LETTER TO EDITOR
Year : 2013 | Volume
: 38 | Issue : 4 | Page : 245-
Reply to: Dilemmas in immunization?
Ali J Abedi
Department of Community Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh, India
Ali J Abedi
Department of Community Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh
|How to cite this article:|
Abedi AJ. Reply to: Dilemmas in immunization?.Indian J Community Med 2013;38:245-245
|How to cite this URL:|
Abedi AJ. Reply to: Dilemmas in immunization?. Indian J Community Med [serial online] 2013 [cited 2020 Feb 23 ];38:245-245
Available from: http://www.ijcm.org.in/text.asp?2013/38/4/245/120162
I read the article titled 'Dilemmas in Immunization?'  with interest, the author has raised a genuine concern regarding dismal state of immunization coverage in India in spite of the fact that immunization is the most successful, single child survival strategy to date. Author has accentuated a very important issue of differences in recommendations of two important agencies, which matter as for as immunization is concerned in India.
While comparing the recommendations of Indian Academy of Pediatrics (IAP) and Government of India (GOI), one should be very clear at outset that IAP recommendations as stated by IAP itself are "The recommendations are the 'best individual practice schedule' for a given child and would necessarily be at some variance from the National Immunization Schedule of the Government of India, which is meant for the public at large." The IAP recommendations thus go beyond the national immunization program and cater primarily to the pediatricians in office practice." 
BCG administration has been an issue for almost a century now and because of conflicting reports on efficacy, many countries like USA and UK have not included this in routine immunization. It is recommended that BCG vaccine may be considered for infants residing among groups of persons with an average annual rate of smear-positive pulmonary TB greater than 15 per 100,000 population (all ages) during the previous 3 years, or infants residing in populations with an annual risk of TB infection greater than 0.1%. The BCG vaccine protects severe form of Tb; BCG has an efficacy of 50-80% for prevention of severe form of the disease. Protective efficacy for pulmonary tuberculosis is 50%.  Most children acquire natural clinical/sub-clinical tuberculosis infection by the age of one year.  Therefore, vaccination after infancy is not recommended by GOI.
In India, virtually all cases of poliomyelitis occur below 5 years of age. This means that nearly 100% of the population would have already been infected with, and hence immune to, all 3 types of polioviruses. However, on rare occasions, we have seen poliomyelitis in older children and even in adults; these are exceptions, which are ignored for preparing general guidelines. In other words, guidelines are based on probabilities of risk of disease, and the risk of disease is extremely low, indeed negligible, beyond 5 years of age. Therefore, OPV is not usually recommended beyond 5 years, either as the first dose or as a reinforcing dose. 
As for as Vitamin A supplementation is concerned, Bal Swasth Poshan Mah (BPSM) program is just in few states and not all over the country. The scheduling in National Immunization schedule of Vaccines is not only done taking into consideration epidemiology of disease but also take into account operational feasibility. For example, newly introduced hepatitis-B vaccine schedule is 6, 10, and 14 weeks, contrary to more conventional 0,1, and 6 months.
Having said this, the Author's concern regarding consensus is justifiable bearing in mind the plight of medical undergraduate.
My sincere thanks to Prof. Zulfia Khan, Department of Community Medicine, JN Medical College, AMU, Aligarh for guidance.