Lockdown and Delayed Vaccination – Here’s What You Can Do About It!

Before you give birth, you cannot imagine loving someone so deeply and unconditionally. But quickly, your baby becomes your whole life; your love for her can push you to do everything in your power to keep her safe and healthy. However, for several parents, concerns have transformed into grave worries because the pandemic is inducing fear of exposure to the coronavirus if they take their babies to a hospital. This is causing a delay in regular check-ups and vaccinations. If your little one needs to be vaccinated, but you are worried about how to go about it during this pandemic, you’ve come to the right place to get some answers. We will be talking about everything you need to know about immunization, the reasons and risks of delaying vaccination, and more.

How Important Is It to Get Your Child Immunized?

Immunization is crucial in protecting your child from infectious diseases such as polio, smallpox, rubella, measles, etc. Babies have underdeveloped immune systems, and need vaccinations along with breast milk and a balanced diet (when they are weaned onto solids) for appropriate and uncompromised mental and physical growth. Each disease has a separate vaccination, and each of these vaccines has a schedule that needs to be followed, to be able to give your little one the immunity she needs to fight the diseases. Therefore, parents can either adhere to a vaccination tracker, or consult a paediatrician and maintain a vaccination calendar for their babies.

However, given the current situation, you might think twice (or ten times) before taking your child to a hospital or clinic to get her vaccinated. Delayed immunization is not a new phenomenon, but it is not recommended, either. Read on below to find some information about delayed vaccination, according to the National Immunization Schedule.

What Is Delayed Vaccination?

Delay in vaccination is the alteration of the sequence of vaccination scheduled for children, according to the National Immunization Schedule. It delays the protection of children against harmful diseases even when the vaccination coverage is high (percentage of people who receive vaccination in a population), mainly because the actual duration of protection is less. Alternative vaccine schedules could also impact the effectiveness of vaccines by affecting their immunological memory.

According to a study published in the Journal of Tropical Pediatrics, a delayed vaccination schedule can be defined as either missing the vaccination within the eligible age of the child (under the National Immunization Schedule) or delaying it by two weeks.

Here is a tabular representation of the National Immunization Schedule. We have also provided detailed information on the vaccines that can/cannot be delayed, later in the article.

Name of Vaccine	Age at Vaccination	Strict Definition of Delay	Loose Definition of Delay
BCG/OPV0	At birth	>6 weeks	>8 weeks
OPV1/DTP1	6 weeks	>6 weeks	>8 weeks
OPV2/DTP2	10 weeks	>10 weeks	>12 weeks
OPV3/BCG3	14 weeks	>14 weeks	>16 weeks
Measles	9–12 months	>9 months	>9 months and 2 weeks
OPV/DTP Booster	16–24 months	>24 months	>24 months and 2 weeks

Source: https://academic.oup.com/tropej/article/58/2/133/1636826

At times, parents make a decision to follow their own vaccination schedule (which is not recommended, as it wouldn’t protect the child at the right age), or follow a doctor’s suggestion to delay the vaccination due to medical reasons. Let’s take a look at some reasons why vaccination could be delayed on medical grounds.

What Are the Reasons for Vaccination Delay?

It’s natural for us to think that the lockdown is the only reason for delayed vaccination in children at present. It is definitely a valid reason, as the pandemic has changed a lot of things! However, it’s not the only reason. Vaccinations could be delayed due to –

1. Allergic Reactions

A severe allergic reaction to an earlier vaccine could be a reason why the next scheduled vaccine may be delayed. Such a reaction could include a fever, a drop in blood pressure, headaches, and breathing difficulties in babies. For example, children with egg allergies risk a chance of having an allergic reaction to flu shots. Their flu vaccines are therefore delayed or limited to smaller doses.

2. High Fever

Vaccinations are often delayed if the child is running a high fever of 101 or more on the day of the vaccination. This is because, if the side effect of a certain vaccine is high fever, it will be difficult to gauge it if the child already has a temperature.

3. Asthma

A persistent bout of asthma will need to be looked into before giving your child a flu shot. While the flu vaccine, which has dead viruses, won’t aggravate the condition, a nasal flu vaccine is not recommended as it has live but weakened viruses.

4. Medication

Specific medication can decrease the activity of immune cells. Medicines with high dosages of steroids will require vaccinations to be delayed. Therefore, vaccines for chickenpox, rotavirus, measles, shingles, mumps, and rubella, which are all live-virus vaccines, should be given after the medication dose is over.

5. Being HIV-Positive

Kids who have been tested HIV-positive will need to delay the live-virus influenza vaccine if their immune system is compromised. For the other vaccines, the T-cell count needs to be in an acceptable range. If that is not the case, those vaccines are also delayed.

6. Immunodeficiency Treatments

Children undergoing immunosuppressive treatment or chemotherapy, or those with a compromised or weakened immune system, would also need certain vaccines to be delayed (mainly those with live viruses).

Since the pandemic, several hospitals have reported a drastic drop in immunizations being performed. As children below the age of 10 have been strictly advised to stay indoors, there has been a drop of about 30% in vaccinations for chickenpox, pneumonia, typhoid, meningitis, and hepatitis.

Which Vaccines Can and Cannot Be Delayed?

It is highly recommended that you adhere to a vaccination schedule for your baby, as a delay can result in risks and harm due to infectious diseases. However, there are some vaccines that can be given to your child at a slightly later stage. Refer the list of vaccinations below to find out which vaccinations can be delayed, and which ones shouldn’t be delayed. After that, you can plan your trip to the hospital wisely!

Vaccines That Can Be Delayed:

• DTP first booster (DTP B1) can be given to children between the age of 16 and 18 months. The bracket of 2 months is a safe time for you to delay the vaccination, but not longer than that.
• Inactivated Polio Vaccine (IPV) first booster is also given to kids between 16 and 18 months of age. Depending on your child’s age, you can safely delay this vaccine by a couple of weeks.
• DTP second booster (DTP B2) can be given any time between 4 and 6 years of age, so you get a 2-year gap to get your child vaccinated.
• Haemophilus influenzae type B vaccine First Booster (HiB1) can be given between 16 and 18 months of age.
• Varicella 2 vaccination can be scheduled for any time between the ages of 4 to 6 years.
• Hepatitis A (HEP A2) can be given any time between the ages of 16 and 18 months.
• TDAP (Tetanus, Diphtheria and Acellular Pertussis) can be given to children between 9 and 14 years of age.
• TD (Tetanus and Diphtheria Booster) can be given between 15 and 18 years of age.
• HPV (Human Papilloma Virus) shots 1 and 2 can be given between 9 and 14 years, or they can be given along with the 3rd shot any time between the age of 15 and 18 years.

Vaccines That Cannot Be Delayed:

• Bacille Calmette Guerin (BCG) vaccine – given at birth.
• Hepatitis B birth dose.
• Hepatitis B (HB 2, 3, and 4) – given at week 6, week 10, and week 14 respectively from birth.
• Oral Polio Vaccine (OPV) birth dose – given within 15 days of birth.
• IPV 1, 2, and 3 – given at week 6, week 10, and week 14 respectively.
• DTP 1, 2, and 3 – given at week 6, week 10, and week 14 respectively.
• Haemophilus Influenzae Type B vaccine (HiB 1, 2, and 3) – given at week 6, week 10 and week 14 respectively.
• Pneumococcal (PCV 1, 2 and 3) – given at week 6, week 10, and week 14 respectively.
• Rotavirus – given at week 6, week 10, and week 14.
• MMR 1 and 2 – given at 9 and 5 months respectively.
• Varicella 1 – given at 15 months.
• Hepatitis A – given at 12 months.
• Typhoid (TCV) – given at 6 months.
• Meningococcal (MCV 1 and 2) – given at 9 and 12 months respectively.
• Japanese Encephalitis (JE 1 and 2) – at 12 and 13 months respectively.

Source: https://www.indianpediatrics.net/dec2018/1066.pdf

Getting your kids vaccinated might seem daunting, but you cannot skip these shots! The timelines and brackets that some vaccines have might put you at ease, as you can delay them for a few weeks or months, depending on your child’s age. Several studies have certain loose and strict definitions for delaying the mandatory vaccines, too. One such study is discussed below. Nonetheless, it is always best to consult a paediatrician who will closely assess your child’s health, and advise you according to the guidelines, which we will discuss now.

Are There Any Guidelines Being Followed for Delayed Vaccination?

No medical expert would recommend altering the vaccination schedule, but if vaccination has to be delayed under certain circumstances, they follow these guidelines set by the World Health Organisation.

Another way of altering the vaccination schedule is to know whether your child can get multiple shots together. The next section will answer this question.

Can Children Be Given Multiple Shots Together?

Most vaccines are available in combinations, such as DTP and MMR. What affects the impact of a vaccination is the presence of an antibody (a fighter cell) that would interfere with the immunization effect of a live-virus vaccine. So, not all shots can be combined or given together during the same visit. A waiting time of 15 to 30 days is recommended in such cases. Consulting your paediatrician for more guidance is recommended, as each case will be different.

Clearly, there are concerns when it comes to giving multiple shots to children. This might make parents determined to wait until the lockdown is lifted. But, is delaying vaccination normal, and for how long can you do it? Let’s find out!

Is It Normal to Delay Vaccination in Lockdown?

As explained earlier, vaccines provide the necessary immunity for your child to fight infectious diseases. Therefore, they must not be delayed. However, it is okay to delay vaccines if you have a time bracket of couple of weeks or months, and if the paediatrician advises so. The paediatrician would also assess your child for vaccination preventable diseases (VPD), which is uncommon but can still exist and cause an outbreak in the community.

For How Long Can You Delay Certain Vaccines?

The mandatory or the primary vaccines that are given in the first 12 months of the child’s birth must be adhered to. The booster shots, however, can be delayed, depending on your child’s health condition and the permissible timeline according to your child’s age. It is highly advised that you stay in touch with your paediatrician and keep a detailed report of your child’s health and vaccination schedule.

If you are still contemplating delaying your child’s vaccination schedule, you should know the risks involved, so as to make an informed decision.

What Are the Risks of Delayed Vaccination to a Child?

Delayed vaccination comes with a set of risks. Vaccines are scheduled to provide immunity to your child at the right age, and also protect the people around her, be it family or the community. Let’s take a look at the risks in detail.

1. Risks to the Child

Unimmunized children are at a high risk of catching infectious diseases such as –

• Polio – Polio can cause permanent paralysis.
• Measles – Can lead to brain damage or death.
• Mumps – Mumps can severely affect your child’s hearing, and cause deafness.
• Meningitis – Meningitis can also cause severe damage to hearing, deafness and brain damage.
• Tetanus – This disease is caused by germs found in the soil. A minor wound coming in contact with even a little bit of soil can lead to a tetanus infection.

2. Risks to Others

Delayed immunization in your child can also affect the health of the family members. The ones at risk are –

• Those with compromised immunity.
• Infants who are too young to be vaccinated.
• Those with chronic health conditions.
• Elder family members who are at risk of health complications.

When you cannot delay the vaccination schedule anymore and need to take your little one to the hospital, you must take some precautions to keep her safe.

What Precautions Can Be Taken When Visiting a Hospital or Clinic?

Taking the following precautions when getting your child vaccinated will help you ensure her safety:

• Speak to the receptionist to ensure the hospital won’t be crowded, and to know the norms they are following to maintain hygiene and social distancing.
• Take an appointment to avoid staying longer for your turn at the hospital.
• Ensure you don’t have more than one attendant attending to your baby.
• For toddlers, be sure they wear a mask along with you and avoid touching surfaces.
• Use sanitising wipes to wipe the seats and armrests of chairs if you or your child need to sit down.
• For infants, use a face shield to protect them.
• Ensure the attendant also wears a mask and gloves, and he/she sanitises his/her hands appropriately before vaccinating your baby.
• As much as possible, opt for hospitals that have digital platforms to update information electronically and discourage the use of paper and pen.

FAQs

1. Why Can’t I Postpone Certain Vaccines If I am Planning for My Infant to Get Them All Eventually?

Your little one’s immunity is underdeveloped, and she is at a high risk of contracting infectious diseases that could potentially be fatal. The National Immunization Schedule is designed keeping in mind your child’s immunization requirements. A delayed vaccine schedule, especially the primary vaccination schedule, will leave your child unprotected when she needs it the most. Therefore, adhering to the vaccination schedule is a must.

2. Can There Be Any Advantages of Delaying Vaccinations?

There are no advantages of delayed/late vaccination, especially when talking about the primary vaccinations, because your child is left unprotected from several diseases without immunization. Any lapse in the vaccination schedule can cause severe health conditions. The booster shots, however, can be scheduled for a later stage, but only if your paediatrician suggests the delay after assessing your child’s complete health report.

3. Do I Need to Immunize My Child on Time, Even If I am Nursing?

As explained in the article above, most primary vaccines are given to infants before they turn a year old. It’s true that breast milk does protect your baby from simple illnesses by providing her with certain essential antibodies, but it does not protect her much from infectious diseases such as polio, tuberculosis, chickenpox, etc. Therefore, skipping vaccination while nursing your baby is not a wise thing to do.

4. Will My Child Have to Initiate the Vaccines All Over Again in Case I Miss an Appointment?

No, your child will not have to get the missed vaccines all over again. Most medical practitioners follow the recommendations given in the delayed vaccine schedule chart designed by the World Health Organization (given above in the article). Nonetheless, you must contact your paediatrician for appropriate guidance on late vaccinations.

5. Can I Delay Vaccination If My Child Is Over a Year-Old?

Most experts advise parents to adhere to the vaccination schedule, because delayed immunization is the most harmful for babies that are under a year old. For children who are over a year old, some booster shots can be delayed. Consulting your paediatrician is recommended before changing the vaccination schedule.

Immunizing your little one will help provide her with a healthy future. The lockdown and the fear of catching the virus can result in delayed vaccination, but several hospitals take precautionary measures to allow parents to get their children vaccinated on time. Consult your paediatrician for an alternative schedule if you are too worried about taking your child to a hospital or clinic. But, if your little one is an infant, it is in her best interest not to skip or delay the vaccination schedule.

Also Read:

Vaccination for Newborn Babies in First 24 Hours
Myths and Facts about Vaccines
Can Infants Get Vaccines with Cold or Cough