immunization in practice - clearing the cobwebs: correspondence

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CORRESPONDENCE Immunization in Practice - Clearing the Cobwebs: Correspondence Chandra Mohan Kumar & Preeti Sharma Received: 28 April 2013 / Accepted: 23 May 2013 # Dr. K C Chaudhuri Foundation 2013 To the Editor: We read the article Immunization in PracticeClearing the Cobwebsin ahead of print publication of Indian Journal of Pediatrics [1] with a lot of interest and noticed some information which can be misleading for practicing pediatri- cians and post graduate students who are the primary target readers of this article, apart from several typographical errors. The purpose of this communication is to draw attention of the authors. We have following observations: In Abstract: In the list of vaccines supplied free of cost by Govt. of India the name of MMR is missing but the newest member of this group Hib vaccine, which is included so far in only 9 states in India has been included. In abbreviations: In PCV, Cstands for conjugate and in IPV, Istands for Inactivated. In section on scheduling of vaccination: A statement is made However if two or more live vaccines are to be administered, then an interval of 28 d are required.This statement should be suitably modified to say that two live vaccine can also be given together. For example, if a child presents first time after 9 mo, BCG, OPV and measles, all three live vaccines should be given simulta- neously. However, if live vaccine are not given on the same day, then there should be a minimum gap of 4 wk between two live vaccines. In table 3 (IAP Immunization Schedule), the visit at 6 mo, included in IAP Immunization Schedule 2012 [2], is missing. Hence OPV1 and Hep B3 are completely missed out from the schedule. In the description of Rotavirus vaccine, it has not been mentioned that for RV1(Rotarix), which is more common- ly available in India, only two doses are required not three [3]. This needs to be clarified because a practitioner may unnecessarily prescribe third dose. Regarding Rotavirus vaccine the maximum age for administering the last dose should be 8 mo, instead of 32 wk. Another important omission is about contraindication for Rotavirus vaccine. History of intussusception in the past is an absolute con- traindication for rotavirus vaccine administration [4]. There are two avoidable typographical mistakes. In BCG vaccine description miliarytuberculosis has been typed as military tuberculosis. Similarly in the list of high risk categories nephrotic syndromeis written as nephritic syndrome. References 1. Dutta AK, Ray S. Immunization in practiceclearing the cobwebs. Indian J Pediatr. 2012;80:40410. 2. http://www.iapcoi.com/hp/pdf/IAP%20Immunization%20Timetable %202012.pdf. Accessed on April 2013. 3. Recommendations and reports prevention of rotavirus gastroenteri- tis among infants and children recommendations of the Advisory Committee on Immunization Practices (ACIP) February 6, 2009/ Vol. 58/No. RR-2 http://www.cdc.gov/mmwr/PDF/rr/rr5802.pdf. Accessed April 2013. 4. Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization and IAP immunization timetable 2012. Indian Pediatr. 2012;49:54964. C. M. Kumar (*) : P. Sharma Department of Pediatrics, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India e-mail: [email protected] Indian J Pediatr DOI 10.1007/s12098-013-1107-7

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CORRESPONDENCE

Immunization in Practice - Clearing the Cobwebs:Correspondence

Chandra Mohan Kumar & Preeti Sharma

Received: 28 April 2013 /Accepted: 23 May 2013# Dr. K C Chaudhuri Foundation 2013

To the Editor:We read the article “Immunization in Practice–Clearing the Cobwebs” in ahead of print publication of IndianJournal of Pediatrics [1] with a lot of interest and noticed someinformation which can be misleading for practicing pediatri-cians and post graduate students who are the primary targetreaders of this article, apart from several typographical errors.The purpose of this communication is to draw attention of theauthors. We have following observations:

In Abstract: In the list of vaccines supplied free of cost byGovt. of India the name of MMR is missing but the newestmember of this group Hib vaccine, which is included so farin only 9 states in India has been included.

In abbreviations: In PCV, ‘C’ stands for conjugate and inIPV, ‘I’ stands for Inactivated.

In section on scheduling of vaccination: A statement ismade “However if two or more live vaccines are to beadministered, then an interval of 28 d are required….”

This statement should be suitably modified to say thattwo live vaccine can also be given together. For example, ifa child presents first time after 9 mo, BCG, OPV andmeasles, all three live vaccines should be given simulta-neously. However, if live vaccine are not given on the sameday, then there should be a minimum gap of 4 wk betweentwo live vaccines.

In table 3 (IAP Immunization Schedule), the visit at6 mo, included in IAP Immunization Schedule 2012 [2], is

missing. Hence OPV1 and Hep B3 are completely missedout from the schedule.

In the description of Rotavirus vaccine, it has not beenmentioned that for RV1(Rotarix), which is more common-ly available in India, only two doses are required not three[3]. This needs to be clarified because a practitioner mayunnecessarily prescribe third dose. Regarding Rotavirusvaccine the maximum age for administering the last doseshould be 8 mo, instead of 32 wk. Another importantomission is about contraindication for Rotavirus vaccine.History of intussusception in the past is an absolute con-traindication for rotavirus vaccine administration [4].There are two avoidable typographical mistakes. In BCGvaccine description ‘miliary’ tuberculosis has been typedas ‘military tuberculosis’. Similarly in the list of high riskcategories ‘nephrotic syndrome’ is written as ‘nephriticsyndrome’.

References

1. Dutta AK, Ray S. Immunization in practice–clearing the cobwebs.Indian J Pediatr. 2012;80:404–10.

2. http://www.iapcoi.com/hp/pdf/IAP%20Immunization%20Timetable%202012.pdf. Accessed on April 2013.

3. Recommendations and reports prevention of rotavirus gastroenteri-tis among infants and children recommendations of the AdvisoryCommittee on Immunization Practices (ACIP) February 6, 2009/Vol. 58/No. RR-2 http://www.cdc.gov/mmwr/PDF/rr/rr5802.pdf.Accessed April 2013.

4. Indian Academy of Pediatrics Committee on Immunization(IAPCOI). Consensus recommendations on immunization and IAPimmunization timetable 2012. Indian Pediatr. 2012;49:549–64.

C. M. Kumar (*) : P. SharmaDepartment of Pediatrics, Hamdard Institute of Medical Sciencesand Research, Jamia Hamdard, New Delhi 110062, Indiae-mail: [email protected]

Indian J PediatrDOI 10.1007/s12098-013-1107-7