Introduction

This is the second in the series on the Up- date on lAP Immunization Policies, Guidelines and Recommendations. In the previous section, statements on vaccines to be offered to children as policy of lAP, were given. They include all UIP vaccines such as BCG, OPV, DPT and Measles vaccine, and in addition, Measles-Mumps-Rubella vaccine and Hepatitis B vaccine. It is the earnest hope of the Academy that sooner than later, the Government will also include the MMR and HB vaccines in the UIP schedule.

Having increased the number of vaccines and doses, a practical and user-friendly immunization time table is needed and that will be presented at a later date. Such a time table must include all the vaccine doses required by policy and it must also accommodate the optional vaccines, for the benefit of those who opt to offer them. This section, however, is concerned only with the guidelines of lAP for the appropriate use of optional vaccines.

These are general guidelines to enable members to choose various optional vaccines and for assisting in conducting camps/campaigns, when so requested. The detailed information about the age of immunization and the number and timing of doses are not given here, but may be found in the {AP Guide book on Immunization published in 1996. We hope to revise it and publish the new version in due course.

Guidelines

On the use of Hepatitis B Vaccine Beyond Infancy

The Indian Academy of Pediatrics considers it important to offer older children (beyond infancy when HB vaccine is to be given under policy), the opportunity for catch up immunization with HB vaccine. Three doses of pediatric strength vaccine may be given, ideally, at 0, 1 and 6 months, counting the day of the first dose as day O. Ordinarily, routine screening for markers of past HB infection is not necessary. If there have been some risk factors of past infection, such as acute or chronic HBV infection within the household, or prior blood transfusion, then screening is advised. For this purpose, Anti-HBc test alone is sufficient in most situations.

On Immunization Camps and Campaign in Schools and Communities

The main purpose of camps and campaigns taking health care modalities to groups of people should be to extend services that are not routinely available in or to the community. (Pulse polio immunization is an exception, as it is given to attempt to break the chain of poliiovirus transmission in the community). The lAP stipulates the following guidelines:

* When immunization camps/ campaigns are organized using newer vaccines, the information given to the parents and the public should be accurate and appropriate.

* If parents are asked to pay the cost of vaccine, special provision must be made to provide vaccine free of cost, or at subsidised cost, to the families known to be poor. If such equity in service cannot be provided, then such camps/campaigns should not be organized.

. The organizers of immunisation camps/ campaigns are not entitled to any financial profit.

. We encourage the organizers of such camps/campaigns to obtain the prior approval of the relevant local health authority, for which purpose the plan of action may be vetted by the local branch of lAP.

These guidelines may be brought to the attention of those who might be planning to conduct such camps/campaigns, especially school authorities, school health agencies, voluntary organizations, vaccine marketing agencies, and parents/parent-teacher associations. If any Academy member becomes aware of any violation of these principles, it is the member's duty to bring it in writing to the immediate local branch president or secretary. The branch may deal with the matter according to the decision of the office bearers and at- tempt to enable the organizers of the camp to take remedial steps. If it is felt that further steps are necessary, the branch shall write to the Secretary General for referral to appropriate Committee/Experts.

On Typhoid Fever Vaccines

Although optional, the IAP encourages the active promotion of immunization against typhoid? fever in all communities.

. For urban overcrowded communities, with known prevalence of typhoid fever cases especially in under-five children, the whole cell killed vaccine is recommended at a convenient and appropriate age for local epidemiology, from age 6 months upto 2 years.

. For unimmunized children of 2 to 6 years, the same vaccine is recommended in urban overcrowded communities and in families of low income in all communities. For those families that can afford a more ex- pensive vaccine, the Vi vaccine may be offered as a single dose.

. For previously unimmunized children of 6 or more years, the above recommendations hold good, except that the choice now includes the oral typhoid fever vaccine also.

. In general, a child started on the whole cell killed vaccine. may be kept on the same vaccine by periodic boosters. If so desired, . a child may be given the whole cell killed vaccine below 2 years, followed by Vi vaccine at or after 2 years, and the oral vaccine at or after 6 years.

On Rib Vaccine

Continues to be an optional vaccine. No active promotion of Hib vaccine, but it may be offered for infants of families whose parents can afford the vaccine without hurting other important priorities such as nutrition, Hepatitis B vaccine, etc. The manufacturer's recommendations must be followed regarding age and doses.

On Hepatitis A Vaccine

Continues to be an optional vaccine. No active promotion of HA vaccine in any community, but it may be offered to children of those who are of a high economic level. (Economic standard is taken as a surrogate of living standards; the higher the living standards, the more likely that children would escape, or would have, escaped, natural infection, hence the usefulness of vaccine to prevent later infection with the attendant risks of serious disease). The manufacturer's recommendation must be followed regarding age and doses.

On Varicella Vaccine

Continues to be an optional vaccine. No active promotion of varicella vaccine up to age 10 to 12 years. At that time, one dose may be offered to those who have not had varicella (clinical) previously and who could afford the . cost. For children older than 12 years (without i past history of varicella), the manufacturer's I recommendation must be followed (for want of Indian data on this issue), namely, to give 2 ! doses 4 to 8 weeks apart.

On Immunization Records

Every dose of any vaccine given to children must be documented on an appropriate Card or Booklet to be retained by the parents. The Immunization Card of the lAP is highly recommended for this purpose. Parents must be instructed to keep the document safely and to present it to any doctor, clinic or immunization camp, to be kept updated on all doses of vaccines. Pulse polio immunization is ex- empted from this requirement, but parents may be advised to note the number of doses given for any future reference.

Members of the lAP Committee on Immu- nization: Chairperson: T. Jacob John; Con- vener: Anand P. Dubey; Members: Thomas  Cherian, Tapan Kumar Ghosh, Indrashekhar Rao, H.P.S. Sachdev, Navin Thacker; (Ex-officio): Gajender S. Hathi, Madhu R. Lokeshwar, A. Parthasarathy, Raju C. Shah.