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Correspondence

Indian Pediatr 2015;52: 258

Listen to Mother First : Reply 


Vipin M Vashishtha

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

     


It was indeed a serious lapse on the part of the consulting pediatrician. Mother’s views/concerns should never be taken lightly more so in case of vaccination. Proper communication with parents becomes much more important considering that vaccines are given to healthy children and no vaccine is either 100% safe or 100% effective. 

In the above instance, three vaccines were inadvertently re-administered within a week, which is against the established principles of vaccination in most instances. While only a single dose of BCG is indicated as per the vaccination schedule, more than one dose is required for OPV and Hepatitis-B. The birth dose of OPV and hepatitis-B serve only as ‘priming’ dose for the subsequent doses. For multi-dose vaccines, the minimum interval between 2 doses of the same vaccine is usually 4 weeks. This minimal interval of 4 weeks between primary doses allows development of successive waves of antigen-specific primary responses without interference [1].

While no untoward reaction should have occurred with the administered doses of OPV and Hepatitis-B, there may be some interference theoretically with the induction of ‘priming’ with previous doses. However, the clinical significance is extremely difficult to judge. These extra doses should not be counted and subsequent doses of both the vaccines should be administered on the scheduled dates as indicated by the vaccination timetable. 

In case of BCG, which acts mainly through induction of T-cell mediated immunity, any interference with primary induction of immune responses may or may not occur. Also, some heightened local reactions like ulceration at vaccination site or marked regional adenitis may be anticipated few weeks/months later in few instances. There is no need of administration of extra dose of BCG to this child also. 

References

1. Basic immunology. In: Vashishtha VM, Choudhury P, Bansal CP, Yewale VN, Agarwal R. eds. IAP Guidebook on Immunization 2013-2014. National Publication House, Indian Academy of Pediatrics, Gwalior, 2014. 


 

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