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Immunization Dialogue

Indian Pediatrics 1999; 36:1239-1240

Pulse and Routine Immunization Against Poliomyelitis


Q. Will successful completion of three years pulse polio programme in India change the routine 5 dose polio immunization schedule?
 


Y.S. Chavan,
Trimurti Hospital,
Somesh Colony,
Kala Mandir Marg, Nanded-l.
Maharashtra, India.
 

Reply

Dr Chavan's question is very interesting and also very important. The Government of India embarked upon the very ambitious program of annual pulse polio immunization covering the whole nation, while maintaining the routine immunization schedule as before. After three cycles of pulse immunization, children below 3 years would have received 6 doses of OPV in the pulse campaigns, plus 4 or 5 doses in the routine schedule, thus totalling 10 or 11 doses per child. Since pulse immunization will continue and since all children below 5 are targeted for the same, after 5 cycles each child would have received 14 or 15 doses. Many children would have had 5 routine doses in the first year and 2 more doses subsequently if they had followed the immunization time table as recommended by the lAP, thus totalling 17 doses per head. This is unnecessarily too many doses, but to the best of my knowledge there has been no detailed discussion or planning about dovetailing pulse doses with routine doses of OPV.

From the late 1970's there have been several field studies for the control of polio and interruption of transmission of polioviruses in India. In each study, polio surveillance was established first and then the intervention was applied; thus the intervention could be evaluated by the degree of reduction of cases. Since our national pulse polio immunization program was started before establishing surveillance, a very un- wise move indeed, we will have to continue pulse immunization until after evaluation can be conducted and elimination of polio demonstrated by successful surveillance covering every nook and comer of our vast country. That may take at least 5 more years from now. Knowing that each child is targeted for 10 doses by pulse, there is no longer any need to give 7 doses by routine immunization. Indeed, if our nation had accepted the 7 dose schedule, there would have been no need for the pulse; the idea was for one or the other, namely 7 doses or pulse, not both. Since we will have to continue pulsing for more than 5 years, perhaps upto 8 or 10 more years, we certainly can cut back on the routine doses. To begin with, we need not give the routine reinforcing ('booster') doses in the second and fifth years of life since in those years there would be two doses each under pulse. Wherever the incidence of polio has drastically reduced, only 3 doses are sufficient under the routine schedule, since 2 more doses will be given by pulse during infancy itself. The lAP Immunization Committee is due to discuss these issues. in its next meeting. This is one example of the urgent need for an Immunization Advisory Committee to, advise the buerocracy regarding the optimum use of our resources. We must not forget that all OPV is imported in India, by spending precious foreign exchange. It is rumoured that international prices have been recently inflated for the "purpose of accelerating this drain.

 

                                                            T. Jacob John,
                                                                  Chairman,
                                   Committee on Immunization
                                                           and President.
Indian Academy of Pediatrics,
                                                              Thekkekara,
                                  2/91
E-2, Kamalakshipuram,
Vellore,
Tamil Nadu
- 632 002,
                                                                           India.

   

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