It was indeed a serious lapse on the part of the consulting pediatrician.
Mother’s views/concerns should never be taken lightly more so in case of
vaccination. Proper communication with parents becomes much more
important considering that vaccines are given to healthy children and no
vaccine is either 100% safe or 100% effective.
In the above instance, three vaccines were
inadvertently re-administered within a week, which is against the
established principles of vaccination in most instances. While only a
single dose of BCG is indicated as per the vaccination schedule, more
than one dose is required for OPV and Hepatitis-B. The birth dose of OPV
and hepatitis-B serve only as ‘priming’ dose for the subsequent doses.
For multi-dose vaccines, the minimum interval between 2 doses of the
same vaccine is usually 4 weeks. This minimal interval of 4 weeks
between primary doses allows development of successive waves of
antigen-specific primary responses without interference .
While no untoward reaction should have occurred with
the administered doses of OPV and Hepatitis-B, there may be some
interference theoretically with the induction of ‘priming’ with previous
doses. However, the clinical significance is extremely difficult to
judge. These extra doses should not be counted and subsequent doses of
both the vaccines should be administered on the scheduled dates as
indicated by the vaccination timetable.
In case of BCG, which acts mainly through induction
of T-cell mediated immunity, any interference with primary induction of
immune responses may or may not occur. Also, some heightened local
reactions like ulceration at vaccination site or marked regional
adenitis may be anticipated few weeks/months later in few instances.
There is no need of administration of extra dose of BCG to this child
1. Basic immunology. In: Vashishtha VM,
Choudhury P, Bansal CP, Yewale VN, Agarwal R. eds. IAP Guidebook
on Immunization 2013-2014. National Publication House, Indian Academy of
Pediatrics, Gwalior, 2014.