PARENTS GUIDE TO NEWER VACCINES
PREFACE

Vaccinations against infectious diseases have been one of the greatest success of modern medicine. Vaccines have played an important role in the control of these diseases. Till early 1990's, routine childhood vaccinations included protection against TB, Diphtheria, Whooping Cough, Tetanus, Polio and Measles .

With the advances in medical sciences and production technologies, there has been an upsurge in the availability of newer vaccines. Few of the newer vaccines in our country have already been covered in vaccination programmes in many other countries. The logistics and health economics in India preclude the inclusion of these newer vaccines in our national health program, which is a basic need and a right of every child.

Increased availability of such new vaccines, which are safe, effective and well tried in several other countries apart from India are now within many parents' reach. This has put pressure on parents due to prevailing misconcepts, cost factors and limited availability of authentic and easy to understand information on these newer vaccines. We believe that informed parents are better parents who can take a reasonable and responsible decision for the health and well-being of their children.

We have a word of caution over here. As the research and experience in medical science continues to grow, changes in opinions and practice become inevitable over a period of time. We sincerely believe that our small effort helps parents to understand the modern vaccinology in the best interests of their children.

Dr. Ravindra Pradhan
Dr. Niranjan Shendurnikar



HIB VACCINE
What is Hib disease ?
Infection with a micro-organism named Haemophilus influenzae type b (Hib) produces severe medical illnesses which may even result in fatality in children under 5 years of age, with the majority of victims being infants. The organism is pathogenic for humans only.
Hib infection is acquired by inhalation of infected respiratory droplets or by contact with infected respiratory secretions. This usually occurs in conditions of overcrowding such as day care centres and play centres where there are a number of children living together. If one child is suffering from Hib infection, he is likely to spread it to other children. Maternal antibodies provide infants upto 6 months of age with variable levels of protection against Hib disease.
What is the status of Hib disease in India ?
Hib is a fastidious and difficult germ to grow requiring special care during culture, hence it is not regularly reported in laboratories. There is a very limited data available on the incidence of Hib disease in our country. Various published references give credence to the idea that a significant number of cases of pneumonia and meningitis in India are due to Hib.
What increases susceptibility to Hib disease ?
Age is the most important factor in susceptibility to Hib disease. The period of peak risk is between 6 - 17 months of age. Children upto the age of 5 years are usually affected. Overcrowding, day care attendance is a significant factor for Hib disease. The risk is greatest for the youngest children and diminishes with age, so that there is decreasing risk for children 2 years of age and older.
How can this disease present ?
The disease manifests in a variety of ways such as meningitis, which is the inflammation of the membranes that cover the brain and the spinal cord. This is the most common manifestation. This is life threatening and requires prompt medical attention because of rapid progression of infection. Other illnesses caused by this micro-organism are pneumonia, ear infections, epiglottitis ( severe infection of the back of the throat ) and bone and joint infections. Complications of Hib meningitis can be fatal and leave upto 38 % of survivors with permanent brain damage causing hearing loss, language disorders or delay, mental retardation, inco-ordination, cerebral palsy or spastic conditions, convulsive disorders, and visual impairment.
How can Hib disease be prevented ?
Hib disease can be prevented by vaccination from the age of 6 weeks onwards. There are a number of vaccines for Hib available under various trade names and they are highly effective in prevention of invasive Hib disease of infants and young children. The vaccines have a protective efficacy of over 95 %. Routine immunization with Hib vaccine in developed countries like USA and UK over the last 10 to 12 years has markedly reduced the incidence of the severe manifestations of Hib disease.
What is the immunization schedule and it's adverse effects if any ?
The IAP Immunization Committee in it's policy statement considers Hib vaccination as optional for children. The manufacturer's recommendations are to be followed for the individual vaccines. The Hib vaccines are exceptionally safe and mostly free from reactions, locally or systemically.
Upto what age can children be immunized with Hib vaccine ?
Most experts believe that there is hardly any need or value in giving Hib vaccines to children beyond 5 years of age.
A Word Of Caution :
Vaccination with Hib prevents infection and meningitis and other severe disease only due to Hib. The germ is not responsible for causing flu and flu like illness. This vaccination does not protect against all types of meningitis. Meningitis/Encephalitis in children is caused by a wide variety of micro-organisms which may be bacteria (Streptococcus, Pneumococcus, Tuberculosis, etc. ) or viruses causing encephalitis ; against which this vaccine does not protect. In other words, meningitis due to other organisms can occur inspite of vaccination for Hib. Hepatitis A Vaccine
 



HEPATITIS A VACCINE
What is Hepatitis A ?
Hepatitis A is caused due to infection by a virus, involving mainly the liver. The clinical picture varies from silent or sub-clinical infection, to clinical hepatitis (involvement of the liver ) with or without jaundice, to jaundice with severe complications, coma and death. The frequency and severity of symptoms increases with age. The older child and adult are more likely to develop serious complications. The duration of illness also varies, but most patients begin to recover by the third week. Hepatitis A is not associated with chronic liver disease.
What is the extent of the disease in India ?
Due to poor environmental conditions, the disease is existing widely and throughout the year in India. Occasional outbreaks are also known to occur periodically.
Which vaccine is available against Hepatitis A ?
Currently an inactivated ( killed virus ) vaccine is available against Hepatitis A, which has been inactivated by treatment with formaldehyde.
What is the reported efficacy and safety of Hepatitis A vaccine?
The protective efficacy of the killed virus vaccine is more than 95 %. The safety record of this vaccine is also excellent. Mild pain and tenderness at the site of vaccine does occur in about 10 to20 % of recipients.
Should hepatitis A vaccine be recommended in India?
With improvement in economic conditions in many families, children from middle and upper socio-economic group may remain susceptible to HAV infection. Hepatitis A vaccine may be offered to these children who would have escaped natural infection. Hence the vaccine would prevent later infection with the possible risks of complications in adult life.
What is the duration of protection of hepatitis A vaccination?
Primary course of the vaccine followed by a booster provides predicted protection for 10 to 20 years.
What is the schedule for Hepatitis A vaccination?
A single dose of Hepatitis A 720 Elisa units is used for primary immunization in children and adolescents from 1 year upto and including 18 years of age. A booster dose is recommended anytime between 6 and 12 months after the first dose to ensure long term protection. The vaccine is well tolerated and the side effects are only mild and transient.
What are the other measures to prevent Hepatitis A ?
As Hepatitis A is a water and food borne disease, proper hygeinic measures such as good hand washing, safe water supply
( boiled or UV purified ) , exclusion of infected persons from handling food and avoiding eating raw eggs, and open unhygeinic fly infested food ensures reasonable protection against Hepatitis A and other water borne illnesses.
 

 


HEPATITIS B VACCINE
What is Hepatitis B ?
Hepatitis B is a disease caused by a virus that attacks the liver. This virus is known as Hepatitis B virus which can lead to lifelong infection of the liver, it's scarring and ultimately liver cell failure. It is estimated that India has the second largest pool of persons infected with this virus in the world ( next to China ). Currently available data indicates that about 4 % of our country's population is infected with this virus and carries it in their blood and body secretions.
What are salient facts about Hepatitis B ?
Hepatitis B disease is one of the most highly infectious and easily transmissible of all childhood infections. Virus can spread easily from one person to another, particularly if the contact is close or continued. Children are at risk to acquire this infection from one of the following ways : (a) Babies can acquire Hepatitis B from an infected mother during childbirth. (b) Due to close contact with someone who is a carrier of virus ( lifelong Hepatitis B infection ). (c) Exposure to unsterile needles or blood infected with HB virus.
Some persons who are infected with this virus are never able to recover fully from the infection. They carry the virus in the blood and continue to infect others for the rest of their lives. For a considerable duration of their illness, these people do not exhibit any signs of illness and pose a considerable threat for the spread of infection to the other uninfected and unprotected children. Such infected persons are labelled as chronic carriers of HbsAg or Australia antigen positive.
Why should my child be protected ?
The chances of progress of the infection, failure of the clearance of the virus from the body and the later on complications are much higher in children, rather than in adults. There is no definite cure available for Hepatitis B infection and that is why Hepatitis B vaccination offers the best protection against the infection. World Health Organisation ( WHO ), the Global Advisory Authority on Childhood Vaccines has recommended that HB vaccine should be included as a part of regular vaccination of childhood.
When should the vaccine be given ?
Safe, effective and highly purified vaccines against Hepatitis B, produced by recombinant DNA technology have become available in India over the last ten years. Three doses of the vaccine in recommended schedule on Day 0, 1 month and 6 months offer more than 95 % protection to the recipient. It is desirable that the babies be started on immunization from an early age, preferably at birth, so as to offer best protection. If your child has not received HB vaccine earlier, he/she can be vaccinated anytime during childhood. Side effects after HB vaccination are usually mild and transient, such as mild fever, redness and local pain at the site of injection. No scientific data exists to link the administration of HB vaccine with any chronic or debilitating disease.
What are other facts about Hepatitis B ?
Hepatitis B infection is one of the viral infections of liver. There are other viruses as well that infect the liver and cause jaundice such as A, C, D, E, G. HBV will protect your child against Hepatitis B and D only. Jaundice can still occur due to infection of the liver by other viruses.
Hepatitis B infection is not spread through food or water or by casual contact.
 

 

VARICELLA ( CHICKEN POX ) VACCINE
What is Varicella ?
Varicella , also known as chicken pox is caused by varicella zoster virus , belonging to the family of herpes virus. The disease presents with sudden onset of low to moderate grade fever and few symptoms, a rash appearing on the first or second day of fever, lasting for 5 to 7 days, the rash then forming scabs which then fall off leaving behind a variable amount of scarring. The rash also appears over and in the mouth, pharynx, larynx, trachea, conjunctiva and genitals.
The infection is transmitted by direct contact or indirectly through a third person. Air borne infection is possible because of the virus being present in the respiratory secretions. Severity of the disease is more pronounced in older children and in adults. Re-activation of the latent virus, long after the primary infection may result in Herpes Zoster or "Shingles".Chicken Pox during pregnancy and at the time of delivery can cause serious complications in newborn. Period of infectivity ranges from 1 to 2 days prior to the illness and upto 7 days after the onset ( till crusts have formed on all lesions ).
What are the complications of the disease ?
The complications are relatively rare in children but are more pronounced in older children and in adults. These can include pneumonia, extensive skin lesions, bleeding and encephalitis ( involvement of the brain ).
What are the myths about the disease ?
It is popularly believed that chicken pox is due to the wrath of the goddesses and therefore no treatment is to be taken. However it has been proved that it is due to varicella zoster virus and that it is preventable.
When should the vaccine be given ?
A single injection provides adequate immunity to children from the age of 12 months, upto and including 12 years. Two doses at an interval of 6 to 8 weeks are required for children 13 years of age and above.
The vaccine is given subcutaneously. The side effects are usually mild and transient, and include mild fever and few rash.
Why should my child be protected ?
Chicken Pox in younger children is as such quite a harmless disease. However, the severity of the disease is more pronounced in elder children and in adults. The incidence of complications is higher, there is loss of school days for children as well as loss of working days for the parents. Chicken Pox during examinations may lead to loss of an educational year or the child being only promoted. Thus for the prevention of the disease and it's complications, the vaccine may be given to children over the age of one year. Vaccination for varicella also provides protection against Herpes Zoster. The vaccine provides protection against Chicken Pox to an extent of over 95 %.
 

 

TYPHOID VACCINE
What is Enteric Fever ( Typhoid ) ?
Typhoid Fever is an acute infectious illness, caused by a bacteria known as Salmonella Typhi. The child gets infected when he/she consumes food or water contaminated by these bacteria which enter the child's blood through his intestines. The illness starts with the onset of fever, headache, loss of apetite, abdominal pain, rose spots and enlargement of liver and spleen. The illness usually lasts a course of approximately 2 to 3 weeks, needing hospitalisation in about 40 to 50 % of children. Infrequently, it results in some complications such as intestinal perforation, delirium and liver involvement.
What is the extent of problem in India ?
The magnitude of the disease is directly related to the level of sanitation and water supply in the community. With poor hygeinic conditions and sanitation, children of all age groups have been affected and outbreaks of the disease affecting a large number of children in a given locality are known to occur following contamination of water supply, so often seen in urban congested localities. The number of cases in last decade have increased, more so in cities and towns and the causative bacteria have become resistant to commonly used antibiotics, thus requiring a longer duration of treatment and delayed recovery.
Which vaccines are available for the prevention of typhoid fever ?
Currently two types of vaccines, namely (1) Vi antigen vaccine and (2) Oral typhoid vaccine are available for prevention of Typhoid Fever. Earlier, an economical and cost effective killed vaccine was available for children and adults, but it's production has been discontinued few years ago.

a) Vi Antigen Vaccine : The earliest age for giving this vaccine is at 2 years of age and it requires only one injection in thigh/upper arm. Since the vaccine gives protection for a period of 2 to 3 years, a repeat dose is required once in every 3 years to ensure continued protection to the child.

b) Oral Typhoid Vaccine : This vaccine is available in a capsule form, to be taken on empty stomach, on alternate days for a total of 3 capsules. Since the capsules have to be swallowed intact, this can only be given to children who are 6 years or older. Again, this has to be repeated once after every3 years.
What are the side effects of typhoid vaccine ?
Newer typhoid vaccine are largely well tolerated. Vi antigen vaccine can produce some local pain, a mild fever in few children, but these effects are transient and short lived. Oral typhoid vaccine can give rise to abdominal discomfort and occasional vomiting and diarrhoea.
What is the protective efficacy of the vaccine ?
Most important facts to remember is that the currently available typhoid vaccines offer relative protection against typhoid ( 70 - 75 % ) and do not give absolute immunity against the disease. This is due to the fact that typhoid fever is a water and food borne disease ( germs multiply in stale and unhygeinic food ). A large innoculum ( dose ) of ingested bacteria can overcome the protection offered by typhoid vaccine.
What are the other measures to prevent typhoid ?
Proper hygeinic measures such as good hand washing, safe water supply ( boiled or UV purified ) , exclusion of infected persons from handling food and avoiding eating raw eggs, and open unhygeinic fly infested food ensures reasonable protection against typhoid fever.
 

RABIES VACCINE
What is Rabies ?
Rabies is an extremely serious disease transmitted as a result of a bite by an animal carrying the virus in its saliva. The most common source of infection to children is the dog bite, however cats and other animals can also be responsible for the transmission of this disease. Rabies is the most severe of any communicable disease for which no treatment is currently available.
What is the extent of disease in India?
India carries one of the largest stray dog population (estimated 18 million) and it is believed that nearly 30,000 people die of rabies every year in India due to bites by a rabid animal.
What measures should be taken after a bite?
Washing the wound/bite with soap and running water for at least 5 minutes is a very effective measure for the physical removal of the virus from the wound. Alcohol and/or Iodine should be applied to the wound locally after washing the area. The doctor should be consulted immediately thereafter for further treatment.
When and how should the vaccine be used?
Even though the disease is old, modern technology has greatly improved the quality of the new vaccines against rabies (tissue/cell culture vaccine). All these vaccines are highly effective, well tolerated and do not cause serious side effects, when given as per recommended schedule. One of the best thing about rabies vaccines is that they are effective and are most often used to prevent the rabies immediately after the dog bites. New tissue culture rabies vaccine when used after a animal bite, are to be given in a minimum of 5 doses(Day 0,3,7,14,28) to ensure adequate protection. A 6th dose (on 90th day) may be given to boost up the immunity further.
Sheep brain rabies vaccines which conventionally required 7 to 14 doses are unsafe for human use, cause serious reactions and have been discarded in many countries of the world.
Do all dog bites need rabies vaccine ?
Giving rabies vaccine after all dog bites may not be necessary. Each case of dog bite or even a suspected dog bite can be best evaluated by your doctor to decide the need to begin vaccination after the bite (post exposure prevention).