Starting today – 31 the world will focus its attention on Immunisation. That the WHO has decided to set apart a whole week to devote attention to this subject is extremely relevant considering that epidemiologists are now fighting against the emergence of a new deadly highly communicable virus, Covid-19 for which there is still no vaccine. The Sunday Observer spoke to Consultant Epidemiologist Dr Deepa Gamage, Epidemiology Unit, Ministry of Health to find out what measures are advised to minimise the risks of transmission of Covid-19 as schools get ready to re-open and why immunisation is especially vital at this time around .
Excerpts …
Q: The immunisation program for children and pregnant mothers have not been conducted for some time. Why was it stopped? Has it been recommenced? Considering the current health crisis in the country is it a priority attention?
 Dr Deepa Gamage |
A: The immunization activities of children and pregnant women were temporarily suspended in mid-March 2020, due to the curfew imposed in the country along with other stringent measures to control the spread of Covid-19. Considering the requirement of continuing age appropriate vaccination, and maintaining immunity in preventing vaccine preventable deadly diseases, the resumption of childhood vaccination has always been considered a priority in the country. However, due to the Covid-19 outbreak in the country, we need to take very stringent measures in conducting vaccination clinics to prevent Covid-19 transmission while conducting immunization clinics.
Q: What are the measures the Epidemiology Unit has taken to reduce risks of Covid-19 transmission when conducting immunisation clinics in the country?
A: To prevent transmission of the disease at clinic settings, the Epidemiology Unit has recommended relevant precautionary measures on how, when and what to do in conducting immunization clinics. Specialist Paediatricians at hospitals and all technically competent Regional Epidemiologists, Consultant Community Physicians at district and provincial level and Medical officers of maternal and Child Health are working together with Medical Officers of Health in guiding the field health staff, monitoring and supervising the procedure taking all preventive measures for Covid-19 transmission.
Q. As many people still don’t fully understand why immunisation is necessary, explain its role in preventing communicable diseases and boosting immunity against communicable diseases.
A. Immunisation provides protection for specific vaccine preventable diseases through the vaccine. Some communicable diseases have very high transmission and if unprotected without giving relevant vaccines, and if one contracts those diseases it can cause serious complications. A child or a person can die or suffer from long term disabilities arising from complications of the disease. By giving the vaccine, antibodies are developed to fight against a particular disease. It will protect the child if he comes in contact with an infected person subsequently.
Q: Briefly outline the schedule of the current national immunisation program and what specific diseases are covered by it.
A. The BCG vaccination is given at birth and should not be stopped or postponed during this outbreak situation as almost all babies are born in hospitals. Usually for all eligible babies BCG vaccination is given at birth within 24 hours after birth before discharging the baby from the hospital. The Petavalent vaccine (provide protection to Diphtheria, Pertussis, Tetanus, Haemophilus B and Hepatitis B) and Oral Polio Vaccine (OPV) and Inactivated Polio Vaccine (IPV) are given at two and four months of age, and another Pentavalent and OPV doses at six months of age.
When the baby is nine months old MMR (to protect from Mumps, Measles, and Rubella) dose is given followed by Live JE vaccine (to protect from Japanese Encephalitis) at one year of age.
Booster dose of DPT (Diphtheria, Pertussis, Tetanus) and OPV are given at 18 months and MMR 2nd dose at three years of age. Another booster of DT (Diphtheria, Tetanus) dose and OPV are given when the child is five years old.
Q. What about children attending school?
A. At school level, Human Papillomavirus (HPV) vaccine is given to girls at Grade 6 on completion of 10 years as two doses in keeping a minimum of a six month gap in between for the protection for cervical cancer which could get in middle age.
Also, Td vaccine to boost the immunity to prevent diphtheria and tetanus is given to all children in Grade 7 as a booster dose for Diphtheria and Tetanus.
Q. Pregnant women- what are the vaccines that can protect their newborn or foetus?
A. Pregnant women are given TT (Tetanus Toxoid) vaccine to protect the newborn from neonatal tetanus, which can be contracted at birth or soon after. According to our schedule requirements they will get two doses during 1st pregnancy and an additional dose in subsequent pregnancy.
Q. With the lifting of curfew, and fears of Covid-19 outbreak still persisting will there be a change in the schedule of the National immunisation program?
A: There is no change in the schedule, and the same schedule will be continued from the recommended age as 1-2 months. But most important are some other important recommendations we have given to follow in these clinics to prevent Covid-19 transmission and to provide vaccination to all missed children. These include the following:
1. To minimise the number of attendees at a given time, clinic staff should prepare a schedule for the Public Health Midwife (PHM) areas to the clinic. Based on the schedule the respective PHM should give prior appointments to clients in their areas to prevent overcrowding.
2. All health care staff involved in immunisation should follow the appropriate infection control measures
3. In providing immunisation services in Covid-19 affected areas (currently reporting or reported Covid-19 patients within preceding month), it is advised to wear a surgical face mask during the immunisation service procedure.
Q. What about protective measures to prevent respiratory diseases?
A. It is important that the clinic staff and the attendees strictly adhere to the following protective measures to prevent the spread of respiratory diseases:
1 Establish a reception desk / counter to screen / identify parent- child with respiratory tract infection by history.
2. The person at the counter should wear a surgical face mask.
3. Should not perform immunisation services during the respiratory tract infection and assure that a new appointment will be given for vaccination once recovered.
Q. Any special precautions to be taken at immunisation clinics in the case of children with respiratory problems to prevent Covid-19 transmission?
A. A child with respiratory symptoms should be postponed until the symptoms are fully resolved after treatment. During the time of giving appointments, health workers should advise mother/caregiver not to bring any child with respiratory symptoms until fully cured. They should also advise parents/ caregivers with respiratory symptoms not to accompany a child for immunisation and advise them to arrange another healthy person to accompany the child as a clinic attendee. In the event of immunising a child from a family where a family member/ members are being quarantined, the vaccination should be postponed until the quarantine period is completed.
Q. Any other precautions?
A. All staff should adhere to cough etiquette. All attendees should wash their hands with soap and water before entering the clinic (ensure that hand washing facilities are available in each clinic) and practise hand washing after each child vaccination. The clinic attendees should maintain a safe physical distance between each other (at least one metre.) Only a minimal required number of people should attend the clinic from one household in order to minimise overcrowding. Only the mother/ care giver and the child due for the vaccination should enter the vaccinating clinic room.
Q Any particular seating arrangements inside and outside the clinics?
A. Seats for the attendees should be arranged keeping a minimum of one metre’s distance or seating arrangement on every other chair based on the availability of the space. Ensure minimum number of clinic attendees at a time (based on the clinic space available), inside and outside the clinic premises as a measure of minimizing the possibility of Covid-19 transmission. Keep the premises well ventilated with all doors and windows open with fans switched on.
Q. With schools set to open shortly and fears of Covid-19 spread, tell us how your immunisation program will be conducted this year. Will it be the same as before?
A: In schools, immunisation clinics will be conducted the same as before. There is no requirement to change immunisation clinic settings in the school.
Q. Is immunisation a guarantee against preventable diseases for a lifetime? Or can a person get the same disease against which she/he was immunised again?
A. The national schedule includes several doses for the same disease in order to provide adequate protection. These different multiple doses usually provide adequate lifelong protection. But for some diseases like measles and rubella, additional catch-up vaccination has been conducted for adequate protection of adults sometime back. The elderly are usually protected as herd immunity, which means once the majority of the population is immunized and adequately protected (either through vaccination or through previous disease situation), un- immunised few people are protected as continued disease transmission cannot happen due to the protected majority.
Q. How does the Expanded Immunisation Program operate?.
A. The main responsibility of policy, procurement, implementation, monitoring and evaluation of the National Immunisation program is under the Epidemiology Unit, Ministry of Health. Immunisation is considered as Communicable Disease control and prevention strategy. Vaccine-preventable disease surveillance is also considered in taking decisions for the National Immunisation Program schedule plans. The vaccination is considered as the life course approach in providing adequate protection. There is an Advisory Committee on Communicable Disease which includes several experts from different expertise in the committee and is headed by the Director-General of Health Services in the country for the immunisation program decisions.
Q. For our readers benefit sum up the golden rules with regard to immunisation – why it is important and how it could protect one from preventable diseases which could lead to morbidity and fatality.
A: Vaccinate your child starting at birth throughout the life course and at the appropriate age to prevent morbidity and mortality as this will offer them a chance to have adequate protection against long term disabilities besides ensuring a healthy nation.