Saturday, January 16, 2016

India Introduces Injectable Polio Vaccine

From April, 2016 the trivalent polio vaccine that is currently administered will be replaced by the bivalent variety to reduce incidence of vaccine-derived polio virus. 

India is all set to introduce injectable polio vaccine (IPV) in its universal immunisation programme (UIP) in a phased manner from November. This will be over and above the oral vaccine. From April, 2016 the trivalent polio vaccine that is currently administered will be replaced by the bivalent variety to reduce incidence of vaccine-derived polio virus. India eliminated wild polio virus infection in January last year. In the first phase of IPV introduction, 17 high-risk states and four Union Territories will be covered. These are Bihar, Chandigarh, Delhi, Gujarat, Haryana, Punjab, Rajasthan, Uttar Pradesh, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Assam, Madhya Pradesh, Andaman and Nicobar islands, Lakshadweep, Dadra and Nagar Haveli and Daman and Diu. -

IPV is one of the three vaccines that were approved by the government for inclusion in the UIP more than a year back on the recommendation of the National Technical Advisory Group on Immunisation. The other two vaccines, measles-rubella and rotavirus are still in the works. “From November we will introduce IPV in the UIP schedule, in three phases, starting with the high-risk states. The single dose of the vaccine will be administered with the third dose of the DPT vaccine at 14 weeks. This is as per the global endgame strategy and also in preparation for our own switch to bivalent oral polio vaccine next year. For now, the administration of the oral vaccine will continue,” said a senior official in the Health Ministry. Oral polio vaccine is made of live attenuated polio virus of all three strains of polio – P1, P2 and P3. India currently uses the trivalent vaccine. The other variety, the bivalent one that India will introduce next year has only attenuated P1 and P3 strains. India eradicated P2 in1999 — the last case was in Aligarh — but the most number of cases of vaccine-derived polio happen because of P2. Till date about 44 such cases of polio derived from the vaccine have been reported in the country. That is why the switch to bivalent oral vaccine. IPV on the other hand is made up of killed polio virus and will give a child immunity from all three strains. There is no risk of vaccine-derived polio either.

In May 2012, The World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan 2013-18, calling on countries to strengthen routine immunization programmes and introduce at least one dose of IPV in all countries using only oral polio vaccine. IPV is to be given in addition to the existing oral polio vaccine, in order to boost population immunity. For the first year GAVI, which is an international vaccine alliance, has given about 28 million vaccine doses to India. This is against India’s original demand for 40 million doses to account for wastage, transportation etc. India’s total annual birth cohort is 27 million. The first instalment is not sufficient to cover all states but the government is hopeful of further support from GAVI. The target is to cover all states in the next seven-eight months. Continuing IPV without GAVI support will entail a cost of approximately Rs 200-250 crore.

Compared to oral form of polio vaccine, the IPV is also expensive with each dose costing anywhere between Rs. 100 and Rs. 120. According to estimates, the State and Central governments will be incurring an additional expenditure of Rs. 7.50 crore per year to administer the inactivated form of polio vaccine.

“Apart from completing the training part, we are almost through with the logistics part. The Government of India has given clear cut instructions to switch to IPV by April 25 and we will be able to meet the deadline in Telangana State,” says Chief Programme Officer, National Health Mission (NHM) in Telangana, G. Srinivasa Rao.

The existing oral polio vaccine, which is cheap and can be easily administered, uses live but weakened forms of the poliovirus. However, live vaccine viruses can occasionally revert to virulence and there is always a chance of having a ‘live’ polio virus in the community. With IPV, however, there are no such risks because the virus is already deactivated, doctors here clarified.

Senior paediatricians have also stressed on the importance of training workers on handling IPV and maintaining the cold chain, which is necessary, while the drug is being transported.

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