Meningitis in babies: What you need to know

Meningitis is a condition that causes inflammation in the meninges, which protect the brain and spinal cord. Meningitis is most often caused by a virus or bacteria.

Meningitis is an uncommon but potentially dangerous infection. Babies under 2 months of age are at greater risk of getting meningitis due to their immature immune systems.

Meningitis can have lasting effects on babies and can be fatal in some cases. However, prompt medical treatment can significantly reduce the risk of serious complications.

Symptoms

The symptoms of meningitis in babies may not be alarming at first. Some babies may simply appear irritable or tired.Meningitis can become serious quickly, so it is essential to be aware of its symptoms and to seek medical care immediately if meningitis is suspected.

The most common symptoms of meningitis in babies include:

  • Bulging fontanel (the soft spot on top of the head). This may be due to increased pressure or fluid in the brain.
  • Fever. A high temperature is a red flag for an infection, but some babies, especially those under 3 months of age, may not have a fever.
  • Cold hands and feet with a warm torso.
  • Chills. This may include shivering or chills, with or without a fever.
  • A stiff neck. Babies may hold their bodies in a stiff position and may hold their head tilted back.
  • Irritability and crying, especially when picked up. This could be due to a sore or stiff neck or muscle and body aches.
  • Rapid breathing.
  • Vomiting persistently.
  • Refusing to feed.
  • Extreme sleepiness. A person may have difficulty with or be unable to wake the baby.
  • Red or dark rash or marks on the body. If a baby has a fever, appears ill, and develops a rash, seek medical care right away.

Babies with symptoms of meningitis should get emergency medical care. Prompt and aggressive treatment helps ensure a better outcome.

Causes

The most common causes of meningitis in babies are bacteria and viruses. Bacterial meningitis is more dangerous than viral meningitis, though both require prompt medical care.

Causes of viruses include:Non-polio enteroviruses, Influenza, Herpes simplex viruses (HSV), Varicella-zoster virus, Measles and mumps, West Nile virus or other viruses spread by mosquitoes.

Most of these viruses don’t cause meningitis in a healthy person. However, babies are at a higher risk of meningitis and other complications, so protecting them from these illnesses is vital.

Causes of bacterial meningitis: Group B streptococcus, known as group B strep, Escherichia coli (E. coli), Streptococcus pneumoniae and Haemophilus influenzae type b (Hib),  Listeria monocytogenes, Neisseria meningitidis,

Prevention

Meningitis can spread easily from person to person. Although it cannot be prevented completely, some precautions can significantly reduce the risk of a baby getting it.

Vaccines are the key

Although vaccines do not prevent all cases of meningitis, they help protect against several types of serious bacterial and viral meningitis. This greatly reduces the risk of a baby getting the disease.

Hib (Haemophilus influenzae type b) vaccine

Hib vaccine is given at 2, 4, and 6 months of age, and again between 12 and 15 months of age. Hib vaccine is given either alone or in a combination vaccine.

Pneumococcal vaccine

Pneumococcus bacteria can cause meningitis and other serious infections, such as pneumonia. The pneumococcal vaccine is typically given at 2, 4, and 6 months of age, followed by a final dose between 12 and 15 months of age.

Children with certain health conditions may get an additional dose between 2 and 5 years of age.

Meningococcal vaccine ( Menactra and Menveo )

The most common type of meningococcal vaccine is known as the meningococcal conjugate vaccine (MCV4). This vaccine is  given to babies above 9 months of age and older. 

MMR vaccine

The MMR vaccine protects against measles, mumps, and rubella.The MMR vaccine is given at 9 months, 12 to 15 months of age and again at 4 through 6 years of age.

Flu in toddlers: “Everything you need to know”

Toddlers can experience numerous colds each year before they start school. However, influenza, or flu, can take these aches and pains to a higher, and potentially much more serious level.

It is common for very young children to experience illness many times each year due to their developing immune systems and a tendency to put everything into their mouths.

Symptoms

The flu is an acute, viral, respiratory infection that most people recover from in 3-7 days.Symptoms of the flu in toddlers are similar to those of adults and may include dry cough, sore throat, blocked or runny no, fever, muscle aches, headache, tiredness

When children get the flu, they are also more likely than adults to experience gastrointestinal problems, such as vomiting and diarrhea.

Difference between cold and flu symptoms

What appears to be flu symptoms in toddlers can be signs of other illnesses, such as a cold. Knowing what is causing a child’s illness helps adults provide better care, promotes a better recovery, and reduces the risk of complications.

The following chart depicts key differences between cold and flu symptoms in toddlers:

Treatment

Children will typically recover in a week, but they may still feel tired for roughly 3–4 weeks. Key elements of successful home treatment include: getting plenty of rest,drinking lots of fluids,using ibuprofen or acetaminophen in pediatrician-recommended dosages

People should never treat a child’s fever with aspirin due to its connection to Reye’s syndrome.

A doctor can offer treatment if it is needed. Toddlers who may be at risk of serious complications can take flu antiviral medication. However, this treatment is most effective if the child receives it within 48 hours of symptoms appearing.

When to see the doctor

It is common for children under 5 years of age to need medical care. If someone is concerned about a child’s symptoms, they should consider taking them to see a doctor. Studies indicate 10–15% of children in the U.S. seek medical treatment each year because of the flu.

Seek medical attention without delay if any of the following symptoms develop: breathing difficulties,chest pain,severe dehydration,confusion,seizures,a fever of 104°F or more,chest pain,lips or face turning blue,no improvement with at-home care

a doctor will likely begin the diagnosis of the flu in a toddler by taking a complete medical history and a review of their symptoms. If needed, the

doctor will test for the flu by taking a sample of the toddler’s mucus from their nose or throat.

Risk factors

Even though most toddlers will recover quickly and without complications, the flu can be dangerous for some young children.

A doctor will likely begin the diagnosis of the flu in a toddler by taking a complete medical history and a review of their symptoms. If needed, the doctor will test for the flu by taking a sample of the toddler’s mucus from their nose or throat.

According to the Centers for Disease Control and Prevention (CDC), children aged 6 months to 5 years face a significant risk of developing complications due to the flu.

The illness results in between many child admissions to the hospital every year. Although it is very rare, the flu can be fatal for some children.Children are at a higher risk of getting the flu and experiencing complications when they have additional health concerns such as asthma,diabetes,cancer,immune system problems,chronic lung disease,heart disease,kidney disorders,Pre existing neurological problems

For young children, potential complications are pneumonia, ear infections,sinus infections,seizures.

Prevention

Everyone, from age 6 months and above should get a flu shot every year. Some young children may need two shots to receive full immunity.

Other prevention tactics include: washing hands regularly,keeping all surfaces clean,teaching children to cover their mouths when coughing,using tissues after sneezing

Outlook

Although the flu can be dangerous for some, most toddlers will recover from the flu in a week or less. They can remain contagious for up to 1 week or longer after becoming sick.

A child should be free from fever for at least 24 hours before it is safe for them to return to nursery or childcare. However, some schools or childcare providers may have other specific rules.

If a person has concerns about any of the symptoms a toddler has, they should seek medical help.

https://academic.oup.com/jpids/article/2/4/368/912320

https://www.medicalnewstoday.com/articles/153363.php

https://healthcare.utah.edu/the-scope/shows.php?shows=0_5nzgsffm

EasySix

The Easy Six vaccine prevents 6 ( hexavalent) diseases in one shot .It’s  produced by Panacea Biotec.

It provides immunity against all 6 diseases, Diphtheria, whooping cough, Tetanus, Meningitis (caused by Haemophilus influenzae type b), Hepatitis B and Polio. This vaccine is available in a ready to use fully liquid formulation, and does not require constitution, thus saves time .

Difference from Hexaxim? 

It contains the whole cell Pertussis antigen Hexaxim are Painless vaccines with acellular Pertussis antigen, 

Adverse Effects :

It may cause slight fever, rarely causes persistent crying, some pain in infants due to certain allergic reactions in response to inactivate whole cell components of Pertussis. All these reactions can be easily controlled by over-the- counter (OTC )Paracetamol drugs. 

Flu vaccines “The Quadrivalent”

Influenza vaccine composition needs to be changed each year after evaluating the genetic composition of circulating Influenza virus strains at that time. Influenza viruses continuously evolve and vaccines need to be updated each year to provide effective immunity against flu. WHO recommends the revised ingredients of the Influenza virus vaccine each year, based on the observations and evaluations of the various laboratories worldwide. Scientists at the National Institute of Virology (NIV) in Pune, run by the Indian Council of Medical Research’s (ICMR) approves the new vaccine before it enters the Indian market.

What is the quadrivalent flu vaccine?

A quadrivalent influenza vaccine is designed to protect against four different influenza viruses; two influenza A viruses and two influenza B viruses.

Why was the quadrivalent flu vaccine developed?

For many years, influenza vaccines were designed to protect against three different influenza viruses (trivalent vaccines). Trivalent vaccines include an influenza A (H1N1) virus, an influenza A (H3N2) virus and one influenza B virus. Experts had to choose one B virus, even though there are two different lineages of B viruses that both circulate during most seasons. Adding another B virus to the vaccine aims to give broader protection against circulating influenza viruses.

Who can get quadrivalent flu vaccine?

Different vaccines are approved for different age groups. There is a quadrivalent influenza shot that can be given to children as young as 6 months of age ( Junior). Other quadrivalent influenza shots are approved for people 3 years and older ( Adult) .

The new stocks of Influenza vaccine normally enter the Indian markets by mid august or early September. It is advised to get the vaccination done if you or your family member belong to a high risk group as soon as the new vaccine becomes available. Children from 6 months to 9 years of age are susceptible to Influenza and can be given a vaccine each year. Pregnant women should be given the vaccine in the 2nd or 3 rd trimester as they are highly susceptible to serious flu infection. Vaccine will not only protect the mother-to-be but also her newborn baby later.  Adults coming under high risk category are patients with Lung, Liver, Heart and Kidney disorders, Diabetes, hematological diseases, diseases that impair respiratory functions, and immunosuppression. Also, the personnel employed in nursing homes or health care facilities and household contacts of children <5 years are recommended to take the yearly flu shots.

Case scenario: Does a baby need an additional Hep B dose at 6 months after previous doses of combination vaccines?

Q: If a  baby had received hexaxim at 6 week followed by pentavac pfs at 10weeks and  14 weeks. Should we still give her HepB vaccine for the 6th month dosage?

Hepatitis B vaccination is recommended as 3 doses only. Timeline of the doses depends on the type of vaccine used. If it is a monovalent vaccine with only Hepatitis in it is given at Birth dose followed by a monovalent 2nd dose at 6 weeks ,then a monovalent  3rd dose can be given at 6 months of age (2nd and 3rd dose can be monovalent/pentavalent combination also).

Alternatively if the baby has received  the combination vaccines which includes Hep B during 3 primary doses of combination vaccines ( pentavalent-pentavac pfs and /or  hexavalent-hexaxim),  given at 6, 10 and 14 weeks after birth dose (monovalent), then no further vaccination is  required for Hepatitis B as the immune response of the baby is already primed with the given doses. 

Why is the Measles vaccine given at 9 months? Is measles a common disease that early in life?

Measles is a highly contagious disease; spread by breathing, coughing or sneezing the viral infected respiratory droplets and direct contact with the diseased patient. Before the vaccines came into existence, more than 90% children used to be infected with this deadly viral disease. Measles can be severe with complications like Pneumonia and Encephalitis, which can be fatal in children less than 5 years of age. Since, infants are protected against Measles for 6-9 months only after birth, by the passive immunity attained through maternal antibodies. Measles vaccine has to be essentially given to all infants >9 months of age and young children for further immunity as a part of national immunization programs.

Vaccine Panda’s Vaccination reminder service and its advantages

What stops some parents from getting their children vaccinated with even the free essential Government supplied vaccines? Why do they compromise their children’s health? Incomplete and delayed vaccination makes the child drastically vulnerable to deadly diseases which could be easily prevented. India has the highest number of deaths in children up to 5 years of age , largely from the vaccine-preventable diseases- VPD. Ironically, India is the largest producer and exporter of vaccines. So, lack of available vaccines is not the problem .

A recent study revealed that only not all children are completely vaccinated with the recommended three doses of DPT vaccine and only about a third receive the first dose of measles by 10 months under the Universal Immunization program by the government.

One of the major problems seems to be a lack of good ‘record-keeping’. Paper based Immunization cards issued to the new parents have the high probability of getting lost or misplaced, making it hard to track vaccination history and complete pending vaccinations.

Developed countries too have some  ‘vaccination gaps’ due to superstitions attached to side effects of vaccines. Mostly, parents simply forget to take their children for vaccinations in between their busy schedules. Sadly, people are simply unaware of the possibility of an outbreak of a deadly disease due to this delay. About 90% vaccination coverage is required to maintain ‘herd immunity’ in an area to avoid such outbreaks.  It is very unfortunate to see children dying of diseases which are easily preventable by vaccines. Viruses and bacteria exist everywhere in our environment. It’s our duty to protect our child at the right time before he is exposed to the dreaded pathogens in the environment? Vaccines should be given at an appropriate age and in recommended doses, maintaining proper gaps to maximize the immune response generated by them in a child.

Immunization chart is an important document based on interpretations of thorough research and understanding of vaccine responses in individuals at a certain age. They should be followed religiously to avoid situations like, “How did our baby get Measles even after the doctor had given the vaccine?”  The reason is that you might have been late for vaccination!! Your baby might have come across the virus at his friend’s birthday party just before the vaccine was given. 

All vaccines take about 2 weeks to generate the required immune response. Then, why not give all the vaccines as early as possible to the babies. Exactly, that is why babies are given multiple vaccines in one doctor visit.  Vaccines are quite effective if all the recommended doses are given following the right schedule.

VaccinePanda-VP helps you to stay on schedule!!

Your doctor also gives you a paper chart. It is not only difficult to adhere to but is mostly handwritten, confusing and illegible. Most doctors won’t call to remind you about a child’s vaccination, as It’s a costly and  time-consuming task for a busy doctor’s clinic. For a parent, it is completely human to miss the vaccination dates . After all, there are hundreds of other things, parents need to handle. Vaccine reminders help you to plan the Doctor’s visit in advance. VP sends you 3 reminders for every vaccination visit on your registered email address and via SMS 7 days before, 2 day before and 2 days after the due date. This service is absolutely FREE . Your child’s charts are always kept safe with us in a digital format . You can access it on your phone or laptop anytime.

VP makes a tailor made vaccination chart for your baby based on his/her sex and birthdate, based on the latest recommendations by Indian Academy of Pediatrics (IAP)-( which are followed by all the pediatricians in India ). Your chart gets updated every time you get your child vaccinated by us. VP enters the actual date of vaccination and the vaccine brand. If you fail to take the vaccine on the suggested date, VP takes care of rescheduling the future vaccination dates automatically based on the required minimum time gap between doses after we enter the actual vaccination date. An updated vaccination history of your child will not only give you added confidence about immunization of your child but also gives you an opportunity to discuss the cost and benefits of future vaccination visits with us. VP maintains a database of all the possible vaccine products with its contents and cost details.

 The updated chart neatly displays the vaccine name and dose number along with brand administered and the date of visit,along with its Batch Number. Parents feel well informed with the medical content regularly posted to their mailbox. ‘Ask the Question’ feature on the website lets you post your queries.Parents will be greatly benefited by this.

26 million children are born in India every year, the largest number of births in any country of the world. Taking care of immunization delays and improving adherence can have a great impact on the global scenario of preventing diseases in the world.

VaccinePanda will try to do its bit by increasing awareness about vaccines and helping parents to never miss their child’s vaccine dose. A dose missed is a missed opportunity to save a life when you easily can!!

Air Purifiers Vaccine Panda’s take

 Is the air inside home safe? During days when the AQI ( Air Quality Index ) is poor- (~900-categorized under “severe” levels) , especially in winters when the weather becomes gloomy and hazy, don’t you feel stuffy at home when all the windows are shut.Sometimes ‘Pollution Emergency’ is declared by the Government . Schools are closed and kids are forced to stay indoors. Are you really safe from the harmful smoke pollutants inside your home?Not really!! Don’t you feel a burning sensation in your eyes and throat similar to, when you are out in traffic.This is a common scenario in most of the Metro cities. It’s time to keep indoor pollution under control by installing air purifiers.

Do Air Purifiers make your home pollution free?

Air purifiers are machines that suck the pollutants (including fine Particulate Matter, PM2.5 particles) from air in indoor settings. Earlier, air purifiers were required only for people with allergies and Asthma. Now, it is fast becoming an essential need for a busy city house.

In an air purifier, the air passes through three/more layers of filters. First of all,  its bigger particles are cleaned. Then the harmful gases, (like methane, carbon monoxide etc.) are adsorbed into a carbon primed middle filter. Lastly, the finer particulates (most harmful) are captured through High Efficiency Particulate Air (HEPA) filters thus keeping indoor pollution under control. 

Important points to look while purchasing an air purifier:

  1. A HEPA filter is a must  to take care of the smallest particulate matter that can’t be seen and is the most harmful.
  2. It must have a Pre-filter mechanism so that the air passes through it before it passes through an expensive HEPA filter. It also increases its shelf life.
  3. It should have an adsorbent material like activated charcoal to take care of smelly stuff, fumes and chemicals in the air
  4. It must be quiet
  5. It should have  UV light for sterilization of pathogens. Ultraviolet light is directed only inside the air purifier and it kills dust mites and all germs including viruses which can’t be captured by HEPA filters. This feature helps in keeping the filters free of build up of bacterial and fungal film. Such purifiers are easy to maintain but be cautious, while buying.  Check that purple light is not leaking out, as it can cause eye damage. Unbreakable quartz bulb is the safest but very expensive option for providing UV light. 
  6. Do not buy Ozone generator purifiers. Ozone is actually a harmful gas and can cause irritation in the throat and lungs, when inhaled.Ionizers and most electrostatic precipitators produce ozone as a by-product. Verify the ozone output before buying. It should be low
  7. Don’t get tricked by cheap air purifiers, which boast about high Clean Air Delivery Rate (CADR). The number only suggests the purifier’s ability to remove pollutants like tobacco smoke, dust and pollen from specific amounts of air. It has nothing to do with the effectiveness to filter very small particles,  which are actually the most harmful. Also, higher numbers does not indicate the better durability of a purifier. CADR is often measured at the highest setting of the purifier. These kinds are often impractical to keep at homes, due to high noise. Look for high CADR along with specifications like HEPA filters and pre filters (often the expensive ones). Only CADR will not serve any purpose

I hope this article was helpful in providing some information about air purifiers so you can choose wisely. So,keep indoor pollution at bay. This is a good investment for your family’s health. Just select the one which suits your budget, is efficient as well as safe for long term use. 

Is Polio vaccine is mandatory for all children below 5 years?

Why is that the Polio vaccine mandatory for all children below 5 years in India?

Polio virus is extremely infectious and it spreads through fecal oral routes in  nations where sanitation facilities are poor. Wild polio virus infects a susceptible young child, when he eats improperly handled, fecal contaminated food. Virus multiplies inside the intestines of an infected child. The kid keeps shedding the virus continuously through feces, making other children sick too. It’s important to deprive the virus from it’s susceptible hosts through vaccination. In the case of Polio, herd immunity plays an important role. This can be achieved when the whole community develops immunity to the virus. Young children are given repeated vaccination on all Pulse polio days to offer them complete immunity to Polio disease. Oral Polio vaccine is mandatory for all children below 5 years under routine immunization programs.

How has the Polio situation improved after vaccination?

In the pre-vaccination era, 1 in every 200 children suffered from Polio. Vaccination has helped immensely to reduce the cases and even eradicate Polio altogether from major parts of the planet . The World Health Organization (WHO) has certified India as a Polio free nation on March 27, 2014. 

Polio oral drops and injectable Inactivated Polio Vaccine should be given to all the children below 5 years to get complete immunity from Polio virus.

Why is Polio considered a serious disease?

Polio causes permanent paralysis in the infected young children. Most polio-infected people (~ 90%) have no symptoms. They are just carriers. Others, 10% will have initial symptoms of fever, fatigue, vomiting, headache, stiffness in neck and limbs pain, finally leading to paralysis. Polio is a debilitating disease which has no cure at all. Heat and physical therapy, along with antispasmodic drugs are used to alleviate the symptoms, but nothing can reverse the permanent polio paralysis. Prevention is the only savior. Hence, the Polio vaccine is mandatory for all children below 5 years.

Why is Polio vaccine mandatory even after eradication of Polio?

In India, Polio has been eradicated.But the danger of Polio outbreaks still looms due to neighboring Polio affected countries like Pakistan and Afghanistan. Polio vaccination drive is important to curb the circulation of wild poliovirus between boundaries. This must be done till Polio disease is completely eradicated from the entire planet. Polio vaccine is mandatory for all children below 5 years in all Polio affected countries and their neighboring countries.

DIPHTHERIA ,TETANUS, PERTUSSIS VACCINES

Popularly known as triple antigen, DTwP is composed of tetanus and diphtheria toxoids as well as killed whole-cell pertussis (wP) bacilli adsorbed on insoluble aluminum salts which act as adjuvants. The content of diphtheria toxoid varies from 20 Lf to 30 Lf and that of tetanus toxoid (TT) varies from 5 Lf to 25 Lf per dose. The vaccines need to be stored at 2–8°C. These vaccines should never be frozen, and if frozen accidentally, should be discarded. The dose is 0.5 mL intramuscularly and the preferred site is the anterolateral aspect of the thigh. The immunogenicity (protective titer for diphtheria >0.1 IU/mL and for tetanus >0.01 IU/mL) and effectiveness against diphtheria or tetanus of three doses of the vaccine exceeds 95%.

Adverse Effects:

Most adverse effects are due to the pertussis component. Minor adverse effects like pain, swelling, and redness at the local site, fever, fussiness, anorexia, and vomiting are reported in almost half the vaccinees after any of the three primary doses. 

Recommendations for Use

The standard schedule is three primary doses at 6, 10, and 14 weeks and two boosters at 15–18 months and 4–5 years. The standard dose of pertussis vaccine is 0.5 mL; this is administered intramuscularly in the anterolateral thigh of children aged <12 months and in the deltoid muscle in older age groups.The booster should be given ≥6 months after the last primary dose.

Early completion of primary immunization is desirable as there is no maternal antibody for protection against pertussis. The schedule for catch-up vaccination is three doses at 0, 1, and 6 months. The second childhood booster is not required, if the last dose has been given beyond the age of 4 years. Both DTwP/ DTaP are not recommended in children aged 7 years and older due to increased risk of side-effects. It is essential to immunize even those recovering from DTP as natural disease does not offer complete protection.

Efficacy and Preference of a Particular Acellular Pertussis Vaccine Product

It is similar to that afforded by the whole-cell vaccines.DTaP vaccines are not more efficacious than DTwP vaccines, but have fewer adverse effects.


Acellular vs Whole Cell vaccine debate

A wholly acellular pertussis vaccine series was significantly less effective and durable than one that contains at least one dose of the traditional whole cell vaccine.Crux – include at least one whole cell vaccine in the schedule.The current evidence is tilted in favor of wP vaccines as far as effectiveness of the pertussis vaccines is concerned. However, the industrialized world would not take the risk of reverting to wP vaccines considering the low acceptance of these vaccines by the public in the past.

Vaccination of Adolescents and Adults

Immunity against pertussis following primary or booster DTwP/ DTaP vaccination wanes over the next 6–12 years. So, it doesn’t matter which pertussis you chose, booster is recommended at 9 yr .Most nations do routine booster immunization of adolescents and adults with standard quantity tetanus toxoid, and reduced quantity diphtheria and acellular pertussis (Tdap) vaccine instead of tetanus and diphtheria (Td). The standard strength DTwP and DTaP vaccines cannot be used for vaccination of children 7 years and above due to increased reactogenicity.Immunogenicity studies have shown that antibody response to a single dose of Tdap booster in previously vaccinated children/adolescents is similar to that following three doses of full strength DTwP or DTaP vaccines.The Indian Academy of Pediatrics (IAP) has also recommended only a single one-time dose of Tdap to adolescents aged 10–12 years of age.There is no data on the effectiveness of aP vaccines in India.

Catch-up vaccination is recommended till the age of 18 years.

Persons aged 7 years through 10 years who are not fully immunized with the childhood DTwP/DTaP vaccine series, should receive Tdap vaccine as the first dose in the catch-up series; if additional

doses are needed, Td vaccine should be used. For these children, an adolescent Tdap vaccine is not required.

A single dose of Tdap may also be used as replacement for Td/ TT booster in adults of any age, if they have not received Tdap in the past.

Tetanus toxoid, and reduced quantity diphtheria and acellular pertussis can now be given regardless of time elapsed since the last vaccine containing TT or diphtheria toxoid.

There is no data at present to support repeat doses of Tdap.

Indian Academy of Pediatrics recommends decennial Td booster for those who have received one dose of Tdap (5 years for wound management).

Only aP-containing vaccines should be used for vaccination in those aged >7 years.

It is desirable to regularly boost adult immunity against diphtheria in addition to tetanus every 10 years.

Safety of Tdap during pregnancy:

There is limited safety data available .A recent study demonstrated that infants whose mothers had received Tdap vaccine during pregnancy had higher pertussis antibody concentrations between birth and the first vaccine dose than the cohort whose mothers did not receive the vaccine.

IAP Recommendations in pregnancy

Tetanus toxoid, and reduced quantity diphtheria and acellular pertussis during pregnancy: Maternal immunization, particularly of pregnant women may be an effective approach to protect very young infants and neonates. IAP therefore now suggests immunization of pregnant women with a single dose of Tdap during the third trimester (preferred during 27 weeks through 36 weeks of gestation) regardless of number of years from prior Td or Tdap vaccination. Tdap has to be repeated in every pregnancy irrespective of the status of previous immunization (with Tdap). Even if an adolescent girl who had received Tdap 1 year prior to becoming pregnant will have to take it since there is rapid waning of immunity following pertussis immunization.

WHO guidelines for administration of Tdap/Td in pregnant women

Unimmunized: For pregnant women who have not been previously immunized, one dose of Tdap/Td and another dose of Td at least 1 month apart should be given during pregnancy so that protective antibodies in adequate titers are transferred to the newborn for prevention of neonatal tetanus. The first dose should be administered at the time of first-contact/as early as possible and the second dose of Td should be administered 1 month later and at least 2 weeks before delivery. A single dose of Tdap/Td should be administered in each subsequent pregnancy.

Fully immunized: Five childhood doses (three primary doses plus two boosters) and one adolescent booster Tdap: one dose of Tdap is necessary in every pregnancy.

INDIAN ACADEMY OF PEDIATRICS RECOMMENDATIONS ON PERTUSSIS VACCINATION

Primary immunization: The primary infant series should ideally be completed with three doses of wP vaccines. Goal is to achieve early and timely vaccination initiated at 6 weeks and no later than 8 weeks of age, and achieve high coverage (≥90%) with at least three doses of assured quality pertussis vaccine at all levels (national and subnational).

  • There is no data on the efficacy or effectiveness of aP vaccines
    in India and almost all the recommendations are based on the performance of these vaccines in industrialized countries.
  • The aP-containing combinations were licensed in India on the basis of immunogenicity studies only.
  • The aP vaccines may be preferred to wP vaccines in
    those children with history of severe adverse effects after previous dose/s of wP vaccines, children with progressive neurologic disorders, if resources permit. 

Boosters: The first and second booster doses of pertussis vaccines should also be of wP vaccine. However, considering a higher reactogenicity, aP vaccine/combination (Table 1) can be considered for the boosters, if resources permit.

Schedule in HIV positive infants

They should be immunized against pertussis.

Tdap/Td in Wound Management

For children who are completely unimmunized, catch-up vaccination should be provided by giving three doses of tetanus toxoid-containing vaccine (DTwP/DTaP/Tdap/Td) at 0, 1, and 6 months depending on the age of the child and nature of previous doses received for more comprehensive protection. For partially immunized children, catch-up vaccination entails administration of at least three doses of tetanus toxoid-containing vaccine including previous doses received. Children with unknown or undocumented history should be treated as unimmunized.

DT VACCINE

This vaccine comprises diphtheria and tetanus toxoid in similar amounts as in DTwP/DTaP, should be stored at 2–8°C and the dose is 0.5 mL intramuscularly. It is recommended in children below 7 years of age where pertussis vaccination is contraindicated.

  • Recommended schedule: Three primary doses at 6, 10, and 14 weeks and
    two boosters at 15–18 months and 4–5 years
  • Minimum age: 6 weeks
  • The first booster (4th dose) may be administered as early as age 12 months,
    provided at least 6 months have elapsed since the third dose
  • DTaP vaccine/combinations should preferably be avoided for the primary
    series
  • DTaP may be preferred to DTwP in children with history of severe adverse
    effects after previous dose/s of DTwP or children with neurologic disorders.
  • First and second boosters may also be of DTwP. However, considering a higher
    reactogenicity, DTaP can be considered for the boosters
    Catch-up vaccination:
  • Catch-up schedule: The second childhood booster is not required if the last
    dose has been given beyond the age of 4 years
  • Catch up below 7 years: DTwP/DTaP at 0, 1, and 6 months
  • Catch up above 7 years: Tdap, Td, and Td at 0, 1, and 6 months