On UIP

On Optional Vaccines and Related Matters

IAP POLICIES ON IMMUNIZATION, 1999

On UIP

The Academy continues to endorse and support the Universal Immunization Program and its immunization schedule, recognizing the fact that they provide only the basic minimum immunization needs of all children in our country. All the doses of vaccines under the UIP schedule are (or should be) available free of charge, to all eligible children.

Immunization to be Supplemented

The Academy, however, believes that this schedule must be supplemented with additional doses of OPV and DPT and selected newer vaccines, the cost of which has to be borne by the family or another source.

On OPV

The policy of the Academy is to give all children 5 doses of OPV in the first year of life, followed by 2 more doses, one in the second year and the next in the fifth year of life, for a total of 7 doses, to ensure reasonably high probability of personal protection from poliomyelitis. For the purpose of counting the doses, OPV given in pulse campaign may also be included.

On DPT

Regarding DPT, the policy of the Academy is to endorse the UIP schedule of 3 doses in infancy and one booster in the second year of life and to supplement the UIP schedule with a second booster of DPT in the fifth year of life (instead of the DT booster under UIP).

On Newer Vaccines

It is the policy of the Academy to supplement the UIP schedule further, with 2 additional vaccines, namely MMR vaccine and Hepatitis B (HB) vaccine. Other licensed newer vaccines such as Vi vaccine and Ty 21a oral vaccine (as well as the classical whole cell killed vaccine) against typhoid fever, Haemophilus influenza type b (Hib) vaccine, Varicella vaccine and Hepatitis A (HA) vaccine are considered as optional vaccines. Optional vaccines are of two categories (of priority), namely those to be actively promoted and others not to be actively promoted. Guidelines for the use of optional vaccines will be provided in a later issue of Indian Pediatrics.

On MMR Vaccine

MMR vaccine is to be given in the second year of life, with a minimum interval of 3 months after the measles vaccine dose given at or after 9 months of age.

On HB Vaccine

If pregnant woman is a known carrier of Hb virus, her neonate should be given HB immune globulin (HBIg) within 12 hours of birth and also one dose of HB vaccine with a separate syringe and needle, at a separate site on the body. If HB immune globulin is not available, then HB vaccine must be given as stated above. If there has been delay over 12 hours, then HBIg need not be given, but vaccine may be started. The second dose of HB vaccine must be given 4 weeks (or one month) later, or latest at 6 to 8 weeks of age. The thirs dose is to be given 5 months (range 4 to 6 months) later. The third dose may be given at the same time as measles vaccine, at or after 9 months.

If the pregnant woman's HB virus carrier status is unknown, the above schedule applies for HB vaccination of the infant, but there is no indication to give HBIg.

If the mother is known not to be a carrier, then there is no need (but no harm) to start HB vaccination at birth. In this case, the first dose can be conveniently given at the first clinic visit for other vaccines, such as at 6 weeks, when a dose of DPT and OPVare due. The second dose of HB vaccine is to be given 4 weeks (or one month) later and the third dose 5 months (range 4 to 6 months) later. The third dose may be given at the same time as measles vaccine.

Members of the Committee on Immunization

Chairperson

T. Jacob John

Convener

Anand P. Dubey

Members

Thomas Cherian

Tapan Kumar Ghosh

Indrashekhar Rao

H. P. S. Sachdev

Navin Thacker

Ex-officio

Gajender S. Hathi

Madhu R. Lokeshwar

A. Parthasarathy

Raju C. Shah

Back

GUIDELINES

On the use of Hepatitis B Vaccine Beyond Infancy

The Indian Academy of Pediatrics considers it important to offer older children (beyond infancy when HB vaccine is to be given under policy), the opportunity for catch up immunization with HB vaccine. Three doses of pediatric strength vaccine may be given, ideally, at 0, 1 and 6 months, counting the day of the first dose as day 0. Ordinarily, routine screening for markers of past HB infection is not necessary. If there have been some risk factors of past infection, such as acute or chronic HBV infection within the household, or prior blood transfusion, then screening is advised. For this purpose, Anti-HBc test alone is sufficient in most situations.

On Immunization Camps and Campaign in Schools and Communities

The main purpose of camps and campaigns taking health care modalities to groups of people should be to extend services that are not routinely available in or to the community. (Pulse polio immunization is an exception, as it is given to attempt to break the chain of poliiovirus transmission in the community). The IAP stipulates the following guidelines:

	When immunization camps/campaigns are organized using newer vaccines, the information given to the parents and the public should be accurate and appropriate.
	If parents are asked to pay the cost of vaccine, special provision must be made to provide vaccine free of cost, or at subsidised cost, to the families known to be poor. If such equity in service cannot be provided, then such camps/campaigns should not be organized.
	The organizers of immunisation camps/campaigns are not entitled to any financial profit.
	We encourage the organizers of such camps/campaigns to obtain the prior approval of the relevant local health authority, for which purpose the plan of action may be vetted by the local branch of IAP.

These guidelines may be brought to the attention of those who might be planning to conduct such camps/campaigns, especially school authorities, school health agencies, voluntary organizations, vaccine marketing agencies, and parents/parent-teacher associations. If any Academy member becomes aware of any violation of these principles, it is the member's duty to bring it in writing to the immediate local branch president or secretary. The branch may deal with the matter according to the decision of the office bearers and attempt to enable the organizers of the camp to take remedial steps. If it is felt that further steps are necessary, the branch shall write to the Secretary General for referral to appropriate Committee/Experts.

On Typhoid Fever Vaccines

Although optional, the IAP encourages the active promotion of immunization against typhoid fever in all communities.

	For urban overcrowded communities, with known prevalence of typhoid fever cases especially in under-five children, the whole cell killed vaccine is recommended at a convenient and appropriate age for local epidemiology, from age 6 months upto 2 years.
	For unimmunized children of 2 to 6 years, the same vaccine is recommended in urban overcrowded communities and in families of low income inall communities. For those families that can afford a more expensive vaccine, the Vi vaccine may be offered as a single dose.
	For previously unimmunized children of 6 or more years, the above recommendations hold good, except that the choice now includes the oral typhoid fever vaccine also.
	In general, a child started on the whole cell killed vaccine may be kept on the same vaccine by periodic boosters. If so desired, a child may be given the whole cell killed vaccine below 2 years, followed by Vi vaccine at or after 2 years, and the oral vaccine at or after 6 years.

On Hib Vaccine

Continues to be an optional vaccine. No active promotion of Hib vaccine, but it may be offered for infants of families whose parents can afford the vaccine without hurting other important priorities such as nutrition, hepatitis B vaccine, etc. The manufacturer's recommendations must be followed regarding age and doses.

On Hepatitis A Vaccine

Continues to be an optional vaccine. No active promotion of HA vaccine in any community, but it may be offered to children of those who are of a high economic level. (Economic standard is taken as a surrogate of living standards; the higher the living standards, the more likely that children would escape, or would have, escaped, natural infection, hence the usefulness of vaccine to prevent later infection with the attendant risks of serious disease). The manufacturer's recommendation must be followed regarding age and doses.

On Varicella Vaccine

Continues to be an optional vaccine. No active promotion of varicella vaccine up to age 10 to 12 years. At that time, one dose may be offered to those who have not had varicella (clinical) previously and who could afford the cost. For children older than 12 years (without past history of varicella), the manufacturer's recommendation must be followed (for want of Indian data on this issue), namely, to give 2 doses 4 to 8 weeks apart.

On Immunization Records

Every dose of any vaccine given to children must be documented on an appropriate Card or Booklet to be retained by the parents. The Immunization Card of the IAP is highly recomended for this purpose. Parents must be instructed to keep the documents safely and to present it to any doctor, clinic or immunization camp, to be kept updated on all doses of vaccines. Pulse polio immunization is exempted from this requirement , but parents may be advised to note the number of doses given for any future reference.

Members of the IAP Committee on Immunization