Letters to the Editor
Indian Pediatrics 2002; 39: 108-111
1. Measles and MMR Immunization
Since US references are quoted in both the communications, it will be worthwhile quot-ing relevant information from the Red Book 2000 of American Academy of Pediatrics(1), since updated in 2001.
First and foremost it should be clearly understood that no monovalent Measles vaccine formulation is available in the US and Measles immunization is a part of MMR vaccine administration.
On scheduling immunization, the Red Book 2000(1), observes: "The Immunization schedule used in the United States may not be appropriated for developing countries because of different risks, age specific immune res-ponses, and vaccine availability. The schedule recommended by the Expanded Program on Immunization of the World Health Organiza-tion should be consulted (http://www.who. org). Modifications may be made by the Ministries of Health in individual countries, based on local consideration".
Indian has incorporated one dose of monovalent Measles vaccination after 9 months of age in its National Immunization Schedule and IAP has endorsed it for the reasons rightly stated by Dr. Havaldar; in India, we cannot afford to wait till one year of age as suggested by Dr. Chorghade for the 1st dose of Measles vaccine. Therefore, IAP has recommended in its ‘IAP Policies, Guidelines and Recommendations - April 2001’(2) to administer one dose of MMR vaccine at 12-15 months of age preceded by one dose of Measles vaccine at 9+ months and has also stated the need for evaluation of a second dose of MMR and its timing since one dose of MMR does not offer sufficient protection against Mumps, though it may do so for Rubella. Therefore, the second option mentioned by Dr. Havaldar is acceptable to IAP and hence its plea and recommendation to the Government of India to include MMR vaccine in the National Immunization schedule.
Now to answer the individual questions of Dr. Chorghade:
IAP Time Table 2001(2) recommends, monovalent Measles vaccine at 9+ months followed by a single dose of MMR at 12-15 months. Whether a 2nd dose of MMR vaccine at 4-6 years or 11-12 years, may be needed, has to be evaluated on the basis of occurrence of Mumps cases following a single dose of MMR vaccination in children.
2. Immunization Schedule for HIV Infected Children
Dr. Havaldar’s observations on HIV/AIDS prevalence in India and his concern about inadvertently administering Oral Polio Vaccine to all children inclusive of possible HIV infected children are well taken. The current recommendation of various vaccines to HIV/AIDS afflicted children as recom-mended by WHO, AAP, ACIP and IAP are given in Table II.
3. Varicella Vaccine
On Dr. Havaldar’s observation that ‘Varicella Vaccine’ is a definite contra-indication for HIV infected persons and pediatricians must be alerted on this issue’, I would like to draw his attention to the 2001 AAP/ACIP recommendations, which has WHO approval also:
Issues in immunization, relevant to the epidemiological situation in our country have been dealt with in the ‘IAP Policies, Guide-lines and Recommendations on Immunization 2001’ and valid comments from experts and readers are most welcome for future consideration.
*For regions where risk of TB is high
IAP Committee on Immunization, ‘Brindavan’,
166, Park Road, Western Extension,
Anna Nagar, Chennai 600 101, Tamil Nadu, India.