We thank the NTAGI for publishing its recommendation on Hib vaccine in
Indian Pediatrics(1) as this journal allows ‘extended peer review’ in its
correspondence columns. We are concerned that the technical advisory body
has overlooked crucial evidence gathered in studies done by the ICMR while
making its recommendations.
In 2002, one of the members of this subcommittee,
Professor Thomas Cherian wrote in this journal quite categorically, that
based on the data available Hib vaccine could not be recommended for
routine use in the EPI in India(2). He recommended more studies be done to
establish the need for vaccination. Press reports in 2005(3) suggest that
one such study was indeed undertaken by the ICMR in Anaicut block, Vellore.
We did not find the results of the study published in an indexed journal
in spite of an extensive search of the literature. We presume the data
must have been made available to the NTAGI.
The first part of the ICMR study was supposed to look
at the incidence of pneumonia (regardless of etiology) and deaths from
pneumonia. The WHO suggests that 19% of the under five mortality (U5MR) in
India is due to pneumonia(4). Given the fact that the U5MR is 71.9/1000
this implies that 14/1000 children under 5 years of age die of pneumonia.
The NTAGI report of 2008(1) says ‘there is (now)
sufficient evidence of relatively high Hib disease burden in India to
warrant early introduction of Hib vaccine into the UIP’. Professor Cherian
Thomas represented WHO on this NTAGI sub-committee. We expected new
research done after 2002, which had made the author change his mind and
which allowed the expert group to make this recommendation, would be
quoted in the report. However in looking through the data reviewed during
the subcommittee process (Appendix 2), we find no reference to any
population based study from India done after 2002 under the heading ‘Hib
disease burden and Epidemiology’. The studies quoted on pneumonia and
respiratory infections were all published between 1984 and 1999.
We believe that the data from the ICMR study in Anaicut
on the incidence of pneumonia and deaths from pneumonia are crucial for
advising policy. We wonder why it was not made available to the NTAGI. If
it were available, we are curious as to why it has not been referred to in
the report. We urge that this be done urgently and published as a reply to
this communication, so it can advise policy. Selective use of data is not
compatible with the principles of evidence based medicine.
References
1. Subcommittee on introduction of Hib vaccine in
universal immunization program, National Technical Advisory Group on
Immunization, India, Kant L. NTAGI Subcommittee Recommendations on
Haemophilus influenzae Type b (Hib) Vaccine Introduction in India. Indian
Pediatr 2009; 46: 945-954.
2. Cherian T, Thomas N, Raghupathy P, Durot I, Dutta A.
Authors Reply: Is Hib vaccination required at all in India? Indian Pediatr
2002; 39: 1068-1071.
3. Staff reporter The Hindu. Hib vaccine to fight
pneumonia. The Hindu Online edition 17 June 2005. http://www.hinduonnet.com/2005/06/17/stories/2005061714000800.htm.
Accessed on 4 December 2009.
4. World Health Organization. Estimating the local burden of
Haemophilus influenzae type b (Hib) disease preventable by vaccination.
World Health Organization 2001. http://www.who.int/vaccines-documents/DocsPDF01/www625.pdf
. Accessed on 4 December 2009.