TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Narayana Holla
  2. Service delivery
  3. Tuesday, 13 December 2016

Dear members and viewers of technet For the successful implementation of routine immunization, country should have a specific IMMUNIZATION SCHEDULE. Members of National Technical Advisory Group on Immunization periodically meet and review the progress involving the collaborative development partners and major stakeholders. Generally, there will be one National Immunization Schedule (NIS) so that all the beneficiaries will get the vaccines as per schedule even if they move out of regular residential area or visit different facilities irrespective public sector or private sector within the country. NIS expands to meet the goals and objectives of Global Vaccination Action Plan (GVAP). There can be delay in communicating the revised schedule to all service providers especially to private sector. In India, Indian Association of Pediatricians (IAP) has always played an important role in the immunization programme. However IAP recommended immunization schedule has not one but multiple versions, some times in the same facility especially private Medical Colleges. Often, both, the parents and the facility that provided vaccination service found it very difficult to decipher the vaccines administered. Parents are provided with the “Tayicard”, MCP card and the equivalent by the Govt and the private card with IAP schedule; parents get totally confused and lose faith with both the sectors. ANMs provide vaccination services at the outreach and at planning units (PHC/CHC/Govt Hosp). They expressed that there should be only one immunization schedule for all the vaccines supplied by the Govt which we call as “ESSENTIAL VACCINES – Part A” and other vaccines available in the private sector which we call as “OPTIONAL VACCINES – Part B” as one “combo-card”. This will strengthen the Routine immunization programme of the country and promote child’s health. Keeping this in mind, we critically reviewed the revised IAP schedule, shared our “Draft” observations with a few pediatricians, IAP and local development partners for additional inputs and further revision. The same is attached for sharing with the technet community and viewers for valuable inputs. Regards Holla and the team

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Narayana Holla Accepted Answer

Dear sir

Thanks a lot for responding.

This whole thing started last year in May 2015 when parents came to our PHC for Measles 1st dose, previous ones taken in a Private Medical College in a Metro city. I was not able to decipher the vaccines received by the infant, after a fortnight I came to know that the service provider was also not able to decipher the vaccines given. Then me and the ANMs of Sampaje PHC attached to our college started to address the issue and came out with prototype of Combo-card. The present pictorial type of schedule printed in the "Tayicard" based on Mission Indradhanush principle by the Govt attracted us and to support / strengthen the Govt, in the Combo-card we also printed 'as it is' with a little modification to include our Master Register number for linkage.

As you rightly suggested there should be consensus of opinion between UIP / IAP and evolve a common schedule including vaccines of NIS and optional applicable to the country - 2017 for solving multiple problems.

In our country, outreach sessions / fixed sessions conducted in the public sector is frequently supervised with monitoring checklist but not that of private sector. Regular training / reorientation occurs in the Govt sector both as routine and when there is a change in policy like introduction of Pentavalent, MCV 2 doses, JE 2 doses, NIDs, SIAs and now MR campaign. Participation proactively by the private sector is very minimal and hence there is a huge operational gap.

Regarding seroconversion following vaccination with vaccines having no VVM: I did not explore any study regarding this, but may be available done in our country. But I had the opportunity to investigate measles outbreaks in which among the vaccinated who got measles were vaccinated were vaccinated mainly by the private sector with poor cold chain maintenance, no VVM, reconstituting with diluent at room temperature. Reconstituted multi-dose measles vial was kept in the domestic refrigerator at the bottom shelf and used for days. BCG was reconstituted with saline from NS bottle at room temperature. OPV is being administered even when the VM was/is in discard stage - even now as reported by an observer. Hands-on training was given on the spot at all such instances and shared in the training workshops with photos but without identity. We wish to conduct a study on receiving support and protocol as it requires funding and ethical approval.

Providing knowledge about optional vaccines by the Govt sector looks a welcome step. Vaccines like PCV are costly, very few beneficiaries coming to Govt sector may be able to afford. But the basic problem is again the cold chain which is very week in the private sector and will not have any VVM. Being optional, public sector has no chance to keep the same in the proper cold chain though available with them. In our country, if this is advocated, Medical Officer may have to face the litigation / repimand. Thus, though holistic, operationalizing may be difficult.

About the batch number I fully agree with you. In fact, in our institution we are mentioning in the discharge notes having unlimited space. Another reason, as of now we have not included is: our college is procuring vaccines free from the Govt with VVM, proper cold chain maintained and service provided as per WHO/GOI guidelines by the GOI trained staff, under supervision. We are recording such details in our stock register, if required it is easily available. Many whom we shared have not given this suggestion also. We can consider this and we have to make some more space adjustment in the card.

Thanks and regards once again

Holla and the team

  1. more than a month ago
  2. Service delivery
  3. # 1
Logical Epid Accepted Answer

nice points Dr.Holla. it is indeed very confusing for parents when there are multiple immmunization schedules and both are very different. UIP schedule of government and indian academy of paediatrics IAP schedule both claim they follow WHO position paper recommendations. WHO position paper recommends multiple schedules for each vaccines and countries are free to choose one according to local epidemiology and other factors. we have problem that within same country government UIP is choosing one recommendation from WHO position paper for hepatitis B and IAP is choosing another schedule of hepatitis b from the same WHO position paper and parents are left confused. there should one expert committee at national level from IAP and UIP, they should sit across every year and announce IMMUNIZATION SCHEDULE FOR INDIA 2017, which can be revised every year based on latest recommendations. it should be have all recommended vaccines and also optional vaccines.

1. Are there any studies published regarding seroconversion of vaccines with VVM and vaccines without VVM? it is very general and vague statement when it is not supported by data or research evidence. i agree that having vvm on every vial in private sector is a good indicator of vaccine potency. this should be demanded by iap to supply only vaccines with vvm and should also be discussed with vaccine manufacturing companies to supply all vaccines only with vvm. at present there is no such mandate or rule or law

2. when pneumoccoccal and rota are causing so many deaths, is it not reposibility of government phc to inform parents that these additional vaccines are available and can be taken if affordable. why should only private pediatricians mention optional vaccines?even government cards should mention optional vaccines. let parents make informed decisions

3. why should batch number and manufacturers name be mentioned only for optional vaccines. even government vaccination card should have space to write batch number for every vaccine administered. let parents have that record and inform in case of any aefi

i am not against iap or uip, but further discussion are required to reach consensus than to just criticise one another. good issue raised but hope it gets followed up than just ending up in discussion forums. may be many other countries are also facing such situation. experts in forum can suggest how other countries are tackling such issues and can india adopt those to have a unifrom immunization schedule.

  1. more than a month ago
  2. Service delivery
  3. # 2
Narayana Holla Accepted Answer

It is learnt from Times Of India (TOI) dated 25 Dec 2016 that IAP has removed the revised Immunization schedule from the website on account of certain problems and conflict and is expected to comeout with a solution in Jan 2017.

Hope this time the schedule of essential vaccines of IAP and NIS will match so that all children can get essential vaccines from the public sector with VVM depicting potency. If this happens, all can complete the primary vaccination before first birthday[FIC below one year - the key performance indicator of Routine Immnization].

  1. more than a month ago
  2. Service delivery
  3. # 3


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