Apropos of the query regarding Hib vaccination schedule, this is to clarify herewith that IAP ACVIP recommendations are mainly for individual protection of a particular child in an office-practice setting. They are the most appropriate way of using available licensed vaccines to provide best possible protection to an individual child. It may not always be feasible to apply these guidelines in-toto while designing a mass, national level vaccination program. The logistics, cost and other operational issues may override other considerations. Combination vaccines have several advantages like fewer injections, better compliance, reduced requirement of syringes and needles, reduced burden on cold chain, and easier record-keeping. In fact, they are more ‘program-friendly’ than single antigen products. IAP also prefers combination vaccine over separate injections of its equivalent component vaccines [1]. Regarding the booster of Hib vaccine, IAP has recommended its use in its schedule; however, the Government of India (GoI) has not yet included it in their National Immunization Schedule, mainly because of programmatic consi-derations. They also believe the current epidemiology of Hib disease in the country does not warrant a booster dose.

The issue regarding safety of pentavalent vaccine has been critically analyzed at various fora, including in the IAP ACVIP. The GoI and WHO have cleared this vaccine as no causal association between administration of the vaccine and death of children could be found so far. Following a detailed discussion and analyzing all the available evidences, the Academy has also issued a statement in the favor of the safety of pentavalent vaccine [2]. After getting reassurance on the safety of this vaccine, the GoI has recently decided to broaden the coverage of the vaccine to all other States of the country not covered so far. The lack of an effective AEFI surveillance system uniformly all over the country, and poor routine immunization coverage of many States were the reasons why this vaccine was not launched all over the country in the first go.

Vipin M Vashishtha
Convener, IAP Advisory Committee on Vaccines and
Immunization Practices (ACVIP).
Email: [email protected]

1. Indian Academy of Pediatrics, Advisory Committee on Vaccines and Immunization Practices (ACVIP), Vashishtha VM, Kalra A, Bose A, Choudhury P, Yewale VN, Bansal CP, et al. Indian Academy of Pediatrics recommended immunization schedule for children aged 0 through 18 years, India, 2013 and updates on immunization. Indian Pediatr. 2013;50:1095-108.