Dilemmas in Immunization?

Sir,

There has been confrontation in my mind and I am sure it must be in the mind of some of our colleagues too regarding certain aspects of immunization. The confusion is not exactly regarding National Immunization Schedule but for immunization in special circumstances. Since only 43% of Indian children in the age group 12-23 months are fully immunized (National Family Health Survey-3) and that of Uttar Pradesh is only 23%,(1) meaning thereby more than half of children under-five years of age are either partially immunized or are totally unimmunized. Keeping in mind the grim state of affairs of our country with respect to immunization, we can replace the word “Special” with “Normal” circumstances.

The schedule for immunization for this age group and in different circumstances is governed by two schools of thoughts. On one side is the Ministry of Health and Family Welfare (MOHFW) and World Health Organization, whereas, on the other side is the Indian Academy of Pediatrics (IAP).

First, as per Ministry of Health and Family Welfare guidelines, the upper limit for BCG vaccination is 12 months,(2) whereas the Indian Academy of Pediatrics advocates it till the age of 7 years and beyond.(3) Second, recommendation by MOHFW (2008) for DPT was up to the age of 24 months, beyond which DT was to be administered.(2) The guideline for the same vaccine as per IAP was up to the age of 5 years.(3) Third, National Immunization Schedule (MOHFW) listed only DT at 5 years,(2) whereas as per IAP schedule, DPT (booster) and OPV (booster) are to be given at the same age.(3) Although, new recommendations by the ministry have arrived, paving way for sorting out the issue of administration of DPT (booster 2) at 5 years of age,(4) but what about OPV(booster 2)?. Fourth, 2^nd dose of vitamin A is to be administered at the age of 18 months and thereafter every 6 months till the age of 5 years (IAP), but according to the Child Health and Nutrition months or Bal Swasth Poshan Mah (BSPM) in the months of June and December, the second dose of vitamin A is to be given only in the above mentioned months, e.g., if the child is administered the first dose of vitamin A along with measles in February, then the next dose along with DPT (booster 1) should be given in the month of November, but as per BSPM guidelines, the same dose should be given in December, the same year.

Why are these two responsible bodies following two different paths when both of them are fighting the same battle and their concern is same, i.e., achieving universal immunization coverage.

I, being a health worker and as teacher of Community Medicine, in the light of the above mentioned differences is very often standing at an odd situation when it comes to managing immunization camps jointly by various agencies and teaching the medical undergraduates.

I request the esteemed intellectuals in the field of public health and pediatrics to come forward and develop a consensus, consensus pertaining to immunization, the consensus in the interest of children and community, in general, and health workers and teachers of public health, in particular.