How To Safely Vaccinate Children During COVID-19 Pandemic

New Delhi: India’s vaccination programme called Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually, as per the National Health Mission. UIP is one of the most cost-effective public health interventions and largely responsible for the reduction of vaccine preventable under-5 mortality rate. UIP provides protection to children from 12 vaccine preventable diseases including Polio, Measles, Rubella, Diphtheria, Pertussis, Tetanus, among others. This year, however, the coronavirus pandemic has disturbed the immunization programme. Sharing the impact of Coronavirus and a subsequent lockdown on UIP in Bihar, Dr. Syed Hubbe Ali, Health Specialist at UNICEF, Bihar, said,

In the state, 1.10 lakh children are immunized every month, however, due to the lockdown, the service was disrupted for one AND a half month. Anganwadi centres were closed so parents couldn’t take their children there for routine immunization. Though some health centres were functional, people were not coming out because of the fear of COVID-19.

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UNICEF in Bihar along with State Health Society, Bihar developed micro plans and organised catchup campaigns to vaccinate missed children. Catch up campaigns began on May 6 and slowly picked momentum, the reach widened with unlock and containment zones turning into non-containment zones. As per Dr Ali, the routine immunization in Bihar is almost completely on track as compared to the 2019 figures.

Deepak Kapur, Chairman, Rotary International’s India National PolioPlus Committee, informed that there is a renewed focus on immunization and the first round of SNID (Sub National Immunization Days) post COVID was held in September across 10 states including Bihar, Delhi, Gujarat, Haryana, Maharashtra, Punjab, Rajasthan, Jharkhand, West Bengal, Uttarakhand and Chandigarh (UT). The immunization coverage was sub-optimal, with a nearly 23 per cent dip in the total number of children vaccinated compared to SNID held in September 2019, he added.

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Most Crucial Vaccines That Are Not To Be Missed

The 12 vaccines available in the UIP are some of the most crucial vaccines and should not be missed. Detailing on the same, Dr. Shreya Dubey, Consultant, Neonatology and Paediatrics, CK Birla hospital, said,

Vaccinations at birth like BCG for tuberculosis, Hepatitis B and polio drops are very important. Vaccinations at 6, 10 and 14 weeks like those against Diphtheria, Pertussis, Tetanus, Hemophilus influenza should preferably not be delayed. Similarly, MMR vaccine which protects against Measles, Mumps and Rubella should be received timely.

Also Read: Vaccination During Pandemic: Fear Of Contracting COVID-19 Prevents Parents From Taking Kids For Vaccination

Dr. Fazal Nabi, Director, Pediatrics at Jaslok Hospital and Research Centre in Mumbai suggested vaccinating newborns with BCG, OPV and Hepatitis B vaccines in maternity set up, before discharge. He said, primary vaccination series including DPT vaccine, Hepatitis B, Rotavirus vaccines, among others should be prioritised. To reduce the visits to the hospital and at the same time get maximum vaccines, Dr. Nabi recommended combining a few vaccines. He said,

Typhoid conjugate vaccines may be clubbed with the influenza vaccine at 6 months or MR/MMR vaccine given for measles, mumps and rubella at 9 months. Inactivated JE vaccines (where applicable) should be administered at 1 year. Hepatitis A vaccines, HPV vaccines and boosters may be postponed to a later date if logistic issues of transport, and others exist. They may be administered after the priority vaccines have been given. Multiple vaccines can be administered in the same session without fear of any increased adverse effects.

Also Read: Opinion: Why Are People Scared To Get Vaccinated?

The Impact Of Delay In Vaccination Due To COVID-19 Pandemic

The fear of catching SARS-CoV-2 is real which is resulting in the delay of routine immunization. Dr. Nabi is of the opinion that there is no documented risk of immunising a well child during the COVID-19 pandemic. He said,

COVID- 19 is an evolving disease and hence, we need to monitor strictly for any increased adverse event following immunization (AEFI).

According to the health experts, following COVID precautionary measures can reduce the risk of contracting the Novel Coronavirus and because of the fear of the virus, immunization should not be postponed. Dr. Shreya Dubey reiterated the message and said,

Delaying immunisation, especially in the first two years of life is not advisable as the children are at risk of contracting many life-threatening infections owing to the immature immune system.

Also Read: Opinion: How Crucial Are Vaccines For Preventable Diseases?

Further talking about the impact of delay in immunization due to the fear of COVID-19, Dr. Nabi shared the case study of Ebola outbreak and said,

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 deaths from 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 34-1,274 future deaths due to diseases including measles, yellow fever, polio, meningitis, pneumonia and diarrhoea.

Also Read: How Will India Manage COVID-19 Vaccination Coverage?

How To Safely Immunize Children During COVID-19 Pandemic

Health experts suggest following basic COVID precautionary measures that include hand hygiene, wearing a face mask and maintaining a physical distance. In line with this, Dr. Nabi and Dr. Ali listed a few steps that parents, caregivers and healthcare providers should follow as a precaution:

1. It is strongly recommended to have exclusive vaccination sessions and exclusive vaccination rooms. A polyclinic or nursing home or a hospital should have segregated vaccination areas with separate entrance and exit. Along with this, maintain aggressive infection control measure in the clinic.

2. Any caretaker having cough, cold, or fever should be barred from entering the healthcare facility.

3. It is essential to perform triaging of patients and segregate those with fever and respiratory symptoms.

4. Hospitals or healthcare workers should screen accompanying individuals for fever and respiratory symptoms.

Also Read: Anganwadi Centres, Schools, Panchayat Buildings To Be Used As COVID-19 Vaccination Sites

5. Only one to two caretakers should be permitted with each child. Senior citizens (over 60 year of age) should be requested not to accompany the vaccinee.

6. All caretakers and children, except infants should wear a mask.

7. It is preferable to give vaccinations by appointment only and appointments should be staggered to avoid crowding in the clinic.

8. Well-baby visits may be combined with immunizations.

9. Mothers should maintain physical distance while keeping the babies in their arms and once they go back home, they should take a shower, wash all the clothes and sanitise all the belongings. Children should also be provided with a lukewarm shower.

Also Read: India Should Build COVID-19 Vaccine Confidence, Identify ‘Hesitancy Hotspots’: Immunisation Expert Heidi Larson

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.