The new ACVIP recommendations [1] appear to be a mere conglomerate of various existing recommendations of the Government of India (GoI), the World Health Organization (WHO), and the industry. The main focus of the committee ought to be on issuing recommendations on the available licensed vaccines to provide the best possible protection to an individual child in an office practice setting [2]. The committee needed to appreciate the key attributes of an immunization programme designed for the ‘community’ vis-à-vis the one for ‘individual’ protection. While the programmatic issues, cost and economic factors are the major determinants of the former, safety and efficacy are the key considerations of the latter.

Hepatitis-B: The committee justifies four doses of hepatitis-B vaccine on ‘programmatic basis’ but does not address the issue of proper spacing that has a significant bearing on the long-term protection against the disease. Ideally, the final dose of any primary hepatitis-B schedule should not be administered before 24 weeks (164 days) of age; be it the fourth, fifth or sixth dose of the series [3].

Pertussis: Despite highlighting the superiority of whole-cell pertussis (wP) vaccines over acellular pertussis (aP) vaccines, the committee has accorded equal status to both the vaccines! The discussion is focused entirely on the ‘public’ use of the vaccine whereas the recommendations are offered for the ‘individual/office’ use. No new evidence is provided in favor of aP vaccines that may have emerged in recent times. There is marked variability in the performance of different component aP vaccines in different countries. It is difficult to believe that all the available aP vaccines with different components have similar efficacy.

Poliomyelitis: The ACVIP in its earlier review had expressed their reservations on the efficacy of two-dose fIPV administered at 6 and 14 weeks, and also on the single dose IM-IPV at 14 weeks [4].

Influenza: The data provided in the influenza section are comparatively old, and not India- and children-specific. The issue of vaccine efficacy and effectiveness is not discussed. There is no published data on the safety, tolerability, and effectiveness of the flu vaccines for Indian children.

MMR: IAP had strongly recommended MMR instead of MR in the UIP schedule [5]. Therefore, there should not be any issue about non-availability of MR vaccine in private set-up.

Typhoid: The committee has endorsed WHO guidelines, meant for country-level mass use of the vaccines. Recent age-stratified data on typhoid burden in India should have also been mentioned. The issue of boosters with conjugate vaccines is still debatable. Considering the immaturity of the immune system, gradual waning of immunity 6-12 months after vaccination, and limited opportunity for natural boosting below two years, a booster dose may be required for the children vaccinated below two years of age.

Rotavirus: The change in the administration schedule of RV-1 for office use is not well-supported by the recent data. The data on per dose efficacy of RV-1 when co-administered with OPV at 6 and 10 weeks, particularly among Indian children, is also missing. No new India-specific data is provided that may have emerged since the publication of ACVIP’s 2014 recommendations on RV-1 schedule [5]. Figure 1 is showing catch-up with rotavirus vaccine till 12 months, whereas in the text, the upper limit is restricted to 8 months.

1. Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK, et al. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr. 2018;55:1066-74.

2. IAP Guidebook on Immunization 2013-2014. (Eds) Vashishtha VM, Choudhury P, Bansal CP, Yewale VN, Agarwal R. Gwalior: National Publication House, Indian Academy of Pediatrics, 2014.

3. Centers for Disease Control and Prevention. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. Available from: https://www.cdc. gov/mmwr/volumes/67/rr/rr6701a1.htm. Accessed January 31, 2019.

4. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP), Vashishtha VM, Choudhary J, Yadav S, Unni JC, Jog P, et al. Introduction of Inactivated Poliovirus Vaccine in National Immunization Program and Polio Endgame Strategy. Indian Pediatr. 2016;53: S65-S69.