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Introducing pentavalent vaccine in the EPI in India: a counsel for caution.

A similar feeling of sadness and betrayal was evoked by the report of National Technical Advisory Group on Immunization (NTAGI) sub-committee on Haemophilus influenzae B (Hib) published recently3. On December 14, 2009, the Health Secretary chaired a meeting to discuss the policy framework for vaccine preventable disease in the country. Invited to this meeting were the chairperson, vice-chairperson and Indian Academy of Pediatrics representative to the NTAGI Hib sub-committee. Data from an ICMR study in Anaicut block of Vellore, obtained under the Right to Information Act were presented. The study showed that the incidence of all-cause pneumonia was 30 per 1000 children under-five, and mortality was 0.3 per 1000 children under-five. Thus mortality is 50 times lower than 14 per 1000 projected by the UNICEF for India4. It was additionally pointed out that even if mortality was assumed to be as high as 10 per cent (instead of 0.7% observed in the study), there would be 3 deaths per 1000 children under-five. This study data undercut one of the main points in the sales pitch for introducing 2 vaccines the pneumococal conjugate vaccine and the Hib vaccine in India. Members of the NTAGI were asked why the data on pneumonia were not included in the NATGI report when it had selectively quoted nasopharyngeal-carrier data from the same study. The Chairperson of NTAGI admitted that the results from Anaicut and also that from Kolkata and Chandigarh Indian J Med Res 132, July 2010, pp 1-3