Indian Pediatr 2015;52: 256
Immunization Recommendations Should not be
A-D-7, Devi Marg, Bani Park, Jaipur, Rajasthan, India.
This refers to the Guidelines regarding immunization schedule for
children upto the age of 18 years recommended by IAP . There are some
contradictory or confusing statements which need clarification:
Rotavirus vaccine: There is no change in
the existing schedule of RV1 vaccine that includes the first dose at 10
weeks of age instead of 6 weeks in order to achieve better immune
response, and the second dose at 14 weeks to fit with existing National
immunization schedule . It is further stated RV1 (Rotarix) should
preferably be employed in 10 and 14 week schedule, instead of 6 and 10
weeks, which suggests that for RV5 (Rota Teq) 1st dose is to be
administered at 6 weeks.
Hepatitis B vaccine: Under footnotes it is stated
that ideally, the final (3rd or 4th) dose in the Hepatitis B vaccine
series should be administered no earlier than age 24 weeks, and at least
16 weeks after the first dose, whichever is later. On the contrary, it
also states "Hepatitis B vaccine may also be given in any of the
following schedules: birth, 1 and 6 mo; birth, 6 and 14 weeks; 6, 10 and
14 weeks; birth, 6, 10 and 14 weeks."
HPV vaccine: It is stated that "two doses of HPV
vaccine are advised for adolescent/pre-adolescent girls aged 9-14 years;
for girls 15 years and older, current 3 dose schedule will continue." In
the figure 1, range of recommended ages for all children in yellow shade
is for 11 and 12 years, which would suggest that it is not recommended
for 9 and 10 year old girls, and also that two doses are required till
the age of 12 years, and not till age of 14 years.
Changing the needle: Under General instructions
in the footnotes, authors state that changing needles between drawing
vaccine into the syringe and injecting it into the child is not
necessary. Currently used syringes and needles are meant for single use.
When the needle pierces skin or rubber stopper, it loses its sharpness.
To reduce pain, after refilling the syringe, it would be advisable that
the needle be changed. There is no need to change the needle if vaccine
or other liquid has been withdrawn from an ampule, and injected. In case
liquid from one container is withdrawn and pushed in another containing
vaccine and withdrawn, then needle should be changed.
1. Vashishtha VM, Choudhury P, Kalra A, Bose A,
Thacker N, Yewale VN, et al. Indian Academy of Pediatrics (IAP)
recommended immunization schedule for children aged 0 through 18 years –
India, 2014 and updates on immunizations. Indian Pediatr. 2014;51:785-
2. Vashishtha VM, Kalra A, Bose A, Choudhury P, Yewale
VN, Bansal CP, et al. Indian Academy of Pediatrics, Advisory
Committee on Vaccines and Immunization Practices (ACVIP). Indian Academy
of Pediatrics (IAP) recommended immunization schedule for children aged
0 through 18 years, India 2013 and updates on immunization. Indian