Introduction

The lAP Committee on Immunization has updated its stand on several issues and has made clear statements on them in January, 1999. They have been approved by the Executive Board in its meeting in February, 1999 at Jaipur and they have become the official stand of the Academy. These decisions have been classified in 3 categories, namely policies, guidelines and recommendations. Policies are, generally speaking, expected to be practiced by all members of the Academy. They have been enunciated as the best options in our country, in the best interests of the children whom we serve. There have been no changes in our immunization policies.

Guidelines relate to those items which are outside the purview of policy, and for which guidance is necessary in case the opinion is chosen by members. Recommendations are" in general, what the Academy, in our role of advocacy on behalf of children, requests other agencies to do. Guidelines and recommendations will be presented later. This communication covers the issues of policies on immunization.

lAP Policies on Immunization, 1999

On UIP: The Academy continues to endorse and support the Universal Immunization Program and its immunization schedule, recognizing the fact that they provide only the basic minimum immunization needs of all children in our country. All the doses of vaccines under the DIP schedule are (or should be) available free of charge, to all eligible children.

Immunization to be Supplemented: The Academy, however, believes that this schedule must be supplemented with additional doses of OPV and DPT and selected newer vaccines, the cost of which has to be borne by the family or another source.

On OPV: The policy of the Academy is to give all children 5 doses of OPV in the first year of life, followed by 2 more doses, one in the second year and the next in the fifth year of life, for a total of7 doses, to ensure reasonably high probability of personal protection from poliomyelitis. For the purpose of counting the doses, OPV given in pulse campaigns may also be included.

On DPT: Regarding DPT, the policy of the Academy is to endorse the UIP schedule of 3 doses in infancy and one booster in the second year of life and to supplement the UIP schedule with a second booster of DPT in the fifth year of life (instead of the DT booster under UIP).

On Newer Vaccines: It is the policy of the Academy to supplement the UIP schedule further, with 2 additional vaccines, namely MMR vaccine and Hepatitis B (HB) vaccine. Other licensed newer vaccines such as Vi vaccine and Ty 21a oral vaccine (as well as the classical whole cell killed vaccine) against typhoid fever, Haemophilus injluenzae type b (Hib) vaccine, Varicella vaccine and Hepatitis A (HA) vaccine are considered as optional vaccines. Optional vaccines are of two categories (of priority), namely those to be actively promoted and others not to be actively promoted. Guidelines for the use of optional, vaccines will be provided in a later issue of Indian Pediatrics.

On MMR Vaccine: MMR vaccine is to be given in the second year of life, with a minimum interval of 3 months after the measles vaccine dose given at or after 9 months of age.

On HB Vaccine: If pregnant woman is a known carrier of HB virus, her neonate should be given HB immune globulin (HBlg) within 12 hours of birth and also one dose ofHB vac- cine with a separate syringe and needle, at a separate site on the body. If HB immune gIobulin is not available, then HB vaccine must be given as stated above. If there has been delay over 12 hours, then HBlg need not be given, but vaccine may be started. The second dose of HB vaccine must be given 4 weeks (or one month) later, or latest at 6 to 8 weeks of age. The third dose is to be given 5 months (range 4 to 6 months) later. The third dose may be given at the same time as measles vaccine, at or after 9 months.

If the pregnant woman's HB virus carrier status is unknown, the above schedule applies for HB, vaccination of the infant, but there is no indication to give HBlg.

If the mother is known not to be a carrier, then there is no need (but no harm) to start HB vaccination at birth. In this case, the first dose can be conveniently given at the first clinic visit for other vaccines, such as at 6 weeks, when a dose of DPT and OPV are due. The, second dose ofHB vaccine is to be given 4 weeks (or one month) later and the third dose 5 months (range 4 to 6 months) later. The third dose may be given at the same time as measles vaccine.

Members of the Committee on Immunization: Chairperson: T. Jacob John; Convener: Anand P. Dubey Members: Tho- mas 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.