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Correspondence

Indian Pediatr 2015;52: 257

IAP Immunization Guidelines: Authorís Reply


Vipin M Vashishtha

Convener, IAP ACVIP, Consultant Pediatrician, Mangla Hospital and Research Center, Shakti Chowk, Bijnor, UP, India.
Email: vipinipsita@gmail.com 

     

1. Rotravirus vaccine: It is true that the figure with range does not show the range of administration of rotavirus vaccines [1]. We have deliberately avoided providing a range since it is of paramount importance to complete the series with RV1 or RV5 within the stipulated time limit owing to higher incidence of intussusception if the prescribed age-limit is exceeded.  It is not always possible to display all the information in a single figure or chart. The detailed information on administration of each of the vaccines shown in the figure is provided in the footnotes. One should also make note of the footnote immediately below the figure which reads, "These recommendations must be read with the footnotes that follow".

2. Hepatitis B vaccine: It is customary to provide ideal minimum and maximum intervals between different doses of a vaccine that is employed in more than one dose schedule. This is of significant importance for those who fall behind or start late, i.e. for catch-up vaccination. The schedule and duration provided in the IAP immunization schedule are ideal for immunizing an individual child in office practice. However, Hepatitis B vaccine is also provided through mass immunization in Universal Immunization Program (UIP) in a shorter schedule (i.e. at birth, 6, 10 and 14 weeks) mainly due to logistic and programmatic reasons. These schedules are also found to be protective and permitted for use in large scale immunization programs, particularly in developing countries [2]. 

3. HPV vaccine: The most appropriate time slot recommended for HPV vaccine is indicated in yellow shade in the figure [1]. As elaborated above, it is not possible to display all the information in a single figure and the figure must be read with the footnotes that follow. 

4. Changing the needle: The current recommendation, i.e. "changing needles between drawing vaccine into the syringe and injecting it into the child is not necessary" is based on overall general vaccination practice all over the world. In most instances it is not necessary. The recommendation is also in concurrence with the guidelines issued by international agencies like CDC and WHO. However, on certain exceptional occasions when the clinician thinks the needle may have got blunted due to multiple punctures/pricks, it can be changed. 

References

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;51:785-804.

2. Hepatitis B vaccines. WHO position paper. Wkly Epidemiol Rec. 2009;84:405-19.

 

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