Choudhary and Goyal [1] have raised important issues regarding issues affecting children during the SARS-CoV-2 pandemic. We wish to highlight two additional issues related to the pandemic and the resultant lockdown.

A large number of children are likely to miss out on vaccinations due to postponement of campaigns and interruptions in routine vaccinations [2]. The Strategic Advisory Group of Experts (SAGE) on immunization recommended that all mass vaccination campaigns should be discontinued but routine immunization should continue where possible [3]. In keeping with this, the Indian government has issued guidelines advising continuation of routine immunization activities and the Indian Academy of Pediatrics – Advisory Committee on Vaccines and Immunization Practices (IAP-ACVIP) has issued guidelines for pediatricians in private practice [4,5].

The immunization activities are mainly being carried out in fixed facilities with strict guidelines on hygiene and social distancing. Reduction in outreach immunization activities is likely to have an immediate impact on vaccine coverage. Health workers are involved in COVID-19 pandemic management, with decreased manpower available for routine immunization. The supply chain is also under strain due to transport disruptions. As immunization campaigns have been suspended, there will be a need for ‘catch-up’ campaigns, to identify those who missed their immunizations, as soon as the campaign is restarted.

The private sector is an important provider of immunization services in India. Reasons for the impact on immunization in private practice are lack of PPE for clinic staff, unavailability of vaccines and parent’s inability to travel to clinic due to lockdown. Apart from the suggestions given by IAP-ACVIP [5], establishing a common ‘community clinic’ run by practicing pediatricians by rotation to offer vaccination and other services may also be explored. Moreover, electronic media and social media can be used to highlight the importance of continuing routine immunization services.

Another important issue is child abuse identification and prevention during the lockdown. During lockdown, children do not have access to any outside person to talk about the abuse that they face. They may be denied access to phone or any other mode of communication. Child Line services reportedly have a 50% increase in calls, many of them reporting child abuse [6]. The government has made efforts to ensure access to critical services such as healthcare, nutrition, food security, mental health and psychosocial support and protection against violence. Pediatricians need to be alert to the increased possibility of child abuse during the lockdown, and should report and liaison with the government authorities.

Funding: None; Competing interests: None stated.

REFERENCES

1. Choudhary B, Goyal JP. Management concern for non-covid children during the covid pandemic. Indian Pediatr. 2020 May 04. Available from: https://www.indian pediatrics.net/COVID29.03.2020/CORR-00173.pdf. Accessed May 06, 2020.

2. COVID-19: massive impact on lower-income countries threatens more disease outbreaks. Global Alliance for Vaccines and Immunisation Available from: https://www. gavi.org/news/media-room/covid-19-massive-impact-lower-incomecountries-threatens-more-disease-outbreaks. Accessed April 19, 2020.

3. World Health Organization Guiding principles for immunization activities during the COVID-19 pandemic. Available from: https://www.who.int/immunization/policy/sage/en/. Accessed April 19, 2020.

4. Ministry of Health and Family Welfare. Enabling Delivery of Essential Health Services during     the COVID 19 Outbreak: Guidance note. Available from: https://www.mohfw.gov.in/pdf/Essentialservicesduring COVID19updated0411201.pdf. Accessed April 19, 2020.

5. Indian Academy of Pediatrics. ACVIP Guidelines on Immunizations During COVID 19 Pandemic. Available from:  https://iapindia.org/pdf/1455-FINAL-ADVISORY-ACVIP-Guidelines-on-Immunisations-during-COVID-19-Pandemic-skd.pdf. Accessed May 06, 2020.