Recommendations on IAP Immunization Time Table for 2012

Vipin M. Vashishtha, MD, FIAPConvener, IAPCOI 2011-13

vipinipsita@gmail.com

December 24th, 25th 2011 Meeting of IAPCOI, ITC Maratha, Mumbai

• Immunization schedules ought to be dynamic & adaptable to ongoing epidemiological changes & rapid developments in vaccine sciences

Existing IAP Immunization Schedules

IAP recommended vaccines (2011)

I. IAP Immunization Time Table 2011

Footnotes: • OPV alone if IPV cannot be given• *# Rotavirus vaccine (2/3 doses depending on the brand at 4-8

weeks interval)• ** The third dose of Hepatitis B can be given at 6 months• $ The second dose of MMR vaccine can be given at any time 4-8

weeks after the first dose• $ $ Varicella (2nd dose may be given any time 3 months after the

1st dose)• # Typhoid revaccination every 3 years• & Tdap preferred to Td, followed by repeat Td every 10 years• ^ Only females, three doses at 0, 1-2 (depending on brands) and 6

months

II. IAP Immunization Schedule for adolescents

• IAP recommended vaccines for Adolescents (10 Years to 18 Years)

• IAP Recommendations for Catch up Immunization in Adolescents

• IAP Recommendations for Adolescent Immunization in Special Circumstances

• IAP Recommandations for Adolescents traveller

IAP recommended vaccines for Adolescents (10 Years to 18 Years)

IAP Recommendations for Catch up Immunization in Adolescents

IAP Recommendations for Adolescent Immunization in Special Circumstances

IAP Recommandations for Adolescents traveller

What changes are needed?

• Need to have separate schedules• Need to consolidate footnotes• Need to revise recommendations pertaining

to individual vaccines

The CDC style timetables:

• Three schedules • 0 through 6 years • 7 through 18 years • “Catch-up” – 4 months through 6 years – 7 through 18 years

• Each schedule should have separate footnotes

I. Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—United States 2011

II. Recommended Immunization Schedule for Persons Aged 7 Through 18 Years—United States 2011

Changes to Individual vaccine recommendations:

Hepatitis B vaccine (HepB)

CDC new guidelines for Hep-B schedule:

• For infants born to HBsAg-positive mothers: • Administer HepB vaccine + 0.5 mL of

hepatitis B immune globulin (HBIG) within 12 hours of birth.

• These infants should be tested for HBsAg and antibody to HBsAg 1 to 2 months after receiving the last dose of the series.

http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct11/Child-Adolescent-Immunization.pdf

Hep-B• If mother’s HBsAg status is unknown: • Infants weighing ≥ 2000 grams: within 12 hours

of birth administer HepB vaccine • Infants weighing < 2000 grams: within 12 hours

of birth administer Hep B vacccine + HBIG • Determine mother’s HBsAg status as soon as

possible and, if HBsAg-positive, administer HBIG for infants weighing ≥ 2000 grams (no later than age 1 week).

http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct11/Child-Adolescent-Immunization.pdf

Hep-B

• Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine starting as soon as feasible

http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct11/Child-Adolescent-Immunization.pdf

Hep-B

• The minimum interval between doses:• 1 and dose 2: 4 weeks • Between dose 2 and 3: 8 weeks• The final (3rd or 4th) dose in the HepB series

should be administered no earlier than age 24 weeks, and at least 16 weeks after the 1st dose.

http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct11/Child-Adolescent-Immunization.pdf

Suggested modification:

• IAPCOI schedule:• Three doses at:• Birth, 6 weeks, & 6 months

Tdap vaccine:

• CDC recommended use during pregnancy

Hib vaccines:

• Hib vaccine should be considered for unvaccinated persons aged 5 years or older who have sickle cell disease, leukemia, or HIV infection, or who have had a splenectomy.

PCV:

Discussion & Vote: