Letters to the Editor

Indian Pediatrics 2001; 38: 1068-1069  

Reply

The issues raised by Dr. Yash Pal are important. The administration of OPV should be avoided in immuno-compromised child. An immuno-compromised state like a child suffering from malignancies, on steroids therapy or fulminant AIDS may be obvious at the time of vaccination. In all such cases vaccination with OPV must be avoided (temporarily or permanently depending upon the disease process).

During routine immunization if there is suspicion of altered immune status, then a detailed history must be recorded in such cases to rule out these conditions. Immunization should be avoided if there is immuno-compromised state. If the doctor has failed to record such history, he immunizes the child and VAPP develops, then this may be considered as negligence. If there is no history suggestive of immuno-compromised state or the disease is of such a trivial nature that it can’t be suspected or diagnosed by routine history, examination or investigations (e.g. early AIDS, Congenital agammaglobuli-nemia, etc.) and in such cases if VAPP develops, this is "unexpected outcome" or an accident. We don’t have simple, easily available tests to rule out such rare conditions. In such cases doctors shall not be held negligent.

Administration of OPV during pulse polio immunization, which is one of the biggest community health program is a tremendous time consuming effort by health personnel. It may be practically impossible to record a history of immuno-compromising illness. It is also difficult for the health worker to single out such cases due to the large population they have to cover under such national program. In such conditions, the Government should compensate if there is any VAPP (the situation is somewhat similar to that of the failure of family planning operations).

Satish Tiwari ,
Associate Professor in Pediatrics,
Dr. Panjabrao Deshmukh M.
Medical College,
Shivaji Nagar, Amravati 444 603, Maharashtra, India.
E-mail: [email protected]