Missed childhood vaccinations trigger worry

Children missing out on life-saving vaccines could lead to a resurgence of potentially fatal diseases, such as childhood pneumonias, diphtheria, tetanus, pertussis, hepatitis B and diarrhoea, among others, which threaten to reverse the gains India has made by immunising children against vaccine-preventing illnesses to bring down its infant mortality rate (IMR) from 33 per 1,000 live births in 2017 from 34 the year before.

IMR, which is the number deaths per 1,000 live births in the first year of life, is a crude indicator of the overall health of a country. India is inching closer towards the Sustainable Development Goal of bringing IMR down to 25 or fewer by 2030. Its current IMR being roughly a fourth of 129 infant deaths in 1971, according to the Sample Registration System (SRS) data released in June 2019, but deaths may rise if childhood vaccines are missed.

Many states in India have halted immunisation activities because of the national lockdown and community health workers are being asked to help with Covid-19 surveillance and contact tracing, which leaves them with no time to visit homes to immunise a children in rural areas.

“While the world strives to develop a new vaccine for Covid-19 at record speed, we must not risk losing the fight to protect everyone, everywhere, against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate,” said Dr Tedros Adhanom Ghebreyesus, director-general, World Health Organization (WHO).

With city hospitals and clinics suspending immunisation services till the lockdown is lifted, text messages received by paediatricians from concerned parents have shot up. “We assure parents that services will be resumed as soon as the is lockdown lifted, but still queries keep coming. We used to send reminders for vaccination dates, which have also been suspended, but all pending appointments will be addressed on priority as soon as things get back to normal. Children must be kept safe, from Covid-19 and all other diseases,” said Dr Krishnan Chugh, director, department of paediatrics, Fortis Healthcare.

The WHO also recommends that if immunisation services are suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritising those most at risk.

Parents seeking information on vaccination have made paediatrics the fastest growing speciality on online health portals, such as Practo, which registered a 350% growth for paediatrics on its eConsult platform since March 1. The top queries were to do with cough and cold, affect of delayed vaccination, and fever and headache in toddlers, according to the e-health platform.

“The health ministry has written to states twice asking them to continue routine immunisation, coverage of which is close to 90% but now risks falling rapidly. In rural areas, most children receive essential vaccines through government outreach using Ashas (accredited social health activist, or community health workers), who are now engaged in Covid-19 surveillance and community awareness programmes. If immunisation services stop, India risks losing gains it has made in lowering child mortality,” said the official with the Union health ministry, requesting anonymity.

One in five of the world’s 5.9 million under-5 deaths take place in India, with more than half being from vaccine-preventable and treatable infections, such as pneumonia, diarrhoea and sepsis. If all children are vaccinated after birth, more than half these lives could be saved.

In 2018, the last year for which global data is available, 86% of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine, up from 72% in 2000 and 20% in 1980, but an estimated 13 million children never receive any vaccines, putting them at risk of disease and death, according to the WHO.

“The stakes have never been higher. As Covid-19 continues to spread globally, our life-saving work to provide children with vaccines is critical. With disruptions in immunization services due to the Covid-19 pandemic, the fates of millions of young lives hang in the balance,” said Robin Nandy, chief of immunisation, Unicef.

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