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Pediatrics/Vaccine Confusion

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QUESTION: Born on 9th July 2014.

I gave her BCG in hospital itself.

23/08/2014 - DTP (1st dose) (Pentavac PFS)
22/09/2014 - DTP (2nd dose) + Rotavirus (Rotateq)
11/10/2014 - IPV 1st dose (Imovox)

To be given :
25/10/14 - DTP (3rd dose)
10/11/2014 - IPV 2nd dose
10/12/2014 - IPV 3rd dose
10/01/2014 - PCV 1st dose
10/02/2014 - PCV 2nd dose
10/03/2014 - PCV 3rd dose

I dont want to give more than one injection at a time. So didnt give IPV and PCV along with the 1st dose. Planning to start PCV 1st dose after completing 3 doses of IPV.

My question is am I right in giving the vaccines in the above schedule? My Paediatrician said its fine. Internet sources and one other doctor said there should be at least 4 weeks of time interval between 2 DIFFERENT vaccines. Few sources say only between 2 SAME vaccines there should be 4 weeks interval. I am confused. Can you please clarify me?

Also if I miss the primary doses of IPV and PCV, it was mentioned in Internet that it we have to give only 2 doses of IPV and PCV. Is it so?

ANSWER: Hi Swapna,

It is BETTER to give all the vaccines that are due on the same date: By delaying the vaccine, you are posing the baby to some risk: What if baby develops infection before she is immunized? For example, PCV should have been given around 24/8/2014, but you have delayed it till January 2015. Hence between August and January baby is totally unimmunized against PCV. Baby should have been immunized till November (after 3 doses of PCV), but this would now happen by March 2015!! Thus, my advice would be to give all the pending vaccines ASAP without fearing for 2/3 pricks on a day: These "pricks" are for baby's good only, no??

However, to answer your question theoretically, DIFFERENT vaccines (other than measles, MMR and Chicken Pox vaccines) can be given in any relation with each other...no need to wait for 4 weeks. But, I must tell you again that it is not a good idea to delay ANY vaccine. It is BEST to give vaccines on the due date. One must always think of giving BEST to little ones.

If you delay the PCV vaccine by 5 years, you would not require to give even one dose since the vaccine is not required in otherwise well child over 5 years of age... but is it really "saving" or posing the baby on undue risk?? Think about it!!

There will be no confusion if you simply follow the standard immunization chart: It is prepared by experts and indicate BEST for your baby..Why unnecessarily modify and complicate issues??


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

+91-9818356846, +91-11-45535647

www.KumarChildClinic.com



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

QUESTION: Thank you for your reply sir. Yes sir I am worried about it too. Also I do't undrstand why PCV is kept as an optional vaccine. Some of my friends are not giving it as it is optional.  But people at home are totally against more than on prick. So can I follow the below schedule:

11/10/2014 - IPV 1st dose (Imovox)

To be given :
18/10/14 - PCV 1st dose
25/10/14 - DTP (3rd dose) + Rotavirus (Rotateq 2nd dose)
10/11/2014 - IPV 2nd dose
18/11/2014 - PCV 2nd dose
10/12/2014 - IPV 3rd dose
18/12/2014 - PCV 3rd dose

I have given Rotateq for my baby. How many doses I have to give? Is it ok if I give three different vaccines in one week gap? (1st week - dtp and rota, 2nd week - ipv and 3rd week pcv). Nothing wrong na?

Also baby has cold and cough. She doesn't have chest cold. But common cold. Doctor prescribed piriton. Is it safe to give her?

ANSWER: Hi Swapna,

PCV is NOT an optional vaccine. It used to be optional vaccine initially ( 6 years back) when it was first introduced in India, since there was not enough studies to show how common is the disease in India. Howver, fotr the last 3 years or so, it is in the routine list. The only reasons why some people do not go for it is lack of awareness, confusion regarding "optional vaccine" and high cost of the vaccine. However. both Indian academy of Pediatrics (IAP) and WHO strongly recommend the vaccine for routine use.

By giving vaccines every week, baby would be more troubled. In my opinion it is better to give the vaccines on the same day and let the baby not be given vaccines for a month then, rather than going in every week.

For Rotateq, 3 doses are recommended at one month interval.

I hardly ever prescribe cough suppressants like Piriton in young infants. Better not to give any medicine (other than paracetamol for fever)and wait and watch. If cough worsens, please take a second opinion from another doctor (NOT online!)

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

+91-9818356846, +91-11-45535647

www.KumarChildClinic.com






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

QUESTION: Thank you sir. Sorry for troubling you with more questions. My Paediatrician doesn't want to give all three injections on one day. He is the BEST when it comes to diagnosing a disease and also my family doctor. So I don't want to change the doctor.  But I will try my best to give the vaccines in one shot. Should I have to give it in the same thigh or different thigh? Is PCV a painful vaccine?

Also is it wrong to give weekly one vaccine? will the vaccines not work if it given in a weekly schedule as some websites claim that vaccines shouldn't be given in that way. Also as she is in her 14th week, should I have to give all the 3 doses of PCV as I have missed the primary dose?

Answer
Hi Swapna,

When 2 vaccines are to be given, the vaccines should be given on different thighs. When more than 2 vaccines need to be given,then between the 2 pricks on the same thigh, there should be a gap of one inch between the pricks. No, PCV vaccine doesn't cause pain; yes 3 doses are recommended even when started at 14 weeks: These ARE primary doses only: Booster dose would be given at 12-15 months.

It is BEST to give the vaccines on the same day or at the most within 24 hours. I am giving you the link for standard National recommendations of IAP (latest version: November 2013). Please read instruction number 2 under "general instructions" on page 2 of the following link:

http://www.iapindia.org/IMM%20Schedule.pdf

Instruction number 16 in the same heading mentions the "gap" between 2 pricks on the same thigh, as I mentioned above.

These recommendations are formulated by the best experts on the topic by consensus and need to be followed by everyone.

Unnecessary modifications fuel confusion, nothing else. Thus the bottom line: "Keep it simple, follow guidelines, avoid confusion and errors"


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

+91-9818356846, +91-11-45535647

www.KumarChildClinic.com  

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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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