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Hib vaccine is the 8th vaccine knocking at the door to be included in the EPI the world over. However there are some controversies that need to be addressed, especially when it comes to use of this vaccine in India. It is difficult to culture Hib unless one uses sheep blood enriched media for culture. There is a lack of good community based data on Hib burden in India. This makes many feel that Hib is rare in India. However this is not true. There are many studies that have looked at this closely. Hib is a common cause of meningitis and pneumonitis in children less than 5 years old in India. There is wide spread problem of multi-drug resistance by Hib in India. Mortality of meningitis is as high as 100% if third generation cephalosporins are not used in time. Of the survivors of meningitis, 60% develop long-term sequelae. Hib vaccine is very effective and can lead to 99% reduction with mass vaccination in just 2-3 years. It is also a very safe vaccine. Of the conjugated vaccines available in India all are equally effective and safe and there is nothing to choose one over the other. There is a need to give a booster dose at 15-18 months of age. Even UK, which never gave the booster dose, is seriously thinking of changing their practice and give a booster dose. Lastly the combination vaccines of Hib with IPV, DPwT/DPaT, and Hepatitis B are safe and effective and should be encouraged to improve the compliance. The use of Hib vaccine is recommended in India, for those who can afford the vaccine. [ABSTRACT FROM AUTHOR]

A response by Nitin K. Shah to a letter to the editor to his article about certification of new vaccines published in the previous issue.

A letter to the editor is presented about the Indian Vi conjugate typhoid vaccine.

Background: Propofol when given as 2 mg/kg IV bolus for induction of anesthesia is known to cause hypotension requiring vasopressors. The objective of our study was to compare Propofol 2 mg/kg single IV bolus (Precalculated group, PG) with the titration of Propofol (Titration group, TG) to clinical parameters as 10 mg IV increments every 3 seconds on hemodynamic Parameters and Bispectral Index (BIS), during induction. The effect of titration on dose requirement for induction was also evaluated., Methods: Effects on Hemodynamic parameters [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP)], and vasopressors use were recorded at baseline and every 2 minute intervals for 10 minutes. The percent difference in HR, SBP, DBP, and MAP from baseline at 2, 4, 6, 8 and 10 minutes were calculated, to determine the effect on hemodynamic parameters. BIS was recorded at baseline, after injection of Propofol, at intubation and at 10 minutes. Dose requirement of Propofol in TG was also recorded., Results: At 2 and 4 minutes, SBP decreased in PG by 21% and 18% vs. 11% and 9% in TG (p = .00 & .02); DBP decreased by 17% and 15% in PG vs. 5% and 4% in TG (p = .02 & .03); MAP decreased by 19% and 17% in PG vs. 5% and 4% in TG (p = .00 & .01). Vasopressors were required in 14/43 patients in PG vs. 5/41 in TG (p = .03). Titration resulted in 30% reduction in dose., Conclusion: Titration of Propofol reduces hemodynamic changes, dose requirement and is able to achieve same level of BIS as in bolus.

Indian Academy of Pediatrics (IAP) has taken an important step towards adolescent vaccination. In the present article, the author has briefly described the needs for adolescent immunisation along with the IAP vaccination schedule for adolescents, in details.