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Can infections be prevented in older infants?

There are a number of diseases from which one can protect the infant, by immunizing them. The mother must know about these. I would suggest immunization against Smallpox, Tuberculosis, Tetanus, Whooping Cough, Diphtheria, Polio and Measles, in the first one year of life, later on Boosters must be given for continued protection.

In what order would you advise immunization?

The order of immunizations should depend on the disease pattern in the community. In India we like to give BCG from birth to three months. DPT and Polio at monthly intervals for three doses starting from 4th month onwards. Measles vaccine is advised at 9 —12 months and Smallpox vaccination, at one year of age. First Booster of DPT and Polio is done at 18 months to 24 months and second Booster at 5 to 6 years of age. Later Diptheria, Tetanus and Typhoid inoculations are advised every five years for continued protection.

What are the cotraindications for immunization? Do they have any ill effects or complications?

There are a few contraindications for immunization. For example Polio drops should not be given when the child is sick. In fact

I would suggest that all these immunizations should be done when the child is normal and healthy. If the child has cold, cough, diarrhoea, fever or any skin disease like eczema, immunization is not advised. A doctor must be consulted before giving immunization in these conditions. Another condition where immunization should be done under medical advice is a child who had convulsions in the past.

Every immunization can have different complications. Let us take first, one which has no complication. As a rule Polio does not have any complication. With DPT (Triple Antigen) the infant might have temperature which should disappear within 48 hours on its own. But it is a good practice to give Baby Aspirin and this could be repeated and temperature will come down. As regards Smallpox, there could be very many complications if the vaccinated site is not looked after well. Normally we do not expect complications. High temperature, redness or even swelling at the vaccination site are common accompaniments. At times one can get a rash which can be red in character like Measles or other skin complications.

Rash which is red in character usually disappears on its own. In a child, with eczema, secondary vaccination sites can appear on other parts of the body and that is the reason why it is not advisable to have vaccination done for a child with skin lesions. Other complications are uncommon. BCG vaccination usually heals within six weeks but at times there is enlargement of glands in the axilla, which is normal and should not cause any anxiety unless it does not resolve at the end of six weeks at which time the mother should see the doctor. The BCG mark should also form a scar during this period. If there is discharge from the vaccinated site, the doctor must be consulted, but please do not apply any thing on it.

What is the reaction of the Smallpox vaccination and what care should be taken?

The Smallpox vaccination once given usually shows a reddish reaction on the third day which becomes a vesicle on the 5th and pustule on the 7th day. This lasts for 48—72 hours, when the pustule bursts discharging its contents and leaving an ulcer which usually crusts up by the 14th day and heals by leaving a scar at the end of 3 weeks. High temperature may be there on the 8th and 9th day with a lot of redness on the vaccinated site. It is necessary to keep the temperature down (with paracetamol or aspirin). As regards the care of the vaccinated site, it is necessary to' realise that nothing should be applied on it. No powder or medicines need be applied. If necessary, spirit may be applied two to three times a day. When the vaccinated site is discharging, it is very necessary that clean cotton is used for cleaning it.

What is the course of the BCG vaccination?

BCG is done on the left arm, high up. The mark caused by the injection usually disappears and for two to three weeks there may be no reaction on the site. After about three weeks a small vesicle appears at the site of injection, this becomes opaque and later a discharging ulcer. In the course of 2—3 weeks the whole thing clears up leaving a -scar at the site.

During this process the regional lymph-nodes in the axilla always enlarge, sibsiding on their own. In some infants they may take longer.

What are the untoward manifestations of BCG?

The ulcer on the arm may continue discharging for some time but usually heals by 12 weeks. In any case no medicines should be given before this period.

The regional lymph-nodes may enlarge and not regress. Again unless they soften up or become an abscess they should not be touched. If a discharging sinus forms, it needs surgical and medical treatment, so ask your doctor for advice.

Can BCG cause tuberculosis?

No, not in common terminology. I say this because by introducing the germs which are attenuated, one hopes to cause a small primary complex at the skin level, so that immunity is developed. But it does not cause tuberculosis as we understand it. If a child has had the infection earlier then the reaction to BCG inoculation will be very marked which should draw the attention of the treating physician for further investigations and treatment.

What is meant by the term vesicle and pustule?

The term vesicle means small blister filled with clear fluid and pustule means blister with opaque material.

Is it essential to repeat the Smallpox vaccine, if it does not errupt the first time and at what age should we repeat triple antigen vaccine?

If there is no effect of the Smallpox vaccination, i.e. no successful scar, it should be repeated every six weeks till it is positive, and later every three years. Triple Antigen must be repeated at 1 year after the last injection and then at 5 years and later it should not be DPT but DT only, every three years, till the child is 15 years of age. We do not like to give DPT after six years of age. since pertussis vaccine may be dangerous.

Why is the whooping cough element dangerous?

The whopping cough vaccination, if given after the age of six, may produce encephalitis in one in 100,000 cases. We do not want to take any risk with your precious child, hence we do not advise it after the age of six.

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