Immunisation in Pandemic

• Due to the circulation of the virus causing  COVID 19 and the current pandemic there has been a disruption  in routine immunization  activities due to

1. Burden on the health care system
2. Community reluctance
3. Decreased demand for vaccination due to physical distancing requirements

WHO in a interior  guidance report published  on 26^th March 2020 (Guiding  principles for immunization  activities  during  COVID 19 pandemic) has expressed serious concerns  about  possiblity of outbreaks of VPD  (Vaccine  preventable Disease) e.g. Measles, pneumonia, diarrhoea, etc

There was a similar  situation during  EBOLA outbreak  in 2014-2015. The deaths caused by measles, malaria, tuberculosis  due to health systems failure in Africa was far greater  than deaths caused by EBOLA.

A modelling  study done by scientists  at the London school of hygiene  and Tropical medicine on the impact of suspending  routine  vaccine sessionsto prevent 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 34,1274 further deaths due to disease including measles, yellow fever, polio, meningitis, pneumonia etc. So any flare of VPDs will additionally  burden the already distressed health care system. The ministry  of home affairs in its guidelines dated April 15, 2020  has  directed that essential  medical services  be maintained during  the lockdown.

It should be emphasised that “Immunization is a core Health service, that should be prioritized for the prevention  of communicable  disease and safeguarded for continuity during the COVID 19 pandemic wherever feasible.”

At present there is no documented  risk of immunizing a well child during  covid 19 pandemic .

COVID 19 is a evolving disease and hence we need to  monitor strictly  for any increase in AEFI (adverse effects following immunisation).

WHO recommends

1. NITAGS (National Immunization  Technical Advisory  Group) have been advised  to advice the government  regarding maintenance, adaptation, suspension  and/or  reinstatement of immunization  services.
2. Based on the current understanding  of transmission  of COVID 19 virus and recommendation of physical distancing mass vaccination campaigns  should be temporarily  suspended.
3. Where health  system capacity  is intact and essential  health services are operational, fixed site immunization services  and VPD surveillance  should be executed while maintaining  physical  distancing measures
4. Formulate catch up vaccination strategies  for post-COVID period

ACVIP has given guidelines on

1. Continuation of immunization  activities,
2. Prioritization of certain vaccine,
3. Precaution to be taken while immunising.

General advice

1. Exclusive vaccine sessions.
2. Triaging of patients and separation of fever and RTI patients.
3. Senior citizens not to accompany children.
4. All caretakers and children except infants (<1-1.5 yr) should wear masks.
5. Vaccination  by appointment.
6. Stagger appointment to avoid crowding.

Prioritizing vaccines

1. Vaccinate newborns in maternity  set up before discharge–BCG/OPV and Hepatitis B.
2. Prioritize  primary vaccination  series DPT, HepB, HiB, OPV/IPV, Rotavirus, PCV, Influenza, Chicken pox and MR/MMR. Avoid postponing these vaccines
3. Typhoid conjugate vaccines may be clubbed with influenza at 6 months or MR/MMR at 9 months.
4. Inactivated JE vaccines at 1 year.
5. Hepatitis A vaccine and HPV  vaccine may be postponed to a later date.
6. Multiple vaccine can be given in one session .

Summary

1. Vaccines can be rescheduled.
2. Government machinery will restart immunization at the earliest.
3. Doctors and health  machinery  are aware of the importance  of immunization.