Issues in Pediatric Immunization: Need Rethinking!

Dear Dr. Vashishtha,
December 2003 issue of the Pediascene can be called a ‘Compendium of Immunization’. Readers of the bulletin should be grateful to you for the efforts, which could provide insights to many issues related to vaccines and immunizations. You deserve congratulations.
In the last issue you had expressed your views on “Recommendations on Immunization: IAP is in a dilemma!” You had stated: ‘Time and again, recommendations of IAPCOI have come under severe flak and criticism from one quarter or the other..... People have always taken IAP’s recommendations with certain amount of skepticism, some time with some valid reasons behind, some times quite unjustifiably!”.
I would like to take up some issues.
1. I had pointed out that due to some recommendations of WHO, many polio cases are being wrongly discarded, showing false low incidence. The issue was raised on 11th May 2003 at the 8th meeting of the National Certification Committee for Polio Eradication, which was held in New Delhi from 9th to 11th May 2003. Later I wanted to raise this issue with IAP through Indian Pediatrics (Ref. No. IP/2003/488). IAP should have taken up this issue with WHO. The manuscript was rejected. I am happy that Vaccine, a specialty journal published from UK has accepted the manuscript. There is some hope now that it may initiate some thinking and dialogue.
2. After attending a workshop on Polio Eradication held in New Delhi on 20th and 21st May 2000. I had written to Dr. Sobhan Sarkar, Assistant Commissioner, Immunization, Ministry of Health and Family Welfare, New Delhi stating that “IPV be made available for high risk population on payment like other vaccines.” This was written on 9th June 2000, with a copy to Honorary Secretary General IAP, Mumbai. This was published in the August 2000 issue of Indian Pediatrics. The Hony. Secretary General in his letter Ref. No. L/1999/P-673/8561/00 dated June 20, 2000 had this response: “Received a copy of your letter dated 9th June 2000 addressed to Dr. Sobhan Sarkar regarding IPV. I appreciate your efforts in protecting the interests of immunocompromised children.” Should IAP to take any interest in protecting the interests of immunoco-mpromised children ? In case IAP had any interest to safeguard the health of this section of children, it should have raised the issue with the authorities as official body of experts who are supposed to care for children.
3.In your article on immunization in the same issue you have raised some points regarding MMR vaccine and aseptic meningitis. The Committee on Immunization should have taken up long back the issue that MMR with Urabe strain of mumps vaccine should be withdrawn from India, as has been done by many countries.
-Dr. Yash Paul, dryashpaul2003@yahoo.com

IM Injections: Site and Needle Size
Dear Dr. Vashishtha, 
It was a delight to read the latest issue of “Pediascene” covering pediatric vaccination. In fact, salute to you for bringing out this issue single handedly. The presentation and layout was superb along with very informative material that nearly covered all relevant aspects of pediatric vaccination.
However, my fine reading generated few curiosities. You have written that anterolateral aspect of upper thigh should be the preferable site for IM injections, whereas conventional bookish knowledge suggests it to be middle or junction of upper 2/3rd and lower 1/3rd as the preferable site (Intramuscular Injections: Review and Guidelines. Kamlesh et al, Indian Pediatrics, September 2003).
Secondly there still exits some confusion regarding the needle size and gauge. On personal front I find BD 29 G 12.7 mm insulin syringes as perfect for giving injections during infancy. Besides being least painful these help in accurate measurement of vaccine.
Nevertheless, your envy towards Dr. Nitin Shah is as justified as my envy towards you! How come you are able to find out time and so much energy to carry such academic works? Definitively it must have an effect on your practice.
Rest is fine. Looking forward to keep reading marvelous issues of Pediascene and if possible some contributions again in near future.
-Dr Rajiv Garg, rgargmd@bol.net.in


Polio eradication: A Sincere Suggestion!
Dear Sir,
Thank you so much for sending me the special issue of “Pediascene”. It was very interesting and comprehensive. It was also nice to see that our web-discussion on “influenza vaccine” has been published in the issue.
I have also seen one or two past issues of “Pediascene” on the net and found them interesting. However, much of my time is in textbooks/IP/IJPP as I have yet to pass my final DNB(Ped.) examinations.
Sir, can I give my view/small suggestion on Polio Eradication Campaign? The print and electronic media is laying adequate stress on NIDs (Polio Ravivars) and polio eradication soon. However, I feel the stress on what we have already achieved is less, and the public is less aware of that. If we repeatedly highlight the number of cases in 1993 and 2003, that will further stimulate the public to participate in the campaign with greater vigor for a “specific objective” rather than a “routine, annual affair” the feeling that should not gain ground.
-Dr. Puneet Kumar, dr_puneet@mail.medclik.com

Congratulations!!
Dear Dr. Vashishtha,
Thank you very much for sending me a copy of PEDIASCENE. The issue is very informative and I wish to congratulate you for your efforts.
-Dr Surjit Singh, Convener, IAPCOI, PGIMER, Chandigarh.

Excellent Presentation!
Dear Dr Vipin,
I have been reading your news bulletin for past 3 years. The presentation and quality of printing are excellent. It is indeed very creditable that you are able to find time for this academic activity apart from your busy practice.
-Dr Umesh Khanapurkar, Station Road, Bhusawal (MH)