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QUESTION: My grandson is 5 years 4 months old and stays at Hyderabad ,where now a lot of people are suffering from from Swine Flu.As far as I know Zydus Cadilla has a vaccine called Vaxiflu-S(Originally not recommended below 18 years).Serum Institute has launched another in the name of NASOVAC-S , Trivalent Influenza Vaccine, (Human), freeze dried is a live trivalent vaccine for administration by intranasal spray. NASOVAC-S contains three vaccine virus strains of A/H1N1, A/H3N2 and Type B influenza virus .NASOVAC-S is indicated in individuals above 2 years of age for the active immunization for the prevention of influenza disease.This is possibly a  Live Attenuated Intranasal  Influenza vaccine, (LAIV):which is possibly preferred over Inactivated Injection
Now my question is
1)Whether guardians should go for   this Swine Flu  vaccine and whether this will cover normal influenza vaccine utility also
1)At what frequency this Swine Flu  vaccine is given
2)In India which is the most popular brand(including imported ones).
         With thanks

ANSWER: Dear Mr. Kalyan,

Here are the answers:

1. Swine flu is not different from "normal" influenza. Its just a strain of influenza. All "normal" influenza vaccines available in India will cover Swine Flu also.

However, Swine Flu/ "Normal" Flu is a MILD illness in otherwise healthy children/ young adults. Hence routine vaccination is NOT recommended in this age group. At highest risk are elderly (>65 years age). All elderly persons should take the vaccine every year. Pregnant women should also take the vaccine. Among children, it is recommended only in those with chronic lung (excluding asthma, unless very severe cases:receiving oral steroids) / heart/ kidney diseases.

2. If given in children less than 9 years of age, then 2 doses at one month interval when the vaccine is given for the first time. Then from next year, single dose every year. For children above 9 years, single dose in first and every subsequent year.

For all, the vaccine should be taken as soon as the fresh batch comes in market: Usually August-September every year (sometimes delayed to October).

3. Many brands are available. You need to consult child's pediatrician for the same.


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

+91-9818356846, +91-11-45535647

www.KumarChildClinic.com

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

QUESTION: Whether Regular flu vaccine  contains components of the 2009 H1N1 virus.In Hyderabad the doctor in charge of this swine flu operation Dr Ramkrishna Reddy (as reported in Times of India dated 21/12/2014)has lamented that there is SCARCITY of Trivalent Influenza Vaccine.Regular flu vaccines probably does not contain  H1N1 component.This is as per http://www.rxlist.com/script/main/art.asp?articlekey=107467.
CDC,USA (http://www.cdc.gov/flu/protect/vaccine/quadrivalent.htm)is now favouring The quadrivalent flu vaccine  designed to protect against four different flu viruses; two influenza A viruses and two influenza B viruses.In India Serum Institute has launched  in the name of NASOVAC-S , Trivalent Influenza Vaccine, (Human), freeze dried is a live trivalent vaccine for administration by intranasal spray. NASOVAC-S contains three vaccine virus strains of A/H1N1, A/H3N2 and Type B influenza virus .PROBABLY ALL VACCINES ARE NOT SAME and therein is the confusion
  PLEASE CONFIRM.With thanks

Answer
Dear Mr. Kalyan,

The composition of Flu vaccine is NOT decided by individual manufacturers, but dictated by the WHO. ALL brands available in India have TRIVALENT, containing 2 Infulenza A and one Infuenza B virus. the constituents are decided by WHO EVERY YEAR based on surveillance data collected by them in 6 reference laboratories globally to see which strains are circulating commonly. All trivalent vaccines contain three most commmon strains as informed by WHO. The composition is SAME for Northern Hemisphere in a GIVEN YEAR, not only for India. Similarly, the composition for countries in Southern Hemisphere is same, and is decided by WHO. the composition CHANGES every year, hence, re-vaccination is needed every year.

Vaccines are different as some are inactivated vaccines, some are split-virus type vaccines and yet others are live attenuated. BUT constituent STRAINS (the virus types) are same all across all brands GLOBALLY.

The world is changing very fast sir..What was there last year is not applicable now!! The article you have shared is good five years old: 2009. Swine flu virus strain surfaced that yea...hence the vaccine available at that time obviously did not contain that virus (since the vaccine is developed using the data of previous year). From 2010 onwards every flu vaccine has H1N1 strain...and will continue till new there is another pandemic by a new strain!!

No need to be unnecessary confused. Easiest is to follow guidelines issued by experts in the field. I also do the same. And as per Indian recommendations, Flu vaccine is NOT recommended for routine use for a healthy 5 year old child, as I informed earlier also.


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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