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QUESTION: Dear Doctor,

My baby is now 2 months old. She has been given following vaccination till now:
Birth : OPV & Hep B (BCG vaccination)
1 month: Hep B 2nd dose
40 days: Polio drop on govt boooth

Now, her Pediatric recommends to give vacciantion on completion of 2 months for DTP, Hib, IPV, PCV and Rotavirus. He has also given an option to choose either combination of DTP+HIB and IPV by which mild fever can come to baby or pentaxim (combination of DTP+HIB+IPV) which is pain less. Rotateg for rotavrius and Penavar for PCV. I would like to know which vaciantion I should prefer. What would be the cost approxiamtely for all vacinations. Can we avoid any of the vacination like PCV as he said it's optional.

Please Advice accordingly. Thanks

ANSWER: Hi Ansh,

Your pediatrician is correctly advising you. DTP, IPV, Hib, Rotavirus and PCV all are recommended for routine use; none of these is "optional". Only reason some people forego any of these is high cost; otherwise, scientifically all of these are recommended.

You can see latest immunization schedule, as officially recommended by Indian Academy of Pediatrics (IAP) at: http://iapcoi.com/hp/pdf/IAP%20Immunization%20Timetable%202012.pdf

The cost of Pentaxim is Rs. 1893 per dose.

DTP+HiB and IPV are two separate injections and many brands are available. The cost is roughly between Rs. 800-900 per dose depending upon brand.

For Rotavirus vaccines, two brands are available: ROTATEQ and ROTARIX costing Rs. 960 and 1199 per dose. However, ROTATEQ requires 3 doses at one mon interval; ROTARIX requires only 2 doses (at one month interval). Both are equally effective and you can go for any of these. Both these vaccines are Oral.

For PCV vaccines, again there are two brands, PREVENAR 13 and SYNFLORIX. PREVENAR 13 costs Rs. 3801 per dose while the other costs Rs. 1999 per dose. Three doses are recommended for both of these followed by a booster at 12-15 months of age for each of these. However, please note that unlike rotavirus vaccines, these brands are not equally effective. Prevenar 13 is at least 3-5% more effective than Synflorix, as it protects against 13 types of the bacteria, while Synflorix covers 10 types.

Please note that for Rotavirus and PCV, you can choose any brand. however, once you choose, you have to continue with same brand for rest of the dose, as these are not interchangeable.

Also note that in addition to the cost of vaccines as I have mentioned above, the pediatrician would also charge his consultation fee and vaccine/ injection fee, as applicable.


Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846



---------- FOLLOW-UP ----------

QUESTION: Hello Doctor,

Thanks for your valuable answers!
Further to your answers I have few more queries as stated below:

For DTP+HIB+IPV, which one we choose between pentaxim and two sepearete injections...also as u mentioned cost is between 800-900 this is for both injections or DTP+HIB only.

For Rotavirus, in my immunization schedule it advise for each dose after 2 month...dose either 2 or 3 depends on brand..is it ok if take doses after 2 months?

FOR PCV, if I go with SYNFLORIX brand..is that fine? does major 3 bacteria type is not covered into this?

Thanks,
Ansh

Answer
Hi Ansh,

The cost is for both (DPT+HiB AND IPV) injections. Pentaxim in addition to being single injection, has DTaP instead of DTwP: Both DTaP and DTwP are equally effective, but DTaP causes less fever pain (no pain/ fever in most cases) than DTwP. The choice is yours. And these are interchangeable also. You can go for DTwP for first dose and if baby has lot of problem, you can switch to Pentaxim for next dose.

Regarding Rotavirus vaccines, the gap between two doses is one month. Both can be started at 6 weeks of age. No problem if started at 2 months of age; although earlier the better.

Regarding PCV, it is your choice. But you should know the difference. The effectiveness is a little less, as 3 types are not covered.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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