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Vaccine options in India

Dr. M. Vijayalakshmi, M.D (Peds), M.D (USA), F.A.A.P

Disclaimer: By no means do we (AllForKids) claim that this is a comprehensive list of all vaccines available in India. We do not through this article endorse or recommend any particular product over other products. It is for the parents and their pediatrician to decide on the most appropriate vaccine to suit the specific need and situation of their child.

Vaccination Schedule – recommended vaccination schedule as per IAP and AAP guidlines

AgeVaccinations
At Birth BCG,Polio,Hepatitis-B
6 weeks DTaP, Hepatitis-B, HiB, Polio, Pneumococcal
10 weeks DTaP, HiB, Polio, Pneumococcal
14 weeks DTaP,  HiB, Polio, Pneumococcal
6 Months Influenza Vaccine, Hepatitis-B
7 Months Influenza Vaccine
9 Months Measles Vaccine
12 Months Chicken Pox
15 months MMR ,Pneumococcal booster
18 months DTaP, Polio,HiB, Hepatitis-A
2 years Typhoid, Hepatitis-A
3 years Annual Pulse Polio, Catch-up vaccines if any
4 years Annual Pulse Polio, Catch-up vaccines if any
5 years DTaP, Polio, MMR Booster
10 years Tdap booster
16 Years Tdap booster

Recommended vaccines for Adults:

  1. Chickenpox Vaccine – 2 doses, if not vaccinated previously and not infected previously
  2. Hepatitis-A –2 doses, if not vaccinated previously
  3. Hepatitis-B – 3 doses, if not vaccinated previously
Advantages of newer generation vaccines

DTaP Vs. DTP

Tdap/DTaP vaccines which are now available in India is a newer version of DTP vaccine. Tdap/DTaP vaccine which contains acellular pertusis vaccine is safer as it causes lesser adverse reactions than the older DTP vaccine. This means lesser pain at injection site and lesser incidents of fever after vaccination. The vaccine is supplied in India by two major vaccine manufactures: as Infanrix/Boostrix by GSK and as Tripacel by Sanofi Pasteur. The U.S.'s Advisory Committee on Immunization Practices (ACIP) recommends that children receive DTaP instead of DTP and adolescents receive Tdap vaccine instead of TT Booster at age 10 and 16 years.

Oral Polio Vaccine Vs. Injectable Polio Vaccine

Oral Polio Vaccine is a live-attenuated vaccine given as drops to children. This is the most common mode of polio vaccine in India. However , most developed countries have long back switched to Injectable Polio Vaccine (IPV). Injectable Polio Vaccine or Inactivated Polio Vaccine contains killed virus and thus eliminates the chances of any occurrence of vaccine associated paralytic poliomyelitis and any vaccine induced wild polio outbreaks.

Recently Government of India decided to start introducing Injectable Polio Vaccine from 2009 starting with 9 districts of Uttar Pradesh and gradually expand it nationwide.

Injectable Polio Vaccine has now been available in India for some time. These are available as single dose Imovax and few other brands or in combination with DTaP and HiB as Pentaxim

Combination Vaccines

The advantages of combination vaccines are:

  1. Less number of injections for the child and
  2. Generally the cost will be less compared to taking the vaccines separately.

Efficacy of some combination vaccines available in India have not been proven by sufficient studies and as such we do not regularly recommend many of the combinations available in the market.

These are some of the combinations we recommend:

  1. Tritanrix HB+Hiberix
  2. Infanrix +Hiberix
  3. TetraActHIB
  4. Tripacel + ActHiB
  5. Pentaxim

Optional Vaccines *

*We believe that Optional Vaccines is a myth. Any vaccine if it has been proven safe and effective should be given children if it is affordable. Also in most of the Europe the US these vaccines are part of the National Immunization Schedule

  1. Prevenar (Pneumococcal)
  2. Chicken Pox Vaccine
  3. Hepatitis A
  4. Rotavirus Vaccine- Oral

Multi-dose Vs. Single Dose(mono dose)

Single dose vaccines may cost slightly higher because of packing and other expenses involved but they are recommended for the following reasons:

  • Less chance of contamination and associated risks
  • Less chances of quantity errors by administering nurse or doctor
  • Better chance of maintaining efficacy

So wherever possible parents should insist on single dose vaccines for your child.

List of Vaccines

This is not a comprehensive list but a list of vaccines that we have used at AllForKids and found to be safe:

  1. BCG Vaccine
  2. DTaP- Infanrix/Tripacel
  3. HiB – Hiberix/Act HiB
  4. Tritanrix HB – DPT + Hepatitis B
  5. TetraActHiB –DPT + HiB
  6. Pentaxim- IPV + DTaP +HiB
  7. Injectable(Inatctivated) Polio Vaccine - Imovax
  8. Oral Polio Vaccine - OPV
  9. Hepatitis B- Engerix B
  10. Pneumococcal vaccine- Prevenar
  11. Measles Vaccine
  12. MMR- Priorix/Tresivac
  13. Rubella Vaccine- R-Vac
  14. Typhoid Vaccine- Typherix
  15. Hepatitis A- HavPur, Avaxim, Haverix
  16. Influenza Vaccine- Vaxigrip
  17. Chicken pox- Okavax/Varilrix
  18. Tdap booster- Boostrix

Vaccine Safety

Vaccines are actually very safe, despite implications to the contrary in many anti-vaccine publications Most vaccine adverse events are minor and temporary, such as a sore arm or mild fever. These can often be controlled by taking Paracetamol before or after vaccination. More serious adverse events occur rarely (on the order of one per thousands to one per millions of doses), and some are so rare that risk cannot be accurately assessed. As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically. Of all deaths reported to VAERS (Vaccine Adverse Event Reporting System in the USA) between 1990 and 1992, only one is believed to be even possibly associated with a vaccine. Each death reported to VAERS is thoroughly examined to ensure that it is not related to a new vaccine-related problem, but little or no evidence suggests that vaccines have contributed to any of the reported deaths or serious side effects. The Institute of Medicine in its report states that the risk of death from vaccines is "extraordinarily low." Any such extremely low risks from vaccines pale in comparison to the chances of complications of many serious diseases they protect against.

Vaccine Safety in Indian Context

USA has a very extensive VAERS (Vaccine Adverse Event Reporting System) and reporting any actual or suspected adverse events are mandatory for all healthcare providers by law. Also the FDA and other federal agencies keep a close tab on vaccine safety. Unfortunately in India such systems are practically non-existent or poorly managed. Hence the best possible course of action is to stick to the recommendations from the US as far as vaccine safety is concerned.

What parents can do?

Do not compromise on quality for the sake of the savings of a few rupees, the well being of your children is much more important:

  1. Vaccines should be administered only by a Pediatrician or at least a nurse with adequate pediatric training and experience.
  2. Insist on mono- dose vaccines when available
  3. Check to make sure that the expiry and other information on the vaccine bottle/packet is correct
  4. Make sure that the facility has an effective cold-chain to keep the vaccines safe
  5. Ask for a vaccine handout which provides details about the vaccine and any potential side effects
  6. Make sure that the vaccination card is updated by the doctor with the date of vaccination and other information
  7. It is better if the provider is keeping an electronic medical record system to keep track of the vaccinations provided to your child with its batch number.
  8. Know what the usual side effects from vaccine administration are including any pain and fever and take medicines to reduce the impact when needed

Reading this article does not establish a patient-provider relationship between you and AllForKids for any of its doctors. You use any of the information provided in this document at your own risk.