FAQs on Vaccines and Immunization Practices
FAQs on Vaccines and Immunization Practices
3rd Edition
Chief Editor
Vipin M Vashishtha MD FIAP
Director and Consultant Pediatrician Mangla Hospital and Research Center Bijnor, Uttar Pradesh, India
Editor
Ajay Kalra MD DCH MNAMS FIAP
Erstwhile Professor Department of Pediatrics SN Medical College Agra, Uttar Pradesh, India
Foreword
Walter A Orenstein
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23-B, Ansari Road
Daryaganj, New Delhi 110 002, India
Landline: +91-11-23272143, +91-11-23272703
+91-11-23282021, +91-11-23245672
Email: jaypee@jaypeebrothers.com
Corporate Office
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2021, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
FAQs on Vaccines and Immunization Practices
First Edition: 2011
Second Edition: 2015
Third Edition: 2021
9789390020607
Printed at
- A Parthasarathy
- MD DCH DSc (Hon) FIAP
- Senior Consultant Pediatrician
- AP Child Care, Chennai
- Former Distinguished Professor Department of Pediatrics
- The Tamil Nadu Dr MGR
- Medical University
- Retired Senior Clinical Professor Department of Pediatrics
- Madras Medical College, Chennai
- Deputy Superintendent
- Institute of Child Health and Hospital for Children
- Chennai, Tamil Nadu, India
- Aashay A Shah MD (Ped)
- Fellow, Pediatric Gastroenterology Hepatology and Nutrition
- Medanta—The Medicity
- Gurugram, Haryana, India
- Abhay K Shah
- MBBS (Gold Medalist) MD (Gold Medalist) DPed (UNI FIRST) FIAP
- Senior Pediatrician and Infectious Diseases Specialist, Ahmedabad
- Director, Children Hospital and Neonatal Center
- Ahmedabad, Gujarat, India
- Member ACVIP 2020-2021, 2018-19
- Chairperson Infectious Diseases Chapter of IAP 2015
- Adarsh Bansal MPH PhD(c)
- Project Officer
- Department of Community Medicine and School of
- Public Health
- Postgraduate Institute of
- Medical Education and Research
- Chandigarh, India
- Ajay Kalra MD DCH MNAMS FIAP
- Erstwhile Professor
- Department of Pediatrics
- SN Medical College
- Agra, Uttar Pradesh, India
- Arun Wadhwa MD (Ped)
- Visiting Consultant
- Rainbow Children's Hospital
- New Delhi, India
- Ashok K Banga MD (Ped)
- Director and Consultant
- Department of Pediatrics
- Chirayu and Astha Hospitals
- Gwalior, Madhya Pradesh, India
- Ashok K Dutta MD (Ped)
- Former Director Professor and Head
- Department of Pediatrics
- Lady Hardinge Medical College
- New Delhi, India
- Atul Kumar Agarwal MD FIAP
- Consultant Pediatrician
- Department of Pediatrics
- Atul Latika Hospital
- Bareilly, Uttar Pradesh, India
- Baldev S Prajapati
- MD DPed FIAP MNAMS
- Professor and Head
- Department of Pediatrics
- GCS Medical College Hospital and Research Center, Ahmedabad
- Aakanksha Children Hospital and Postgraduate Institute
- Ahmedabad, Gujarat, India
- Canna Jagdish Ghia MD
- Therapy Lead
- Department of Medical Affairs
- Pfizer Vaccines
- Mumbai, Maharashtra, India
- Chandra Mohan Kumar
- MD PGDAP MAMS
- Additional Professor
- Department of Pediatrics
- All India Institute of Medical Sciences
- Patna, Bihar, India
- Chandrakant Lahariya MBBS MD MBA Diplomate of Nat Board PGDHHM FICMCH FIPHA MNAMS
- Senior Public Health Specialist and National Professional Officer
- Department of Health Systems Design and Development
- World Health Organization (WHO) Country Office for India
- New Delhi, India
- CP Bansal MD (Ped)
- Consultant Pediatrician and Director, Department of Pediatrics
- Shabda-Pratap Hospital
- Gwalior, Madhya Pradesh, India
- Dewesh Kumar MD DNB MPS
- Assistant Professor
- Department of Preventive and
- Social Medicine, Rajendra Institute of Medical Sciences
- Ranchi, Jharkhand, India
- Dhanya Dharmapalan MBBS MD
- Consultant in
- Pediatric Infectious Diseases
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- Digant D Shastri
- MD (Ped) FIAP PGDHHM
- Senior Consultant Pediatrician
- Killol Children Hospital
- Surat, Gujarat, India
- Immediate Past President, Indian Academy of Paediatrics
- Member, Standing Committee International Paediatric Association 2019-21
- Managing Editor, Asia Pacific Journal of Pediatrics and
- Child Health
- Dipti Agarwal MD (Ped) MAMS
- Associate Professor
- Department of Pediatrics
- Dr Ram Manohar Lohia Institute and Medical Sciences
- Lucknow, Uttar Pradesh, India
- Gautam Rambhad MD
- India Vaccines Medical Lead
- Department of Medical Affairs
- Pfizer Vaccines
- Mumbai, Maharashtra, India
- Geeta MG MD (Ped)
- Additional Professor
- Department of Pediatrics
- Medical College
- PSG FRI FAIMER Fellow 2015
- Calicut, Kerala, India
- Harish K Pemde MD (Ped) FIAP
- Director-Professor
- Department of Pediatrics
- Lady Hardinge Medical College and Kalawati Saran Children's Hospital
- New Delhi, India
- Hitt Sharma MBBS MBA
- Additional Director
- Department of Clinical Research and Pharmacovigilance
- Serum Institute of India Pvt Ltd
- Pune, Maharashtra, India
- Jaydeep Choudhury
- MBBS DNB (Ped) MNAMS FIAP
- Professor
- Department of Pediatrics
- Institute of Child Health
- Kolkata, West Bengal, India
- Sachidanand Kamath MD (Ped)
- Senior Consultant Pediatrician
- Department of Pediatrics
- Indira Gandhi Co-operative Hospital
- Ernakulam, Kerala, India
- M Surendranath MD DCH FACI
- Head, Department of Pediatrics
- Vijay Marie Hospital
- Hyderabad, Telangana, India
- Madhu Gupta MD PhD
- Professor, Department of Community Medicine and
- School of Public Health
- Postgraduate Institute of
- Medical Education and Research
- Chandigarh, India
- Meeta Dhaval Vashi MBBS MD (PSM)
- Surveillance Medical Officer
- WHO
- Mumbai, Maharashtra, India
- Naveen Thacker MD FIAP
- Director
- Deep Children Hospital and Research Center
- Gandhidham, Gujarat, India
- Neha Goel MD
- Resident, Department of Pediatrics
- Vardhaman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Nigam P Narain
- MD DCH PhD MRCP (UK) FRCPCH (UK) FIAP FNNF
- Retired Professor and Head
- Department of Pediatrics
- Patna Medical College
- Patna, Bihar, India
- Nupur Ganguly MBBS DCH DNB FIAP
- Professor
- Department of Pediatric Medicine
- Institute of Child Health
- Kolkata, West Bengal, India
- Obeid Shafi
- MD Diplomate of American
- Board of Pediatrics
- Specialist, Department of Pediatrics
- Manipal Hospital, New Delhi, India
- Omesh Kumar Bharti
- MBBS DHM MAE (Epidemiology)
- State Epidemiologist
- State Institute of Health and
- Family Welfare, Parimahal
- Department of Health and
- Family Welfare
- Government of Himachal Pradesh
- Shimla, Himachal Pradesh, India
- Parang N Mehta MD (Ped)
- Consultant Pediatrician
- Department of Pediatrics
- Mehta Childcare
- Surat, Gujarat, India
- Piyali Bhattacharya
- DCH MD (Ped) FIAP FRCP (London)
- Consultant Pediatrician
- Department of Pediatrics
- General Hospital
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Prem Pal Singh DCH
- Senior Consultant Pediatrician
- District Combined Hospital
- Amroha, Uttar Pradesh, India
- Premashish Mazumdar
- DM (Neonatology) MD (Ped)
- Consultant Pediatrician and Neonatologist, Department of Pediatrics and Neonatology
- Global Rainbow Hospital
- Agra, Uttar Pradesh, India
- Pritesh Nagar MD
- Pediatric Intensivist
- Department of Pediatric and
- Neonatal Intensive Care, Aditya Hospital
- Hyderabad, Telangana, India
- Priya Marwah MBBS DNB (Ped) MBA (Human Resource Management)
- Clinical Program Director cum
- Bone Marrow Transplant Physician
- Department of Bone Marrow Transplant
- South East Asia Institute for Thalassemia, Jawahar Circle
- Jaipur, Rajasthan, India
- Puneet Kumar MBBS
- Owner-Consultant
- Kumar Child Clinic
- New Delhi, India
- Rakesh Bhatia MD (Ped)
- Ex-Professor,
- Department of Pediatrics
- SN Medical College
- Agra, Uttar Pradesh, India
- Rashna Dass Hazarika MD (Ped)
- Chief, Department of Pediatrics and Neonatology
- Nemcare Superspecialty Hospital
- Guwahati, Assam, India
- Ravitanaya Sodani MD (Ped)
- Assistant Professor
- Department of Pediatrics
- Lady Hardinge Medical College and Kalawati Saran Children's Hospital
- New Delhi, India
- Sangeeta Sharma MBBS MD
- Professor and Head
- Department of Pediatrics
- National Institute of Tuberculosis and Respiratory Diseases
- New Delhi, India
- Sanjay Niranjan DCH MD
- Ex Pool Officer
- Department of Pediatrics
- King George Medical University Lucknow
- Founder and Director
- Neochild Clinic
- Lucknow, Uttar Pradesh, India
- Sanjay Srirampur MD DCh
- Head, Department of Pediatrics
- Aditya Hospital
- Hyderabad, Telangana, India
- Sanjay Verma MD
- Professor (Pediatrics)
- Infectious Disease Unit
- Department of Pediatrics
- Advanced Pediatric Center (APC)
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Satish Kamtaprasad Tiwari
- MD (Ped) LLB
- Professor
- Department of Pediatrics
- PDM Medical College
- Amravati, Maharashtra, India
- Satish V Pandya
- MD (Ped) PGDAP PGDGC
- Consultant Pediatrician and Counselor
- Department of Pediatrics
- Varun Complete Healthcare
- Vadodara, Gujarat, India
- Srinivas G Kasi MBBS MD
- Consultant Pediatrician
- Kasi Clinic
- Bengaluru, Karnataka, India
- Shalabh Agarwal MD Pediatrics
- Consultant Pediatrician
- Department of Pediatrics
- Surabhi (Mother & Child Care)
- Moradabad, Uttar Pradesh, India
- Shobha Sharma MD FIPNA FISPN
- Professor
- Department of Pediatrics
- Vardhaman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Shweta Singh MD
- Associate Professor
- Department of Biochemistry
- Hamdard Institute of Medical Sciences and Research
- New Delhi, India
- Sudhir Kumar Choudhary MD FIAP
- Consultant Pediatrician
- Department of Pediatrics
- Chiranjeev Children Hospital Dehradun, Roorkee, Uttarakhand, India
- Sumit Mehndiratta
- BBS DCH DNB (Ped) MNAMS FIMSA
- Specialist Grade II
- Department of Pediatrics
- Vardhaman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Unmesh A Upadhyaya MD (Ped)
- Consultant Pediatrician and Neonatologist
- Department of Pediatrics
- Vismay Childcare Hospital
- Ahmedabad, Gujarat, India
- Vijay N Yewale MD DCH
- Consultant Pediatrician
- Department of Pediatrics
- Director
- Dr Yewale Multispecialty Hospital for Children, Navi Mumbai
- Head, Institute of Child Health Apollo Hospitals, Navi Mumbai
- Navi Mumbai, Maharashtra, India
- Vipin M Vashishtha MD FIAP
- Director and Consultant Pediatrician
- Mangla Hospital and
- Research Center
- Bijnor, Uttar Pradesh, India
- Vivek R Pardeshi
- MBBS MD (PSM) DNB
- Surveillance Medical Officer
- WHO
- Mumbai, Maharashtra, India
- Yash Paul MBBS DCh
- Consultant Pediatrician
- Department of Pediatrics
- Shah Hospital
- Jaipur, Rajasthan, India
Few measures in preventive medicine can compare with the impact of vaccines. Smallpox has been eradicated and polio is on the verge of eradication. Two of the three wild poliovirus serotypes have been certified as eradicated. Measles transmission has been terminated in large areas of the world. Most recommended vaccines are highly effective in preventing vaccine-preventable diseases in vaccine recipients. But nearly all vaccines have another special property, the induction of herd immunity or community protection. Most vaccine-preventable diseases are transmitted from person to person in a chain of transmission from infectious case to susceptible. When a transmitting case comes in contact with an immune person, transmission does not occur and the chain of transmission is broken. Since infectious cases do not have unlimited contacts, if the immunity levels are high enough in a community, the likelihood that such cases will meet a susceptible is very low. Thus, transmission can be terminated for many diseases in a given community before 100% vaccine coverage is achieved. Who are the people indirectly protected? They are children too young for vaccination, persons with compromised immunity who cannot make adequate immune responses to vaccines, persons with contraindications to vaccination, and persons who do not respond to vaccine for other reasons. All are protected indirectly by high levels of immunity in the population.
Prevention from vaccines is very attractive because generally with a few doses, long-term, even lifelong, protection can be achieved with many vaccines. In contrast, the lifestyle changes needed to prevent many chronic diseases require a lifetime of continued implementation.
During the last few decades, there has been a revolution in Vaccinology. Vaccines have been produced that prevent cancer. The Human Papillomavirus Vaccine (HPV) prevents approximately 70% of cervical cancers globally. And hepatitis B vaccine can prevent one of the major causes of liver cancer. Antibodies against polysaccharides are key to the defense against several bacteria that cause pneumonia, meningitis, and other serious clinical syndromes. However, young infants make poor immune responses against plain polysaccharides. By conjugating polysaccharides to protein carriers, excellent immune responses can be achieved even in very young infants. Conjugation technology is the basis for vaccines against Haemophilus influenzae type b (Hib), pneumococci, and meningococci. We can now prevent one of the most common causes of severe diarrhea and dehydration, leading to death, rotavirus. And other new technologies, including the use of recombinant DNA, messenger RNA, vaccine vectors, genetic reassortment and other techniques are being brought to bear to bring us new and better vaccines.
Efforts are underway to develop new vaccines against more infectious diseases as well as enhancing more widespread and better use of existing vaccines. No where is this more apparent than in the massive efforts to develop safe and effective vaccines to protect against SARS-CoV-2, the virus that causes COVID-19. Hopefully, some vaccines to mitigate the COVID-19 pandemic will be available for use in the coming year.
The most favorable benefits of vaccines are only achieved when they are used widely in populations for whom they are recommended. Vaccines do not save lives, vaccinations save lives. A vaccine dose that remains in the vial is 0% effective regardless of the results of clinical trials show. And this handbook provides a major resource to vaccine providers in using vaccines optimally. This book is devoted to answering practical questions on recommended vaccines, recommended schedules, indications, contraindications, and precautions. It tries to answer questions regarding particular clinical situations, which may not be easily answered from reading existing recommendations. Use of the book, will help you minimize the risks of vaccine-preventable diseases in the populations you serve while maximizing the safe use of those vaccines.
Walter A Orenstein MD
Professor of Medicine
Pediatrics, Global Health and Epidemiology
Emory University and
Associate Director, Emory Vaccine Center
Former Deputy Director for Immunization Programs
Bill and Melinda Gates Foundation
Former Assistant Surgeon General
United States Public Health Service
Former Director, National Immunization Program
Centers for Disease Control and Prevention
Preface
The quest for vaccines is no longer limited to infectious diseases, but to anything which even remotely has some possible involvement of the immune system. That means more vaccines and greater research. And more the vaccines, more the questions which will need to be answered. Moreover, research and development of vaccines occurs exponentially, making it expedient for updates to be brought out more frequently than ever before.
This third edition continues to provide an avenue to answer many of the queries that arise in the mind of the inquisitive, especially keeping in view the advances that have taken place since the last edition. Earlier chapters have been intensively scrutinized and revised and new ones have been added on newer topics. Therefore, some esteemed authors have now joined us, both to revise the earlier chapters and to contribute to newer subjects. Our grateful thanks to these invaluable colleagues.
The year 2020 is an exceptional year. The whole world is in the grip of a deadly pandemic of Covid-19 caused by an SARS-CoV-2 virus. Vaccines against coronavirus have become the most anticipated product to rapidly end this scourge of mankind. An unprecedented number of vaccine candidates against Covid-19 are in the pipeline and some employing new platforms like mRNA, DNA, viral vector, antigen presenting cell vaccines, etc. has never been tested before. In the coming year or so billions of people around the globe are going to witness an unprecedented, massive immunization drive on a scale that has never been seen by mankind before. There is a sudden surge in the online searches regarding vaccines, immunity, correlate of protection, durability of immune responses, T cell immunity, neutralizing antibodies, etc. not only amongst health care professionals but in the general population as well. Hence, the publication of a new edition of this book is in sync with this heightened demand of updating knowledge about vaccines and immunization process.
We hope that this edition will also enjoy the same reputation that its predecessors did so fondly.
Vipin M Vashishtha
Ajay Kalra
Acknowledgments
We are especially thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), and Ms Savleen Kaur (Development Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving the go-ahead at the very beginning and helping us in every way possible to bring out this book.