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Consensus recommendations on immunization and IAP immunization timetable 2012

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Abstract

Justification

Vaccinology today is a rapidly changing specialty of medical science where new developments are regularly taking place. There is a need to review/revise recommendations about existing vaccines in the light of recent information.

Process

Following an IAPCOI meeting in December 2011, a draft statement was prepared and circulated among the meeting participants to arrive at a consensus.

Objectives

To review and issue recommendations on the recent contentious issues pertaining to rotavirus, Hib, and pneumococcal conjugate vaccines, and to revise recommendations for 2012 Immunization timetable for pediatricians in office practice.

Recommendations

IAPCOI abolished the earlier categorization of vaccines in four categories. On rotavirus, the committee stresses the need of having more data on disease burden in India. Further, there is a need to optimize use of rotavirus vaccines in India to achieve higher yields in term of protective efficacy. For the want of adequate data, the committee is not able to issue any specific recommendation on the suitability of a particular rotavirus vaccine (monovalent vs multivalent) for the country. The committee also acknowledges a small risk of acute intussusception following use of current generation of rotavirus vaccines and recommends inclusion of the history of intussusception in the past as an absolute contraindication. The committee concludes that there are no safety concerns of Hib vaccines as reported frequently in lay media. On the disease burden of pneumococcal diseases, the committee concludes that there is a need of conducting more community based studies to gather more evidence. Similarly, the data on prevalence of different pneumococcal serotypes in the country is sparse and limited to few hospital based studies. There is need of establishing real-time multisite pneumococcal disease surveillance in the country. Due to scarcity of data on the prevalence of pneumococcal serotypes and non-typeable hemophilus influenza (NTHi) in India, it is difficult to comment on the superiority of one pneumococcal conjugate vaccine over other. The committee also revised the recommendations for the year 2012.

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References

  1. Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization, 2008. Indian Pediatr. 2008;45:635–648.

    Google Scholar 

  2. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD. The WHO-coordinated Global Rotavirus Surveillance Network. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and metaanalysis. Lancet Infect Dis. 2012;12:136–141.

    Article  PubMed  Google Scholar 

  3. Ramani S, Kang G. Burden of disease & molecular epidemiology of group A rotavirus infections in India. Indian J Med Res. 2007;125:619–632.

    PubMed  CAS  Google Scholar 

  4. Kang G, Arora R, Chitambar SD, Deshpande J, Gupte MD, Kulkarni M, et al. Multicenter, hospital-based surveillance of rotavirus disease and strains among indian children aged <5 years. J Infect Dis. 2009;200:S147–S153.

    Article  PubMed  Google Scholar 

  5. Phua KB, Lim FS, Lau YL, Nelson EA, Huang LM, Quak SH, et al. Safety and efficacy of human rotavirus vaccine during the first 2 years of life in Asian infants: randomised, double-blind, controlled study. Vaccine. 2009;27: 5936–5941.

    Article  PubMed  CAS  Google Scholar 

  6. Armah GE, Sow SO, Breiman RF, Dallas MJ, Tapia MD, Feikin DR, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial. Lancet. 2010;376:606–614.

    Article  PubMed  CAS  Google Scholar 

  7. Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med. 2010;362:289–298.

    Article  PubMed  CAS  Google Scholar 

  8. Zaman K, Dang DA, Victor JC, Shin S, Yunus M, Dallas MJ, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. Lancet. 2010;376:615–623.

    Article  PubMed  CAS  Google Scholar 

  9. Rotavirus vaccines: an update. Weekly Epidemiol Rec. 2009;84:533–540.

  10. Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006;354:23–33.

    Article  PubMed  CAS  Google Scholar 

  11. Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006;354:11–22.

    Article  PubMed  CAS  Google Scholar 

  12. Vesikari T, Karvonen A, Prymula R, Schuster V, Tejedor JC, Cohen R, et al. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet. 2007;370:1757–1763.

    Article  PubMed  CAS  Google Scholar 

  13. Rotavirus Vaccines. In: Yewale V, Choudhury P, Thacker N, Editors. IAP Guide Book on Immunization. 6th Edition. Mumbai: 2011. p. 116–123.

  14. Levine MM. Immunogenicity and efficacy of oral vaccines in developing countries: lessons from a live cholera vaccine. BMC Biol. 2010;8:129.

    Article  PubMed  Google Scholar 

  15. Grassly NC, Fraser C, Wenger J, Deshpande JM, Sutter RW, Heymann DL, Aylward RB. New strategies for the elimination of polio from India. Science. 2006;314:1150–1153.

    Article  PubMed  CAS  Google Scholar 

  16. John TJ. Antibody response of infants in tropics to five doses of oral polio vaccine. Br Med J. 1976;1:812.

    Article  PubMed  CAS  Google Scholar 

  17. Paul Y. Oral polio vaccines and their role in polio eradication in India. Expert Rev Vaccines. 2009;8:35–41.

    Article  PubMed  Google Scholar 

  18. Gladstone BP, Ramani S, Mukhopadhya I, Muliyil J, Sarkar R, Rehman AM, et al. Protective effect of natural rotavirus infection in an Indian birth cohort. N Engl J Med. 2011;365:337–346.

    Article  PubMed  CAS  Google Scholar 

  19. Bhandari N, Sharma P, Taneja S, Kumar T, Rongsen-Chandola T, Appaiahgari MB, et al. A dose-escalation safety and immunogenicity study of live attenuated oral rotavirus vaccine 116E in infants: a randomized, double-blind, placebo-controlled trial. J Infect Dis. 2009;200: 421–429.

    Article  PubMed  CAS  Google Scholar 

  20. Narang A, Bose A, Pandit AN, Dutta P, Kang G, Bhattacharya SK, et al. Immunogenicity, reactogenicity and safety of human rotavirus vaccine (RIX4414) in Indian infants. Hum Vaccin. 2009;5:414–419.

    PubMed  CAS  Google Scholar 

  21. Safety, tolerability and immunogenicity of vaccination with Rotateq in healthy infants in India. Study NCT00496054. Available from: http://clinicaltrials.gov/ct2/show/results/NCT00496054?sect=X0125#all Accessed on March 9, 2012.

  22. Detailed Review Paper on Rotavirus Vaccines by Ad-hoc group of experts on rotavirus vaccines. Available from: http://www.who.int/immunization/sage/3_Detailed_Review_Paper_on_Rota_Vaccines_17_3_2009.pdf Accessed on February 8, 2012.

  23. Pitzer VE, Patel MM, Lopman BA, Viboud C, Parashar UD, Grenfell BT. Modeling rotavirus strain dynamics in developed countries to understand the potential impact of vaccination on genotype distributions. Proc Natl Acad Sci USA. 2011;108:19353–19358.

    Article  PubMed  CAS  Google Scholar 

  24. World Health Organization. Rotavirus vaccine and intussusception: report from an expert consultation. Weekly Epidemiol Rec. 2011; 86: 317–324.

    Google Scholar 

  25. Patel MM, López-Collada VR, Bulhões MM, De Oliveira LH, Bautista Márquez A, Flannery B, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. 2011;364:2283–2292.

    Article  PubMed  CAS  Google Scholar 

  26. Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, Elliott EJ, Booy R, et al. Intussusception following rotavirus vaccine administration: postmarketing surveillance in the National Immunization Program in Australia. Vaccine. 2011;29:3061–3066.

    Article  PubMed  CAS  Google Scholar 

  27. Baggs J, Haber P. Continued surveillance for intussusception (IS) following RotaTeq in VAERS and VSD. Atlanta, GA, Centers for Disease Control and Prevention, 2010 (http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct10/12-4-rota-VAERSRotaTeq.pdf, accessed July 2011).

  28. Bahl R, Saxena M, Bhandari N, Taneja S, Mathur M, Parashar UD, et al. Population-based incidence of intussusception and a case-control study to examine the association of intussusception with natural rotavirus infection among Indian children. J Infect Dis. 2009;200:S277–S281.

    Article  PubMed  Google Scholar 

  29. Bhowmick K, Kang G, Bose A, Chacko J, Boudville I, Datta SK, et al. Retrospective surveillance for intussusception in children aged less than five years in a South Indian tertiary-care hospital. J Health Popul Nutr. 2009;27:660–665.

    PubMed  Google Scholar 

  30. Cortese MM, Parashar UD. Centers for Disease Control and Prevention (CDC). Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58:1–25.

    PubMed  Google Scholar 

  31. Ram A. No clinical trials carried out, TN, Kerala to introduce controversial vaccine. Available from: http://epaper.timesofindia.com/Repository/ml.asp?Ref=VE9JQ0gvMjAxMS8xMC8xOSNBcjAwMz A2&Mode=HTML&Locale=english-skin-custom Accessed on December 14, 2011.

  32. Tripathi A. Petition against pentavelent vaccine. Available from: http://ibnlive.in.com/news/petition-againstpentavelent-vaccine/211694-17.html Accessed on December 14, 2011.

  33. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86:408–416.

    Article  PubMed  Google Scholar 

  34. Gupta M, Kumar R, Deb AK, Bhattacharya SK, Bose A, John J, et al. Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India. Indian J Med Res. 2010;131:649–665.

    PubMed  Google Scholar 

  35. Broor S, Parveen S, Bharaj P, Prasad VS, Srinivasulu KN, Sumanth KM, et al. A prospective three-year cohort study of the epidemiology and virology of acute respiratory infections of children in rural India. PLoS One. 2007;2:e491.

    Article  PubMed  Google Scholar 

  36. Johnson HL, Kahn GD, Anne M, Palaia AM, Levine OS, Santosham M. Comprehensive review characterizing the epidemiology of streptococcus pneumoniae in India. The 8th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD). Iguaçu Falls, Brazil, 11–15 March 2012, Abstract # A-428-0023-00743.

  37. Mathew JL, Patwari AK, Gupta P, Shah D, Gera T, Gogia S, et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2011;48:191–218.

    Article  PubMed  Google Scholar 

  38. Johnson HL, Bassani DG, Perin J, Levine OS, Cherian T, O’Brien KL. Burden of childhood mortality caused by streptococcus pneumoniae in India. The 8th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD). Iguaçu Falls, Brazil, 11–15 March 2012, Abstract # A-428-0023-00743.

  39. Nisarga RG, Balter I, Premalatha R, Govindaraj M, Batuwanthudawe R, Moscariello M, et al. Prospective, multinational, active, hospital-based epidemiologic surveillance for IPD and pneumonia burden among children in Bangalore south-zone, Bangalore, India. Presented at the 29th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID) June 2011. The Hague, Netherlands.

  40. Minz S, Balraj V, Lalitha MK, Murali N, Cherian T, Manoharan G, et al. Incidence of Haemophilus influenzae type b meningitis in India. Indian J Med Res. 2008;128:57–64.

    PubMed  CAS  Google Scholar 

  41. John TJ, Pai R, Lalitha MK, Jesudason MV, Brahmadathan KN, Sridharan G, et al. Prevalence of pneumococcal serotypes in invasive diseases in southern India. Indian J Med Res. 1996;104:205–207.

    PubMed  CAS  Google Scholar 

  42. Invasive Bacterial Infections Surveillance (IBIS) Group, International Clinical Epidemiology Network (INCLEN). Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India. Lancet. 1999;353:1216–1221.

    Article  Google Scholar 

  43. Kanungo R, Rajalakshmi B. Serotype distribution & antimicrobial resistance in Streptococcus pneumonia causing invasive & other infections in south India. Indian J Med Res. 2001;114:127–132.

    PubMed  CAS  Google Scholar 

  44. Levine OS, Cherian T, Hajjeh R, Knoll MD. Progress and future challenges in coordinated surveillance and detection of pneumococcal and Hib disease in developing countries. Clin Infect Dis. 2009;48:S33–S36.

    Article  PubMed  Google Scholar 

  45. Shin J, Baek JY, Kim SH, Song JH, Ko KS. Predominance of ST320 among Streptococcus pneumoniae serotype 19A isolates from 10 Asian countries. J Antimicrob Chemother. 2011;66:1001–1004.

    Article  PubMed  CAS  Google Scholar 

  46. Kim SH, Song JH, Chung DR, Thamlikitkul V, Yang Y, Wang H, et al. Changing trend of antimicrobial resistance and serotypes in Streptococcus pneumoniae in Asian countries: an ANSORP study. Antimicrob Agents Chemother. 2012;56:1418–1426.

    Article  PubMed  CAS  Google Scholar 

  47. Bravo LC. Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP) Working Group. Overview of the disease burden of invasive pneumococcal disease in Asia. Vaccine. 2009;27:7282–7291.

    Article  PubMed  CAS  Google Scholar 

  48. Vashishtha VM, Kumar P, Mittal A. Sero-epidemiology of Streptococcal Pneumoniae in developing countries and issues related to vaccination. Journal of Pediatric Sciences. 2010;5:e48.

    Google Scholar 

  49. Johnson HL, Deloria-Knoll M, Levine OS, Stoszek SK, Freimanis Hance L, Reithinger R, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among childrenunder five: the pneumococcal global serotype project. PLoS Med. 2010;7. pii:e1000348.

    Article  PubMed  Google Scholar 

  50. Selva L, Ciruela P, Esteva C, de Sevilla MF, Codina G, Hernandez S, et al. Serotype 3 is a common serotype causing invasive pneumococcal disease in children less than 5 years old, as identified by real-time PCR. Eur J Clin Microbiol Infect Dis. 2011 Nov 4. [Epub ahead of print]

  51. Saha SK, Rikitomi N, Biswas D, Watanabe K, Ruhulamin M, Ahmed K, et al. Serotypes of Streptococcus pneumoniae causing invasive childhood infections in Bangladesh, 1992 to 1995. J Clin Microbiol. 1997;35:785–787.

    PubMed  CAS  Google Scholar 

  52. Arifeen SE, Saha SK, Rahman S, Rahman KM, Rahman SM, Bari S, et al. Invasive pneumococcal disease among children in rural Bangladesh: results from a populationbased surveillance. Clin Infect Dis. 2009;48:S103–S113.

    Article  PubMed  Google Scholar 

  53. Saha SK, Naheed A, El Arifeen S, Islam M, Al-Emran H, Amin R, et al. Surveillance for invasive Streptococcus pneumoniae disease among hospitalized children inBangladesh: antimicrobial susceptibility and serotype distribution. Clin Infect Dis. 2009;48:S75–S81.

    Article  PubMed  Google Scholar 

  54. Paradiso P, Rodgers GL, Girgenti D, et al. Inducing Protective Immunity to Pneumococcal Serotype 3: Impact of Schedule, Geography, and Immune Parameters on the Response to CRM197-Based PCV13. Presented at the 7th International Symposium on Pneumococci and Pneumococcal Diseases, March 14–18, 2010, Tel Aviv, Israel.

  55. Vesikari T, Wysocki J, Chevallier B, Karvonen A, Czajka H, Arsène JP, et al. Immunogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared to the licensed 7vCRM vaccine. Pediatr Infect Dis J. 2009;28:S66–S76.

    Article  PubMed  Google Scholar 

  56. Department of Health and Human Services. Clinical Review of Biologics License Application for Prevnar 13 (Pneumococcal 13-valent Conjugate Vaccine (Diphtheria CRM197 Protein)). 2010. Available from: http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM206341.pdf. Accessed on March 1, 2012.

  57. Tregnaghi MW, Sáez-Llorens X, López P, Abate H, Smith E, Pósleman A, et al. Evaluating the efficacy of 10-valent pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV) against community-acquired pneumonia in Latin America. The 29th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID). The Hague, The Netherlands; 7–11 June 2011. Abstract 1411.

  58. Andrade AL, Ternes YM, Vieira MA, Sgambatti S, Lamaro-Cardoso5 J, Kipnis A, et al. Effectiveness of 10-valent conjugate pneumococcal vaccine on communityacquired pneumonia and pneumococcal carriage after vaccination in Brazil: A population-based study. Presented at the 7th World Congress of the World Society for Pediatric Infectious Diseases (WSPID), Melbourne, Australia, 16–19 November 2011, Abstract 670.

  59. Miller E, Andrews NJ, Waight PA, Slack MP, George RC. Effectiveness of the new serotypes in the 13-valent pneumococcal conjugate vaccine. Vaccine. 2011;29:9127–9131.

    Article  PubMed  CAS  Google Scholar 

  60. Poolman J, Frasch C, Nurkka A, Käyhty H, Biemans R, Schuerman L. Impact of the conjugation method on the immunogenicity of Streptococcus pneumoniae serotype 19F polysaccharide in conjugate vaccines. Clin Vaccine Immunol. 2011;18:327–336.

    Article  PubMed  CAS  Google Scholar 

  61. Hausdorff WP, Hoet B, Schuerman L. Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A? BMC Pediatr. 2010 Feb 2;10:4.

    Article  PubMed  Google Scholar 

  62. Shinefield H, Black S, Ray P, Fireman B, Schwalbe J, Lewis E. Efficacy, immunogenicity and safety of heptavalent pneumococcal conjugate vaccine in low birth weight and preterm infants. Pediatr Infect Dis J. 2002;21:182–186.

    Article  PubMed  Google Scholar 

  63. John TJ, Vashishtha VM. Path to polio eradication in India: A major milestone. Indian Pediatr. 2012;49:95–98.

    Article  PubMed  Google Scholar 

  64. World Health Organization. A New Strategy for the ‘Polio Endgame’? Available from: http://www.who.int/immunization_standards/vaccine_quality/new_strategy_polio.pdf Accessed on March 3, 2012.

  65. Cáceres VM, Sutter RW. Sabin monovalent oral polio vaccines: review of past experiences and their potential use after polio eradication. Clin Infect Dis. 2001;33:531–541.

    Article  PubMed  Google Scholar 

  66. Dömök I. Experiences associated with the use of live poliovirus vaccine in Hungary, 1959–1982. Rev Infect Dis. 1984;6:S413–S418.

    Article  PubMed  Google Scholar 

  67. Von Magnus H, Petersen I. Vaccination with inactivated poliovirus vaccine and oral poliovirus vaccine in Denmark. Rev Infect Dis. 1984;6:S471–S474.

    Article  Google Scholar 

  68. Modlin JF, Halsey NA, Thoms ML, Meschievitz CK, Patriarca PA. Humoral and mucosal immunity in infants induced by three sequential inactivated poliovirus vaccinelive attenuated oral poliovirus vaccine immunization schedules. Baltimore Area Polio Vaccine Study Group. J Infect Dis. 1997;175:S228–S234.

    Google Scholar 

  69. World Health Organization. Polio vaccines. Grading tables. Table V: Sequential administration IPV-OPV. Available from: http://www.who.int/entity/immunization/polio_sequential_administration_IPV_OPV.pdf Accessed on March 4, 2012.

  70. Polio vaccines and polio immunization in the preeradication era: WHO position paper. Wkly Epidemiol Rec. 2010;85:213–228.

    Google Scholar 

  71. Recommended Childhood and Adolescent Immunization Schedules-United States, 2012, Committee on Infectious Diseases. Pediatrics 2012;129;385 Available from: http://pediatrics.aappublications.org/content/129/2/385.full.html Accessed on March 4, 2012.

  72. Recommended composition of influenza virus vaccines for use in the 2012-2013 northern hemisphere influenza seasons. February 2012. Available from: http://www.who.int/influenza/vaccines/virus/recommendations/201202_recommendation.pdf Accessed on March 4, 2012.

  73. Recommended composition of influenza virus vaccines for use in the 2012 southern hemisphere influenza season September 2011. Available from: http://www.who.int/influenza/vaccines/virus/recommendations/2011_09_recommendation.pdf Accessed on March 4, 2012.

  74. Chadha MS, Broor S, Gunasekaran P, Potdar VA, Krishnan A, Chawla-Sarkar M, et al. Multisite virological influenza surveillance in India: 2004-2008. Influenza Other Respi Viruses. 2011 Sep 29. doi: 10.1111/j.1750-2659.2011.00293.x. [Epub ahead of print]

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Indian Academy of Pediatrics Committee on Immunization (IAPCOI)., Vashishtha, V.M. Consensus recommendations on immunization and IAP immunization timetable 2012. Indian Pediatr 49, 549–564 (2012). https://doi.org/10.1007/s13312-012-0116-3

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