NEWER VACC INES : Dr. S.G. KASI, Bangalore 

 

The past few years has witnessed the introduction of many new vaccines in the Indian market. Some of these vaccines are targeted against diseases which are not very familiar to pediatricians or against diseases for which India specific epidemiological data is scanty or non-existent. The IAPCOI has categorized 
vaccines into four categories: Category 1 vaccines are all the EPI/UIP vaccines, BCG, DTwP, OPV, Measles, DT, TT, HepB. Category 2 vaccines are those that are unequivocally recommended by the IAPCOI for an individual child if parents can afford the vaccine. ( in addition to EPI) Typhoid, Hib, HepB, MMR, IPV, Tdap, Td, HPV. Category 3 vaccines are those where the cost benefit ratio or the vaccine efficacy for an individual child is lower than category 2 vaccines as of currently available data and hence are to be administered after one-toone 
discussion with parents on a named child basis.PCV 7, Hep A, Chicken Pox, DTaP, Rotavirus. Category 4 vaccines are vaccines to be given under special circumstances Rabies, Influenza, PPV 23, JE Vaccine, Meningococcal.
ROTAVIRAL vacci ne : In India, Rotavirus is estimated to cause 25 million diarrhoeal episodes, 5 million out patient visits, 500,000 hospitalizations and 120,000 deaths. THE VACCINE: Currently, two live oral vaccines are licensed and marketed worldwide, Rotarix™ and RotaTeq™. Rotarix is the only vaccine marketed in India. The 1st dose should be given before the age of 14 weeks and the 2nd dose before the age of 32 weeks. 

Pneumococcal vacci ne : 

BURDEN: Streptococcus pneumoniae (SP) infections are a leading cause of mortality and morbidity in young children, the elderly and those with debilitating medical conditions.].It is estimated that 135,000– 150,000 deaths in India in the under 5 population are due to pneumococcal pneumonia. THE VACCINE: The 7 valent pneumococcal conjugate vaccine (PCV 7), PREVENAR, contains polysaccharide antigen of serotypes 4, 6B, 9V, 14, 18C, 19F and 23 linked to a protein carrier CRM137. This vaccine covers only 55% of the prevalent strains in India(v/s 85-90% otstrains in USA ) The just introduced. 10 valent and 13 valent PCV is likely to be introduced in India shortly. These will provide broader serotype coverage. HPV vacci ne : Data from national cancer
registries in India indicate that cervical cancer is the most common cancer/ cause of cancer related death in Indian women THE VACCINE: Two vaccines have been licensed globally; a quadrivalent vaccine from Merck marketed as Gardasil™ and the other a bivalent vaccine from GSK marketed as Cervarix™.Both are manufactured by recombinant DNA technology that produces noninfectious virus like particles (VLP) comprising of the HPV L1 protein, the major capsid protein of HPV. Both the vaccines are highly immunogenicand highly efficacious. The IAPCOI recommends offering HPV vaccine to all females who can afford the vaccine. Age for initiation of vaccination is 10- 12 years. Catch up vaccination is permitted up to the age of 26 years. Three doses at 0, 2 and 6 months are recommended with Gardasil™ . Minimum interval – 1st & 2nd dose - 4 weeks 2nd and 3rd dose - 12 weeks. Three doses 0, 1 and 6 months with the Cervarix vaccine.

INACTIVATED (INJECTABLE) POLIO VACCINE?? : OPV has faltered in the “end game” of polio eradication! Why is IPV important in India? Proven immunogenicity & efficacy in India & other developing countries. Remarkably
safe vaccine - No VAPP --, No VDPV. 2/3 doses beginning at 6/8 weeks can rapidly boost population immunity. Can be integrated with EPI (6-10-14 weeks schedule with DPT). The immunogenicity of IPV has been investigated and
proven in several studies from India and other developing countries. 2 doses in 1st year was immunogenic /r 3 doses in 1st year was more immunogenic than 2 doses. *If given after 2 months of age, maternal antibodies do not impair seroconversion. 8 weeks interval between doses is more immunogenic than 4 week interval 6-10-14 weeks was as immunogenic as 8-16 weeks schedule. In all studies, boosters caused the GMT’s to increase more than 10-fold. IgG neutralizing antibody response of IPV is far superior to that of OPV. OPV USE SHOULD CONTINUE AS PER GOVT POLICY FOR RI & SIAs : Why should I use both OPV & IPV?? OPV is necessary as long as there is circulation of wild virus in the community. OPV with it’s superior mucosal immunity is necessary to break the chain of transmission. Morever the efficacy of IPV in halting spread of cVDPV is unknown. So far all cVDPV outbreaks have been halted with OPV. Ofcourse IPV gives superior humoral immunity and protection against paralytic polio. H1N1 Vacci ne: Two Types of 2009 H1N1 Influenza vaccines are available. Influenza A (H1N1) 2009 Monovalent Vaccine (Inactivated) – Given IM– For persons 6 months of age or older. – May be given to any person at high risk due to a medical condition, including pregnant women. Influenza A (H1N1) 2009 Monovalent Vaccine (Live, Attenuated) – Given Intranasal – An option for vaccinating healthy non-pregnant persons aged 2-49 years only – Do not administer to: • Children 2-4 years of age with a history of wheezing • Persons with a chronic medical condition Adults and children >9 years of age will need 1 dose of vaccine. Children, ages 6 months to 9 years will
need 2 doses at 4-6 week interval. Children 6 – 36 months will need 0.25 ml/ dose, others 0.5ml/dose. 2009 H1N1 Initial Target Groups: Pregnant women * Persons aged 6 mo-24 yrs •Persons aged 25-64 yrs with a medical condition that puts them at higher risk • Health care personnel and emergency medical services personnel • Persons living with or caring for infants less than 6 mo of age.