I have read the
correspondence on ‘Is Hib vaccination required at all in India’(1)
with interest. In their reply, Dr Cherian and colleagues protest
"the Cynical attitude towarsd research that involves
participation of industry"(2). They say their trials are
available for audit 15-20 years after the completion of the study
and are in no way influenced by the manufactureres.
It is unbelievable
that members of any standing in the Academy of Pediatrics, will
fudge data at the behest of commercial sponsors. This is not the
reason why the declaration of commercial interest is in place. The
data is always pure. It is how the data is interpreted that may be
influenced, consciously or unconsciously, by the sponsor. Such
influence can be seen even in the reply given by Dr Cherian and
colleagues.
Drs Beri and
Ojha(1) have referred to an article published in ‘Vaccine’
showing that children in India seem to develop natural immunity to
Hib in infancy(3). The understanding used to be, that children
under 2 years have a poor immune response to capsular
polysaccharide of Hib. Overseas, even children who develop
invasive Hib infection such as meningitis, often do not develop a
substantial concentration of serum antibodies, if they are under
18 months of age(4). The presence of natural immunity in infancy
in India, was therefore of sufficient interest as to be published
in ‘Vaccine’. Natural immunity can make use of the vaccine
redundant in India, if the report in Vaccine is true. It is
remarkable that in their reply(2) Cherian et al. fail to
note this finding, even after it is pointed out to them, and they
write, "children everywhere develop natural immunity by 5
years and this does not negate the need for the vaccine in
India".
While I am not against the
sponsorship of research by industry, I commend the policy of ‘Indian
Pediatrics’ to publish this declaration of commercial interest,
which allows the reader to look for such subtle, often
unintentional, bias in published articles. This policy and the
policy letters by readers critical of biased papers ensure that
sponsored research is worthy of the science.
Vikas Taneja,
Department of Pediatrics,
Sir Ganga Ram Hospital,
New Delhi - 110 060.
References:
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1.
Beri RS, Ojha RK. Is Hib vaccination required at
all in India? Indian Pediatr 2002; 39: 1067-1068.
2.
Cherian T, Thomas N, Raghupathy P, Durot I, Dutta
A. Reply: Is Hib vaccination required at all in
India?
3.
Puliyel JM, Agarwal KS, Abass FA. Natural immunity
to haemophilus b in infancy in Indian children.
Vaccine 2001; 19: 4592-4594.
4. Michaels RH,
Norden CW. Pharygeal colonization with H.
influenzae type b: A longitudinal study of
families with a child with meningitis or
epiglottitis due to H. influenzae type b. J Infect
Dis 1977; 136: 222-228.
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