WEB BASES DISCUSSION

Live Attenuated Hepatitis A Vaccine

I have been told that the live attenuated vaccine being promoted by this one company is a single dose vaccine and it has been endorsed by the IAP for vaccination against Hep A. Further the references shown by the representative are if no use as the seroprotection to this single dose vaccine has been compared with seroprotection in non immunized children and only in China. Does the IAP actually endorse it?

-docvikas, 7.7.06

There are lots of confusion and controversies regarding Vaccines and vaccination schedule in our country. Every vaccine provider practices a different schedule for vaccination.

-One Professor at KGMU, Lucknow is advocating 2 months gap between DPT Hib-Hep-B doses in her patients.

-Most obstetricians give 1st dose of Hep B, on the first postnatal visit, without caring for BCG.

-Hep-B vaccination is the most mismanaged, with the first dose being given from any day after birth till 2 months, and the gap between 1st and 3rd dose may be anywhere from 3 months to an year.

-Hib vaccine has been mentioned as optional/additional/compulsory in different vaccination cards.

-Some are alternately giving DPT-OPV and HepB every fortnightly.

This prevailing confusion is because the recommendations of IAP are not widely publicized. The least IAP could do is to present clear guidelines as to what vaccines are available and what is the best schedule, and publish this in leading media channels.

-Manoj Singh, Yamini Bal Chikitsalaya, Lucknow, 7.7.06

With so many current and upcoming vaccines, so many different disciplines of healthcare providers delivering them, so many governing bodies/persons deciding need and schedules, so many factors affecting choice-time, money, locality, literacy status, variety of brands.

To formulate single schedule for universal implementation is too difficult for anybody.
Everybody has freedom to prepare and follow his own schedule provided it conforms basics of immunization.

Tailor made schedules with scope for circumstantial revision is need of the time.
For guidelines answering almost all questions and practical approach best reference is one handbook authored by our beloved president Dr.Naveen Thacker.

-pramodmkulkarni, 7.7.06

(From www.iapindia.org/cfforum)

Experts’ views:

The live attenuated Hepatitis A Vaccine has been licensed for use in China since 1992. It contains live attenuated H2 strain which was isolated from a 12 years old boy and was attenuated by serial passage through monkey kidney cells and human lung diploid fibroblast. The manufacturer claims 92 to 100 percent seroconversion with single dose administered by subcutaneous route

This vaccine has recently been licensed for use in India. There is only one Indian study conducted at Pune on this vaccine showing 95% seroconversion. The vaccine has not been studied extensively outside China. All vaccines ideally should be subjected to post marketing surveillance for efficacy and adverse reactions in India as being done in the western world. As vaccine is licensed and available it can be used, For 100% seroconversion and long term protection second dose after 6 months should be administered.

-Dr Shyam Kukreja,

Convener, IAP Committee On Immunization

(In a recently concluded CME of ID chapter of IAP at New Delhi, the experts were of the views that the new Chinese Hepatitis A vaccine would need more trials before claiming it to be effective in a single dose. The best seroconversion with the available Hepatitis-A vaccines is achieved after 2-doses. They were quite skeptical of the company’s claim of its efficacy in single dose.-Editor)

Effect of Prone and Supine Position on Sleep, Apneas, and Arousal in Preterm Infants

OBJECTIVE. Prematurely born compared with term born infants are at increased risk of sudden infant death syndrome, particularly if slept prone. The purpose of this work was to test the hypothesis that preterm infants with or without bronchopulmonary dysplasia being prepared for neonatal unit discharge would sleep longer and have less arousals and more central apneas in the prone position.

METHODS. This was a prospective observational study in a tertiary NICU. Twenty-four infants (14 with bronchopulmonary dysplasia) with a median gestational age of 27 weeks were studied at a median postconceptional age of 37 weeks. Video polysomnographic recordings of 2-channel electroencephalogram, 2-channel electro-oculogram, nasal airflow, chest and abdominal wall movements, limb movements, electrocardiogram, and oxygen saturation were made in the supine and prone positions, each position maintained for 3 hours. The duration of sleep, sleep efficiency (total sleep time/total recording time), and number and type of apneas, arousals, and awakenings were recorded.

RESULTS. Overall, in the prone position, infants slept longer, had greater sleep efficiency (89.5% vs 72.5%), and had more central apneas (median: 5.6 vs 2.2), but fewer obstructive apneas (0.5 vs 0.9). The infants had more awakenings (9.7 vs 3.5) and arousals per hour (13.6 vs 9.0) when supine. There were similar findings in the bronchopulmonary dysplasia infants.

CONCLUSIONS. Very prematurely born infants studied before neonatal unit discharge sleep more efficiently with fewer arousals and more central apneas in the prone position, emphasizing the importance of recommending supine sleeping after neonatal unit discharge for prematurely born infants. (PEDIATRICS Vol. 118 No. 1 July 2006, pp. 101-107 )

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