I poster

1. IAP recommendations 2012:
Major Changes

2. Contents
•Polio
•Hepatitis B
•Influenza
•Other changes

3. Polio

4. Polio: Important developments
•India has not reported a single case of wild Polio
since January 2011
•7 VDPV cases reported in 2011 and 1 iVDPV reported
in 2012 (West Bengal)
•WHO declared India non-endemic in Feb 2012
•To reduce incidence of VAPP and VDPV (especially
type 2), in April 2012, WHO recommended
introduction of bOPV inplace of tOPV as well as IPV
in all countries currently using OPV in their routine
immunization programme

5. Polio: Important developments (cont)
•India Expert Advisory Group (IEAG) has also
recently recommended bOPV and IPV
•In light of these developments IAP has
decided to endorse gradual shift from tOPV to
bOPV in the national immunization
programme and to introduce a sequential
schedule of IPV and OPV rather than a
combined schedule for private practice

6. Polio: IAP recommendations
•Phased OPV removal : switching from tOPV to
bOPV1&3 for routine EPI & campaigns.
•Retained the birth dose of OPV (necessary
where the risk of poliovirus transmission is
high).
•Sequential immunization schedules starting
with IPV & then OPV induce protective
immunological responses to all 3 serotypes in
≥ 90% & ↓ risk of VAPP

7. Polio: IAP Time Table
Age Vaccine
Birth OPV
6 weeks IPV
10 weeks IPV
14 weeks IPV
6 months OPV
9 months OPV
16 - 18 monthsIPV
4½ - 5 years OPV

8. Polio: Catch-up schedule and
Travellers
Catch-up schedule (< 5yrs of age)
3 doses of IPV; 2 doses at 2 months interval followed by a 3rd dose after 6
months.
Travelers
•Immunized individual (previously received ≥3 doses of OPV or IPV) should
be offered another dose of polio vaccine as a once-only dose before
departure.
•Non-immunized individuals should complete a primary schedule of polio
vaccine, using either IPV or OPV ( at least 3 doses of either vaccine).

9. Hepatitis B

10. IAP Recommendations
•IAPCOI has now recommended a 0–6 week–6 month
schedule for routine Hepatitis-B vaccination in office
practice for children:
–the first dose at birth
– second dose at 6 weeks
– and third dose at 6 months
•Administering Birth dose to all infants before hospital
discharge critical
•Final dose not to be administered before 6m of age

11. Rationale
•This schedule is not only closer to immunologically
ideal and most widely used 0-1-6 months schedule
•Confirms to latest ACIP recommendations wherein
the final (third or fourth) dose in the Hepatitis-B
vaccine series should be administered no earlier than
age 24 weeks and at least 16 weeks after the first
dose.
•0-1-6 is the only schedule widely followed across the
world and for which there is abundant evidence of
effectiveness (Taiwan, Thailand and USA)

12. Rationale (cont)
•Birth dose extremely important to protect against chronic
infection and possibly Hepatocellular carcinoma
•The GMTs with 0, 1, and 6 months schedule are upto 10 times
higher than 6,10,14 wk schedule.
•Infants who achieve higher Anti HBs titers may be protected
better in later years.
•The seroprotection rates are found to be highest when the
interval between the second and third dose is longer.
•The classic 0, 1, and 6 months schedule yields a high
seroconversion rate and relatively high titers of anti-HBs that will
persist for an extended period of time.

13. Influenza

14. IAP recommendations
•Data since 2004 suggests a clear peaking of circulation
during the rainy season across the country- ‘June to
August’ in North (Delhi), west (Pune) and East (Kolkata),
and ‘October to December’ in South (Chennai)
•This data is also consistent with the WHO circulation
patterns for 2010 and 2011 for India which also shows a
clear peak coinciding with the rainy season across the
country.
•Vaccination should be with the latest strains available
and before the peak of Influenza circulation in the rainy
season

15. IAP recommendations (cont)
•In addition to this, WHO classifies India under the
‘South Asia’ transmission zone of Influenza
circulation.
•This along with summary review of the 2011
southern hemisphere winter influenza season
strongly points towards India’s alignment with the
availability of Southern hemisphere vaccine
(available in March-April)
•This will ensure that we have the latest available
strains for early vaccination to prevent the peak of
circulation of Influenza in the rainy season across the
country.

16. Other changes
•Rota virus vaccination: History of
intussusception in the past is added as an
absolute contraindication to rotavirus vaccine
administration.
•Pneumococcal vaccination: Prematurity and
very-low birth weight are added as another
high risk category for pneumococcal vaccine
administration

17. IAP Immunization Calendar at a glance
Age ►
Vaccine ▼
Birth 6 wk 10 wk 14 wk 18 wk 6 mo 9 mo 12 mo
1
5
m
o
18 mo
2-
3
Y
r
4-6
Yr
BCG BCG
Hep B Hep B1 Hep B2 Hep B3
Polio vaccines
OPV0 IPV1 IPV2 IPV3 OPV1 OPV2 IPV B1
OPV
3
DTP
DTP 1 DTP 2 DTP 3 DTP B1
DTP
B2
Hib Hib 1 Hib 2 Hib 3 Hib-booster
Pneumococcal PCV 1 PCV 2 PCV 3 PCV -booster PPSV
Rotavirus* RV 1 RV 2 RV* 3
Measles Measles
MMR
MMR 1
MM
R 2
Varicella
Varicella 1
Varic
ella 2
Hep A
Hep A 1
Hep
A 2
Typhoid Typhoid
Influenza Influenza (yearly)
Meningococcal Mening
ococcal
Cholera Cholera 1 & 2
JE JE
9
th
July 2012

18. Conclusions
•Polio: Sequential IPV-OPV schedule in place of
combined OPV+IPV schedule.
•Hepatitis-B: ‘Birth-6 weeks-6 months’ instead
of earlier ‘0- 6 weeks-14 weeks’ schedule.
•Influenza: Southern Hemisphere vaccine to
provide earliest and most accurate protection
against the circulating strains of Influenza
virus.