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correspondence

Indian Pediatr 2019;56:338

Some Issues Arising From 2018-19 IAP
Immunization Recommendations


Yash Paul

Pediatrician, Shah Hospital, Jaipur, Rajasthan, India.
Email: dryashpaul2003@yahoo.com

 


I would like to draw attention of the experts to some issues related to the recent guidelines by the Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) [1].

People belonging to low socio-economic groups are more prone to get infections because of overcrowding and poor sanitary conditions. Many of these people work as domestic helps, and carry the risk of spreading their infections to the people where they work. Thus, these are the people who should be immunized in their own and others’ interest. There are two vaccine preventable diseases which need attention:

Pertussis: In year 2008, IAP Consensus Recommendations on Immunization stated that "there is no reason to believe that the disease burden of pertussis is low in adolescents in India" and thus Tdap vaccine instead of Td/TT vaccine was recommended in all children/adolescents who could afford to use the vaccine [2].

Presently there is a huge difference in the cost between Tdap and Td/TT vaccines. People belonging to low socio-economic group cannot afford the costly Tdap vaccine. There is thus a need to develop a combination vaccine of tetanus with reduced quantities of diphtheria and whole cell pertussis components.

Typhoid: IAP-ACVIP guidelines (2018-19) recommend Typhoid Conjugate Vaccine (TCV) because it has improved immunological propertis, and can be used in younger children (³6 months) [1]. The cost of TCV is beyond reach of many families who need the vaccine. Second issue is the need for booster doses. For Polysaccharide typhoid vaccine, booster dose is recommended every 3 years. Regarding TCV, the guidelines [1] state that: "the need for revaccination with TCV is currently unclear. The protection with TCV may last for upto 5 years after administration of one dose, and natural boosting may occur in endemic areas." It is not clear why this natural boosting is not expected to occur following Polysaccharide Typhoid Vaccine?

The guidelines [1] also state that if a child has received Typhoid polysaccharide vaccine, offer one dose of TCV at least 4 weeks following the receipt of polysaccharide vaccine. How to justify the administration of TCV to a child in whom same/other doctor had administered Polysaccharide vaccine 4 weeks earlier? Unaffordability of TCV may lead to decline in typhoid vaccine coverage, and subsequent resurgence of disease in our country.

References

1. Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK, et al. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 through 18 years. Indian Pediatr. 2018;55:1066-74.

2. Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus Recommendations on Immunization, 2008. Indian Pediatr. 2008;45:635-48.

 

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