How long is your shotlist

Ragini isnt the only one shaking her head over the complex regimen of vaccines. Almost every new parent is bogged down by the plethora of shots floating in the market. Besides the hole they burn in the pocket,the fear of side-effects is making the confusion worse.

A FEW SHOTS TOO MANY

Nowadays,Indian parents go for two lines of vaccinations. First,there is the list rolled out by IAP,a scientifically empowered group comprising paediatrics across the country. Two,there is a national immunisation schedule approved by the government that terms five basic vaccines as compulsory. These are Diphtheria Pertussis Tetanus DPT,Hepatitis B,Oral Polio,BCG and Measles vaccines.

The IAP list has these optional vaccines: Typhoid,Haemophilus Influenza Type B HIB,Hepatitis-A and Varicella chicken pox. Other vaccines,according to IAP,which could be given after discussions with parents,are: Pneumococcal conjugate and Rotaviral.

This is not all. IAP adds new vaccines in its schedule depending on their importance and efficacy by reviewing relevant international data and its relevance to the Indian settings.

After backing pneumococcal for pneumonia,mencivac or meningococcal vaccine and injectable polio vaccines,it has now pitched for the cervical cancer vaccine for girls. Three doses of human papilloma virus HPV vaccine,according to IAP,should be given at 0,1-2 and six months.

THE COST FACTOR

The national immunisation schedule,on the other hand,has different considerations. The government adds a vaccine in its schedule on the basis of its feasibility in terms of price and availability in India, said Dr M K Bhan,secretary,Department of Biotechnology,Government of India.

Take,for instance,the vaccine against chicken pox: The disease is not a major health threat,so it does not find a place in the national immunisation schedule, said a senior official in the Union Health Ministry.

While the high cost of vaccine is an issue,my problem is that how could the immunity of a child who goes to a private doctor be different from those who follows the government recommendations. This makes me think whether these vaccines are really important or are meant just for minting money. Since I can afford them,I follow the paediatricians advice, said Kriti Sharma,who works with a multi-national company.

Dr Ajay Khera,Deputy Commissioner,Routine Immunisation programme in the Union Health Ministry,says that managing an individual is different from managing a big health programme.

The cost of a vaccine may not be important for an individual but such factors have to be consideration in a government immunisation programme, he said.

NEED FOR UNIFORMITY

The word optional is troubling the doctors as well.

The new vaccines are not bad. But the recommendations keep changing and even we get confused at times. It is important to bring in uniformity, said Dr Satwinder Kapoor,consultant,paediatrician,Max Hospital,Pitampura,New Delhi.

Interestingly,vaccines recommended to be used in the national immunisation programme differ from state to state.

The vaccine schedule for Delhi has a typhoid vaccine and MMR vaccine. Likewise,the Japanese Encephalitis JE vaccine is recommended in UP and adjoining states. The Hepatitis B vaccine has been recently introduced in some of the states.

Doctors working in the government sector face another dilemma. It is understandable that India is a democratic country and allows paediatricians to offer a wide choice to parents. In the government sector,however,it is difficult to answer people as to why children who visit us need not have certain shots, said Dr Vinod Kumar Paul,Head of Department,Paediatrics,All India Institute of Medical Sciences AIIMS.

Dr Paul and his team examine 300-400 children every day. He says he himself feels that vaccines like pentavalent and Rotavirus should also be given to children who follow the government schedule. These vaccines tackle important diseases. I hope they make it to our list as well.

The immunisation schedule was simple a couple of years ago. And so was life.

Deepa Chopra,another mother,says: I had no confusion when I used to take my first child for vaccinations seven years ago. But now I am faced with a barrage of pricks for my two-year-old. There are too many options,too many brands now.

Dr Sanjeev Bagai,CEO and senior paediatrician,Batra hospital,says the immunisation schedule should be clear-cut without specifying the optional vaccines so as to end the confusion .

Internationally and nationally,a lot of varying immunisation schedules are used. Words such as optional should not be printed on the chart. The newer vaccines of HPV and pneumococcal are extremely essential,but as they are termed optional,parents are obviously questioning them.

With the list of new vaccines growing,parents are skipping the optional ones,especially those which are not life-threatening.

Why should I unnecessarily give a shot to my child for something like chicken pox if it is not life-threatening. I have decided not to go for it, said Sangeeta Malik,another parent.

Game for JABS?

National immunisation schedule

Diphtheria Pertussis Tetanus DPT,Hepatitis B,Oral Polio,BCG and Measles.

IAPs optional vaccines

Typhoid,Haemophilus Influenza Type B HIB,Hepatitis-A and Varicella chicken pox.

New vaccines in the IAP list

Pneumococcal for pneumonia,mencivac or meningococcal,injectable polio vaccine,and human papilloma virus HPV vaccine against cervical cancer in girls