Question from AIPGE 2004
A 3½ year old child has not received primary immunization. Which of the
following is the best vaccination advice to such a child?
1. BCG, DPT1, OPV1, and DPT2, OPV2 after 4 weeks.
2. BCG, DT1, OPV1, measles, vitamin A.
3. BCO, DPT1, OPV1, measles, vitamin A.
4. DT1, DT2 and booster after 1 year.
Read On for a brief tutorial on this contentious topic
VACCINATION SCHEDULE FOR UNIMMUNIZED CHILD
BCG is not generally considered for children above 5 years. However, for the high-risk children above 5 years in endemic areas, BCG may be given as a vaccine under special circumstances. Taking all precautions like routine tuberculin testing, history of contact, previous anti tuberculosis therapy etc.
All the earlier views on complications due to DPT vaccine at or after 5 years have since been negated and hence the recommendations of DPT vaccine even upto 7 years. Since the risk of Diphtheria and Tetanus continues even after 7 years as compared to Pertussis, the recommendation of DT after 7 years and preferably Td at 10 and 16 years. 7 Doses of TT thus given offers protection up to 21-25 years.
Regarding HB schedule for unimmunized Children: The 3rd dose at 1 year has been recommended to reduce the number of contacts as otherwise the child has to make an additional contact for HB vaccine alone at 6 months, since at 1 year the child can also have the DPT, OPV Booster.
Now coming to the specific "Time Table" designed by you. Our suggestion will be
Age 4 to 7 years
I First :BCG*, DPT1, OPV1, HB1
Age 7 to 18 years
I First:DT1*/TT1 **, HB1, MMR
BCG* is indicated upto 5-7 years only for high risk children in endemic areas after routine Mx Testing.
DT**/TT** when given for the first time at this age at least 2 doses at 4 weeks interval.
Typhoid*** whole cell vaccine is recommended 2 primary doses at 4 weeks interval followed by a booster dose every 3 years.
Book:Report of the IAP Committee on Immunization:II Ed. Indian Academy of Pediatrics, Kailash Darshan, Kennedy Bridge, Mumbai:40,47,49-50.