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Immunisation is the birthright of every child born. It is a proven tool for controlling and even eradicating deadly diseases affecting children. India is a developing country and being one of the most populous countries, deadly communicable diseases could spread like wildfire affecting children -the future of the country, ultimately leading to a huge burden on the health care system and the family in terms of emotional, physical, and economic turmoil. All this can be simply prevented with timely vaccination. An immunization campaign, carried out by the World Health Organization (WHO) from 1967 to 1977, eradicated smallpox, which had led to millions of deaths in the past. Immunisation prepares our bodies to fight against diseases by means of developing lasting antibodies in case the child comes in contact with them in the future.
Lack of vaccination has led to millions of deaths previously worldwide due to diseases like measles, tuberculosis, poliomyelitis, diphtheria, tetanus, pneumonia, and diarrhoea. A newborn baby receives protection via maternal antibodies, which wanes off after a few months, hence the need for vaccination to prevent these deadly diseases. Vaccination provides immunity against these diseases, lack of which leads to weaker immunity, recurrent infections affecting the health of the child, negatively impacts growth and development, affects other organs, may lead to lifelong sequelae, and also plays a part in spreading infections to other children.
|Birth||BCG, OPV 0, Hepatitis B -1|
|6 weeks||IPV-1, DTwP-1, Hepatitis B -2, Hib -1, Rotavirus 1, PCV 1|
|10 weeks||DTwP-2, IPV 2, Hib -2, Rotavirus 2, PCV 2, Hep B 3|
|14 weeks||DTwP-3 , IPV-3 , Hib -3, Rotavirus 3, PCV 3, Hep B 4|
|6 months||Influenza (IIV) 1|
|7 months||Influenza (IIV) 2|
|6-9 months||Typhoid Conjugate Vaccine|
|9 months||MMR I|
|12 months||Hep-A 1|
|15 months||MMR 2, Varicella 1, PCV Booster|
|16- 18 months||DTwP B 1 / DTaP booster -1, IPV B 1, Hib booster 1|
|18-19 months||Hep-A 2, Varicella 2|
|4-6 years||DTwP B 2 / DTaP booster -2, IPV B 2, MMR 3|
|10-12 years||Tdap / Td, HPV (Only for females, three doses at 0, 1-2 and 6 months|
India, as the country, contributes to one-fifth of global under-five mortality with a significant number of deaths attributable to vaccine-preventable diseases. There is no doubt that substantial progress has been achieved in India with the wider use of vaccines, resulting in the prevention of several diseases. However, a lot remains to be done and, in some situations, progress has not been sustained. Successful immunization strategy for the country goes beyond vaccine coverage in that self-reliance in vaccine production, creating an epidemiological database for infectious diseases and developing surveillance systems are also integral parts of the system. It is apparent that the present strategy focuses on mere vaccine coverage.
An urgent need at present is to strengthen routine immunization coverage in the country with EPI vaccines. India is self-sufficient in the production of vaccines used in UIP. As such the availability of the vaccine is not an issue. For improving coverage, immunization needs to be brought closer to the communities. There is a need to improve immunization practices at fixed sites along with better monitoring and supervision. Effective behaviour change communication would increase the demand for vaccination. There is certainly a need for introducing innovative methods and practices. For eg. In Bihar, "Muskan Ek Abhiyan" an innovative initiative started in 2007 is a good example, where a partnership of government organizations, agencies, and highly motivated social workers has paid rich dividends. Full vaccination coverage, a mere 19% in 2005 zoomed to 49% in 2009.
In the last 50 years Immunization has delivered excellent results in reducing morbidity and mortality from childhood infections. And with that, there has been a substantial reduction in the incidence of many vaccines' preventable diseases. But there are a number of barriers that adversely affect the immunization coverage rates in India. Some of the challenges to immunization include limited capacities of staff, and gaps in key areas such as predicting demand, logistics, and cold chain management, which result in high wastage rates.
India also still lacks a robust system to track VPDs. Vaccination coverage varies considerably from state to state, with the lowest rates in India's large central states. Differences in uptake are geographical, regional, rural-urban, poor-rich, and gender-related. We now need to step up our efforts to strengthen all components of UIP (vaccination schedule, delivery, and monitoring, and VPD/AEFI surveillance), overcome all barriers (geographical, politico-social,and technical) and invest heavily to achieve immunization's full potential and a healthier nation.
Some of the key areas which can be addressed are as follows:
Creating awareness amongst the people about the need for vaccination and change in their attitude is of utmost importance. Let's hope that India and the world will see a better future where none of the children is affected by these vaccine-preventable diseases and children of the nation are safe and healthy.
(The article is contributed by Dr Fazal Nabi, Consultant Paediatric Intensivist at Global Hospital, Mumbai)
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