Impact of Covid-19 in children: Vaccination schedules

The coronavirus disease (COVID-19) pandemic has led to significant interruptions in immunisation programmes globally alongside the disruption of other routine health services.

Impact of Covid19 in children vaccination

The coronavirus disease (COVID-19) pandemic has led to significant interruptions in immunisation programmes globally alongside the disruption of other routine health services. 230 lakh children missed out on basic vaccines which have to be delivered through routine immunisation services in 2020 and up to 170 lakh children likely did not receive even a single vaccine during the entire year worldwide. Coming to the Indian scenario, nearly 31 lakh children missed their first vaccination dose against diphtheria, tetanus, and whooping cough in 2020. India is now experiencing a large dropout, with DTP-3 coverage falling from 91% to 85%.

A large study that was conducted recently showed in different countries showed that the most common reason for missed childhood vaccination was getting affected by COVID-19 at the vaccination clinic (15%). Other reasons for missed vaccination include worry about getting COVID-19 when leaving the house (11%), following healthcare provider recommendations (10%), clinic closure (10%), or wanting to save services for people who need the most(10%). Due to the fear of contracting the Covid infection a lot of parents avoided taking their kids for even the very basic primary vaccinations. This increases their chance to catch the dreaded vaccine-preventable diseases like measles, mumps, rubella, diphtheria, pertussis, and tetanus, thus leading to an overall increase in childhood morbidity and mortality.

What should be done if certain due vaccines are missed?
This is a common situation in the COVID-19 pandemic. The parents have to be reassured that the vaccination schedule can be resumed without any need to restart the series. Multiple vaccines in one sitting and using the minimum permitted interval between two doses of the same inactivated vaccine can be practiced to complete the schedule in the shortest possible time. Multiple epidemics of measles occurred in 2015 in Guinea because of the interrupted immunisation during the Ebola outbreak.

The principles need to be followed as recommendation by IAP:

• The birth dose of OPV, BCG, and hepatitis B vaccine should be administered within 24 hours of birth or as early as possible after birth. If for any reason this is not done, these vaccines should be administered at the first contact with the healthcare facility.

• The primary vaccination series and the vaccines for outbreak-prone diseases should be prioritized for example DPT, hepatitis B, Hib, OPV/IPV, rotavirus, PCV, influenza, varicella, and MR/MMR. Postponing these vaccines is to be avoided.

• Multiple vaccines can be administered in the same session without fear of any increased adverse effects.

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• We may use the shortest acceptable interval between two doses of the same vaccine if the prospective vaccinee reports to a health facility; and is unlikely to come for follow-up. For inactivated primary vaccines this is 28 minus 4 days i.e. 24 days.

• When missed (because of the logistic issues of transport, etc.), hepatitis A vaccines and HPV vaccines may be administered after the priority vaccines have been given.

• When missed (because of the logistic issues of transport, etc.), the booster dose(s) may be given at the next earliest available opportunity.

• If a child is in a healthcare facility for any reason, and eligible for immunisation, this opportunity should be utilised for administering eligible vaccines.

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Vaccine storage temperature will affect the efficacy of the vaccine

Yes, of course, vaccines must be stored properly from the time they are manufactured until they are administered. Potency is reduced every time a vaccine is exposed to an improper condition. This includes overexposure to heat, cold, or light at any step in the cold chain. Once lost, potency cannot be restored. The mere getting vaccine will not prevent infections unless it is properly stored.