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November 4, 2014

Baby Vaccination



For DTP vaccine there is brand called Easy-five, QuinVaxem etc while for DTaP there is brand called as Pentaxim.  

Let us see how the two differ :
When you go to the health center to get your baby vaccinated, you will be given an option choose between Easy-five or Pentaxim vaccine. Easy-five and pentaxim both give protection against 5 diseases.

DTP or DTwP
DTaP
Vaccine name is Easy-five, Pentavac,
QuinVaxem etc
Vaccine name is Pentaxim
DTP stands for Diptheria, Tetanus and Pertusis
DTaP stands for Diptheria, Tetanus and acellular Pertusis
Easy-five covers Diptheria, tetanus, pertussis ( cellular component), haemophilus Influenza type b and Hepatitis B.
Pentaxim covers Diptheria, Whooping cough , Tetanus, Haemophilus influenzae type b and IPV (injectable polio vaccine).
Protection offered is similar, but DTP has side-effects like fever and irritability
DTaP does not have these side-effects.
DTP is less expensive
DTaP is more expensive.

It is upto you to decide which vaccine to administer depending on all these factors. If you go for QuinVaxem route, baby should be given oral polio vaccine, while in case of Pentaxim hepatitis-B vaccine must administered separately.

Options Available
1) Pentaxim + hepatitis-B (Painless) (By Aventis)
Pentaxim as the name goes is a combination vaccine against 5 different types of infections. It was discovered in 1997 and is imported from France. It is imported by Aventis Pharma India Ltd and costs Rs 2070. As per my google search Pentaxim is now being banned There have been numerous studies over the years, that the dosage of vaccine in Pentaxim against Pertussis is low, that it is not able to protect humans from infection in the long run.
A recent study by WHO also states that pertussis (respiratory disease, which spreads through contact) is on the rise  again & is prevalent among 5+ years old children in the United  States & Europe, where this vaccine has been adopted as part of the  national immunization schedule.
Immunity for the other 4 diseases pentaxim covers is as good as the individual vaccines. Only pertussis is under question.

Other options are quite painful even while injecting to the baby, plus there are  high chances of swelling around the area of injection for upto 10 hrs.  post vaccination.The baby will get fever & feel pain in the area of injection along with swelling. But infection prevention weighs higher than pain prevention. So, if your baby is due for its vaccine, do opt for a different  combo of vaccine other than PENTAXIM, to avoid chances of infection in  later stages of life!
Moreover, he pain while giving vaccination is the same for all. The painless part is only for pertussis where the prick is there but fever/ swelling is  less. So actually it should be called fever less.Painful is actually more recommended as it has been used on india for years ( you would have got it too as a baby) and us very effective against pertussis . The painless was a recent innovation. It was supposedly as effective  without the pain but very very recently it is being noticed that  pertussis is happening to people vaccinated with painless in childhood  at a higher rate than those with painless.
As a parent please take a call between 1-2 days of crankiness and less chance of whooping cough. Some babies can have a very bad reaction to the painful - high fever too much crying for whole day or even seizures etc. Then painless should definitely be used but such a bad reaction is rare.

 IAP (Indian Academy of Pediatrics) in October 2013 has not recommended feverless/painless injection, since it was found that DTaP is much less effective than DTwP ("normal" DTP or whole cell DTP) containing vaccine. Subsequent recommendations of IAP in November 2014 and September 2016 have also endorsed this.
Alternative to Pentaxim (Fever-less Injection)  are


2) Infanrix + Inactivated Polio Vaccine (Inactivated Polio Vaccine, in the form of injection)
   Infanrix which is 6 in 1 and is made by GSK (London) based company, Costs around Rs 700. It is rated C and L3.

3) Tripacel ( By Sanofi Pasteur, Canada) + IPV
It Costs around Rs 800.  

4) Pentavac SD + Oral Polio Drops or Inactivated Polio Vaccine
Pentavac SD is manufactured by Serum Institute of India (SII) and its indigenous and very effective. It costs Rs 500. It is rated C and L3.
(
I personally oppose Pentavac vaccination due to following news items
2014: http://www.omsj.org/blogs/after-54-infant-deaths-government-finally-admits-three-deaths-associated-with-pentavalent-vaccination

2015: http://www.tribuneindia.com/news/chandigarh/infant-dies-at-mani-majra-ut-bans-pentavac-vaccine/72865.html

These could be planted by Foreign companies too as SII is Indian company. However i am not convinced as there and number of states involved and therefore i do not prefer or opt for this vaccine. However to my surprise my Pediatrician kept on convincing me that it is the best and most opted vaccination.
)

5) Easyfive (By Glaxo Pharma Ltd) + Polio Drops
It costs around Rs 600. It is rated D and L4.It is even available for free in Govt Dispensary.


6) QuinVaxem (By Novartis) + Polio
It  costs Rs 1000 (Painless not available)

There are two more vaccine for follow up:-
 a) QUADRAVAC vaccine + POLIOVAC + Hep B
QUADRAVAX is manufactured by Serum Institute of India (SII).It costs around Rs 450.

b) Comvac4 + Polio Vac
Comvac 4 is manufactured by Bharat Biotech. It costs around Rs 150.


In the cost of medicine the same vaccination by the same company can come into 2 formats i.e with pain and painless. As per my understanding the difference is not in the vaccine but in Syringe. The same vaccine comes along with painless syringe and can costs 10 TIMES more than the same vaccine with thicker syringe.

I would like to refer Table Published at Page 796 of Indian Academy of Pediactrics Vol 51 in 15 Oct 2014 issue:-








Clinical Efficency Data




(MRP

Brand Name
Manufacturer
Hib Conjugate
Alum Phos/ 0.5 ml
Thiomersal
D
P
T
HiB
Hep B
Efficacy PMS Trial
Pain
Swellling
Fever
WHO PQ
World Wide Usage
Cost MRP

Pentavac
Serum Institute of India
PRP-T
< or equal to
1.25 mg
Yes, (0.005
%)
100
95.3
100
100
100
No
22.4
39.1
17.5
Yes
40
million
585
Quinvaxem
Novartis vaccines
HbOC- CRM-197
0.3 mg
No (only
in traces)
99
99
100
100
98
Phase IV PMS
trial*
10
4
13
Yes
>400
million doses
1000
Shan5
Shantha Biotech
PRP-T
0.625
mg
Yes (<0.050
mg)
99.4
89.9
99.4
98.3
97.8
No
36.3
2.6
5.7
Yes
24
million

Comvac-5
Bharat Biotech
PRP-T
0.3 mg
Yes (0.025
mg)
98
76
98
100
98
No
9.2 (Un)
4.4 (Un)
24 (Un)
No
-
600
Easyfive- TT
Panacea
PRP-T
0.25 mg
Yes (0.025
mg)
97.7
65-72
99
89.5
97.3
No
-
42.3 (Un)
73 (warm to touch)
Yes
55
million
600
ComBE five
Biological Evans
PRP-T
<1.25
mg
Yes, (0.01%
w/v)
98.3
96.5
100
89.5
94.7
No
13
4
28
Yes
-
580
NP-not published; D-Diphtheria; P-Pertussis; T-Tetanus; Hib-Hemophilus influenza type b; Hep-B-Hepatitis-B; PMS-Post-marketing surveillance; *PMS trial in Guatemala;Un-unspecified.

As can be seen from aforesaid table
Quinvaxem has higher efficiency and lower by effects.
Pentavac has higher efficiency buy higher by effects.
Shan 5 has moderate efficiency and lower by effects.

Comvac 5 is not WHO pre qualified.
Easyfive is not very effective and has higher by effects.


IPV (Inactivated Polio Vaccine) costs around Rs 500.

Prevnar 13 (By Wyeth) Costs around Rs 3,800
Synflrix 10 costs around 1900

Rotarix (By Glaxo) injection costs around Rs 1,500. 2 doses are required.
Rotateq (By Merck)  injection costs around Rs 900. 3 doses are to be given.
Rotavac ( By Bharat Biotech)  injection costs around Rs 54. 3 doses are to be given.

As you can see cost of vaccine by Indian Company is way less. Another point of significance is that ROTAVAC was developed in Indian laboratories, utilizing an Indian strain, tested on Indian subjects and thus can be expected to be more effective in the Indian population.However Rotavac has been launched in Mar-16 and that too only in 4 states Andhra Pradesh, Haryana, Himachal Pradesh and Odisha.

3 comments:

  1. Thanks Ankit. Very helpful information. Really appreciate it...

    ReplyDelete
  2. is pentaxim less effective as i came to know

    ReplyDelete