Immunization in Clinical Practice Nitin K Shah, Naveen C Thacker, Abhay K Shah, Alok Gupta
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1Immunization in Clinical Practice2
3Immunization in Clinical Practice
Second Edition
Editors Naveen Thacker MD FIAP Consultant Pediatrician Deep Children Hospital Gandhidham, Gujarat, India Nitin K Shah MD DCH FISHTM Consultant Pediatrician PD Hinduja Hospital Mumbai, Maharashtra, India Academic Editors Abhay K Shah MD DPed FIAP Senior Consultant Pediatrician Chairperson IAP Infectious Diseases Chapter 2015 Ahmedabad, Gujarat, India Alok Gupta MD FIAP President IAP Chairman Jaipur—India Environment and Child Health group of IAP Foreword Pramod Jog President 2016 IAP
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Immunization in Clinical Practice
First Edition: 2005
Second Edition: 2016
Printed at
Dedicated to
5Betterment of health
of all the children of the world6
  • A Parthasarathy MD DCH DSc (Hon) FIAP
  • Senior Consultant
  • AP Child Care, Chennai
  • Ex-Distinguished Professor of Pediatrics
  • The Tamil Nadu Dr MGR Medical University
  • Senior Clinical Professor of Pediatrics (Retd)
  • Madras Medical College, Chennai
  • Deputy Superintendent
  • Institute of Child Health and Hospital for Children
  • Chennai, Tamil Nadu, India
  • Abhay K Shah
  • Senior Consultant Pediatrician
  • Chairperson IAP Infectious Diseases Chapter 2015
  • Ahmedabad, Gujarat, India
  • Anil K Dutta
  • Vice President
  • Clinical R & D and Medical Affairs
  • Wavre, Belgium
  • Anupam Sachdeva
  • Chairman
  • Department of Pediatrics and Academics
  • Sri Ganga Ram Hospital
  • New Delhi, India
  • Anuradha Bose
  • Professor of Pediatrics
  • Christian Medical College
  • Vellore, Tamil Nadu, India
  • Ashish Bavdekar
  • Consultant
  • Pediatric Gastroenterologist, KEM Hospital
  • Pune, Maharashtra, India
  • Ashish Pathak
  • Professor
  • Department of Pediatrics
  • RD Gardi Medical College
  • Ujjain, Madhya Pradesh, India
  • Ashok Kumar Dutta
  • Professor and Head
  • Department of Pediatrics
  • School of Medical Sciences and Research
  • Sharda University
  • Greater Noida, Uttar Pradesh, India
  • Baldev S Prajapati
  • MD D Ped Gold Medalist FIAP MNAMS FICMCH
  • Professor of Pediatrics
  • GCS Medical College, Hospital and
  • Research Centre, Ahmedabad
  • Aakanksha Children Hospital and
  • Postgraduate Institute, Nava Vadaj Road
  • Ahmedabad, Gujarat, India
  • Child Health Division
  • Deep Naveen Thacker
  • Resident
  • Department of Pediatrics
  • RD Gardi Medical College
  • Ujjain, Madhya Pradesh, India
  • Devendra Khandait
  • Senior Programme Officer
  • Bill and Melinda Gates Foundation
  • India
  • Digant D Shastri
  • Senior Consultant Pediatrician and CEO
  • Killol Children Hospital
  • Surat, Gujarat, India
  • Divya Dave MD (Ped)
  • Associate Professor of Pediatrics
  • GMERS Medical College
  • Vadodara, Gujarat, India
  • Hemant Khanna
  • Medical Director, Vaccines
  • Sanofi Pasteur India Pvt Ltd.
  • Mumbai, Maharashtra, India
  • 8Hitt Sharma
  • Additional Director
  • Medical Affairs and Clinical Trials
  • Serum Institute of India Pvt Ltd.
  • Pune, Maharashtra, India
  • HP Singh
  • Associate Professor
  • Department of Pediatrics
  • SS Medical College
  • Rewa, Madhya Pradesh, India
  • Jaydeep Choudhury
  • Associate Professor
  • Department of Pediatrics
  • Institute of Child Health
  • Kolkata, West Bengal, India
  • Josemund Menezes
  • Asia Pacific Regional Director
  • Clinical R & D, Sanofi Pasteur
  • Singapore
  • Jyoti Joshi
  • Deputy Director and Team Lead-AEFI Surveillance and Vaccine Safety
  • Immunization Technical Support Unit
  • Ministry of Health and Family Welfare
  • Public Health Foundation of India
  • New Delhi, India
  • Monjori Mitra
  • Consultant Pediatrician
  • Institute of Child Health
  • Kolkata, West Bengal, India
  • MR Lokeshwar MD DCH
  • Consultant Pediatrician
  • Lilavati Hospital and Research Centre
  • Bandra, Mumbai
  • Shushrusha Citizens
  • Co Operativ Hospital Ltd. Dadar
  • Mumbai, Maharashtra, India
  • Narendra K Arora
  • Executive Director
  • The INCLEN Trust International
  • New Delhi, India
  • Naveen Thacker MD FIAP
  • Consultant Pediatrician
  • Deep Children Hospital
  • Gandhidham, Gujarat, India
  • Niranjan Shendurnikar MD FIAP
  • Consultant Pediatrician
  • KG Patel Children Hospital
  • Vadodara, Gujarat, India
  • Nitin Shah
  • Consultant Pediatrician
  • PD Hinduja Hospital, Mumbai
  • Hon. Pediatric Hematologist Oncologist
  • BJ Wadia Children Hospital
  • Mumbai, Maharashtra, India
  • Nupur Ganguly
  • Associate Professor
  • Deputy Director (Academics)
  • Institute of Child Health
  • Kolkata, West Bengal, India
  • P Ramachandran
  • Professor and Head
  • Department of Pediatrics
  • Sri Ramachandra Medical College, Porur
  • Chennai, Tamil Nadu, India
  • Panna Choudhury (Late)
  • Consultant Pediatrician (Retd)
  • Lok Nayak Hospital
  • New Delhi, India
  • Pramod Jog
  • President, IAP 2016
  • Chairman, IAP–ACVIP 2015-17
  • Pravin Mehta
  • Consultant Pediatrician
  • Jack and Jill Nursing Home, Ghatkopar
  • Mumbai, Maharashtra, India
  • Preeti M Galagali MD PGD AP
  • Director and Consultant
  • Adolescent Health Specialist
  • Bangalore Adolescent Care and Counselling
  • Bengaluru, Karnataka, India
  • 9Priya Perriera
  • GlaxoSmithKline Vaccines
  • Wavre, Belgium
  • Raj Shankar Ghosh
  • Deputy Director
  • Vaccine Delivery
  • Bill and Melinda Gates Foundation
  • India
  • Rajal B Prajapati MD (Ped) D Ped
  • Professor of Pediatrics
  • Smt NHL Municipal Medical College
  • Ahmedabad, Gujarat, India
  • Rajiv Kumar Bansal MD FIAP
  • Senior Consultant Pediatrician
  • Head of Department Pediatrics
  • Santokba Durlabhji Hospital
  • Jaipur, Rajasthan, India
  • Raj Kumar
  • Senior Registrar
  • Department of Pediatrics
  • Kanchi Kamakoti CHILDS Trust Hospital and CHILDS Trust Medical Research Foundation
  • Chennai, Tamil Nadu, India
  • Raju C Shah
  • Consulting Pediatrician
  • Ankur Institute of Child Health
  • Ahmedabad, Gujarat
  • Professor and Head (Retd)
  • GCS Medical College
  • Ahmedabad, Gujarat, India
  • Ritabrata Kundu
  • Professor
  • Department of Pediatrics
  • Institute of Child Health
  • Kolkata, West Bengal, India
  • Rohit Agrawal
  • Director
  • Chandrajyoti Children's Hospital, Mumbai
  • Consultant Pediatrician, Kohinoor Hospital
  • Mumbai, Maharashtra, India
  • S Balasubramanian
  • Head, Department of Pediatrics
  • and IAP IDC PID Fellowship Coordinator Kanchi
  • Kamakoti CHILDS Trust Hospital and CHILDS
  • Trust Medical Research Foundation
  • Chennai, Tamil Nadu, India
  • Sanjay Gandhi
  • Vice President
  • Clinical R & D and Medical Affairs (Vaccines)
  • GSK Vaccines
  • Mumbai, Maharashtra, India
  • Sanjay Srirampur
  • Head, Department of Pediatrics
  • Aditya Superspeciality Hospitals
  • Hyderabad, Telengana, India
  • Satish Kumar Gupta
  • Health Specialist (Immunization)
  • UNICEF India Country Office
  • New Delhi, India
  • Satish Pandya MD (Ped) PGDAP PGDGC
  • Consultant Pediatrician and Counsellor
  • Director—Varun Children Hospital
  • Vadodara, Gujarat, India
  • SG Kasi
  • Consultant Pediatrician
  • Kasi Clinic
  • Bengaluru, Karnataka, India
  • Shailesh Mehta
  • Area Medical Lead-GAVI/Supernationals
  • GSK Vaccines, Wavre, Belgium
  • Sharad Agarkhedkar
  • Professor and Head of Department
  • DY Patil Medical College, Pimpri, Pune
  • Mumbai, Maharashtra, India
  • Sheikh Minhaj Ahmed
  • Pediatric Intensivist
  • Faculty—GGMC and Sir JJ Group of Hospitals
  • Mumbai, Maharashtra, India
  • 10Shyam Kukreja
  • Head, Department of Pediatrics
  • Max Superspeciality Hospital PPG
  • New Delhi, India
  • Sudhanshu Pandey
  • Associate Director
  • Medical Affairs
  • MSD Pharmaceuticals Pvt Ltd.
  • Mumbai, Maharashtra, India
  • Suhas V Prabhu
  • Visiting Consultant Pediatrician
  • PD Hinduja Hospital
  • Mumbai, Maharashtra, India
  • Suresh Jadhav
  • Serum Institute of India Pvt Ltd., Pune
  • Executive Director
  • Mumbai, Maharashtra, India
  • Surjit Singh MD DCH (Lon) FRCP (Lon)
  • Professor of Pediatrics and Incharge Pediatric
  • Allergy Immunology Unit
  • Advanced Pediatrics Centre
  • Postgraduate Institute of Medical Education and
  • Research, Chandigarh, India
  • T Anh Wartel
  • Senior Director
  • Clinical Development at Sanofi Pasteur, Singapore
  • T Jacob John
  • Emeritus Professor
  • Department of Virology
  • Christian Medical College and Hospital
  • Vellore, Tamil Nadu, India
  • Tanu Singhal
  • Consultant Pediatrics and Infectious Disease
  • Kokilaben Dhirubhai Ambani Hospital
  • Mumbai, Maharashtra, India
  • Uday Bodhankar
  • International President
  • Commonwealth Association for Health and Disability, Bodhankar Children Hospital
  • Nagpur, Maharashtra, India
  • Vijay Yewale
  • Consultant Pediatrician and Neonatologist
  • Dr Yewale's Multispecialty Hospital for Children
  • Navi Mumbai, Maharashtra
  • Honorary Pediatrician
  • Mathadi Hospital Trust
  • Consultant Pediatrician
  • Fortis Hospital
  • Vipin Vashishtha
  • Director and Consultant Pediatrician
  • Mangla Hospital and Research Center
  • Bijnor, Uttar Pradesh, India
11The First Booster
I have great pleasure in writing the foreword for this highly immunogenic book presented by Nav-Nit.
Immunization has assumed paramount importance in the current era and it is expected that every pediatrician is acquainted with the Need, Efficacy, Safety, Cost-effectiveness, Affordability, Flexibility and Ethical issues (NESCAFE) pertaining to individual vaccines in the ever-expanding field of vaccinology.
Two eminent experts in the field who have vast experience and knowledge of the subject have authored this book. Drs Naveen Thacker and Nitin Shah have compiled the book with contributions drawn from national and international luminaries. The first section deals with basic information that is so vital for successful outcome. The next section includes widely used vaccines, covering relevant details about each of them. The third section focuses on immunization in special circumstances that has uniquely referred to adolescents and adults. Finally, in the last section, readers will get a glimpse of what future is likely to hold for the next generation and find an access to Internet resources.
There is no doubt that the best vaccine is HE vaccine, i.e. Health Education. A pediatrician should not miss any opportunity to administer this vaccine to parents by educating them about different aspects of child health in the clinic. For a pediatrician, who wants to be ‘BIG’, an expertise in Breastfeeding-nutrition, Immunization and Growth-development is a must.
The edition has a combo of Naveen's experience with international agencies and Nitin's brilliance in academics. I am sure that this combo vaccine will get into the memory cells and will be readily available when the reader gets the first booster (the first edition!).
As readers enjoy sips of NESCAFE one after other, while reading individual vaccines with ‘avidity’, they are bound to develop ‘affinity maturation’.
I am sure that the book itself will act as a vaccine and immunize all those who recognize the value of vaccines in the arena of child health, by providing authentic source of information.
Pramod Jog
President IAP, 2016
Chairman, IAP-ACVIP 2015–1712
13It has been more than 10 years since the first edition of this book came out in 2005. Over the years, this book has been appreciated well by one and all. We have also received some important feedback since then. Also, many changes have happened in the field of immunization in the last 10 years. Many vaccines have been added in the Indian market like HPV and quadrivalent meningococcal vaccines. As a nation's pride, an indigenously manufactured Indian conjugate typhoid vaccine V-TT has entered India and the world for the first time. Other newer vaccines have entered international market like conjugate meningococcal A vaccine for African belt and dengue vaccine. Many concepts have changed like how a vaccine works and how long does it work. Newer epidemiological data have put challenges to old vaccines and old schedules like recent pertussis outbreaks in developed countries using exclusively DTaP vaccines. Many indigenous manufacturers are now getting empowered to make vaccines available at lower costs like 116E Rotavirus vaccine by an Indian manufacturer. Better adjuvants are being invented like the AS04 and others in the series. More and more nations are including various important vaccines in national programs with or without GAVI support. It is heartening to note that India is one amongst these countries now having pledged to introduce Rotavirus vaccine and PCV in NIP after successful inclusion of DTwP-Hepatitis B-Hib pentavalent vaccine in NIP which will, of course, help the nation save many precious lives and help India achieve MDG4 sooner than was thought of.
All these meant a need for a revised edition of this book which will incorporate all these changes. So here we are with the latest edition. All the contributors are genuine experts in the field of vaccinology. We sincerely hope this edition will deliver what it is aimed for and will serve as a reference book, especially for the practicing pediatricians, family physicians, postgraduate students and paramedics.
Naveen Thacker
Nitin K Shah
Alok Gupta
Abhay K Shah
14We are thankful to staff of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, Samina Khan, Paras Verma, Mohit, Pankaj Kumar Mandal, Deepak Goel, Kesav Kumar and Lincy, Surbhi and Sonali from Gandhidham for their help.