Monday, March 3, 2008

VACCINES-BIRD"S EYE VIEW/IAP-&AAP

Introduction:These two giant organisations in the world are making the policy decisions on immunisations for children&is formulated by Advisery commitee on immunisation practices on the respective countries.This is a comparative study of observation between Indian academy of pediatrics,&American academy of pediatrics regarding their immunisation policy,meant for elite population & N R I S.For completion sake & for quick reference certain other countries' immunisation are included,as we have lot of NRIS IN THESE COUNTRIES:1)INDIA 2)USA3)AUSTRALIA 4)UK 5) MALAYSIA 6)SINGAPORE.
Immunisation is a global procedure against preventable diseases as per prevalance.World's Eco system is such that mother nature has distributed the organisms in its own way.In the densely populated country like India like every dog has its day,these organisms also had their days &played their part to reduce population explosion.The health measures required to counteract simply sucks the country's finance like leeches.People's co operation is essential in disease eradication.In India people expect all vaccines to be available free,thanks to LION'S &ROTARY CLUBS IN PROVIDING HEPATITIS &POLIO VACCINES RESPECTIVELY.Ignorance is still alive even with educated people. Every parent must feel that they are morally responsible for prevention of disease to their children even if one is poor.Let him beg ,borrow, or ,steal to immunise his child.

I A P IMMUNISATION TIME TABLE:2005--2006.
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Total doctor's visit-10
diseases covered---10(optional vaccines-3)
Birth
OPV-0
Hep B-1
6 weeks DTPW-I/DTPa-1
OPV-1
HEP B-2
Hib-1
10 weeks DTPW-2/DTPa-2
OPV-2
Hib-2
14 weeks DTPW3/DTPa3
OPV-3
HEP.B-3
Hib-3

9 Months. meascles
15-18 months DTPWB-1/DTPaB-1
OPVB-1
Hib B-1
MMR
2 YEARS Typhoid+

5 years DTPWB-2/DTPaB2

10YEARS Td#/TT
16.YEARS Td#/TT


PREGNANT WEMEN:2 DOSES OF Td#/TT.

Vaccines that can be given after discussion with parents:---

>6 WEEKS----------PNUMOCOCCAL CONJUGATE VACCINE *
>15 months---------Varicella(chicken pox)#.
>18 months---------Hep A +
#<13>13 YRS- 2DOSES.(1-2 MONTHS INTERVAL)

+ 2 doses (6-12 months interval) (hep.A)

*3 primary doses at 6, 10 ,14 weeks followed by booster at 15 months (Pnuemococcal)
New recommendations:2 Doses of MMR.USE of combination vaccines &IPV in private practice.
Observation:one of the countries recomendingBCG.Only country to advice typhoid.No rota virus, or meningococcal vaccine advised.Chiken pox,pneumococcal,&hepatitis A are advised after discussion with parents.T .T FOR PREGNANT women advised .


A A P--JAN 2008. (U S A) AMERICAN ACADEMY OF PEDIATRICS.
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Hep.B-1--Birth,1mo,2 mo,12-15 mo
Rota virus-1 mo,3 mo,6 mo.
Diph,tetanus, pertusis--2mo,4mo,6mo,15mo.
Hib-2mo,4mo,6mo, 12-15mo
pnuemo--2 mo,4 mo,6 mo,12-15 mo.pnuemo-polisacharide(ppv)--2--6yrs.
Inactivated polio--2 mo,4 mo,12-15mo, 4-6 yrs.
Infuenza- yearly.4-6 yrs for certain high risk group
MMR--12-15 mo, 4-6 yrs
Varicella-12-15mo, 4-6yrs.
Hep A---2 doses.12-15 mo--19-23 mo,
Meningococcus:--recomended for teens &college students.
MCV 4--FOR HIGH RISK group,at 2--6 yrs.
HUMAN PAPPILLOMA VIRUS VACCINE :FOR GIRLS AT AGE 12-13YRS.

IMMUNISATION SHCEDULE --UK.SEP 2006.
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3 DAYS.--BCG if TB in family in last 6 months.
Hep.B.if mother is Hbs Ag +ve
2 mo.---DTaP+IPV+Hib+pneumococcal(pcv)
3 mo.---DTaP+IPV+Hib+Meningitis-C
4 MO.--DTaP+IPV+Hib(pediacel)+pneumococcal(prevnar)+meningitis-c(neisvac)

12 mo.--Hib+meningitis-c(menitorix)
13 mo.-MMR+Pnuemococcal
3 -1/2---5 yrs.-dtap+ipv, or,Dtap+ipv(,Repavax)or,Infanrix
MMR(Priorix,or mmr)
13-18yrs.-Td+IPV(TETANUS/DIPHTHERIA/POLIO)
OVER 65&
<65 AT RISK GROUP:-Annual influenza vaccine+one of pnuemococcal.

AUSTRALIAN GOVERNMENT--31 OCT 2007
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Birth :Hep.B
2 mo :DPT+POLIO+Hib+HepB+pnuemo+rota virus
4 mo. :DPT+POLIO+Hib+Hep .B(Infanrix-Hexa)+Pnuemo(prevnar)+Rota virus(Rotateq)
6 mo :DPT+POLIO(IPV)+Hib+Hep.B+Pnuemococal+Rotavirus.

12mo :MMR+Hib+Hep.B+ Meningococcal-C.
18 mo.VARICELLA.
4 YRS :DPT+POLIO+MMR.
Comments:No,BCG/TYPHOID/H EPATITIS A advised.

M A L A Y S I A 28 FEB 2006
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At birth : B C G

2. mo.---Hep,B+OPV+DPT/DT+Hib

3.mo---Hep.B+opv+DPT/DT+Hib

5.mo.--Hep.B+OPV+DPT/DT+Hib

6.mo.--Meascles.

!2 mo.--MMR

18.mo.--opv+DPT

5-7 yrs.-OPV+DPT+MMR.

12--15yrs--TT+Rubella.
COMMENTS: Hib,/rotavirus/pnuemo/ meningo/Hep A /Influenza/chickenpox are not advised.

SINGAPORE--GOVERNMENT--11-AUG-2007.
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Birth: BCG+Hep.B(FIRST DOSE)

1.mo.--Hep.B (SECOND DOSE)

3.mo.--DPT/DT-- 1st dose.
oral sabin 1st dose

4 .mo-DPT/DT----2nd dose.
oral sabin ---2nd dose.

5.mo.DPT?DT ----3rd dose-----Hep.B. can be combined for patient compliance
oral sabin ----3rd dose.
5-6.mo.--Hep B----3rd dose-if not comb9ned above.

1-2 yrs.----MMR-primary dose.

18. mo.--DPT/DT+ORAL SABIN 1st booster.

6-7yrs--DT+ORAL SABIN-------2nd booster.

11-12 yrs.-DT+ORAL SABIN-----3rd booster.+MMR BOOSTER DOSE.
comments;No Measles/Rubella//Hib/ Pnuemo/meningo/Rota/Influenza/Hep A advised.Using OPV like India.All Other countries using IPV
OBSERVATION & ANALYSIS:
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There is conses of openion for immunising for the following diseases in all the countries.
1) Hepatitis B 2)Polio 3)Diphtheria.4)Tetanus.5)Wooping cough.6)Meascles.7)Mumps.
8)Rubella.
2)Tuberculosis:IAP continues to advice BCG, AS THE DISEASE IS STILL PREVALENT IN INDIA
&also believed to reduce incidence of desseminated TB such as TBM,OR REDUCE THE MORBIDITY IN TBM. Malaysia& singapore continues BCG as INDIA IS NEARBY&there is lot of traveller's movement.Other developed nations stopped BCG as they think the disease has been eradicated, or they believe that TB eradication is better done by other non-vaccine methods like offering better treatment(like surgical removal of the pulmonary liesions wherever
possible)
3)Vaccines for the following disease are advised byIAP,ONLY after discussion with the parents.
a)H.influenza(hib)b)chicken pox.(varilrix for varicella)c)Hepatitis A.d)pnuemococcal vaccine.The reasons are not given.Perhaps it may be due to following causes.a) It is expensive(not available free of cost).b)low incidence of the disease.c)not virulent compared to Hep.B. d)Anaphylaxis &other side effects possible.
4)Following vaccines are advised by AAP ONLY FOR HIGH RISK GROUP.
A) Influenza
B)Hep.A.
C)Meningococcal.
The center for disease control(cdc) in USA from time to time advises adults &kids for influenza shots, whenever there is evidence of a slight epidemic.Recently there was one schoolchild died in USA,&THE AUTHORITIES SAID THAT IT WAS AN ISOLATED CASE,EVEN THOUGH IT IS VACCINE PREVENTABLE DISEASE(T V News.feb 2008 usa)
5)Typhoid is recommended only in india.Does it mean that it has been eradicated world wide?
6)Rota virus vaccine:Advised only by USA& AUSTRALIA.
Mortality is said to be 200-300 per year in USA& all children said to suffer at least once before 5 yrs of age.The occurence of intusseption after vaccine is so negligible that the issue does not seem to merit further discussion.Though in India ROTA VIRUS DIARRHOEA IS PREVALENT.THE MORTALITY RATE HAS COME DOWN.Still the the incidence of diarrhoea &pnumonia are the top two for highest mortality.If pnuemococcal vaccine(prevnar) &rota virus vaccine(rotateq) are used in India,pediatric physicians will have no work!.(Oh! politics,Oh Finance--Thou shall get up?
7)Tetanus Toxoid: in pregnancy(to prevent neonatal tetanus)
Not advised by any country other than India.India can boast almost 100% success in eradicating neonatal tetanus.AAP advises TT/DPT TO ALL CHILDREN.It means tetanus organisms are present in the American soil.Does a pregnant women is immune to tetanus in USA?

8)POLIO:
Polio-immunisation.AAP advises ,inactivated polio vaccines,which is undoubtedly more effective than oral polio.IAP continues to advise ,oral polio only for various socio economic/ political reasons,while fully acknoledging that IPV IS BETTER..AMONG many causes for our inability to eradicate poilo the use of oral polio itself is considered as one cause.Now IAP advises &recomends IPV may be given by private practitioners, if they desire to do so.The key to global polio eradication,lies in India.UP &Madhya pradesh continues to harbour polio virus.Unless the government machinary is fully geared up there like other statesfor polio eradication it can not be expected that global polio eradication is in the near vicinity.UK advises IPV for 13-18 yr age group also.Theoritically &practically it is found to be good in UK.India should emulate this as it is possible for adults to excrete polio virus,in their excreta.These excreta may infect children ,&this is a worthy point to ponder about&if practiced may yield in polio eradication in India or any other country.
AAP;FURTHER RECOMENDS TO ADOLESCENTS as below:This is not recomended by IAP.ALL VACCINES ADMINISTERED IN CHILDHOOD ARE REPEATED ONCE OR TWICE+pappilloma virus vaccine for girls 11-12 yrs ,if not at 13-18 yrs.USA is the only country to recomennds,pappilloma virus vaccine,meningococcal+pnuemococcal also given
DTP+TDaP+HPV=MCV ARE COMPULSARILY GIVEN AT 11-12 YRS All other vaccines either as a catch up immunisation or certain hige risk group (immune difficiency like status)