1. Armed Forces Immunization Policy: Quo Vadis? Surg Cdr RW Thergaonkar

2. Present Policy UIP vaccines from local SHO No stated policy for immunization in special circumstances Status of vaccines outside UIP unclear No official immunization schedule

3. Proposal 1.To introduce MMR, quadri/pentavalent (HiB containing) Typhoid and Hep B vaccines 2.To promulgate a policy for vaccines under special circumstances 3.Non UIP vaccines to be acknowledged as optional 4. To prepare an amended immunization schedule for children entitled to medical care in the Armed Forces

4. 1. Introduction of New Vaccines Issues Pentavalent v/s standalone DPT, Hep B & HiB vaccines Pentavalent alone or mixed pentavalent/quadrivalent Adolescent stand-alone Rubella v/s MMR ? MR Vaccination

5. 2. Vaccines under Special Circumstances ConditionVaccines Recommended Asplenia/hyposplenia/planned splenectomy at least two weeks prior to surgery HiB, Pneumococcal, Meningococcal HIVHiB, Pneumococcal (PCV13 & PPV 23), Meningococcal, Typhoid Inactivated Influenza, Hep A, Varicella, HPV at 10 Years

6. 2. Vaccines under Special Circumstances ConditionVaccines Recommended Complement Deficiency HiB, Pneumococcal, Meningococcal Most other vaccines contraindicated Hematopoetic Stem Cell Transplant Recipients Reimmunisation after 12 m of transplant IPV, HiB, Hep B, PCV 13 & PPV 23 Varicella MMR (if immunocompetent)

7. 2. Vaccines under Special Circumstances ConditionVaccines Recommended Solid Organ Transplant Influenza and Varicella for Household Contacts Chronic Neurological, Renal, Hepatic, Gastroenteritic, Cardiac, Pulmonary and Endocrine Disorder Pneumococccal, Hep A, Varicella, Influenza, Rotavirus Preterm BabyPCV 13, Rotavirus, Influenza

8. 3 Status of Non UIP Vaccines Pediatrician’s Perspective Available in market, FDA Approved Pressure from parents Do we look obsolete vis-à-vis private practitioners? Public Health Perspective Nation-wide implementation Responsibility for AEFI’s “I buy, you give” not an option

9. 4 Revised Immunization Schedule AgeRecommendedOptional Vaccine* BirthBCG, OPV, Hep B 1 6 weeksDPT(1) Hep B (2) HiB(1), OPV (1) IPV (1), Pneumococcal conj (1) Rota (1) 10 weeksDPT(2) HiB (2), OPV (2)Rotavirus (1), IPV (2), Pneumococal conj (2) 14 weeksDPT (3) Hep B (3) HiB (3), OPV (3) IPV (3), Pneumococcal conj (3) Rota (2)

10. 4 Revised Immunization Schedule AgeRecommendedOptional Vaccine* 6 mthsHep B (3)** 9 mthsMeasles 15 mthsMMR (1)Hep A (2 doses 6 mths apart), Chicken Pox 18 mthsDPT Booster (1) HiB Booster, OPV Booster (1) IPV (4), Pneumococcal Conjugate Booster

11. 4 Revised Immunization Schedule AgeRecommendedOptional Vaccine* 2 yrsTyphoid (repeat 3 yrly) 5 yrsDPT Booster (2), OPV Booster (2) MMR (2) Chicken Pox Booster 10 yrsdTTdaP

12. 4 Revised Immunization Schedule Program Issues All pentavalent have been suggested If so, Hep B at 6 months is out Hep B at birth? Pentavalent again at 18 months? Can the visits at 15 & 18 months? Why not Japanese Encephalitits? What about vit A? Discordance with national program

13. Discussion