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IAP Guide Book on Immunization 2009-2011 What has changed?

IAP Guide Book on Immunization 2009-2011 What has changed?. Dr S G Kasi Consultant Pediatrician Bengaluru Member , IAPCOI 2011-2013. How does the IAPCOI work?. Recommendations on new vaccines licensed and available are based on the likely: epidemiology and disease burden

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IAP Guide Book on Immunization 2009-2011 What has changed?

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  1. IAP Guide Book on Immunization 2009-2011What has changed? Dr S G Kasi Consultant Pediatrician Bengaluru Member , IAPCOI 2011-2013

  2. How does the IAPCOI work? • Recommendations on new vaccines licensed and available are based on the likely: • epidemiology and disease burden • vaccine efficacy, safety IN THE INDIAN CONTEXT. • Recommendations are based on the available data and consensus opinion, This is a dynamic process and the guidelines may change from time to time as new information is available

  3. Guidelines for WHOM?? • These recommendations of IAPCOI are meant primarily for pediatricians in office practice as best individual practice guidelines. • In addition, IAPCOI also submits its recommendations on incorporation of various new vaccines in the national immunization schedule.

  4. What has changed?? • Changes in Content • Changes in Categories • Changes in Schedules • Changes in individual vaccines • Changes in Cold Chain

  5. What has changed??

  6. Idsurv & IAPCOI • Disease Surveillance by the IAP Committee on Immunization -www.idsurv.org (Case reporting made SARAL) • Register through the website www.IDsurv.org . A confirmatory email and sms with username and password will be sent once request is scrutinized • At present following diseases are being reported under IDsurv Project • ƒ Acute Bacterial Meningitis, ƒChicken Pox, Diphtheria, Dengue, ƒEnteric Fever, Measles ,Mumps, Pertussis, Pneumonia

  7. Reporting a case • You can report a case in the following ways 1. Through website idsurv.org after logging into your account. 2. Through sms from your registered mobile number. 3. Through mobile website m.idsurv.org 4. Through IVR (Integrated Voice Recognition System)

  8. CHANGES IN CATEGORIES 4 to 2 !! • IAP CATEGORIZATION OF VACCINES 2009-2011 • 1 . Vaccines recommended by IAP for routine use. • 2. Vaccines to be used in special circumstances only. • IAP CATEGORIZATION OF VACCINES 2008 Category 1 vaccines • ALL EPI VACCINES:BCG, DTwP, OPV, Measles, DT, TT, HepB Category 2 vaccines • IAP recommended vaccines ( in addition to EPI)Typhoid, Hib, HepB, MMR, IPV, Tdap, Td, HPV Category 3 vaccines • Vaccines to be given after one to one discussion: PCV 7, Hep A, Chicken Pox, Rotavirus Category 4 vaccines • Vaccines to be given under special circumstances: Rabies, Influenza, PPV 23, JE Vaccine, Meningococcal.

  9. Why the change in Categories ?

  10. Change in Categories • These recommendations of IAPCOI , published in the Guide Book, are meant primarily for pediatricians in office practice as best individual practice guidelines. • However, members may use their own discretion while using them in a given situation

  11. Changes in schedule:

  12. IAP Immunization timetable2009-11 IAP Recommended Vaccines:

  13. IAP Immunization timetable2009-11 IAP Recommended Vaccines:

  14. IPV & OPV?Solo or Duet?

  15. Hepatitis A Vaccine – Change in age for 1st dose from 18 months to 12 month Why?

  16. * * Hepatitis A prevalence: High/Very High Intermediate Low/Very Low * Intermediate level in urban and high level in rural India a highly endemic country is shifting to intermediate endemicity.

  17. Seroprevalence studies show susceptibility in 30-40% of adolescents and adults in higher SE Status Anti-HAV positivity by city. Mall et al, Ind Jnl Gastrol 2001,20 132.

  18. Age related seroprevalence of anti-HAV in Mumbai:effect of SE class Dhawan et al, Ind Jnl of Gastroenterol 1998, 17:16

  19. Anti-HAV Positivity (%) In High SE Population (Western India) * * * * p < 0.00001 Journal of Viral Hepatitis, July 2001

  20. Studies show a reduction in cord blood seropositivity . • About 15 years ago, the cord blood anti- HAV antibody levels in newborns was nearing 100 %, which in turn reflected the maternal antibody prevalence • In recent studies, this level has come down to 50-60 per cent

  21. Outbreaks of Hepatitis A • Shimla, Himachal Pradesh between the period January-March 2007: 450 cases were reported • An outbreak of viral hepatitis A in Ibrahimpatanam town of Andhra Pradesh in 1995. • Kottayam in Kerala: 1105 cases from Sep 2004 to Jan 2005 • Of the 965 children surveyed, in an urban slum near Vellore 26 (2.78%) had jaundice between February to July 2006. • During 2002-2004, 6 outbreaks of hepatitis A were recorded among children from semi-urban and rural Maharashtra

  22. Why 12 months for 1st dose ? • Seroprevalence of HAV antibodies was lowest in 6 months to 2 yr age group • Maximum exposure to HAV occurred in 2-5 yr age • Antibody titres with vaccination at 12 months are comparable to those achieved at 18 mths- 2 years.

  23. Varicella Vaccine Why and when 2 doses?

  24. After a single dose of varicella vaccine, approximately 15% of vaccines remain at risk of developing a breakthrough varicella disease. Two doses of varicella vaccine offer superior individual protection as compared to a single dose

  25. What is Breakthrough Varicella? Varicella developing more than 42 days after immunization and usually occurs 2-5 years following vaccination. • in 70% of instances is typically mild, with <50 skin lesions • maculopapular rather than vesicular rash, low or no fever, and shorter (4-6 days) duration of illness. • Nevertheless, breakthrough varicella is contagious, may be severe, can result in outbreaks and has occasionally caused deaths in the immunocompromised.

  26. Breakthrough Varicella

  27. Risk Factors for Breakthrough Varicella • Young age at vaccination (< 15 months), • Increasing time since vaccination ( 3-5 years) • Receipt of steroids within 3 months of vaccination • Initiation of vaccination in older children and adolescents • Administration of vaccine within 28 days of MMR vaccine but not on the same day.

  28. 1 dose v/s 2 doses

  29. Why Vaccine Failure ? • Vaccine failure with single dose is mainly primary • The observed vaccine failure after 1 dose of vaccine may be explained in most probability as that immunized children either do not develop humoral immunity to VZV at all or that there is an initial immune“burst” of immunity that is enough to generate a positive gpELISA result but is inadequate to generate a sustained memory T cell response leading to waning of immunity over a period of time

  30. Varicella Vaccine • The IAPCOI now recommends two doses of varicella vaccine for children of all age groups. • For primary immunization, the first dose should be given at the age of 15 mths and the second dose at 4-6 years ( earliest 3 months after dose 1).

  31. Varicella Vaccine • For catch up vaccination, children below the age of 13 years should receive 2 doses 3 months apart and those aged 13 years or more should receive 2 doses at an interval of 4-8 weeks

  32. Pneumococcal Vaccine: Any Change in schedule and Number of doses?

  33. Shortened PCV schedule for public use consideration • PCV7 has been introduced into the ‘2 + 1’ (two infant doses plus a booster) national vaccination schedule in several European countries. • However one should refrain from using 2+1 schedule for individual in office practice and can be used only in NIP.

  34. PCV 10 • The recommendations for the primary vaccination of unvaccinated infants and children are essentially the same as described above for PCV-13. It is recommended that subjects who receive a first dose of PCV 10 should complete the full vaccination course with the same formulation.

  35. MMR: 2 doses, No Change • 2 doses recommended. • Dose 1 at 12-15 months • Dose 2 at 4-6 years( or at any time 8 weeks after dose 1) • >12 months : 2 doses of MMR at >8 weeks interval All the currently licensed preparations of MMR vaccine are safe and effective and any one may be used.

  36. Rota Viral Vaccines What is new?

  37. G2P4 is the most common strain in India • Unpredictability of serotypes in a season/year • Serotype specificity offers the best protection • Serotype specificity offers the best protection

  38. Age for Rota Vaccines?

  39. Rotavirus Vaccines- Schedule • The first dose should be given between 6 weeks and 14 weeks six days of age. Immunization should not be initiated in infants 15 weeks or older. • All the doses of should be completed within 32 weeks of age.

  40. Rota VaccinesInterchangablity & Regurgitation

  41. Interchangeability of Rotavirus Vaccines • If one product is not available, the series should be continued with the product that is available. • If any dose in the series was human bovine pentavalent vaccine, or if the product is unknown for any dose in the series, a total of three doses should be administered.

  42. Regurgitation of vaccine • Readministration need not be done though the manufacturers of Human monovalent live vaccine recommend that the dose may be repeated at the same visit. • The infant should receive the remaining recommended doses of rotavirus vaccine following the routine schedule.

  43. Any recent changes in Tdap?

  44. Tdap • Tdap - single dose at the age of 10-12 years. • Catch up vaccination is recommended till the age of 18 years. • A single dose of Tdap may also be used as replacement for Td/TT booster in adults of any age if they have not received Tdap in the past.

  45. What has changed in Tdap? • 2007-08: A gap of 5 years should be maintained between Tdap and previous TT/Td vaccines. Gap may be 2 years in those who are at high risk of contracting pertussis or for developing complications of pertussis. • 2009-11: It is now recommended that Tdap can be given regardless of time elapsed since the last vaccine containing tetanus toxoid or diphtheria toxoid.

  46. When to use Cholera vaccine in Office Practice?

  47. Oral Cholera Vaccine - SHANCHOL

  48. Killed Bivalent Oral cholera Vaccine • Volume/dose= 1.5ml • Store at 2-8 deg C • 2 doses at 2-4 week interval

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