A Parent’s Guide to Childhood Immunization

A Parent ’ s Gu i de to A CSR Initiative by: Himalaya BabyCare Childhood Immunization

Dr. Srinivasa Murthy C L A Parent’s Guide to CHILDHOOD IMMUNIZATION A CSR initiative by: Himalaya BabyCare Co-Author: Dr. Lathiesh Kumar Kambham Editor: Dr. Chetan Ginigeri

Disclaimer The content of this book is for informational and educational purposes only and is not intended to replace the advice or medical care of a doctor. As new findings become available through research, some of the recommendations herein might be subject to change. You are encouraged to seek the up-to-date information on childhood vaccinations from your physician or your child’s pediatrician. All rights reserved. Copyright of this material/book and its content shall subsist with Himalaya Wellness Company. Copying this material/book and its content without the permission of Himalaya Wellness Company is a punishable offense. A Parent’s Guide to CHILDHOOD IMMUNIZATION Copyright © Himalaya Wellness Company, 2024

It all began in 1930 in the forests surrounding Dehradun. Mr. M. Manal, the founder of Himalaya Wellness Company, curiously looked on as villagers fed the roots of a local herb to calm a herd of agitated elephants.This herb was Rauwolfia Serpentina, the inspiration that led to the creation of Serpina®, the world’s first natural antihypertensive drug which was launched in 1934. Mr. Manal embarked upon the journey of uncovering the mysteries of Nature at a time when herb-based health care was looked at with skepticism. Fuelled by his vision of bringing the best of Nature’s solutions backed by scientific research to people suffering health concerns, he was determined to contemporize Ayurveda through modern technology. With a single hand-operated tableting machine bought after pawning his mother’s bangles, he strode ahead on the road less traveled and full of challenges. It took him four years of extensive research to formulate the first offering Serpina®, which laid the foundation for Himalaya’s strong foothold in research. In 1955, came the historic breakthrough that established Himalaya as a symbol of trust in the Indian healthcare landscape. Liv.52, a formulation for liver health, became the best-selling flagship offering and a name synonymous with brand Himalaya. Ever since, as a head-to-heel problem-solving brand, Himalaya has introduced many other iconic products such as Septilin, Cystone, Bonnisan, and Rumalaya forte, which reinforced the trust of millions of customers, making Himalaya a household name. Broadening horizons, Himalaya diversified into Personal Care, BabyCare, Wellness, and Animal Health while consolidating all portfolios under one umbrella “Himalaya Since 1930”. Today, Himalaya is a leading global health and personal care brand with close to 500 products sold in over 100 countries – touching millions of lives every day and realizing the promise of Happiness through Wellness in every home and heart.

Babies have always been a top priority at Himalaya BabyCare. Hence, we are committed to helping parents with offerings and initiatives on baby and mom care, making their parenting journey hassle-free and worry-free. Immunization is the key to child survival and health. Childhood immunization ensures life-saving protection against vaccine-preventable diseases like measles, polio, tetanus, and more. However, millions of children in India are deprived of vaccines due to various reasons like safety concerns, misinformation, and lack of awareness, to name a few. We believe that interactions/advice of health professionals is critical in shaping parental attitudes regarding vaccination. This book is an ongoing effort from Himalaya BabyCare to educate parents on the risks associated with childhood illnesses and the life-saving benefits of vaccines.The content of this book is created based on the frequently asked questions from parents across regions, in a simplified manner. With this book, while we intend to address the concerns of parents willing to vaccinate their children, our primary focus is to create awareness amongst hesitant parents who delay or refuse vaccination, thus empowering them to make the right choices toward ensuring healthy and quality lives for their children. With Babies Always, Himalaya BabyCare Our Purpose

We understand that your precious little one's delicate skin needs special care. Keeping this in mind and your baby's safety at the forefront, we have thoughtfully crafted a range of baby care products based on the Ayurvedic discipline of Kaumarabhritya. Our products are gentle, research-based, and free from harsh chemicals, formulated to help nourish and protect your baby's skin. Himalaya BabyCare Gentle • Safe • Researched

Table of contents What is a vaccine, and how does it work? What to expect during your child’s vaccination visit ChildhoodVaccination for Preventable Diseases Q&A onVaccination (Part 1): General Vaccination schedule recommended by the Indian Academy of Pediatrics AvailableVaccines Q&A onVaccination (Part 2): Specific 10 16 23 27 47 53 56

WHAT IS A VACCINE, AND HOW DOES IT WORK? 1

Did you know? One child dies every 20 seconds from a disease that could have been prevented with vaccination. However, children who survive develop severe physical disabilities. Immunity Our immune system is designed to protect us from anything foreign entering our bodies. Doctors call these things “non-self.” When a disease-causing organism, that is, a germ–virus or bacterium enters the body, the immune system recognizes it as “non-self” and produces antibodies to get rid of it. These antibodies find and destroy the specific germ that is causing the infection. In addition to destroying the germ, the immune system records every pathogen it has ever defeated to recognize and destroy the microbe quickly if it re-enters the body. This is called immunity! Immunity is why a person who gets an infectious disease doesn’t get it again. It is indeed a very efficient system, but there is only one problem. The first time a child is exposed to a disease or infection, their immune system cannot create antibodies fast enough to keep them from getting sick. Eventually, the immune system will fight off the infection and This staggering number underlines the fact that globally, one out of five children does not receive timely immunization that could not only save lives but keep children safe and healthy. 11

Vaccines Vaccines resolve this delicate situation. Vaccines contain the same germ that causes the disease. This germ has been either killed or weakened to the point that it does not make your child sick. The vaccine stimulates the immune system to produce antibodies, exactly like it would if the child gets exposed to live germs. The child will develop immunity to that disease and, best of all, doesn’t have to get sick in the first place. This makes the vaccines such potent medicine. It won’t be wrong to say that most children get fully protected after receiving the vaccines. It means that they will never get serious diseases or infections if they are immunized against vaccine-preventable diseases. Our immune system is designed to protect us from anything foreign that enters our body. When a disease-causing organism enters the body, the immune system recognizes it as “non-self” and produces antibodies to get rid of it. leave the child resistant to future infections, but not before the child gets sick with that infection. Put simply, the child must get sick before developing immunity. 12

In the future, if the disease-causing germs attack the body, the antibodies are ready to fight and destroy them. Your child is protected! How do vaccines work? A weakened form of the germ-virus or bacterium is injected into the body. The body thinks the weak germ is a threat and builds antibodies to fight them. How well do vaccines work? Vaccines work well. Like medicine, not all vaccines are 100% effective. However, most vaccines are highly effective. In fact, after standalone or multiple doses, immunization can offer vaccine-induced immunity about 90 to 100% of the time. For better understanding, consider vaccines as seatbelts. Although they are not 100% effective at protecting you while driving, they significantly reduce the risk of being injured. In rare cases, vaccinated children can still get the disease because they only get partial protection from the vaccine. This is more common in children with an underlying health problem that affects their immune systems. They may develop mild symptoms if exposed to the disease-causing germ but will not suffer from serious complications. 13

How safe are vaccines? You may wonder if vaccines can harm your child. Probably not. Any medicine can cause a reaction. Even aspirin and vaccines are no exception. Most children won’t have any reaction to a given vaccine, but for those who do, most reactions are minor—a sore leg, a slight rash, or a mild fever that goes away within a day or two. Some children may develop moderate reactions such as high fever, chills, or muscle aches. A few of the serious reactions are febrile seizures or fits and severe allergic reactions. These worrying possibilities may make some parents think that it might be better not to vaccinate their children. However, these reactions are rare and affect one in a million children. Evena life-threateningallergic reaction can be brought under control by a doctor in the hospital. In addition, we have weighed the benefits of vaccines over their rare and severe side effects. Further, immunization protects children against specific and serious diseases, which would otherwise cause stress and worry about whether a child becomes severely ill or possibly die from a condition that a vaccine could prevent. 14

Some vaccines can also be given orally (by mouth) or nasally (sprayed into the nose). Most vaccines are given by injection (a needle) into your child’s thigh or rarely left arm. How are vaccines given? Your child can safely get more than one vaccine at a time. Some vaccines protect against multiple diseases in a single shot, while others are given separately. 15

What to expect during your child’s VACCINATION VISIT 2

Relevant information that needs to be shared If your child had a severe allergic reaction to previous vaccination or a vaccine ingredient Babies often develop a sore leg or mild fever after vaccination. However, let your healthcare provider know if your baby has ever had a serious reaction. A few uncommon reactions such as anaphylaxis or febrile seizure could be the reason not to get another dose of a specific vaccine. Milder allergies aren’t a problem, so don’t worry if your child might have allergies you are unaware of. Before the vaccination visit If you have a vaccination record card for your child, take it along with you so that the healthcare provider can enter the vaccine details administered during that visit. If your baby is getting the first vaccination(s), ask for a vaccination record card. This record could come in handy later to share the necessary information on your child’s vaccination, for example, if your child is getting into a school, you are moving to a different location, switching doctors, or traveling abroad. 17

During the vaccination • Your healthcare provider will ask questions to determine whether there are reasons your baby should not get certain vaccines. If your child has a high fever or a history of fever after receiving a vaccination Mild fever is not a cause of concern as it is one of the most common side effects after immunization. However, high fever may hinder the vaccine efficacy. If your child has a compromised or suppressed immune system Medical conditions such as AIDS, cancer, or medical treatments including steroids, chemotherapy, or radiation could compromise a child’s immunity. In such cases, live-attenuated viral vaccines should not be given. If your child has a moderate or severe cold or other illness on the day of the vaccination You might be asked to postpone vaccination until your child gets better. 38.9°C 18

• Always ask your healthcare provider if you have any questions or would like more information. • Your provider might ask you to hold your baby in a certain way to steady the arm or the leg where the shot will be given. These techniques are designed to keep children still without holding them down or frightening them. • Many healthcare providers often advise keeping a child in the hospital under observation for about 15 to 20 minutes after getting vaccines to ensure immediate medical attention in the unlikely event of an allergic reaction or in case the child becomes dizzy or faints. • Ensure that all vaccinations are noted on your baby’s vaccination record card. 19

When to call your healthcare provider After the vaccination visit If your child develops a fever or sore leg/arm at the site of the shot: • You may give a non-aspirin pain reliever to the child to reduce any pain or fever following vaccination. Make sure to consult your doctor beforehand. • Keep your child hydrated by providing plenty of fluids. • Avoid overdressing the baby. • You may also use a cool, wet washcloth over the sore area to help relieve pain. The baby has been crying uncontrollably for three or more hours Fussiness for more than 24 hours Fever above 40°C (104°F) Worsened swelling at the injection site Immediately contact the hospital or doctor if you notice the following: 40°C 20

You know your child best. If you notice anything that is not normal after vaccination, contact your healthcare provider immediately. When to visit the emergency room Take your baby to the nearest hospital right away if the baby develops a severe allergic reaction. Signs include: Dizziness Skin rash Swelling of the throat Difficulty in breathing Wheezing Fast heartbeat Hoarseness Unusual sleepiness Limp or unresponsiveness Seizures or convulsions 21

Make sure to remember when the reaction occurred, or you observed the alarming signs and when and what vaccinations were administered. It will help the doctor understand your baby’s health condition better. Checklist for your child’s vaccinations Your baby’s first vaccination may start right after birth or by the age of two months. Your healthcare provider will give you an immunization schedule for your child. • Make subsequent appointments based on your child’s immunization schedule. • Make sure to bring your child’s vaccination record card if it has already been given to you during the first visit. • Schedule the next appointment based on the date of your child’s next vaccination before leaving your healthcare provider’s office. • Set a reminder for the next date in your cell phone or home calendar so that you do not forget it. • Keep your child’s vaccination record card in a safe place so that you can find it when you need it. Remember, vaccination is a part of your child’s routine care. Keeping with their immunization schedule is crucial to protect their health. 22

Childhood Vaccination for Preventable Diseases 3

Disease Caused by Spread by Complications Chickenpox Varicella-zoster virus Air or direct contact Bacterial infections, meningitis, encephalitis, pneumonia, or death Diphtheria Corynebacterium diphtheriae Air or direct contact Heart failure, paralysis, pneumonia, or death Hib disease Haemophilus influenzae type b Air or direct contact Meningitis, epiglottitis, pneumonia, arthritis, or death Hepatitis A Hepatitis A virus Personal contact or through food or water Liver failure or death 24

Hepatitis B Hepatitis B virus Contact with body fluids Chronic infection, cirrhosis, liver failure, liver cancer, or death Influenza(Flu) Influenza virus Air or direct contact Pneumonia, Reye’s syndrome, myocarditis, or death Measles Measles virus Air or direct contact Pneumonia, ear infections, encephalitis, seizures, or death Mumps Mumps virus Air or direct contact Meningitis, encephalitis, inflammation of testicles or ovaries, or deafness Pertussis (whooping cough) Bordetella pertussis Air or direct contact Pneumonia, seizures, brain disorders, ear infection, or death Disease Caused by Spread by Complications 25

Polio Poliovirus Through the mouth Paralysis, or death Pneumococcal disease Streptococcus pneumoniae Air or direct contact Bacteremia (blood infection), meningitis, or death Rotavirus infection Rotavirus virus Through the mouth Severe diarrhea, dehydration, electrolyte imbalance, kidney and liver disease, or death Rubella (German measles) Rubella virus Air or direct contact Encephalitis, arthritis/arthralgia, hemorrhage, or orchitis Tetanus (lockjaw) Clostridium tetani bacteria Through cuts in the skin Broken bones, breathing difficulty, or death Disease Caused by Spread by Complications 26

4 Q&A on Vaccination General Part 1

01 Doesn’t my child have natural immunity against diseases? Yes, but temporary! Babies have natural immunity or protection against some diseases that they acquire from their mothers. They get specific antibodies either during pregnancy (through the blood) or during breastfeeding, which can give them protection against some common infections like the common cold. However, this immunity is temporary and starts declining, making your baby vulnerable to other diseases or serious infections. A timely immunization gives your child the required protection from diseases that vaccines can prevent, especially at the age when they are most vulnerable. 28

03Why are children administeredmultiple doses of some vaccines? It depends on whether the vaccine is live or inactivated (killed). For an inactivated vaccine, multiple doses are required. Each dose contains some fixed number of disease antigens (virus or bacteria).With each dose, your child develops immunity in 02 How do we know whether vaccines can cause long-term health issues? A vaccine is released or licensed for public use only after assessing its safety and efficacy in clinical trials. Also, the vaccine is continuously monitored whilst its doses are administered to millions.With over 50 years of experience with vaccines,the chance of a vaccine causing any unexpected long-term health issue is negligible. Moreover, there is no biological evidence saying vaccines would cause any long-term effects. Researchers have already performed numerous studies to observe the many potential risks of vaccines. Fortunately, if vaccines were identified as a risk factor, we would have known by now! Many experts believe that withholding a vaccine that is effective against diseases while its long-term effects are being studied would be unethical as it could potentially save many lives. Also, waiting for many years to look for long-term health issues is somewhat impractical. 29

phases.That means the subsequent doses boost immunity to reach a certain protection level. In comparison, live vaccines contain some amount of live disease antigen which goes inside the body to spread and reproduce.One single dose is enough to build immunity in most children. However, a second dose is administered since some children do not develop immunity from the first dose. 04 Are some of the vaccine ingredients toxic? Given at a very high dose, any substance, even water, can be toxic. Some vaccine ingredients can be harmful only if present in a high amount. However, at low doses, such substances are safe. 30

05 Is it okay to vaccinate my child at a young age? The immunization schedule developed by the health authorities helps to protect children even before they are exposed to life-threatening diseases. Vaccines in early childhood help them build immunity when they are most vulnerable to diseases that can cause serious complications. When vaccinated timely, the child builds immunity or protection sooner in life. Vaccine ingredients such as aluminum help in the effective working of vaccines; formaldehyde is not used anymore during manufacturing and may be present as a very minimal trace. If you have any concerns, speak to your doctor. 31

Please ensure that your baby gets all the vaccinations well on time.

07 Why do children not receive some vaccinations after reaching a certain age? Different vaccines are administered to children in specific age groups only. This is because, at a particular age, a vaccine gives the maximum protection, thereby saving lives and reducing the disease burden. After a child reaches a certain age, they may acquire natural immunity or cross the age at which the disease is usually life-threatening. That is why some vaccines are not administered after a specific age. Can a child get a disease even after vaccination? Yes, although it is rare, it has been observed that about 1 to 5% of children fail to build immunity following vaccination. These children may get sick if are exposed to that specific 08 06 When should my child be vaccinated? Children are given vaccines according to their age groups. This helps them to build complete protection against certain common diseases. A few vaccines are administered in multiple doses at different time intervals. That is why it is crucial to follow the vaccination schedule given by the health authorities in your area. Make sure to talk to your healthcare provider to understand the immunization schedule so that your child can receive the right vaccines at the right time. 33

disease.There might also be the following cases: • A child may sometimes need an additional dose of the vaccine to build immunity when the first dose fails to do the same. • A child may be exposed to the disease just before the administration of the vaccine.Thus, they may not be able to build immunity during that time and may get sick. • A child may get sick from a similar disease that the child was vaccinated against. For instance, many viruses cause flu-like symptoms but not exactly flu.The flu vaccine fails to build immunity against these different strains in such cases. 34

Can a child get the disease from a vaccine? This usually never happens. In the case of inactivated vaccines, it is not practically possible, however in the case of live vaccines, some children may get a mild form of the disease. In such cases, it is not harmful and probably shows that the vaccine is working. 10 11 If children rarely get these diseases, why do they need to be vaccinated? If we go by numbers, the chances of a child getting the disease that is preventable by the vaccine are minimal.This situation is quite like wearing a seatbelt.You wear a seatbelt to protect yourself in case of an unlikely severe accident. If you have never been in an accident, you may argue about the benefits of the seatbelt. However, the consequences of not wearing a seatbelt are very high. The same goes with vaccines! Your child may never get the disease that the vaccines offer protection against, but you What should I do if my child has a cold or fever at the time of vaccination? Talk to your healthcare provider if you notice any form of sickness, fever, or cold in your child at the time of vaccination. They might assess your child to know whether it is okay to vaccinate the child or wait till the child feels better. 09 35

would better off to give them complete protection to lead a safe life free from the disease risk if they are unfortunately exposed to the disease. Do children have to be vaccinated before attending school? The government does not recommend immunization requirements outlined by the schools. However, some people may feel that these obligations violate their right to choose. Immunization programs as part of public health policy are designed to offer protection to everyone. Vaccines not only protect the child who is vaccinated but 12 36

I find vaccines expensive. What should I do? Government health establishments offer free vaccine administration. However, the vaccination schedule and administration are based on the national immunization guidelines. You may not have the option of painless or certain optional vaccines. 13 Do so many vaccines overwhelm the child’s immune system? Right after birth, the baby is exposed to thousands of viruses and bacteria as part of their daily life while growing up. No one knows how many germs a baby’s body can tolerate, but vaccines do not expose them with a substantial amount of germs. As per many experts, "worrying about getting germs from a vaccine is like worrying about getting wet from a drop of water while swimming in the ocean!" 14 also the children around them.This is called herd immunity. Mandatory vaccination helps in building that immunity and is the most practical solution. Imagine vaccination not being mandatory–many people would forget, put it off, and not get vaccinated. It would lead to lower herd immunity levels leading to community outbreaks of the diseases, putting many lives at risk. 37

A mother understands what a child cannot say. - Proverb

Are vaccines “unnatural”? No, immunity developed following vaccination is the same as immunity developed following "natural" infection with a disease.The difference is that the child doesn’t get sick with the vaccine. 15 Do I need to vaccinate my child for a disease that has been eliminated or is not present in the community? Yes, some diseases may have been eliminated in your region or community. However, with so much interconnectivity and movement, infections can spread from the areas where these are still present. Secondly, if an appropriate number of 16 39

How long does immunity last after vaccinating the child? The type of vaccination determines it. For example, vaccines for measles or hepatitis B confer lifetime protection. Vaccination against whooping cough or pertussis, on the other hand, does not provide lifetime protection. It is crucial to note that whooping cough is not a serious condition in older children but is in infants. For tetanus, your child 17 people are vaccinated, in a community, herd immunity can be reached. This provides an additional layer of protection to people who are not vaccinated, including newborns or infants, and helps prevent any outbreaks in the future. 40

Can a child be vaccinated if they have recently undergone or are about to have surgery? It is advisable not to delay or put off immunization if your child is going to have surgery or had one recently. Moreover, having surgery is not a reason to postpone immunization, or as recommended by medical experts, recent vaccination should not be a reason to delay surgery. 18 may require booster shots for continued protection. The same goes for the flu vaccine, as your child may need a vaccine every year to protect them from getting the flu. It is, therefore, critical that you maintain your child’s immunization record to track booster doses. 41

19 Is there any difference in the vaccine quality providedbyprivatehealthcarefacilitiesandthose provided at government facilities? In India, all available vaccines are licensed by the Drug Controller General of India (DCGI). Hence, they are safe for use. Both government and private healthcare facilities or providers get their vaccines from the government-approved and licensed manufacturers; however, immunization for children and pregnant mothers is free of cost only at the government health facilities. 20 Why do private providers offer some vaccines that are unavailable in the Government’s program? The Ministry of Health & Family Welfare, Government of India, spearheads Universal Immunization Program (UIP). Under this program, the focus is on ensuring that all children and pregnant mothers are protected from diseases that can be life-threatening or cause disability in both groups. In the case of private healthcare providers, they cater to the needs of the individual parents who might want to go for optional, chargeable vaccines, or services. Speak with your doctor if you have any concerns about your child’s scheduled surgery or vaccine. 42

Vaccination Age 16-24 months DPT 1st booster OPV Booster Measles 2nd dose Vitamin A (2nd to 9th dose) DPT 2nd Booster 5-6 years 10 & 16 years TT 16 months with DPT/OPV booster followed by one dose every 6 months up to five years of age As per the Universal Immunization Program (UIP), nine vaccine-preventable diseases are covered, including polio, measles, diphtheria, pertussis, Haemophilus influenzae type b (Hib), diarrhea, tetanus, a severe form of childhood tuberculosis, and hepatitis B. For children, the following vaccinations have been recommended: Which vaccines have been introduced in recent years for children? 21 43

What precautions should be taken after vaccination? 22 Discuss the side effects of the vaccine with your doctor or go through the vaccine information sheet to learn more about the possible side effects your child may experience. Watch out for symptoms of severe reactions for the next few days including convulsions, joint stiffness, or high fever for more than two days. Call your doctor immediately for any concerns. For mild fever, you may also use a sponge bath. Add more liquids to your child’s diet. Consult your doctor before giving any non-aspirin pain reliever to your child. Use a damp, cool cloth to help reduce swelling or redness at the site of injection. 38.9°C 44

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Himalaya & The Science of BabyCare Bringing the best of Nature's care for babies by contemporizing Ayurveda with modern technology

5 Vaccination Schedule Recommended by the Indian Academy of Pediatrics

Completed age Vaccines Note Birth BCG • BCG: Before discharge • OPV: As soon as possible after birth • Hep B: Should be administered within 24 hours of birth OPV Hepatitis B-1 6 weeks DTwP 1/ DTaP-1 • DTwP or DTaP may be administered in primary immunization. • IPV: 6-10-14 weeks is the recommended schedule. If IPV, as part of a hexavalent combination vaccine, is unaffordable, the infant should be sent to a government facility for primary immunization as per UIP schedule. IPV1 Hepatitis B-2 Hib-1 Rotavirus-1 PCV-1 10 weeks DTwP 2/DTaP-2 • RV1: 2-dose schedule; all other rotavirus brands: 3-dose schedule Hepatitis B-3 IPV-2 Hib-2 Rotavirus-2 PCV-2 48

14 weeks DTwP 3/DTaP-3 • An additional 4th dose of Hep B vaccine is safe and is permitted as a component of a combination vaccine. Hepatitis B-4 IPV-3 Hib-3 Rotavirus-3 PCV-3 6 months Influenza (IIV)-1 • Uniform dose of 0.5 ml for 6 months 7 months Influenza (IIV)-2 • To be repeated every year, in pre-monsoon period, till 5 years of age 9 Months MMR-1 6 months onwards Typhoid conjugate vaccine (TCV) A single dose of any of the licensed TCV can be administered 12 months Hepatitis A-1 • Single dose of live attenuated vaccine Completed age Vaccines Note 49

15 months MMR-2 B1 represents the first booster dose Varicella-1 PCV-B1 16 to 18 months DTwP-B1/ DTaP-B1 B1 represents the first booster dose IPV-B1 Hib-B1 18 to 19 months Hepatitis A-2 Two doses, six months apart 4 to 6 years DTwP-B2/ DTaP-B2 MMR-3 A total of two doses of varicella vaccine should be administered B2 represents the second booster dose Varicella-2 9 to12years Tdap • Tdap is to be administered even if it has been administered earlier (as DTP-B2). HPV • HPV: 2 doses at 6 months interval between 9-14 years; 3 doses: from 15 years; or immunocompromised of any age (0-1-6 months for HPV2, 0-2-6 months for HPV4) Completed age Vaccines Note 50

IAP also recommends vaccines under special circumstances. You can discuss these special circumstances with your healthcare provider. These vaccines include: • Meningococcal vaccine • Japanese encephalitis vaccine • Cholera vaccine • Rabies vaccine • Yellow fever vaccine • Pneumococcal polysaccharide vaccine (PPSV 23) 51

The maternal bond is beyond boundaries, and every moment spent with your baby adds to the bonding experiences, giving a new dimension to your life.

6 Available Vaccines

Vaccines Disease prevented BCG Childhood tuberculosis OPV Poliomyelitis Hepatitis B Hepatitis B Pentavalent 1 (DTP, IPV, Hepatitis B) Diphtheria, Pertussis (Whooping Cough), Tetanus, Hib infection (causing pneumonia and meningitis), and Hepatitis B Pentavalent 2 (DTP, IPV, Hib) Diphtheria, Pertussis (Whooping Cough), Tetanus, Hib infection (causing pneumonia and meningitis), and Poliomyelitis Hexavalent(DTP,IPV, Hepatitis B, Hib) Diphtheria, Pertussis (Whooping Cough), Tetanus, Hib infection (causing pneumonia and meningitis), and Poliomyelitis Rotavirus Rotavirus diarrhea IPV Poliomyelitis Flu Influenza MMR Measles, Mumps, and Rubella Varicella Chickenpox 54

Typhoid Typhoid DPT Diphtheria, Pertussis, and Tetanus TT Tetanus Pneumococcal Conjugate Vaccine Pneumococcal pneumonia Vaccines Disease prevented 55

7 Q&A on Vaccination Specific Part 2

01 Is it normal to have scarring following a BCG vaccine? How can I take care of my child? Yes, scarring is normal. Usually, two weeks after your child receives the BCG vaccination, you can see the injection site getting a bit hard and red. This will grow to its peak size by fourth week, and pus will be released. The crust formation takes place around five to six weeks, leaving a small scar at around eight weeks. While taking care, make sure not to press or rub the injection site or apply any medication or herbal lotion. However, if you notice fever or swelling, take your child to the nearest hospital or health facility. 57

02 What if no scar is formed after the BCG vaccination? You do not need to vaccinate your child again in absence of scar formation. In some cases, the scar is not formed but the vaccine has worked, developing immunity against the disease. 03 What are pentavalent and hexavalent vaccines? Why are they beneficial for my child? The pentavalent and hexavalent vaccines are a single injection protecting the children against five or six serious diseases namely, diphtheria, pertussis, tetanus, Haemophilus influenzae type B infections (leading to pneumonia and brain fever), Hepatitis B, or IPV. Three doses of this vaccine are given to the child at 6, 10, and 14 weeks. 04 Which childhood vaccine offers protection from Hepatitis B infection? The first dose of the Hep B vaccine is administered at birth. This dose protects the baby from initial exposure that may be transferred from the mother to the baby at the time of delivery. Subsequently, three more doses of pentavalent or hexavalent vaccine are given at 6, 10, and 14 weeks which offer additional protection against the infection. 58

05 IPV and OPV are given together at six, 10, and 14weeks. Is it safe to give both against the same disease? Yes, it is safe to administer IPV (given as an injection) and OPV (given orally) together on the same day to children, as it ensures added protection. 59

The bond between a mother and her child is the purest of all.

06 Why are vaccines administered differently in the thigh, arm, or orally? Vaccines work effectively and generate the required antibodies only when administered through a specific route. That is why some vaccines are administered in the thigh, some in the arm, and others orally. 07 What if your child missed a shot? Life with young children can be hectic and you may miss making timely vaccination appointments for your child. However, it is crucial to get back on schedule. It is critical to understand that sometimes there is no need to restart 61

What if we relocate? If you move to another district or state, your child’s vaccination schedule continues to be the same. Depending on the area or state, sometimes additional shots may be required. Once you have moved, contact your nearest healthcare provider, and discuss the pending vaccines. Always remember to take your child’s vaccination record to the appointments. 08 09 In the past, if a child got infected with some disease, would he/she still require vaccination against that disease? Yes, the child will still require the vaccination. Most illnesses including diphtheria, tetanus, rotavirus diarrhea, Hib pneumonia, measles, and Japanese encephalitis only give short-term protection even after your child gets infected with full-blown disease. Therefore, your child should still receive timely immunization for long-lasting protection. the entire program; instead, the remaining program should be continued as recommended and completed without fail.You should book a visit with your healthcare provider as soon as possible so that they can help you to figure out what vaccines your child has already had, and which ones are needed in the future. 62

10 Will my child require extra doses during a campaign even after receiving all vaccine doses as per the immunization schedule? A campaign is organized with an effort to control the spread of the disease by vaccinating the most vulnerable age group. Hence, even if the child has received all doses as per the vaccination schedule, he/she will still need to get these additional shots to boost the protection. Moreover, if the child has received additional doses during the campaign, they should still complete the vaccine schedule. 63

11 Can more than one vaccine be administered safely to my child simultaneously? What are the benefits? Yes, some vaccines are given in combination to protect against several diseases at once.Your child’s immune system is EXTRAORDINARY, and it can very easily handle multiple vaccines at a time safely and effectively. This not only For instance, all children up to 5 years of age should receive OPV doses (orally) during the Pulse Polio campaigns, even after receiving OPV and IPV doses during their routine immunization. 64

reduces the number of visits to the healthcare provider but also minimizes additional traveling time to get your child vaccinated.Also, it does not cause adverse effects or affect the efficacy of individual vaccines. What precautions should I take aftermy child is vaccinated? 12 Consider the following while taking care of your baby: Wait for about half an hour at the health facility following your child’s vaccination to ensure that the child gets immediate care in case of any adverse reaction. Continue to breastfeed your child after oral vaccination. Do not apply any medication or herb at the site of injection. 65

The herbs used in Himalaya BabyCare products are time-tested over centuries and are known to be effective and safe for babies. Infused with the Goodness of Herbs

Himalaya BabyCare products are free from harsh chemicals such as Synthetic Color/Dyes, Lanolin, Phthalates, Alcohol, Mineral Oil, SLS/SLES/ALS/ALES,* and Parabens, hence safe for babies. *SLS - Sodium Lauryl Sulfate; SLES - Sodium Lauryl Ether Sulfate; ALS - Ammonium Lauryl Sulfate; ALES - Ammonium Lauryl Ether Sulfate

1. Vaccination. National Health Mission, Ministry of Health and Family Welfare, Government of India. https://nhm.gov.in/New_ Updates_2018/NHM_Components/Immunization/Guildelines_for_ immunization/FAQ_on_Immunization_for_Parents-English.pdf. 2. Indian Academy of Pediatrics (Immunization Schedule 2018-19): http://acvip.org/professional/columns/iap-immunization-schedule- 2018-2019-table-form. 3. What Every Parent Should Know About Vaccines by Paul A. Offit, MD and Louis M. Bell, MD. A good introduction to immunization. Includes chapters about foreign travel, how vaccines work and how they are made, and safety. 4. Vaccinating Your Child: Questions & Answers for the Concerned Parent by Sharon G. Humiston, MD and Cynthia Goode. Another good introduction, which answers many of the questions parents have about childhood vaccinations. 5. World Health Organization: www.who.int/health-topicsvaccines-andimmunization. 6. General vaccine information: www.cdc.gov/vaccines. 7. Information about vaccine safety: http://www.aap.org/immunization/ families/VaccineSafety_ parenthandout.pdf. Learn More 68

Himalaya Baby Massage Oil - Coconut Pre-Bath Pampering Himalaya Gentle BabyWash Himalaya Refreshing BabyWash Himalaya Gentle Baby Shampoo Himalaya Gentle Baby Soap Gentle Bath Care Himalaya Baby Hair Oil Himalaya Extra Moisturizing BabyWash Himalaya Refreshing Baby Soap Himalaya Nourishing Baby Soap Himalaya Extra Moisturizing Baby Soap Himalaya Crème Cleansing Baby Bar Himalaya Baby Massage Oil

Himalaya Baby Powder Himalaya PricklyHeat Baby Powder Himalaya Baby Powder with Pure Cornstarch Himalaya Baby Lotion Himalaya Baby Cream Post-Bath Essentials Hello, Hygiene! Himalaya Germ Free Baby Laundry Wash Himalaya Gentle Baby Wipes Himalaya Shishu Anand Baby Wipes Himalaya Baby Diapers

Helps support skin immunity* Himalaya BabyCare Introduces Pure CowGhee Range

With over 13 years of clinical experience, Dr. Srinivasa Murthy C L is an experienced and well-qualified neonatologist and pediatrician at a leading hospital in Bengaluru. Trained in Pediatrics from the state-of-the-art Advanced Pediatric Center, PGIMER, Chandigarh, Dr. Murthy also holds a fellowship in Neonatal-Perinatal Medicine from the University of Ottawa, Ontario, Canada. As a certified Early Nutrition Specialist (ENS, Germany) and Preterm Nutritionist (International Program on Preterm Nutrition, University of Western Australia), he has vast experience in Neonatal health care and resuscitation of extremely premature neonates. Dr. Murthy’s special interests include asphyxia/therapeutic hypothermia, pulmonary hypertension, neonatal ventilation, congenital heart diseases, and surgical malformations. Besides authoring many publications, Dr. Srinivasa Murthy is the editor of NeoPocket - the handbook on Neonatology and books titled Therapeutic Hypothermia, Neonatal Critical Care Transport & Inborn Errors of Metabolism. www.himalayababycare.com www.himalayawellness.in E-mail: write.to.us@himalayawellness.com Every parent’s top priority is to ensure that their child is healthy, and immunization is one of the most effective and safe ways of protecting children against various potentially life-threatening illnesses. However, even today, some parents hesitate in vaccinating their children, leading to refusal or delay in vaccination. This book, A Parent’s Guide to CHILDHOOD IMMUNIZATION, is an ongoing effort from Himalaya BabyCare to educate parents on the risks associated with childhood illnesses and the life-saving benefits of vaccines. The easy-to-understand ready reference will support parents through their concerns, apprehensions, doubts, and queries, thereby helping them make their immunization journey hassle-free and worry-free. Himalaya BabyCare About the Author Dr. Srinivasa M urthy C L MD (PGI, Chandigarh), MRCPCH (UK)

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