician, I am appalled by this casual attitude, which could cost a human life or impair it when it is perfectly possible to prevent this from happening through a little more awareness and planning. I welcome all the protection that a child gets and strongly recommend all the possible vaccines that he should receive. As a parent, I view the expenditure on this account as an investment for my child's healthy future!

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