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correspondence

Indian Pediatr 2012;49: 998-999

Reply


Vipin M Vashishtha

Convener, IAP Committee on Immunization,  Mangla Hospital& Research Center, Shakti Chowk,
Bijnor, Uttar Pradesh, 246701,India.
Email: [email protected]
 
 


As stated in the consensus recommendations also, this schedule is an interim arrangement to take care of VAPP cases and also to pave the way to ultimately all-IPV schedule. The OPV is retained mainly for two reasons, first, its propensity to induce superior intestinal mucosal immunity to decrease the spread of WPV, and secondly, to avoid confusion regarding OPV at community level that would have resulted had we gone for complete cessation of OPV use since the vaccine is exclusively employed in ongoing SIAs and RI in India. Though it’s true that ‘effective’ mucosal immunity is not visible at ground level, especially in the two endemic hotspots, yet there is no trial that demonstrates superior or even comparable intestinal immunity of IPV in India. The ongoing trials may have some answers and may ultimately settle the issue.  

There is limited experience of using IPV in routine immunization schedules in developing countries. Where IPV has or is being used (for example, in Egypt, states in the Gulf Cooperation Council, Malaysia, South Africa, and Yogyakarta Province, Indonesia), it is usually administered in a sequential schedule with OPV. This schedule is also in accordance to WHO policy which states that "IPV alone may be considered an alternative to sequential schedule only in countries that have the lowest risk of both WPV importation and WPV transmission [1].

The last two doses of polio vaccines i.e. IPV at 15-18 months and OPV at 5 years are retained primarily to accord long-lasting protection to individual vaccine. We may be erring on ‘over-immunizing’ an individual, but in the absence of any indigenous trial and experience, this was the safest path to choose. 

The main reason why industrialized countries have switched over to ‘all IPV’ schedule and deprived their children the ‘critical benefit of gut immunity’ is safety concerns of OPV. As stated earlier, we are providing the best of both the vaccines till the ‘services’ of OPV are still available while minimizing the damage inflicted by it.

Reference

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

 

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