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Indian Pediatr 2012;49: 995 |
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Reply
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Vipin M Vashishtha,
Convener, IAP Committee on Immunization, Mangla
Hospital & Research Center,
Shakti Chowk, Bijnor, Uttar Pradesh, 246701,India
Email: [email protected]
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The IAPCOI’s guidelines are primarily for pediatricians in
their office practice. The stress is more on providing the
best practice guidelines for an individual child overlooking
the programmatic and logistics considerations. Hence, these
guidelines are offering the best ways of utilizing the most
optimum response of an individual vaccine for an individual
person. IAPCOI is also issuing guidelines for mass or public
use of a vaccine in form of recommendations to Government of
India including its position on incorporation of new
vaccines in the national immunization schedule [1]. Let us
not confuse the two recommendations.
As far as Hepatitis-B recommendations are
concerned, we have offered the best ‘feasible’ individual
schedule that can be incorporated in to current IAP’s
immunization timetable. Nowhere have we stated that
hepatitis-B vaccine should not be administered after 24
hours of birth but the recommendations have stated clearly
that it should be offered to all newborns before hospital
discharge (see comments of Table 1and footnote on
Hepatitis-B of Figure 1). Similarly, though the committee
stresses the need and significance of birth dose, it has not
out-rightly rejected the other schedules including the
government’s adopted 6-10-14 weeks, considering the
programmatic implications and logistic issues. When a
vaccine is used in a program, there are many other
considerations apart from vaccine efficacy and effectiveness
like vaccine cost, burden of that particular vaccine
preventable disease, logistics, vaccine safety, public
acceptance, etc. These issues may be inconsequential when a
vaccine is used in office practice for protection of an
individual subject. In the former, one may be forced to
compromise on certain attributes of a vaccine, but there may
be no such compulsions in the latter.
Reference
1. Indian Academy of Pediatrics Committee on Immunization
(IAPCOI), Vashishtha VM, Sukumaran TU, Agrawal R,
Parthasarathy A, Shah N, et al. Consensus
Recommendations on Immunization and IAP Immunization
Timetable 2012. Indian Pediatr. 2012;49:549-64.
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