Child population in India in 1996 was 307 million. The infant mortality rate in 1971 was 129 deaths per 1000 live births. This got reduced to 79 per 1000 live births in 1992. In that year, under 5, mortality rate was 124 per 1000 live births. 103 countries have a lower infant mortality rate of under 5 than India. In India Kerala's IMR was the lowest. In India six killer diseases of measles, whooping cough, tetanus, polio, diptheria and T.B. account for almost half of the mortality vaccines. If your child is not so protected he has 6 to 8% risk of falling a victim to one of these diseases by vaccines. If you child is not so protected he has 6 to 8% risk of falling a victim to one of these disease, and that is a substantial risk! It is, therefore, essential that all parents know what are these diseases about and when can these vaccines be administered to their child. Let us talk briefly about these diseases.

Tuberculosis

It is high bacterial infection that most commonly affects the lungs. It can also affect joints, bones, kidneys etc. In childhood tuberculosis takes other forms. It causes symptoms such as fever, irritability, poor appetite, fatigue etc. In later childhood it is less likely to cause serious trouble. If, however, left untreated, can cause death. Treatment is with antibiotics. Immunization is with BCG vaccine which can be administered at birth or soon thereafter. A sore or a pimple develops at the BCG site after about a month. This dries up in 2-4 weeks and needs no treatment.

T.B. is among the ten top killers in India. Overcrowding and poor environmental hygiene are some of the causes of T.B. It spreads amongst children when its germs spread with the coughing of the T.B. patient. Children who are listless and malnourished without an obvious cause should be investigated for TB. Good nutrition is important in resisting TB infection. Improve the nutrition of the borderline children.

T.B. can be cured. Preventing T.B. is better than treating its serious consequence. It is important that the treatment is continued as long as it is advised. In cases where it is discontinued due to neglect, the person becomes resistant to those medicines and in many such cases he cannot be helped. It is very important that the infected persons cover their mouths and noses while coughing and do not spit out the sputum except in a receptacle contents of which are either burnt or buried.

Polio

The disease begins with a general sick feeling, fever, headache, diarrhea and vomiting. A few cases on to paralysis. If there is any paralysis remaining after the acute stage of the infection is over, it must be brought to expert medical attention.

An unimmdnized child will almost certainly be infected with the polio virus. And for every 200 children who are infected, one will be crippled for life. One-third of all cases of polio occur before the age of one year. At birth or, as soon as possible thereafter, when the baby is immunized against T.B. with B.C.G, a first dose of polio vaccine should also be given at that time. This is taken by mouth. There are three types of virus that can cause polio. A person has to take all three types of vaccine to be completely protected. Each time a trivalent (three type) vaccine is given by being directly dropped onto the tongue. Three other dozes of polio vaccine should be given at the ages of 6,10 and 14 weeks. Polio vaccine should also be given at 1 ? years of age. If there is delay between the dozes, the risk is only during the period of delay. The protection will eventually be as high if all the dozes are given. This vaccine can be given at the same time as shots against DPT. In some cases a booster dose is given at age give. Effect of that lasts for five years.

Diphtheria

Diphtheria is a serious and highly contagious bacterial infection but it is a completely preventable diseases. Enlarged tonsils are generally covered by a gray membrane which look like dirty white patches. Some times it begins in the larynx with hoarseness and barking cough. The child may have mild fever, breathing difficulty, sore throat and cough DPT (Diphtheria, purtussis i.e. whooping cough and tetanus) vaccine has, in the West, made it a rare disease. If attended by breathing difficulties, hospitalisation would be recommended. Without treatment this disease can cause pneumonia and even heart failure. DPT, the vaccines against the above mentioned three diseases are combined and given in a series of three shots, 4 weeks apart, starting at age 6 weeks. The protection from these three shots gradually tapers off and a booster shot given at age 1 ? years and another shot of diphtheria and tetanus given at age 5 years and at intervals of 10 years thereafter. A small lump or 'knot' may form in certain cases at the place where the child received the shot. It may remain for several months but nothing to worry about. Some doctors recommended giving acetaminophen at the time of the shot to reduce significantly the soreness and fever associated some times with these vaccines.

Whooping Cough (Purtussis)

This is a cough with a distinctive "whoop" sound as the child tries to breathe. It is a bacterial infection which clogs the airways with mucus. It may be accompanied with common cold symptoms and vomiting. The child may cough eight or ten times on one breath. Whooping cough could last from 4 to even 8 weeks at a time. The main dangers at this young age are exhaustion and pneumonia. Whooping cough takes from 5 to 14 days to develop after exposure to infection. Fatality from this disease is very high. DPT vaccine generally proves effective in the prevention of this disease. Details about DPT vaccine given in the para on diphtheria apply. Due to the success of immunization programme, it is east to forget how prevalent diseases like whooping cough and polio once were.

Tetanus

Deep cuts or punctured wounds may be contaminated by the street dirt or soil that contains cattle manure. They may some times carry the germs of tetanus (lock jaw). Tetanus germs grow in dirty cuts and generally kill most of the people who become infected, if they are not immunized. Doctors, in case of such wounds, recommend a booster tetanus shot immediately. Delay in getting the shot may prove fatal in some cases. DPT vaccine proves effective, if taken in earlier stages. Details about the use and effect of this vaccine are given in the para on diphtheria.

When mothers give birth in unhygienic conditions, both the mother and the child are at risk from tetanus, if the umbilical cord is cut with an unclean knife or if any unclean article is put on the stump of the cord, tetanus can grow. If the tetanus germs enter the mother's body, and if she is not immunized against tetanus, then her life will also be at risk. All women should get immunized against tetanus before or during pregnancy. As a matter of fact all women of child-bearing age should get immunized against tetanus. A first dose of the vaccine should be given as soon as pregnancy is known. The second dose can be given 4 weeks after the first. No dose should be given in the last 2 weeks of the pregnancy. A third dose should be given 6 to 12 months after the second dose. These 3 tetanus vaccinations protect the mothers and their new born babies for 5 years.

All infants should be immunized against tetanus (which is included in DTP) during the first year of life. He should be given a booster dose at 11/2 and 5 years of age. Tetanus is a major killer of the new born. If the mother is not already immunized, then one baby in every hundred will die of this disease.

Measles

It is a highly infectious and potentially serious viral illness. Measles for the first 3 or 4 days has no rash but the eyes are red and watery. Brownish red spots appear behind the ears and then spread to the rest of the body. White spots appear in the mouth. After 3 days of the rash things should start improving and patches begin to fade. They take about a week to go away entirely. If the fever stays or returns, doctor must be consulted. Bed rest and plenty of fluids are recommended. Complications could be ear and chest infections, vomiting, diarrhea and possibly pneumonia. 3-4 times a day rinsing of the mouth is also recommended. Keep the room warm. Light poses no danger.

An unimmunized child is likely to get measles. It can kill. Children who survive this disease are weakened and may later die from malnutrition or other illness. Measles is also an important cause of malnutrition and blindness. A quarter of all deaths from measles occur before the age of one year. Measles is one of the most dangerous of all childhood diseases. For the first few month of life, the child has some natural protection against measles, inherited from the mother. This interferes with the measles vaccine. But after nine months, natural protection comes to an end. The child is now at risk from measles and can and should be immunized. So it is vital to take a child for measles vaccination as soon as possible after the age of nine months. Measles vaccine has made a great impact and many countries are without cases of this disease.

The first symptoms of measles begin to appear from 1 to 16 days after exposure to the infection. It is contagious for others from the very beginning of the cold symptoms. One attack of measles confers immunity for life.

General

Immunization protects against several dangerous diseases. A child who is not immunized is more likely to become undernourished, disabled, and open to greater mortality risk.

• The vaccines work by building up the child's defences.
• Breast feeding is a kind of natural immunization against several disease. Some of the mother's resistance to disease is passed on to the child in her breast milk, and especially in the thick yellow milk (called colostrum) which is produced during the first few days after the birth.
• All primary immunizations should be completed in the first year of the child's life.
• If, for any reason, a child has not had all the vaccine doses in the first year of life, it is vital to have the child immunized as soon as possible thereafter.
• It is safe to immunize a child who is suffering from fever, cough, cold, diarrhea or some other illness or malnutrition. Any advice against giving the injection is wrong.
• After an injection, the child may cry, develop a fever, a rash or a swelling at the site of injection. No worry. As with any illness, a child should be given plenty of food and liquids. Breast feeding is especially helpful.
• Every woman between the ages of 15 and 44 should be fully immunized against tetanus.
• Parents, please note that a child should be taken for immunization five times in the first year of the child's life.

Immunization Schedule for Children As recommended by Unicef, WHO and Unesco