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QUESTION: I gave my child pentaxim at 1.5 Mths. Now he is 2.5 Months+, but pentaxim is not available in market anymore (out of stock) & the distributor says, it could take 7-15 days for new stock. Please suggest should I hold on for 10-15 days (the child will be 3 Months then), or should I look for alternate (Easy five, pentavac, Tripacel, Boostix, etc). If alternate, then which vaccine is recommended. Also we did not take Hepatitis B, so should we go for it now?

ANSWER: Hi Jaspreet,

PENTAXIM  is a combination of DTaP, Hib and IPV.

It has been recently found that DTaP ("painless" or "gentle DTP) is not as effective as "Normal" (whole cell) DTP vaccine. Hence, new guidelines issued in November 2013 have recommended that DTaP vaccine and DTaP containing vaccines should not be used. Hence, PENTAXIM is currently NOT recommended.

TRIPACEL and INFANRIX are also DTaP vaccines, and can be considered during booster shots (at 18 months and 5 years of age)

BOOSTERIX is a different vaccine (TdaP vaccine) to be given at 10 years of age.

You can go for PENTAVAC/ EASY FIVE? COMVAC 5 (All these are combination of DTwP/ Hib and Hepatitis B). IPV needs to be taken separately, as these combinatioon does not contain IPV. Brands of IPV: POLIOVAC PFS, IMOVAX POLIO, POLPROTEC.

You can see the latest immunizaton schedule as recomended by Indian Academy of Pediatrics since November 2013 at last page of following link: http://www.iapindia.org/IMM%20Schedule.pdf

Please feel free to ask for any further clarificatioon.


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

www.KumarChildClinic.com

+91-9818356846

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

QUESTION: Dear Sir,

Thanks for your valuable comments. If we administer PENTAVAC/ EASY FIVE/ COMVAC 5 as the second  and third dose at 2.5 Months and 3.5 Months respectively, will it suffice to administer OPV instead of IPV? Also, since Easy five covers Hepatitis B, which was not included in first dosage of Pentaxim, will a third dosage of it be required later? Please help.

ANSWER: Hi Jaspreet,

No, as per current recommendations, only IPV should be used at 6, 10 and 14 weeks; OPV is to be given at birth, 6 month, 9 month and 5 years of age. In addition, OPV should be given at all Pulse Polio days ("Polio Ravivar")

If baby has received 1st dose of Hepatitis B vaccine at birth, then present dose with PENTAVAC/ EASY FIVE/ COMVAC 5 would be the second dose. Third dose of hepatitis B vaccine should be given 5 months after 2nd dose. Hence, next 2 doses at 2.5 and 3.5 months of age in such a case would be of QUADROVAX/ EASY FOUR/ COMVAC 4 (DTwP/ Hib combination).

In case baby has not received even one dose till now, then baby would need PENTAVAC/ EASY FIVE/ COMVAC 5 now and at 2.5 months of age and QUADROVAX/ EASY FOUR/ COMVAC 4 at 3.5 months and 3rd dose of hepatitis B as I explained earlier (5 months after 2nd dose).


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

www.KumarChildClinic.com

+91-9818356846


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

QUESTION: Dear Sir,

Thanks so much for your help, but I am troubling you once again with a followup Question. Now the child is 2.5 mths. So far he had BCG + OPV at birth, pentaxim at 1.5 Mths. No Hep B was given at birth. So your recommendation is Easy five & IPV now (at 2.5 Mths) & again at 3.5 Mths, followed by Hepatitis B booster at 8.5 months. Please also clarify on Rotavirus  & Pneumococcal necessity & brands. Sorry for the trouble & thanks in advance for your commendable help.

Jaspreet Singh
Sr Asst Prof, GGSIPU

Answer
Dear Prof. Singh,

I am sorry for some confusion in my earlier reply.

The baby needs to be given PENTAVAC/ EASY FIVE/ COMVAC 5 and IPV now and then again the same at 3.5 months and then Hep B and OPV at 8.5 months.

Both Pneumococcal and Rotavirus vaccines are necessary as they are responsible for significant mortality and morbidity in young chidren and current guidelines them routinely for all children

For Rotavirus, there are two brands: ROTATEQ and ROTARIX. ROTATEQ costs Rs. 990 per dose and 3 doses are required at one month interval. ROTARIX costs Rs. 1270 and only 2 doses are required at one month interval. You can go for any one (ask your doctor) BUT please note that you have to hurry up for this as this vaccine cannot be given once baby is > 15 weeks of age. It is not safe to start this vaccine after 15 weeks of age.

For Pneumococcal vaccine, two brands are available: PREVENAR 13 (costing Rs. 3801 per dose) and SYNFLORIX (costing Rs. 1999 per dose). For both, 3 doses are required at one month interval followed by booster at 12-15 months of age. PREVENAR 13 is certainly better.


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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