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 IAP Textbook
of

VACCINES

A Publication of Indian Academy of Pediatrics

 Disclaimer
The views expressed by the authors on different vaccines and issues pertaining to
immunization shall be considered as their own personal opinions. They should not be
construed or cited as official stand of the Indian Academy of Pediatrics.
 IAP Textbook
of
VACCINES
Editor-in-Chief
Vipin M Vashishtha MD FIAP
Director and Consultant Pediatrician
Mangla Hospital and Research Center
Bijnor, Uttar Pradesh, India

Editors

Rohit Agrawal MBBS DCH MD TU Sukumaran MD DCH MNAMS

Director, Chandrajyoti Children’s Hospital, Mumbai Professor, Department of Pediatrics
Consultant Pediatrician, Kohinoor Hospital Institute of Child Health and Children Hospital
Mumbai, Maharashtra, India Government Medical College, Kottayam, Kerala, India

Academic Editors

Nitin K Shah MBBS MD DCH Naveen Thacker MD FIAP

Consultant Pediatric Hematoncologist Director, Deep Children Hospital and Research Center
PD Hinduja National Hospital and Medical Research Center Head, Department of Pediatrics, Sahyadri Ramkrishna Specialty Hospital
Mumbai, Maharashtra, India Kutch, Gujarat, India

Panna Choudhury MBBS DCH MD FIAP FIMSA FRSTMH FAMS Vijay N Yewale MD DCH
Consultant Pediatrician Consultant
Vice Chairman, Child Health Foundation Dr Yewale Multispecialty Hospital for Children
Executive Director, Indian Academy of Pediatrics Navi Mumbai, Maharashtra, India
New Delhi, India
Associate Editors

CP Bansal MD PD DAP FIAP A Parthasarathy MD DCH MNAMS

Director and Consultant Pediatrician Senior Consultant Pediatrician, AP Child Care, Chennai
Shabd Pratap Hospital Ex Distinguished Professor, The Tamil Nadu Dr MGR Medical University
Gwalior, Madhya Pradesh, India Retired Senior Clinical Professor of Pediatrics, Madras Medical College
Deputy Superintendent, Institute of Child Health and Hospital for Children
Chennai, Tamil Nadu, India

Foreword
Stanley A Plotkin

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IAP Textbook of Vaccines
First Edition: 2014
ISBN: 978-93-5090-947-8
Printed at
 Dedication
This endeavor of the Academy is dedicated to:
“The children of this great country—The future of our nation”
IAP Committee on Immunization
(IAPCOI), 2011-13
CHAIRPERSONS
Rohit Agrawal
TU Sukumaran

CONVENER
Vipin M Vashishtha

MEMBERS
Amarjeet Chitkara
Manjori Mitra
S Sanjay
SG Kasi
Suhas V Prabhu

ADVISORS
Nitin K Shah
Raju C Shah
Naveen Thacker
A Parthasarathy

EX-OFFICIO
Panna Choudhury (Chairman, IAPCOI, 2009-11)
Vijay N Yewale (Convener, IAPCOI, 2009-11)
Sailesh Gupta, Honorary Secretary General, IAP
Ritabrata Kundu, Chairperson, Infectious Diseases Chapter of IAP
Abhay K Shah, Secretary, Infectious Diseases Chapter of IAP
IAP Advisory Committee of Vaccines
and Immunization Practices
(ACVIP), 2013-14
CHAIRPERSON
CP Bansal

CO-CHAIRPERSONS
Rohit Agarwal
Vijay N Yewale

CONVENER
Vipin M Vashishtha

IAP COORDINATOR (HSG)

Sailesh Gupta

MEMBERS
Shashi Vani
Anuradha Bose
Ajay Kalra
AK Patwari
Surjit Singh

CONSULTANTS
Narendra K Arora
Naveen Thacker
Rajesh Kumar
Ajay Gambhir
VG Ramachandran
HP Sachdev

RAPPORTEUR
Panna Choudhury
 Editorial Board

Editor-in-Chief
Vipin M Vashishtha MD FIAP
Director and Consultant Pediatrician
Mangla Hospital and Research Center
Bijnor, Uttar Pradesh, India

Editors

Rohit Agrawal MBBS DCH MD TU Sukumaran MD DCH MNAMS

Director, Chandrajyoti Children’s Hospital Professor
Mumbai Department of Pediatrics
Consultant Pediatrician, Kohinoor Hospital Institute of Child Health and Children Hospital
Mumbai, Maharashtra, India Government Medical College
Kottayam, Kerala, India

Academic Editors

Nitin K Shah MBBS MD DCH Naveen Thacker MD FIAP

Consultant Pediatric Hematoncologist Director, Deep Children Hospital and
PD Hinduja National Hospital and Research Center
Medical Research Center Head, Department of Pediatrics
Mumbai, Maharashtra, India Sahyadri Ramkrishna Specialty Hospital
Kutch, Gujarat, India

Panna Choudhury Vijay N Yewale MD DCH

MBBS DCH MD FIAP FIMSA FRSTMH FAMS Consultant
Consultant Pediatrician Dr Yewale Multispecialty Hospital for Children
Vice-Chairman, Child Health Foundation Navi Mumbai, Maharashtra, India
Executive Director
Indian Academy of Pediatrics
New Delhi, India

Associate Editors
CP Bansal MD PD DAP FIAP A Parthasarathy MD DCH MNAMS
Director and Consultant Pediatrician Distinguished Professor
Shabd Pratap Hospital The Tamil Nadu Dr MGR Medical University
Gwalior, Madhya Pradesh, India Retired Senior Clinical Professor of Pediatrics
Madras Medical College
Deputy Superintendent
Institute of Child Health and Hospital for Children
Chennai, Tamil Nadu, India
 Contributors

Anju Aggarwal MD MNAMS FIAP David E Bloom BA MA PhD

Associate Professor Clarence James Gamble Professor of
Department of Pediatrics Economics and Demography
University College of Medical Sciences and GTB Hospital Harvard School of Public Health
New Delhi, India Harvard University
Boston, USA
Rohit Agrawal MBBS DCH MD
Director, Chandrajyoti Children’s Hospital Anuradha Bose MBBS MD DCH MRCP FRCPCH
Consultant Pediatrician, Kohinoor Hospital Professor
Mumbai, Maharashtra, India Department of Pediatrics
Christian Medical College
Shilpa Khanna Arora MBBS MD Vellore, Tamil Nadu, India
Senior Resident
Department of Pediatrics Shobha Broor MBBS MD
University College of Medical Sciences and GTB Hospital Professor and Director (Laboratory Sciences)
New Delhi, India The INCLEN Trust International and CHNRI
Okhla, New Delhi, India
Narendra K Arora MBBS MD DM
Executive Director Elizabeth T Cafiero MSc (Global Health and Population)
The INCLEN Trust International and CHNRI Department of Global Health and Population
Okhla, New Delhi, India Harvard School of Public Health
Harvard University
S Balasubramanian MD DCH FRCPCH (UK) MNAMS FIA Boston, USA
Senior Consultant Pediatrician
Kanchi Kamakoti Childs Trust Hospital Aruna Chandran MD MPH FAAP
Chennai, Tamil Nadu, India Chief of Epidemiologic Services
Baltimore City Health Department
Garima Bang MD Assistant Scientist
Senior Resident Department of Epidemiology and Pediatrics
Department of Pediatrics Bloomberg School of Public Health
University College of Medical Sciences Baltimore, USA
New Delhi, India
Thomas Cherian MBBS DCH MD
Till Bärnighausen MD SCD Fellowship in Pediatric Infectious Diseases
Associate Professor of Global Health Coordinator, Program and Impact Monitoring
Department of Global Health and Population Department of Immunization Vaccines and Biologicals
Harvard School of Public Health World Health Organization
Harvard University Geneva, Switzerland
Boston, USA
AJ Chitkara MD DNB
Piyali Bhattacharya MD Head
Consultant Pediatric Endocrinologist Department of Pediatrics
Sanjay Gandhi Postgraduate Institute of Medical Sciences Max Superspecialty Hospital
Lucknow, Uttar Pradesh, India Shalimar Bagh, New Delhi, India
xiv
IAP Textbook of Vaccines

Panna Choudhury MBBS DCH MD FRSTMH FIMSA FIAP FAMS Sean Patrick Fitzwater MHS
Consultant Pediatrician Research Associate
Vice-Chairman, Child Health Foundation Johns Hopkins Bloomberg School of Public Health
Executive Director, Indian Academy of Pediatrics Department of International Health
New Delhi, India Baltimore, USA

Jaydeep Choudhury MBBS DNB MNAMS Nathalie Garçon PharmD PhD

Associate Professor Vice-President and Head
Department of Pediatrics Global Adjuvant Center for Vaccine Development
Institute of Child Health GlaxoSmithKline Vaccines
Kolkata, West Bengal, India Wavre, Belgium

Aashima Dabbas MD Andrea Gay MSc (Biology and City Planning)

Assistant Professor Executive Director of Children’s Health
Department of Pediatrics United Nations Foundation
Vardhman Mahavir Medical College Washington DC, USA
New Delhi, India
Canna Jagdish Ghia MBBS MD
Pooja Dewan MD MNAMS Medical Advisor
Assistant Professor Pfizer Limited
Department of Pediatrics Mumbai, Maharashtra, India
University College of Medical Sciences and GTB Hospital
New Delhi, India Nicholas C Grassly DPhil
Professor of Vaccine Epidemiology
K Dhanalakshmi MBBS DNB Department of Infectious Disease Epidemiology
Senior Registrar and Fellow Imperial College, London
Infectious Diseases IAP Chapter London, UK
Kanchi Kamakoti Childs Trust Hospital and
Childs Trust Medical Research Foundation Lisa A Grohskopf MD MPH
Chennai, Tamil Nadu, India Medical Officer
Influenza Division, Centers for Disease Control and Prevention
Dhanya Dharmapalan MBBS MD Atlanta, Georgia, USA
Consultant Pediatrician
Dr Yewale Multispecialty Hospital for Children Piyush Gupta MD FAMS FIAP
Navi Mumbai, Maharashtra, India Professor, Department of Pediatrics
University College of Medical Sciences
AK Dutta MD New Delhi, India
Professor and Head
Department of Pediatrics Satish K Gupta MD
Lady Hardinge Medical College Health Specialist
New Delhi, India UNICEF India Country Office
New Delhi, India
Anil Dutta MBBS MD
Vice-President Alok Gupta MD FIAP
Clinical Research and Development and Medical Affairs Chairperson, Environment and Child Health Group of IAP
GlaxoSmithKline Vaccines, Wavre, Belgium Jaipur, Rajasthan, India

MMA Faridi MD DCH MNAMS FIAP Pramod Jog MBBS MD

Professor and Head Professor
Department of Pediatrics Department of Pediatrics
University College of Medical Sciences and GTB Hospital DY Patil Medical College
New Delhi, India Pune, Maharashtra, India
 xv
Contributors

T Jacob John MBBS DCH FRCP FIAP Puneet Kumar MBBS MIAP
Formerly, Professor and Head Consultant
Department of Virology Kumar Child Clinic
Christian Medical College Dwarka, New Delhi, India
Vellore, Tamil Nadu, India
Ritabrata Kundu MD
Jacob John MBBS MD Professor, Department of Pediatric Medicine
Associate Professor Institute of Child Health
Department of Community Health Kolkata, West Bengal, India
Christian Medical College
Vellore, Tamil Nadu, India Kathryn E Lafond MPH
Influenza Division
Geoffrey David Kahn MSPH Centers for Disease Control and Prevention
Research Associate Atlanta, Georgia, USA
Johns Hopkins Bloomberg School of Public Health
Department of International Health Chandrakant Lahariya MD DNB MNAMS PGDHHM
Baltimore, USA Formerly, Assistant Professor
Department of Community Medicine
Ajay Kalra MD DCH MNAMS FIAP GR Medical College
Erstwhile Professor, SN Medical College, Agra Gwalior, Madhya Pradesh, India
Head of the Department
Rural Institute of Medical Sciences, Saifai Renu B Lal MD
Consultant, Child Health, Agra, Uttar Pradesh, India Influenza Division, National Center for Immunization and
Respiratory Diseases
Deepak Kamat MD PhD FAAP Centers for Disease Control and Prevention
Professor of Pediatrics Atlanta, Georgia, USA
Vice-Chair of Education, Department of Pediatrics
Wayne State University, Children’s Hospital of Michigan Mukta Mantan
Detroit, USA Professor, Department of Pediatrics
Maulana Azad Medical College
Gagandeep Kang MD New Delhi, India
Professor
Department of Gastrointestinal Sciences Ambika Mathur MD PhD
Christian Medical College Program Director, Interim Dean
Vellore, Tamil Nadu, India Graduate School, Wayne State University
Detroit, USA
SG Kasi MBBS DCH MD
Consultant Pediatrician Premasish Mazumdar MBBS MD DM (Neonatology)
Member, IAPCOI 2011-12 Specialist, Premature and Newborn Diseases
Bengaluru, Karnataka, India
Amit Jaggi Memorial Hospital
Agra, Uttar Pradesh, India
Satyena Katewa DCH DNB MBBS
Consultant
Parang N Mehta MD
Pediatric Oncologist
Consultant Pediatrician
Bone Marrow/Stem Cell Transplant
Mehta Hospital
BLK Super Specialty Hospital
Surat, Gujarat, India
New Delhi, India

Amrit Koirala BSc Medical Laboratory Technology (Pursuing MSc Pravin J Mehta MD DCH
Medical Microbiology) Consulting Pediatrician
Student, Christian Medical College Jack-N-Jill Nursing Home and Hindusabha Hospital
Vellore, Tamil Nadu, India Mumbai, Maharashtra, India
xvi
IAP Textbook of Vaccines

Lalitha Mendis MBBS (Cey) MD (Col) PhD (Lond) Dp Bact (Manch) F R Leon Ochiai DPhil MHS
Nat Acad Sciences SL Hon Fell CGP-SL Research Scientist
Emeritus Professor International Vaccine Institute
Department of Microbiology Seoul, South Korea
University of Colombo
Colombo, Sri Lanka Sameer Parekh BHMS MBA
Manager, Medical Affairs and Clinical Trials
Geeta MG MD Serum Institute of India Ltd
Additional Professor Pune, Maharashtra, India
Department of Pediatrics
Government Medical College A Parthasarathy MD DCH MNAMS
Kozhikode, Kerala, India Distinguished Professor
The Tamil Nadu Dr MGR Medical University
Saheli Misra MBBS MRCP (UK) DNB Retired Senior Clinical Professor of Pediatrics
Assistant Professor Madras Medical College
Institute of Child Health Deputy Superintendent
Kolkata, West Bengal, India Institute of Child Health and Hospital for Children
Chennai, Tamil Nadu, India
Monjori Mitra DCH DNB
Associate Professor Alberta Di Pasquale PhD (Vaccinology)
Institute of Child Health Director, Early Projects Global Medical Affairs
Kolkata, West Bengal, India GlaxoSmithKline Biologicals
London, UK
Archisman Mohapatra MBBS MD
Resident Yash Paul MBBS DCH
Department of Community Medicine, IMS (BHU) Consultant Pediatrician
Varanasi, Uttar Pradesh, India Maharaja Agrasen Hospital
Jaipur, Rajasthan, India
Sally Mossman PhD
Head of Viral Vaccine Program Harish K Pemde MD
GlaxoSmithKline Biologicals Professor, Department of Pediatrics
Rixensart, Belgium Lady Hardinge Medical College
Kalawati Saran Children’s Hospital
PV Murthy DCH MD New Delhi, India
Consultant Pediatrician
Venturi Clinic, Bengaluru, Karnataka, India VG Ramachandran MBBS MD
Professor, Department of Microbiology
Pritesh Nagar MBBS MD University College of Medical Sciences and GTB Hospital
Academic Coordinator and In-Charge ICUS New Delhi, India
Department of Pediatrics
Aditya Hospital, Hyderabad, Andhra Pradesh, India Gautam Rambhad MD
Associate Director
Christopher Nelson MD Medical Services
Director, Coalition against Typhoid Secretariat Wyeth Limited
Sabin Vaccine Institute Mumbai, Maharashtra, India
Washington DC, USA
Amit Rawat MD (Pathology) PDCC (Laboratory Immunology)
Jennifer Carroll O’Brien MD MPH Assistant Professor
Assocaite Professor Department of Pediatric Allergy and Immunology
University of Rochester Medical Center Advanced Pediatric Center
Brown Square Health Center Postgraduate Institute of Medical Education and Research
Rochester, New York, USA Chandigarh, India
 xvii
Contributors

Anupam Sachdeva MD Arun Shah MD DCH FIAP FIAMS

Consultant Pediatrician and Director Consultant Pediatrician
Pediatric Hematoncology and Brahampura
Bone Marrow Transplantation Muzaffarpur, Bihar, India
Sir Ganga Ram Hospital
New Delhi, India Himani Shah MBBS MD FCPS
Consultant Pediatrician
Siddhartha Saha MD Chandrajyoti Hospital
Public Health Specialist Mumbai, Maharashtra, India
India Influenza Center
Centers for Disease Control and Prevention Hitt Sharma MBBS PGDCT PDCR
Atlanta, Georgia, USA Additional Director
Department of Medical Affairs and
Sushant Sahastrabuddhe MBBS MPH Clinical Trials
Associate Research Scientist Serum Institute of India Ltd
International Vaccine Institute Pune, Maharashtra, India
Seoul, South Korea
Sangeeta Sharma MBBS MD (Pharmacology)
Mathuram Santosham MD MPH Head
Professor Department of Pediatrics
Director, Health Systems Program National Institute of TB and Respiratory Diseases
Director, Center for American Indian Health Member Secretary, National Technical Working Group of
Professor, International Health and Pediatrics Pediatric TB
Johns Hopkins University Ministry of Health and Family Welfare
Baltimore, USA Government of India
New Delhi, India
Nitin K Shah MBBS MD DCH
Consultant Pediatric Hematoncologist Digant D Shastri MD FIAP PGDHHM
PD Hinduja National Hospital and Chief Consultant Pediatrician and CEO
Medical Research Center Killol Children Hospital
Mumbai, Maharashtra, India NICU and Vaccination Center
Surat, Gujarat, India
Raju C Shah MD FIAP
Professor and Head Surjit Singh MD DCH (Lon) FRCP (Lon) FRCPCH (Lon) FIAP FAMS
Department of Pediatrics Professor of Pediatrics and Chief
GCS Medical College Pediatric Allergy and Immunology Unit
Ahmedabad, Gujarat, India Advanced Pediatric Center
Postgraduate Institute of Medical Education and Research
Pratima Shah MBBS MD
Chandigarh, India
Former Professor
Department of Pediatrics
Tanu Singhal MSc (Tropical Medicine & International Health) MD
SBKS Medical College
Consultant
Ankur Institute of Child Health
Pediatrics and Infectious Disease
Ahmedabad, Gujarat, India
Kokilaben Dhirubhai Ambani Hospital and
Medical Research Institute
Abhay K Shah MBBS (Gold Medalist)
DPED (UNI First) MD (Gold Medalist) Mumbai, Maharashtra, India
Director
Dr Abhay K Shah Children Hospital Sanjay Srirampur MD
Honorary Secretary, ID Chapter of IAP Head, Department of Pediatrics
President, IAP Gujarat Aditya Hospital
Ahmedabad, Gujarat, India Hyderabad, Andhra Pradesh, India
xviii
IAP Textbook of Vaccines

Kamath SS MBBS DCH MD PS Medical College, Karamsad, Gujarat

Medical Director and Consultant Pediatrician Retired Professor and Head
Welcare Hospital Department of Pediatrics and Neonatology
Kochi, Kerala, India BJ Medical College
Ahmedabad, Gujarat, India
Wayne Sullender MD
Visiting Professor Vipin M Vashishtha MD FIAP
Childrens Hospital Director and Consultant Pediatrician
Birmingham, Alabama, USA Mangla Hospital and Research Center
Bijnor, Uttar Pradesh, India
A Sumanth MBBS DCH DNB
Senior Registrar, Department of Pediatrics Jignesh Ved MBBS MD PGDMM
Kanchi Kamakoti Childs Trust Hospital and the Childs Trust Senior Medical Advisor
Medical Research Foundation Pfizer India Limited
Chennai, Tamil Nadu, India Mumbai, Maharashtra, India

Fernanda Tavares MD Sanjay Verma MD

Director Assistant Professor, Department of Pediatrics
Therapeutic Area Head Advanced Pediatric Center
GlaxoSmithKline vaccines Postgraduate Institute of Medical Education and Research
Wavre Nord, Wavre, Belgium Chandigarh, India

Naveen Thacker MD FIAP Marc-Alain Widdowson MD

Director, Deep Children Hospital and Research Center National Center for Immunizations and Respiratory Disease
Head, Department of Pediatrics Centers for Disease Control and Prevention
Sahyadri Ramkrishna Specialty Hospital Atlanta, Georgia, USA
Kutch, Gujarat, India
Sangeeta Yadav MD FIAP
Satish Kamtaprasad Tiwari MD LLB FIAP IBCLC Director Professor
Professor and Head Department of Pediatrics
Department of Pediatrics Maulana Azad Medical College and Associated Hospitals
Dr Panjabrao Deshmukh Memorial Medical College, Amravati University of Delhi
Founder President New Delhi, India
Indian Medicolegal and Ethics Association
Amaravati, Maharashtra, India Vijay N Yewale MD DCH
Consultant
Jeeson C Unni MD DCH FIAP Dr Yewale Multispecialty Hospital for Children
Consultant Pediatrician Navi Mumbai, Maharashtra, India
Dr Kunhalu’s Nursing Home
Cochin, Kerala, India Rajeev Zachariah MD DCH
Well Baby Clinic
Shashi N Vani MBBS MD FIAP Department of Child Health
Emeritus Professor Christian Medical College
Department of Pediatrics Vellore, Tamil Nadu, India
 Foreword

Diseases preventable by vaccination are disappearing all over the world as vaccine coverage increases.
Certain infectious diseases have been essentially eliminated from the Americas, and although Europe
is lagging behind in some respects, even there, epidemics of diseases, for which we have vaccines are
unusual. That is not to say that the picture is completely rosy. Failure to vaccinate is a problem in isolated
populations and some of our vaccines do not give high efficacy, owing to poor immune responses in
particular patient groups or incomplete knowledge about the correlates of protection.
India and neighboring countries have presented special problems. Until recently, governmental interest
in the introduction of new vaccines has been limited, perhaps because of a focus on polio eradication. In
addition, the vast number of potential vaccinees does not make either routine or campaign distribution
easy. Fortunately, the situation is changing for several reasons: the growing interest of physicians, the manifest importance of
Asian vaccine manufacturers, and a greater understanding by governments that vaccination carries economic as well as health
benefits.
Like politics, all vaccination must be local. Although the sixth edition of an international vaccine textbook, which I had
the honor to edit, was published last year (Vaccines, Elsevier), disease epidemiology, vaccine schedules, medical practice, and
vaccine administration differ according to local practices. Thus, a book that focuses on vaccination in Asia, where the majority of
the world’s population lives will serve an important purpose, and I hope it will be read widely throughout this huge geographical
area. Moreover, Asian physicians and scientists should contribute even more to the body of knowledge concerning vaccination
in all its aspects, from basic immunology to vaccine development and clinical trials. In that way, vaccine science will grow and
benefit people in all corners of the world.

Stanley A Plotkin MD
Emeritus Professor of Pediatrics, University of Pennsylvania
Emeritus Professor, Wistar Institute
Adjunct Professor, Johns Hopkins University
Pennsylvania, USA
 From the Desk of IAP President, 2013

Indian Academy of Pediatrics (IAP) has always accorded a very high priority to the various issues related
to pediatric immunization in the country—be it framing recommendations for practicing fraternity
or issuing guidelines on the need of inclusion of a particular vaccine in the national immunization
schedule or training of program managers involved with delivery of vaccines in the field. The Academy
has also played a proactive role in taking on misinformation campaign against vaccines in media. We, as an
academic body, have contributed a lot in the success of Global Polio Eradication Initiative in the country,
and now giving technical support to the ongoing Measles and Rubella Elimination Initiative. In fact, the
Academy has never shrugged off its responsibility of a serious civil society organization, committed to
the wellbeing of the children of this country. The amount of significance accorded to immunization can
be gauged by the fact that a separate subcommittee of the Academy, now rechristened as Advisory Committee of Vaccines
and Immunization Practices (ACVIP), has been purposely constituted to deal with all the issues related to the practice of
immunization in the country for last many years.
The Academy is regularly publishing its recommendations on licensed vaccines and other aspects related to the pediatric
immunization in the form of a compact booklet, IAP Guidebook on Immunization. This book is one of the most sought after
publications of the Academy. Not only the practicing pediatricians, but even the vaccine manufacturers and policy makers
cite the recommendations contained in the book. However, the need of a comprehensive book on the contemporary Indian
scenario of vaccine-preventable diseases, vaccines, and practice of vaccination was felt for quite some time. As Chair of the
ACVIP, and also as President of the Academy in this Golden Jubilee year, I think this book is a perfect gift by the committee
to all the stakeholders involved in the field of immunization in the country and abroad. I am pretty sure that this venture shall
fulfill the great void in our understanding of vaccine sciences and would serve as a reference material to all concerned. In the
last, I congratulate all the contributors from the country and abroad, and the editors who have worked very hard to bring out
this precious publication.

CP Bansal MD PD DAP FIAP

President, Indian Academy of Pediatrics, 2013
Director and Consultant Pediatrician
Shabd Pratap Hospital
Gwalior, Madhya Pradesh, India
 Preface

There seems no exaggeration in William Foege’s words when he uttered, “Vaccines are the tugboats of preventive health”. Apart
from sanitation and safe water, no other intervention seems as powerful as vaccination in providing insulation to humankind
from dreadful diseases. Vaccination has been so effective in taking on some of the formidable diseases that people became
complacent about vaccine-preventable diseases (VPDs) in many developed countries. It is kind of “out-of-sight, out-of-mind”
situation for many VPDs owing to effective vaccination as quite eloquently described by David Neumann. Yet, this phrase is
applicable only for the children residing in less than half of the globe. For majority living in far more hostile and challenging
conditions of the third world, the VPDs are still very much on the horizon. In fact, the children of the less developed countries
need the umbrella of modern vaccination much more than their counterparts of developed world. The full potential of modern-
day vaccines in making humankind disease-free, cannot be exploited until they are employed in the regions of the globe where
their needs are felt the most.
The need of the vaccines is felt the most in India, which accounts for 20% of the world’s child population, and responsible
for 24% of all under-five deaths globally. India has been using vaccines since late 70s in its National Immunization Program
(NIP) and currently running one of the largest mass immunization programs in the world. However, the performance of the
overall program in many fields is still far from satisfactory. Coverage of many traditional vaccines remains disconcertingly low
and many new vaccines that protect against today’s some of the greatest threats to children, including pneumococcal disease
and rotavirus have yet to be introduced into NIP. There are many barriers to achieve desired results; paucity of trained health
professionals and workers in the field of vaccination is one of them. Furthermore, there is scarcity of good quality training and
reliable resources in the field of vaccinology in the country.
Resistance to vaccination is almost as old as Jenner’s smallpox vaccine. Misinformation campaigns against vaccine’s safety
may be detrimental to a well-established vaccination program of any nation. However, it may prove to be fatal to a developing
country’s ongoing vaccination initiatives as experienced in India in recent times. This phenomenon is growing worldwide and
needs to be tackled with deft risk communication. One must not forget James Shannon’s words, “The only safe vaccine is a
vaccine that is never used.”
The Indian Academy of Pediatrics has been at the forefront of advocacy and training pertaining to vaccination, particularly
in the private sector of the country. It has been periodically issuing its recommendations for both public and private health
care sectors in the form of bundled guidelines contained in a ‘Guidebook of Immunization’. However, the need of a publication
containing detailed region-specific information on the epidemiology of VPDs and vaccines has been felt for quite long. This
endeavor of the Academy in the form of a comprehensive textbook on vaccines must be viewed as an attempt to fill this void.
The first edition of the book is in your hands for your perusal. It covers almost all the aspects related to modern vaccinology
including currently available licensed vaccines and general aspects of immunization. Sections are also devoted to vaccines in the
pipeline along with newer vaccine techniques. A separate section of the book deals with issues related to vaccine policies, trials,
ethics and regulatory needs.
The book shall provide in-depth information to the professionals working in the field of vaccination in India and neighboring
South-Central and South-Eastern Asian countries. Special emphasis is provided to disease epidemiology and vaccine needs of
India and neighboring countries. This publication should also serve as a reference material for international health agencies,
government health establishments, vaccine developers, immunization program managers, and vaccine funding agencies. At
the same time, the book should also be of great utility to postgraduate students, faculty members of medical institutions, and
practicing pediatricians of the country.
xxiv
IAP Textbook of Vaccines

A galaxy of national and international experts in the field of immunization has contributed enthusiastically to this project.
We are grateful to all of them for sparing their invaluable time for the book and sharing their vast expertise in the respective
fields of immunization. We apologize for irksome requests and ultimatums, if any in order to meet the deadline. We do sincerely
hope this edition will be considered as a useful resource in the field for all those who recognize the need and the value of vaccines
in the arena of child health.

Vipin M Vashishtha
Rohit Agrawal
TU Sukumaran
Nitin K Shah
Naveen Thacker
Panna Choudhury
Vijay N Yewale
CP Bansal
A Parthasarathy
 Acknowledgments

The editors are highly thankful to the dedicated team of publishers, particularly Dr Neeraj Choudhary and Ms Madhvi Thakur
for their untiring efforts that culminated in publication of this book in time. The assistance provided by Dr Ajay Kalra and
Dr Chandrakant Lahariya in reviewing many manuscripts is also thankfully acknowledged.
 Contents

SECTION 1: GENERAL ASPECTS OF VACCINATION

Chapter 1: History of Vaccines 3

A Parthasarathy, Hitt Sharma, Sameer Parekh

Chapter 2: Vaccination in India: Past, Present, and Future 9

Chandrakant Lahariya

Chapter 3: Vaccine Immunology 25

Deepak Kamat, Ambika Mathur

Chapter 4: Immunological Correlates of Protection Induced by Vaccines 37

Amit Rawat, Surjit Singh

Chapter 5: Epidemiology in Relation to Vaccinology 43

Shilpa Khanna Arora, Piyush Gupta

Chapter 6: General Recommendations on Immunization 52

Tanu Singhal

Chapter 7: Scheduling of Vaccines 57

Panna Choudhury, Garima Bang

Chapter 8: Mucosal Immunology and Vaccination 64

Monjori Mitra

Chapter 9: Mucosal Immunity to Poliovirus 68

Nicholas C Grassly

Chapter 10: Herd Immunity and Herd Protection: Benefits and

Harms to Community by Vaccines 74
Yash Paul

Chapter 11: Adverse Events Following Immunization 79

Ajay Kalra, Premasish Mazumdar

Chapter 12: Cold Chain and Vaccine Storage 89

Satish K Gupta, Digant D Shastri

Chapter 13: Vaccine Safety and Misinformation about Vaccination 100

Anuradha Bose

Chapter 14: Disease Elimination and Eradication 110

Alok Gupta

Chapter 15: Adjuvants 121

Nathalie GarÇon, Alberta Di Pasquale, Fernanda Tavares
xxviii
IAP Textbook of Vaccines

SECTION 2: LICENSED VACCINES

Chapter 16: Tuberculosis Vaccines 139

Sangeeta Sharma
Chapter 17: Inactivated Poliovirus Vaccine 146
T Jacob John, Amrit Koirala
Chapter 18: Poliovirus Vaccine—Live 154
T Jacob John, Amrit Koirala
Chapter 19: Hepatitis B Vaccine 163
Ajay Kalra
Chapter 20: Diphtheria 174
Shashi N Vani
Chapter 21: Tetanus 183
Shashi N Vani
Chapter 22: Pertussis Vaccines 194
Vipin M Vashishtha
Chapter 23: Diphtheria, Pertussis and Tetanus Vaccines 214
AJ Chitkara
Chapter 24: Haemophilus influenzae Type B Vaccines 222
Geoffrey David Kahn, Sean Patrick Fitzwater, Aruna Chandran, Mathuram Santosham
Chapter 25: Pneumococcal Vaccines 240
Thomas Cherian
Chapter 26: Rotavirus Vaccines 249
Rajeev Zachariah, Gagandeep Kang
Chapter 27: Measles Vaccines 265
Sangeeta Yadav, Mukta Mantan
Chapter 28: Rubella Vaccine 273
Sangeeta Yadav, Aashima Dabbas
Chapter 29: Measles and Rubella Initiative 279
Andrea Gay, Naveen Thacker
Chapter 30: Mumps 284
Sangeeta Yadav
Chapter 31: Hepatitis A Vaccines 290
Nitin K Shah
Chapter 32: Typhoid Fever Vaccines 304
Sushant Sahastrabuddhe, Christopher B Nelson, R Leon Ochiai
Chapter 33: Varicella Zoster Vaccine 323
Raju C Shah, Pratima Shah
Chapter 34: Human Papillomavirus Vaccine 334
Saheli Misra, Ritabrata Kundu
Chapter 35: Seasonal and Pandemic Influenza Vaccines 341
Renu B Lal, Kathryn E Lafond, Siddhartha Saha, Wayne Sullender,
Lisa A Grohskopf, Marc-Alain Widdowson, Shobha Broor
 xxix
Contents

Chapter 36: Meningococcal Vaccine 357

MMA Faridi, Pooja Dewan

Chapter 37: Japanese Encephalitis Vaccines 364

Anju Aggarwal

Chapter 38: Rabies Vaccine 375

Jaydeep Choudhury

Chapter 39: Cholera Vaccine 382

Monjori Mitra

Chapter 40: Yellow Fever Vaccine 386

Parang N Mehta

Chapter 41: Combination Vaccines 392

AK Dutta, Harish K Pemde

SECTION 3: VACCINES IN DEVELOPMENT, NEW VACCINE STRATEGIES AND VACCINES IN THE PIPELINE

Chapter 42: Therapeutic Vaccines 401

SG Kasi, VP Murthy
Chapter 43: Enterovirus Vaccines (Especially EV71) 411
Piyali Bhattacharya
Chapter 44: Vaccines against Dengue 417
Ajay Kalra, Sanjay Verma

Chapter 45: Diarrheal Disease Vaccines 421

S Balasubramanian, K Dhanalakshmi, A Sumanth

Chapter 46: Epstein-Barr Virus Vaccines 433

VG Ramachandran
Chapter 47: Hepatitis C Vaccine 439
Abhay K Shah

Chapter 48: Hepatitis E—An Overview and Recent Advances in

Vaccine Research 448
Arun Shah

Chapter 49: Human Immunodeficiency Virus Vaccine 454

Rohit Agrawal, Himani Shah

Chapter 50: Malaria Vaccines 460

Sanjay Srirampur, Pritesh Nagar
Chapter 51: Chikungunya Vaccine 468
Kamath SS, Geeta MG

Chapter 52: Respiratory Syncytial Virus Vaccines and Parainfluenza Virus Vaccines 472
Dhanya Dharmapalan, Vijay N Yewale
Chapter 53: New Technologies for Vaccine Development 475
Anil Dutta, Nathalie Garçon, Sally Mossman

Chapter 54: Alternative Vaccine Delivery Methods 484

Puneet Kumar
xxx
IAP Textbook of Vaccines

SECTION 4: VACCINATION OF SPECIAL GROUPS

Chapter 55: Immunization in Special Situations 501

Rohit Agrawal, Himani Shah

Chapter 56: Vaccination in Immunocompromised Children 507

Satyendra Katewa, Anupam Sachdeva

Chapter 57: Adolescent Immunization 516

A Parthasarathy, Hitt Sharma, Sameer Parekh

Chapter 58: Vaccination Strategies for Travelers 521

Digant D Shastri

SECTION 5: VACCINE POLICIES, TRIALS AND REGULATORY ISSUES

Chapter 59: National Vaccine Policy of India 531

Vipin M Vashishtha

Chapter 60: Vaccine Industry and Manufacturing of Vaccines 541

Gautam Rambhad, Jignesh Ved, Canna Jagdish Ghia

Chapter 61: Issues Relating to Immunization in Developing Countries 548

Lalitha Mendis

Chapter 62: Introduction of a New Vaccine into an Immunization Program 556

Jacob John, Gagandeep Kang

Chapter 63: New Thinking on the Value of Vaccination—Globally and in India 563
Till Bärnighausen, David E Bloom, Elizabeth T Cafiero, Jennifer Carroll O’Brien

Chapter 64: Role of National Technical Advisory Group for Immunization and
National Regulatory Authority in Vaccination Programs and Practices 572
Archisman Mohapatra, Narendra K Arora

Chapter 65: Prioritizing Vaccines in Private Sector 585

Pramod Jog

Chapter 66: Legal Issues in Immunization 588

Satish Kamtaprasad Tiwari

Chapter 67: Ethical Issues in Immunization 595

Yash Paul, Satish Kamtaprasad Tiwari

Chapter 68: Marketing of Vaccines and Healthcare Professionals 599

Pravin J Mehta

Chapter 69: Web Sites Containing Reliable Information Regarding Immunization 602
Jeeson C Unni

Appendices
1. National Immunization Schedule for Infants, Children and Pregnant Women 609
2. IAP Immunization Timetable 2013 610
3. IAP Recommended Immunization Schedule for Children Aged 0-18 Years (With Range), 2013 612

Index 619

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