Dr Ramesh Bajania: Dear friends!

Monsoon Greetings to all!

We are starting our SAPINAR now..

[27/07, 2:23 PM] Dr Ramesh Bajania: Please don't post any other case

or so during this time..

[27/07, 2:23 PM] Dr Nitin Shah: Lets us start with a teaser till

everyone gathers. When was Sir Edward Jenner born?

[27/07, 2:24 PM] Dr Ramesh Bajania: Man who created first vaccine..

Smallpox

[27/07, 2:25 PM] +91 94260 61024: 9 July 1916

[27/07, 2:25 PM] Dr Nitin Shah: 17th May 1749! is the correct reply.

[27/07, 2:25 PM] Dr Ramesh Bajania:

[27/07, 2:26 PM] Dr Nitin Shah: And where was he born?

[27/07, 2:26 PM] +91 94284 14780: England

[27/07, 2:26 PM] Dr Nitin Shah: Absolutely right!

[27/07, 2:26 PM] Dr Ramesh Bajania: Berkeley

[27/07, 2:27 PM] Dr Nitin Shah: Which is the bible of vaccinaology?

[27/07, 2:28 PM] +91 98795 38800: Pkotkin

[27/07, 2:28 PM] Dr Nitin Shah: Now with serious discussion.....

[27/07, 2:28 PM] Dr Nitin Shah: Right Digant Bhai!

[27/07, 2:29 PM] Dr Nitin Shah: 01) Question from Jaychandra

Ratanpara Junagadh: For vaccine related query if multidose vaccine

same brand not available than what to do ideally?

[27/07, 2:29 PM] Dr Nitin Shah: Reply: Ideally same rand should be

used for all subsequent doses of same vaccine. However if previous

brand is not mentioned or available, one can use any other standard

available brnad. But this rule id by default and not by choice. It also

means that we should clearly write the brand used when we vaccinate

any child

[27/07, 2:30 PM] Dr Ramesh Bajania: Brand with details

[27/07, 2:31 PM] +91 98254 67382: What about vaccines with

different dosage schedule? Like rotavirus, two doses and 3 doses

[27/07, 2:31 PM] Dr Nitin Shah: Yes. Brand name, batch number and

expiry. This is legally required.

[27/07, 2:31 PM] Dr Nitin Shah: So for Rota if one chnages brand by

dafault you will have to necessarily give 3 dose.

[27/07, 2:32 PM] +91 98254 67382:

[27/07, 2:32 PM] Dr Ramesh Bajania: Of changed one?!

[27/07, 2:33 PM] Dr Nitin Shah: No total 3 doses. So theoretically it

could be 1 dose of each brands!

[27/07, 2:33 PM] +91 98250 10489: If rotarix 1 then of some onr is

giving rotateq or roatvac then 2 dose of other brand?

[27/07, 2:34 PM] Dr Nitin Shah: Right. Total 3 doses

[27/07, 2:34 PM] +91 98254 67382: Is there any scientific data for

this or its about practical aspect and convenience?

[27/07, 2:35 PM] Dr Nitin Shah: 02) Question from Dr. Sameer

Masrani from Rajkot: Post splenectomy vaccination schedule?

[27/07, 2:35 PM] 91 98250 10489+ : Practical aspect.

[27/07, 2:35 PM] Dr Nitin Shah: Reply: One needs to give age

appropriate doses of all polysaccharide vaccines namely Hib, PCV,

Vi-TCV and MCV to the child as they are prone to polysaccharide

containing organism sepsis. These vaccines should be given BEFORE

splenectomy in a case of planned splenectomy . In case of emergency

splenectomy like in trauma it should be started after 2-3 weeks of

recovery. One can give 2-4 vaccines simultaneously if time available

to splenectomy is less. Lastly don’t forget inactivated influenza too.

[27/07, 2:35 PM] +91 98250 10489: Which company will research

this kind of data.

[27/07, 2:36 PM] +91 98793 02570: 🏻 🏻

[27/07, 2:36 PM] +91 94284 14780: Genuine advantage of veriped

over biovac V

[27/07, 2:36 PM] Dr Ramesh Bajania: Clear

[27/07, 2:36 PM] +91 98980 66694: Ideal dose regime for MMR,, 9

month.15 month 5 year...???

[27/07, 2:36 PM] +91 98241 42020: If someone has given 1st dose of

Rota vac at 1 1/2 month and I complete the schedule with 2doses of

rotarix at 2 1/2 & 3 1/2 month .Is it OK ?

[27/07, 2:36 PM] Dr Ramesh Bajania: Please stick to ongoing vaccine

discussion

[27/07, 2:37 PM] Dr Ramesh Bajania: Nitinbhai will take all

[27/07, 2:37 PM] +91 98250 10489: Okay.

[27/07, 2:37 PM] Dr Nitin Shah: MMR at 15 months and 18 months

[27/07, 2:37 PM] +91 98980 66694: Ok..sirr

[27/07, 2:37 PM] Dr Nitin Shah: Measles at 9 months

[27/07, 2:37 PM] +91 98250 10489: As such rotarix has 2 dose only.

[27/07, 2:37 PM] +91 98980 66694: 🏻 🏻 🏻

[27/07, 2:38 PM] +91 98254 67382: Then why IAP recommends mmr

at 9 months?

[27/07, 2:38 PM] Dr Nitin Shah: Na these two MMR will be with two

doses of Varicella vaccines at 15 and 18 months. No 5 year waiting...

[27/07, 2:38 PM] Dr Nitin Shah: Ask IAP!!

[27/07, 2:38 PM] +91 98254 67382:

[27/07, 2:38 PM] Dr Ramesh Bajania: No confusion..

[27/07, 2:39 PM] +91 94260 01847: Booster of prevenar, MCV and

tcv required if given after 2 years in splenectomy patient

[27/07, 2:39 PM] Dr Nitin Shah: Question from Dr. Shuakat Ali

Pajwani from Vapi and Dr. Ankit Sinojiya from Morbi: Should BCG

be repeated even if you have given it by yourself, proper dose, site

and no scar?

[27/07, 2:40 PM] Dr Ramesh Bajania: 150 live participation

[27/07, 2:40 PM] Dr Nitin Shah: Prevenar only one dose followed by

PPV23 after 8 weeks and one more PPV23 after 5 years. Meningo

may be given after 5 years once. TCV total 2doses 2 years apart

[27/07, 2:40 PM] +91 98250 10489: Sir any country with guideline of

15 and 18 month for varicella?

[27/07, 2:41 PM] Dr Nitin Shah: Several in Europe like Germany is

the best example. Even WHO position paper does not even talk of 2nd

dose at 5 years. KIts a typical American policy and we have blindly

floowed it or copied it!

[27/07, 2:42 PM] +91 98250 10489:

[27/07, 2:43 PM] +91 98252 14749: Sir Wt about varicella MMR

combination available as prorix

[27/07, 2:43 PM] Dr Nitin Shah: Question from Dr. Kamlesh Shah

from Jamnagr: Is it not a high time to have specialised refrigerator at

individual clinic level?

[27/07, 2:43 PM] Dr Nitin Shah: Reply: One needs to have a separate

regrigeratot specially dedicated for storage of vaccines. There should

be a dial thermometer (in-build or external). Temperature log should

be maintained twice a day. There should be no over-crowding of

vaccines in fridge. And all vaccines should be stored as per standard

guidelines.

[27/07, 2:44 PM] Dr Nitin Shah: Thats Priorix-Tetra

[27/07, 2:44 PM] Dr Ramesh Bajania: Time to buy one!

[27/07, 2:44 PM] +91 98792 08977: combination vaccines versus

individual.. Which gives better immunity?

[27/07, 2:44 PM] +91 98252 14749: Yes sir is it advisable any benefit

other then diff prick

[27/07, 2:44 PM] Dr Nitin Shah: Celfrost has an excellent fridge

[27/07, 2:45 PM] Dr Nitin Shah: Question from Dr. Shaukat Ali

Pajwani from Vapi: Is it safe to give MMRV (Priorix-Tetra) at 15

min, comments about adverse reaction

[27/07, 2:45 PM] +91 98793 02570: Yes it can be repeated..rt sir?

[27/07, 2:45 PM] +91 98792 08977: Is there any specific situation for

2nd BCG?

[27/07, 2:46 PM] Dr Nitin Shah: Reply: With both international

brands of MMRV combination vaccine there is increased chance of

high fever and subsequent febrile convulsions with first dose given at

12-15 months (mind you this is the first measles containing vaccine in

these children). This is essentially due to higher titres of anti-measles

antibodies due to adjuvant effect of varicella on MMR when given as

a combined vaccine compared to given separately. In same countries

like Germany where second dose MMRV is given at 18 months there

is no such increased risk for FC. It means the risk of febrile

convulsion is high with first dose of measles containing vaccine given

in combination with varicella in young children. In our country we

give measles or MMR at9 months of age. So scientifically when we

give MMR and varicella at 15 months it is the second dose of measles

containing vaccine and hence should be safe even if given as MMRV.

I do use MMRV at 15 months. However one point. Why do you want

to use MMRV which is so expensive just to save a prick? I give it

only if parents insit on a combination vaccine.

[27/07, 2:46 PM] +91 94263 47733: Varicella and MMR should be

given in combination or separately at 15months of age???

[27/07, 2:47 PM] +91 98253 03100: If 1 st dose is Prevenar,

somebody gives synflorix 2 nd, what to do on 3 rd visit?

[27/07, 2:47 PM] +91 98252 14749: Thanks sir a lot yes I do consider

economy

[27/07, 2:48 PM] Dr Ramesh Bajania: 170 live participation

[27/07, 2:48 PM] Dr Nitin Shah: Reply: I agree that BCG scar is not a

definite sign of immune response but is an easy surrogate marker of

immune response. Hence the standard care is to repeat BCG once if a

scar is not seen say by 3-6 months after BCG

[27/07, 2:49 PM] +91 94263 47733: Ideal age for pneumococcal

vaccine Boaster?

[27/07, 2:49 PM] Dr Nitin Shah: Continue the remaining doses with

Prevenar13

[27/07, 2:50 PM] +91 98240 26682: Do we need to check maternal

HIV status before giving both dose of OPV and BCG?

[27/07, 2:50 PM] Dr Nitin Shah: Ideally yes.In private practice that is

usually available. In public hospital too thats the stahdard of care

[27/07, 2:51 PM] +91 98240 26682: Is it mandatory in private?

[27/07, 2:51 PM] +91 98240 26682: Can we face legal issues for that?

[27/07, 2:51 PM] Dr Nitin Shah: Voluntarily mandatory!

[27/07, 2:52 PM] Dr Nitin Shah: No leagl issues for such decisons.

[27/07, 2:52 PM] Dr Nitin Shah: Question from Dr. Ankit Sinojiya

from Morbi: What to do if BCG adenitis develops?

[27/07, 2:52 PM] +91 98240 26682: Ok thanks sir

[27/07, 2:52 PM] Dr Nitin Shah: Reply: If the BCG gland is firm

leave it alone and observe.Most the time it disappears after several

months. If it shows signs of fluctuations or ruptures excise it

surgically. No AKT in either situation. One may try a course of

antibiotics initially if there are signs of super added infection at BCG

site. Lastly do look for significant lymph nodes at other parts of body

including chest as well as liver and spleen enlargement which if

enlarged may suggest disseminated BCG (BCGiosis) as seen in a pt

with primary immude deficiency syndrome like SCID or MSMD.

[27/07, 2:54 PM] +91 99798 87979: What is to be done if bcg mark is

very large..like 2 cm..like abscess..?

[27/07, 2:54 PM] Dr Nitin Shah: Try local antisepctis and or oral

antibiotic.

[27/07, 2:54 PM] +91 98240 26682: Is birth dose of hepatitis B

feasible all the time? Commonly when we see newborn time already

lapsed

[27/07, 2:55 PM] +91 98240 26682: I find it difficult to follow

[27/07, 2:55 PM] 682+91 98240 26 : Routinely

[27/07, 2:55 PM] Dr Nitin Shah: So around 50-60% of babies do

recieve it at birth

[27/07, 2:56 PM] +91 98240 26682: Is it ok as per guidelines?

[27/07, 2:57 PM] Dr Nitin Shah: Didn't underatsnd you question

[27/07, 2:57 PM] 7979+91 99798 8 : What is to be done bcgiosis?

AKT?

[27/07, 2:58 PM] Dr Nitin Shah: Investigate for Immune deficiency

and treat with AKT as well as the baseline immune deficiency

[27/07, 2:58 PM] +91 98240 26682: Means at birth Hb vaccine 50-

60% coverage

[27/07, 2:58 PM] Dr Nitin Shah: Govt data

[27/07, 2:58 PM] +91 98240 26682: Ok

[27/07, 2:59 PM] +91 99798 87979: If they want last both dose if

PCV10..can we?

Or first PCV10 & then PCV 13 2nd & 3rd?

[27/07, 2:59 PM] Dr Nitin Shah: Question from Dr. Suresh Jain from

Dahod:For IPV I follow 6 weeks easy6, 10 week easy 4 and 14

Week easy 6. Should I give easy6 again at 18 month as booster?

[27/07, 2:59 PM] Dr Nitin Shah: Reply: So if you want to follow 2

doses IPV then you need to start first dose at 8 weeks (and not 6

weeks as you do) and keep a gapof 8 weeks between two doses (that

is 8-12-16 weeks schedule). If parents can afford I would give one

more IPV containing dose at 15 months (and even at 5 years).Lot of

Euroepan countries give one more IPV during adolescence as they

give Tdap-IPV. So more the merrier!

[27/07, 3:00 PM] +91 98240 26682: Is easy 6 approved for use?

[27/07, 3:01 PM] Dr Nitin Shah: Similar Question from Jaychandra

Ratanpara Junagadh: Can we use Easisix?

[27/07, 3:01 PM] Dr Nitin Shah: Reply: It’s a licensed vaccine in

India and hence there is no reason why not to use. However

scientifically there is scanty data. Only one single study on Easisix Vs

Prentavac and IPV given separately. That too not published. Data

available from the product monogram where only seroconversion data

is shown which is not inferior to separate vaccines but no data on

GMTs given. Also Seroconverions data is wrongly labelled as GMTs!

Also this vaccine is exorbitantly expensive without any advantage Vs.

Pentaxim and Hep B given separately. So if Px is available it comes

out to be same cost. Lastly now that Hexaxim xosts have come down

by almost Rs 1000 its more affordable with lots of data on

immunogenicity and safety. I have personally not used Easisix as I am

still waiting for data.

[27/07, 3:03 PM] +91 98240 26682: Ok sir

[27/07, 3:03 PM] +91 94284 14780: Genuine advantage of veriped

over biovac V

[27/07, 3:04 PM] Dr Ramesh Bajania: 203 participating live

[27/07, 3:05 PM] Dr Nitin Shah: Similar question from Dr. Ankit

Sinojiya from Morbi: Are Nexipox, Varivax, Veriped and Varilrix as

similar and as HPVeffective

[27/07, 3:05 PM] Dr Nitin Shah: Reply: All varicella vaccines

available have same mother strain that is Oka strain. It is how the

manufacturers then handle the master seed to make commercial lots

will decide the content, excipients and brands. Available data suggests

that all the varicella brands have similar immunogenicity and efficacy

of about 95% with one dose and near 100% with two doses given 1-2

months apart against severe varicella. So choose the brand you like!

[27/07, 3:05 PM] +91 94284 14780: Thanks sir

[27/07, 3:07 PM] +91 98240 26682: Do we need to vaccinate contacts

of a patient having break through varicella?

[27/07, 3:08 PM] Dr Nitin Shah: Yes provided the index case is less

than 48 hours since onset. At the most upto 5 days

[27/07, 3:08 PM] +91 98240 26682: Ok

[27/07, 3:09 PM] Dr Nitin Shah: And the contacts must not have had

varicella or vaccine in past

[27/07, 3:09 PM] +91 98240 26682: Got it

[27/07, 3:09 PM] +91 98240 26682: What are the options if 1-2

month old healthy neonate comes in contact with varicella ?

[27/07, 3:10 PM] +91 98980 66694: For typhoid tcv..

Regime should be 9 month and 2 yrs!!?

[27/07, 3:11 PM] Dr Nitin Shah: If his mother had varicella in past

this baby is protected till 12 months

[27/07, 3:11 PM] +91 98240 26682: Ok

[27/07, 3:12 PM] Dr Nitin Shah: Similar question from from Dr.

Sameer Masrani from Rajkot

[27/07, 3:12 PM] +91 98980 66694:

[27/07, 3:12 PM] +91 94284 14780: Can MMR and conjugate typhoid

vaccine given at same time? 9 month age

[27/07, 3:12 PM] Dr Nitin Shah: Reply: Tybar-TCV (also same as

Enteroshield) has a major long term immunogenicity study in India.

Single dose of vaccine was given to subjects from 6 mo-45 years of

age and were followed up. All showed good seroconversion and high

titres compared to Vi Polysaccharide with better quantity and avidity

(quality) of IgG antibodies after the vaccine. At 18 months follow up

half the subjects received second dose as booster and remaining half

were followed without booster. The group receiving booster showed

massive rise in antibody levels as expected. The group with booster

also had significant protective titres persisting. Both these groups are

followed up till 3 years and both groups show titres remaining in

protective range till at least 3 years. Further follo up is planned till 5

years. Based on this as on now I will give two doses of this vaccine

two years apart at any age. If 5 years data suggests that titres

remained high in single dose arm, I would probably drop the booster

and give just one dose at any age.

[27/07, 3:12 PM] Dr Nitin Shah: 01) Question from Dr. Sameer

Masrani from Rajkot

[27/07, 3:14 PM] Dr Ramesh Bajania: Most common query

[27/07, 3:15 PM] Dr Nitin Shah: Already tired? If not I will continue..

[27/07, 3:16 PM] +91 98240 26682: Any cross protection for

Paratyphoid by TCV?

[27/07, 3:16 PM] +91 98254 67382: Product insert of typbar tcv

recommends 2nd dose after 3 years

[27/07, 3:16 PM] Dr Nitin Shah: Nil

[27/07, 3:16 PM] Dr Nitin Shah: A separate vaccine containing Vi

and Paratyphoid is under trial

[27/07, 3:16 PM] Dr Nitin Shah: That's fine. Not before 2 years is

what I would say.

[27/07, 3:16 PM] +91 98240 26682: Ok

[27/07, 3:17 PM] Dr Nitin Shah: Ultimately it may become just one

dose

[27/07, 3:17 PM] +91 98254 67382: thanks sir

[27/07, 3:18 PM] Dr Nitin Shah: Question from Dr. Rajesh Khatwani

from Ahmedabad

[27/07, 3:18 PM] Dr Nitin Shah: Question from Dr. Rajesh Khatwani

from Ahmedabad: If child has taken ARV as pre exp proph, and he

gets bite after 2 yrs, how many ARVS? What about after 3 or 4 or

after 5 yrs?

[27/07, 3:19 PM] +91 98254 42525: If we r giving rabies pre expo

proph if pt miss 3rd dose at 7th day need to repeat schedule or 3rd

dose can be gvn anytine

[27/07, 3:20 PM] Dr Nitin Shah: Pre-Exposure doses are -=0-3-14/21

days

[27/07, 3:20 PM] Dr Nitin Shah: And not 0-3-7 days

[27/07, 3:21 PM] +91 98254 42525: Ok and for missing 3rd dose max

time duration for 3rd dose?or reschedule

[27/07, 3:21 PM] Dr Nitin Shah: Reply: Any child who has received

documented complete pre-exposure or post-exposure prophylaxis

using modern tissue culture rabies vaccine needs only two dose at 0-3

days on re-exposure irrespective of duration since last rabies vaccine

(If within 3-6 months there is no need of any dose)

[27/07, 3:21 PM] Dr Nitin Shah: ASAP

[27/07, 3:22 PM] +91 99798 87979: Do need booster every 5

year..single dose?

[27/07, 3:22 PM] Dr Nitin Shah: Question from Dr. Parthiv Shah

from Ahmedabad: Which are the diseases where immunization is

required following infection?

[27/07, 3:22 PM] Dr Nitin Shah: Reply: Diseases which are vaccine

preventable and need vaccines in spite of having suffered natural

disease include Diphtheria, Tetanus, Pertussis, Rotaviral diarrhea,

Pneumococcal disease, Typhoid and HPV.

[27/07, 3:23 PM] +91 98240 26682: For pet dog bite.... to vaccinate

or not?

[27/07, 3:23 PM] Dr Nitin Shah: Always vaccinate the victim as dog

vaccines do not have great efficacy.

[27/07, 3:23 PM] +91 98240 26682: Even if history of dog vaccinated

[27/07, 3:24 PM] +91 98240 26682: Ok sir

[27/07, 3:24 PM] Dr Nitin Shah: Boosters only for those at risk of

constant exposure to rabies like Vets or lab workers

[27/07, 3:24 PM] Dr Nitin Shah: Yes

[27/07, 3:24 PM] +91 99798 87979: Ok sir

[27/07, 3:25 PM] +91 94284 14780: Should we give influenza

vaccine every year each child?

[27/07, 3:25 PM] +91 99798 87979: If booster was nt given, one

pre/post exposure vaccination given...then only 2 dose at any given

time in life?

[27/07, 3:26 PM] Dr Nitin Shah: Yes

[27/07, 3:27 PM] +91 99798 87979: 🏻ok sir

[27/07, 3:27 PM] +91 99798 87979: Sir please..

[27/07, 3:27 PM] Dr Nitin Shah: Very different question from Dr.

Udani from Ahmedabad: Choice of your brands....

[27/07, 3:27 PM] +91 94265 11755: If we have to choose Antirabies

vaccine,which one we should choose?

[27/07, 3:27 PM] Dr Nitin Shah: Rotateq/Rotarix/Rotasure: Reply -

Rotavac or rotasure

Prevenar/ synflorix:Reply - Prevenar

Hexaxim/pentavac: Reply - Pentavac plus at least two doses of IPV

MMR(si)/priorix: Reply - MMR+V (Even in affording pts – why

waste money?)

Biovac A/Havrix: Reply - BiovacA

Influenza/no vaccine: Reply - Influenza yearly (It will sane morbidity

and hospitalization due to CAP which usually follows an apparent

viral URI)

Meningo/no vaccine: Reply - No vaccine

[27/07, 3:29 PM] +91 98796 71273: If rabies vaccine and rabies

immunoglobulin was given and then again dog bite is on face or

level3 after 3 months then what's abt repeat immunoglobulin??

[27/07, 3:29 PM] Dr Nitin Shah: All current modern tissue culture

vaccines are equally good. Chhose any

[27/07, 3:30 PM] +91 94265 11755: Thanks sir

[27/07, 3:30 PM] +91 99798 87979: Variped/varilrix/nexipox?

[27/07, 3:30 PM] Dr Nitin Shah: Question from Dr. Sameer Masarani

and Dr. Ankit Sinojia from Morbi

[27/07, 3:31 PM] Dr Nitin Shah: From available rotavirus vaccines

which is preferred from scientific view? Reply: All the three rotavirus

vaccines have similar efficacy against severe Rotavirus

Gastroenteritis in field efficacy trials in countries with similar socio-

economic development. Like Rotarix has shown near 100% efficacy

in Europe and Rptateq has shown similar efficacy of 100% in US. In

Latin America the efficacy of Rotarix is about 85%. In developing

countries Rotarix has shown efficacy of about 55-65% in South

Africa and Malawi trials and so also Rotateq showed 50-60% efficacy

in Bangladesh, Vietnam, Male, Ghana and Kenya. Indian vaccine

Rotavac (same as Rotasure) has similar efficacy of 56% in India. All

three vaccines are equally safe too. So to me all these three vaccines

are scientifically same. I believe in “Be Indian Buy Indian” if you

have a choice. Besides Indian vaccine is much cheaper.

[27/07, 3:31 PM] Dr Ramesh Bajania:

[27/07, 3:32 PM] +91 98796 71273:

[27/07, 3:32 PM] +91 99798 87979: 🏻

[27/07, 3:33 PM] +91 99798 87979: Biovac-a single dose? Or need 2

[27/07, 3:33 PM] Dr Ramesh Bajania: Single

[27/07, 3:34 PM] Dr Nitin Shah: Question from Dr. Pushkar

Shrivastava from Ahmedabad: The efficacy of 116E strain of

Rotavirus vaccine is undeniably proven but what's his take on its

SAFETY profile?

[27/07, 3:34 PM] +91 94265 11755:

[27/07, 3:34 PM] Dr Nitin Shah: Always one dose

[27/07, 3:34 PM] Dr Nitin Shah: Reply: Field trial for safety of

Rotavac (same as Rotasure) has established safety of this vaccine

against intussusception as risk was same in vaccinees vs placebo. The

incidence rate of confirmed intussusception among vaccine recipients

was 94/100,000 child-years (95% CI, 41, 185) and 71/100,000 child-

years (95% CI, 15, 206) among those receiving placebo the

difference between the treatment arms was not statistically significant

with an odds ratio 1.34 (95% CI, 0.32, 7.82) (p = 0.76).

[27/07, 3:36 PM] +91 99798 87979: Why biovac a> havrix?

[27/07, 3:36 PM] Dr Nitin Shah: Single dose so more cost effective

[27/07, 3:36 PM] +91 99798 87979: efficacy?

[27/07, 3:36 PM] +91 94265 11755: No other extra advantage sir?

[27/07, 3:37 PM] Dr Nitin Shah: 10 long term data on Biovac A from

India. High immunogenicity. Near 100% efficacy. Single dose. What

more do you want?

[27/07, 3:37 PM] +91 99798 87979: Heard like: no long term data for

biovac a..

[27/07, 3:37 PM] +91 99798 87979: Ok..

[27/07, 3:38 PM] +91 99798 87979: In pneumococcal vaccine..

How can we make change over if patient insist ?

From synflorix to prevenar & vice versa

[27/07, 3:39 PM] Dr Nitin Shah: Always PCV10 to PCV13. Reverse

will be harakiri

[27/07, 3:39 PM] +91 99798 87979: Total 3 doses only?

[27/07, 3:39 PM] Dr Ramesh Bajania: 258 live participation

[27/07, 3:40 PM] +91 99798 87979: Demand is always..13 to 10..

[27/07, 3:40 PM] +91 98240 26682: If patient willing for PCV 10 and

not for PCV 13 will it b five to complete PCV 10?

[27/07, 3:41 PM] Dr Nitin Shah: Yes. Total4 doses. 3+1

[27/07, 3:41 PM] Dr Nitin Shah: 01) Question from Dr. Ankit

Sinojiya from Morbi: Which is better PCV10 or PCV13 considering

the costs

[27/07, 3:41 PM] Dr Nitin Shah: Reply: Based on several field

efficacy trials as well as post marketing effectiveness data it is clear

that PCV13 and PCV10 have similar efficacy against invasive

pneumococcal disease for the serotypes contained in the vaccines. Of

course PCV13 has 3 additional serotypes namely 3, 6A and 19A. 19A

amounts to 5-8% of cases of IPD in India. When it comes to

effectiveness against community acquired pneumonia PCV13 has

much greater reduction (40-50%) in hospital treated CAP (all cause

CAP) than PCV10 (10-18%). Similarly PCV13 has greater impact on

AOM than PCV10. PCV10 has not shown to have any impact on

NTHi AOM as was claimed by PCV11. Reduction in NP carriage is

also better with PCV13 then PCV10 which reflects on greater herd

effect with PCV13 than PCV10.

[27/07, 3:42 PM] +91 99798 87979: If first dose of pcv 10 given..only

2 of pcv 13...then booster?

If 2 r given..1 of pcv 13 & booster?

[27/07, 3:42 PM] Dr Nitin Shah: Yes.Something is better than nothing

[27/07, 3:42 PM] Dr Nitin Shah: Yes

[27/07, 3:43 PM] +91 94272 17771: Crystal clear

[27/07, 3:43 PM] Dr Nitin Shah: Question from Dr. Ankit Sinojiya

from Morbi: Which strain of swine flu vaccine to be used? Preferably

please give brand name

[27/07, 3:43 PM] +91 98240 26682: Superb

[27/07, 3:43 PM] +91 99798 87979: 🏻solved many queries

[27/07, 3:44 PM] Dr Nitin Shah: Reply: In most parts of the country

influenza peaks during monsoon that is June to August and hence we

should Southern vaccine that arrives in February each year. However

if a patient comes late use the vaccine available and regularize to

Southern vaccine from next season. All brands of inactivated

influenza vaccines are equally good so use any. Live vaccines have

not been found to be effective since last 3 seasons in the West (may

be against the prevalent strains or since it became quadrivalent or both

reason).

[27/07, 3:45 PM] +91 98792 08977: Any ideal time of year to give flu

vaccine as we see patients year round.. This year specially. Concern is

because of the strain available

[27/07, 3:46 PM] Dr Nitin Shah: See above reply

[27/07, 3:46 PM] +91 98792 08977:

[27/07, 3:46 PM] +91 98792 08977: Thanks

[27/07, 3:46 PM] Dr Nitin Shah: Question from Dr. Ankit Sinojiya

from Morbi: Which is better Gardasil or Cervarix?

[27/07, 3:47 PM] Dr Nitin Shah: Reply: qHPV contains types 6 and

11 which are the cause of 90% of warts so only that vaccine can

prevent genital warts. Genital warts are not as ‘benign’ as they can be

recurrent and difficult to treat with significant morbidity. For the

common serotypes 16 and 18, both are equally effective against

cervical high grade lesions with long term safety and efficacy data.

qHPV has more data on reduction in high grade vulval, vaginal and

anal lesions. It also has data in Men.

[27/07, 3:48 PM] Dr Nitin Shah: Last 10 minutes

[27/07, 3:48 PM] Dr Nitin Shah:

[27/07, 3:48 PM] Dr Ramesh Bajania: Yes Nitinbhai

[27/07, 3:48 PM] +91 98240 26682: Two dose time table for gardasil

is ok ?

[27/07, 3:49 PM] +91 98250 10489: For more then 10 years okay.

[27/07, 3:49 PM] +91 94265 11755: They have reduced doses even in

Cervarix

[27/07, 3:49 PM] Dr Nitin Shah: 03) Question from Dr. Kamlesh

Shah from Jamnagar: Rationale for 2 dose schedule of HPV up to 14

yrs and then 3 dose later on....how and why?

[27/07, 3:49 PM] Dr Nitin Shah: Reply: Adolescents between 9-14

years develop a robust immune response to HPV vaccines with titres

exceeding that seen in younf adults off 16-25years by at least two

folds. Hence studies were undertaken to see if one primary and one

booster (0-6 months) will lead to sufficient titres and Seroconversion

in 9-14 years. Resulst in both boys and girls showed that SC and

GMTs were non-inferior in 9-14 years old given 2 Vs 3 doses and

non-inferior than young adulst give 3 doses (for whom we have

efficacy data). Hence the efficacy data was extrapolated to say two

doses will be sufficient in 9-14 years old. Now in India too DCGI has

approved two dose schedule for 9-14 years old. Beyond 14 years of

age we don not have similar data and hence the cut off is 14 years.

[27/07, 3:51 PM] +91 94277 14171: Gardasil to be given at 0, 2 and 6

sir?

[27/07, 3:52 PM] Dr Nitin Shah: Yes for > 14 years

[27/07, 3:52 PM] +91 94277 14171: thank you sir

[27/07, 3:52 PM] +91 98240 26682: Two dose means 0-6?

[27/07, 3:53 PM] +91 99798 87979: For ipv..as not available

nowadays.

What can we do best from our part in pvt practice?

[27/07, 3:53 PM] +91 98242 20166: How about a mother wants to

take HPV vaccine?

[27/07, 3:53 PM] Dr Ramesh Bajania: 300 live

[27/07, 3:53 PM] Dr Nitin Shah: Yes. minimum is 0-4 months

[27/07, 3:54 PM] Dr Nitin Shah: Give. Envourage

[27/07, 3:54 PM] +91 98242 20166:

[27/07, 3:54 PM] +91 99798 87979: In How many groups?nitin sir is

live?

[27/07, 3:54 PM] Dr Nitin Shah: 05) Question from Dr. Arun Shah

from MuzzafarpurL On one to one discussion with parents if parents

are adamant why not give acellular pertussis vaccine even if there is

slightly inferior immunogenicity considering the high reactogenicity

of whole cell pertussis vaccine? Isn’t it strange that despite disease

outbreak in California, AAP and CDC have not switched to whole

cell killed vaccine.

[27/07, 3:54 PM] +91 99798 87979:

[27/07, 3:54 PM] Dr Ramesh Bajania: 2

[27/07, 3:54 PM] Dr Nitin Shah: Reply: DTap have same efficacy and

effectiveness as DTwP. There may be early waning of protection with

DTaP as compared to DTwP however that is overcome by natural

boosting and vaccine boosters. DTaP are much safer and hence are

demande by parents and it is their right to do so and you duty to give

them DTaP without fearing any guidelines. No single country has

switched to DTwP due to fear of its efficacy. In fact more and more

countries are switching to DTaP. & years down the outbreaks have

died down without any change in the vaccine strategy in these

countries. 5/19 countries with ongoing surveillance had resurgence of

pertussis almost at same time in 2010-11 and 14 did not have any

such outbreaks (and all of them using DTaP). Except for USA where

there was outbreak amongst adolescents, all other 3 countries using

DTaP had infant pertussis (England & Wales, Portuguese) or dropped

first booster in national program (Australia) as the cause of

outbreak. 5th country which had outbreak was using DTwP (Chile).

Even in US recent change to PCR to diagnose pertussis and

unvaccinated population were two important causes of pertussis

outbreaks. Lastly in same USA duting a decade before switch to

DTaP (1990-1999) there were 10 outbreaks in ten years with lots of

cases in adolescents and adults suggesting waning immunity even

with DTwP. Other countries using DTwP also has outbreaks in recent

years including Pakistan.

[27/07, 3:55 PM] +91 99798 87979: 🏻 🏻 🏻

[27/07, 3:56 PM] Dr Nitin Shah: Question from Dr. Ali Reza from

Ahmedabad: In case of unavailability of DTaP vaccine, is it okay to

vaccinate 4 year child with Tdap, as practised in some countries?

[27/07, 3:56 PM] Dr Nitin Shah: Reply: Tdap is licensed for use from

4 years of age so legally you can use it at 4-6years for second booster.

But being a reduced antigen vaccine (1/3rd of aP vaccine and 1/10th

of D antigen) scientifically it will not work as well as infant DTaP. If

you give Tdap as second booster make sure that the child comes back

for the second dose of Tdap at 10 years.

[27/07, 3:57 PM] +91 99798 87979: For ipv..as not available

nowadays.

What can we do best from our part in pvt practice?

[27/07, 4:00 PM] Dr Nitin Shah: I would give one dose of IPV

containing vaccine like Hexaxim or Pentaxim at 14 weeks. If pt can

afford two doses I would give them at 8 weeks and 16 weeks. If they

can afford three dose i will give as 8-16 weeks and a booster at 15

mo. If they can 4 doses i will give 6-101-4 wks-15 mo

[27/07, 4:01 PM] Dr Nitin Shah: Last 5 minutes..For impromptu

questions...

[27/07, 4:01 PM] Dr Ramesh Bajania:

[27/07, 4:01 PM] +91 99798 87979: Whats about intradermal ipv?

[27/07, 4:02 PM] Dr Nitin Shah: ntradermal is as effective as IM for

seroconversion but titres are lower. Also these studies used jet

injevtors for ID route and not manual as is used in India. ID is only

for public health and not private clincis

[27/07, 4:02 PM] +91 99798 87979: Ok air

[27/07, 4:02 PM] +91 99798 87979: Sir

[27/07, 4:02 PM] Ramani Ranjan: Sir my questions pls

1. After antibody containing preparation( HBIG/RIG/Blood products)

how long vaccine has to be deferred?

2. Baby received HBIG and Hep B vaccine : Will schedule of BCG

and other vaccine change?

[27/07, 4:03 PM] 98253 03100 +91 : When will Dengue vaccine

come?

[27/07, 4:03 PM] Dr Nitin Shah: 04) Question from Dr. Ranjan from

Junagadh: After antibody containing preparation (HBIG/RIG/Blood

products) how long vaccine has to be deferred?

[27/07, 4:03 PM] Dr Nitin Shah: Reply: Low/High dose IVIG in will

have highest natural antibodies against most common vaccine

preventable diseases and will interfere with uptake of live injectable

vaccines namely Measles, MMR, Varicella, Live Hep A vaccine.

Hence one should wait for 9-12 months before giving these vaccines.

Other specific immunoglobulins like Hep B IG, Rabies IG, Tet IG,

Hep A IG or Varicella Ig will also have some of these antibodies and

hence we should wait for 3-6 months. Blood products also may have

some of these natural antibodies in plasma and hence one should not

use live vaccines for 3-6 months. Washed PRBC is an exception and

you don’t have to wait for vaccination. This principle does not apply

to any killed/inactivated vaccines.

[27/07, 4:03 PM] Dr Nitin Shah: Its already marketed in some Asian

countries.In India at leat 2 more years

[27/07, 4:04 PM] Ramani Ranjan:

[27/07, 4:04 PM] +91 99798 87979: So hepatitis B..any schedule we

can adjust?

[27/07, 4:05 PM] +91 98795 38800: How about Intranasal &

Sublingual IPV? Same preparation as for IM administration or

different variety?

[27/07, 4:06 PM] Dr Nitin Shah: Still experimental

[27/07, 4:06 PM] +91 98240 26682: Is it mandatory to report AEFI?

Which type of adverse reactions and where to report?

[27/07, 4:07 PM] +91 98796 71273: Which schedule is preferred for

hepatitis b??

0-1.5-6 months...

Or 1.5-2.5-3.5 months

What's prefer practically??

Any change in efficacy vise??

[27/07, 4:08 PM] Dr Nitin Shah: Yes.Locan Immunization officer and

or IPA central office

[27/07, 4:08 PM] Dr Nitin Shah: Yes

[27/07, 4:08 PM] Dr Nitin Shah: From immunological point of view

0-1-6 months is best as leads to high titres after third dose which lasts

long and gives long term protection. Shorter schedules like 01-1-2 or

6-10-14 weeks are logistically better as children may not come back

for third dose at 6 months. But it leads lower titres. Now we know

that titres may not matter as HBV has long incubation period and

there will be anamnestic response even if titres are undetectable.

Hence all schedules are OK provided the child receives three dose

with minimum 1 month gap between doses. In private practice on can

use birth-6weeks-6 months schedule as compliance id good. With use

of Hexaxim any way you will be giving 5 doses of Hep B (birth-6-10-

1 wks-15 mo) so it’s even better.

[27/07, 4:10 PM] +91 99798 87979: Thanks a lot Dr. Nitin sir..it is

very nice informative seminar & useful in day to day practice..

Thanks to Dr. Bajania sir for such a wonderful initiative...

[27/07, 4:11 PM] +91 98240 26682: Thanks dr Nitin sir

[27/07, 4:11 PM] +91 98252 14749: Thank for nice information and

practical approach

[27/07, 4:12 PM] Dr Nitin Shah: Friends, It was a pleasure to

participate in this Sapinar. I tried my best to cover all questions sent

to me in advance as well as tried to reply impromptu questions. It

needed a lot of energy, hard work and time. But it was worth it at the

end for all friends from Gujarat. Hope you enjoyed my honest and

sincere replies. Let me remind you I have said what I practice. Good

bye for time being! Special thanks to Ramesh bhai!!

[27/07, 4:14 PM] Dr Ramesh Bajania: Nitinbhai I thank on behalf of

this august house..

We appreciate your selfless service to our friends!

Yes it takes lot of effort to make it of this high quality session

A big thanks

[27/07, 4:22 PM] Dr Ramesh Bajania: 314 live

[27/07, 4:23 PM] Dr Ramesh Bajania: Real credit goes to our beloved

Nitinbhai who is always there for Group..

He put so much of efforts to make it truly enlightening session for all

of us!