1. Again, we should not confuse with the committee’s recommendations which are mainly for office practice. Considering the current state of polio eradication in the country, the committee believes that persisting with OPV poses significant risks both at the individual and public segment, vaccine associated paralytic polio (VAPP) at the former and circulating vaccine derived poliomyelitis (cVDPVs) at the latter. The move will also provide a timely policy ‘signal’ to Indian policymakers to expedite consultations on endgame and post-eradication vaccine policy. The recent SAGE April 2012 Working Group meeting confirmed early universal IPV introduction (as early as October 2013) integrated into routine immunization program (before planned April 2014 tOPV to bOPV switch) of the country [1]. So, even at the public sector, there is great pressure to introduce IPV to facilitate gradual albeit staggered OPV removal from routine immunization.

2. It is indeed a daunting task of how to strike a balance between individual and public sector use while formulating any recommendation on polio vaccines considering the sensitive nature of the polio eradication program in the country. Since OPV is still in use in the country and SIAs are still organized, we have decided to move gradually, hence the sequential schedule. This schedule will meet our objectives of providing immunity against VAPP and cVDPV, and at the same time permits the benefits of OPV. Even WHO has instructed to move from sequential than to all IPV schedule for countries using OPV during pre-eradication era [2]. The new IAP Immunization timetable has slots for Hepatitis-B and Measles vaccines at 6 and 9 months, respectively. Hence, the new polio schedule will not entail extra visits. 　

3. It is true that there is no efficacy trial of available rotavirus vaccines in the country and efficacy low in other developing countries. But considering the huge burden of rotavirus disease in India, even a low efficacy should translate in to significant number of lives saved. Higher vaccine efficacy is desirable but should not delay use of an effective public health tool.　Regarding proper strain match, it should be noted that there is significant amount of cross-protection offered by the rotavirus vaccines, and even RV1 provided comparable protection against non-vaccine strains in the African trial [3].

4. There is lack of epidemiological data on the incidence of mumps and rubella in different ages in the country but it is a common knowledge that all these diseases are more common amongst school age group of children. According to most recent unpublished data of the last 18 months (till August 16th 2012) acquired through IAP’s IDSurv passive reporting system from pediatricians, school age group has now emerged as the commonest affected group for varicella and 　mumps in the country. Fifty-five percent of all varicella cases and 65% of all mumps cases are in the age-group of 5-12 years.

The second dose of MMR vaccine is not a "booster"; it is intended to produce immunity in the small number of persons who failed to respond to the first dose. If we delay these ‘boosters’ to 10 years of age, a significant number of children will be exposed to these diseases, will experience breakthrough diseases (varicella and mumps), and vaccine efficacy especially against varicella will be compromised. Besides, it is more convenient to ‘catch’ susceptible children before school entry than at later age.　

1. Meeting of the Strategic Advisory Group of Experts on immunization, Geneva, April 2012 - conclusions and recommendations. Available from: http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/6IMBMe eting/2.11_6IMB.pdf 　Accessed on September 2, 2012.　

2. WHO. Polio vaccines and polio immunization in the pre-eradication era:WHO position paper. Wkly Epidemiol Rec. 2010;85:213-28.