Lessons must be learnt from past experiences for reaching the target of 90% immunization coverage by 2018

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Lessons must be learnt from past experiences for reaching the target of 90% immunization coverage by 2018

Full immunization against preventable childhood diseases is the right of every child

New Delhi, 10 November 2017: About five lakh children die in India every year due to vaccine preventable diseases. Another 89 lakh children are at risk due to incomplete or absent vaccination, according to statistics. The Universal Immunization Programme or UIP was relaunched in the year 2014 as ‘Mission Indradhanush’. The target was to achieve 90% immunization coverage by 2020, which has recently been changed to 2018 by the hon’ble Prime Minister.

One of the world’s largest health programmes, Mission Indradhanush believes that full immunization against preventable childhood diseases is every child’s right. Under this mission, vaccines against 12 vaccine-preventable diseases are provided to children and pregnant women. Thus far, about 2.47 crore children have been vaccinated, of which 55 lakh have been fully immunized. Apart from this, 67 lakh pregnant women have also been vaccinated.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Immunization is necessary for one and all. Often, people assume that it is not necessary because their children appear healthy or do not fall sick often. In other cases, health workers may not be able to reach out to some families due to non-availability of members at a certain point. There is a need to create awareness on the importance of immunization particularly for children and expectant mothers. Doing so will help us play a role in the larger good of the nation and achieve the government’s target also in a timely manner. Apart from this, there is also a need to scale up manpower, supplies, budget, and other resources to speed up the process.”

Mission Indradhanush, depicting seven colours of the rainbow, targets to immunize all children against seven vaccine preventable diseases namely Diphtheria, Pertussis, Tetanus, Childhood Tuberculosis, Polio, Hepatitis B and Measles. In addition to this, vaccines for JE (Japanese Encephalitis) and Hib (Haemophilus influenzae type B) are also being provided in selected states.

Adding further, Dr Aggarwal, said, “If the coverage is not sustainable year on year, it will ultimately lead to fatigue. If the mission is intensified, the efforts ahead also need to be at par. There is still reluctance, opposition, and slow acceptance of vaccination apart from other operational challenges. The challenges faced in delivering lifesaving vaccines need to be addressed from the existing knowledge and lessons must be learnt from past experiences.”

The Vaccination Schedule under the UIP is as follows.

  • BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier)
  • DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6weeks,10weeks and 14 weeks and two booster doses at 16-24 months and 5 Years of age
  • OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age
  • Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.
  • Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age
  • TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age
  • TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year
  • In addition, Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006-10 and has now been incorporated under the Routine Immunisation Programme.

People training for the Half Marathon are at risk of acute cardiovascular events

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The Indian Medical Association IMA has called for the immediate cancellation of the Airtel Delhi Half Marathon to be held on Sunday November 19 2017 at 7.00 a.m. because of the prevailing very poor to severe air quality in the Delhi NCR region. The AQI in many areas in the national capital has crossed 999. This is a public health emergency. Runners or those who exercise outdoors in conditions of air pollution are especially at a greater risk of inhaling toxic air pollutants. Some physiological changes that occur during exercise may aggravate the harmful effects of air pollution on health. Breathing becomes faster and deeper during exercise or running. The increased respiratory minute ventilation means people inhale more of toxic pollutants. Changeover to mouth breathing from nasal breathing means the nasal filtration mechanism is bypassed. Exercise practice in polluted outdoor environment over a period of 5 days impairs nasal mucociliary clearance in young healthy amateur runners. J Breath Res. 2016 Dec 21 10 4 046018 . As a result of the reduced nasal mucociliary clearance more air pollutants are absorbed instead of being cleared by the respiratory system Br J Sports Med. 2001 Aug 35 4 214 22 . Because of the increase in airflow velocity pollutants travel much deeper into the airways which further adds to the amount of pollutants inhaled. Air pollution also has a significant negative effect on performance of the athletes. PM10 has a significant correlation with reduced performance in marathon runners. Under normal breathing conditions PM10 is filtered through the nose. But because of mouth breathing during exercise PM10 is not removed and is instead inhaled in large amounts Med Sci Sports Exerc. 2010 Mar 42 3 585 91 . Air pollution is a well recognized health hazard. And exercising under conditions of high pollution thus may have disastrous health consequences even for the healthy participants. In healthy individuals it can cause cough or breathlessness on exertion. In asthmatics air pollution can trigger off an acute asthma attack. In COPD patients it can worsen their disease. Air pollution can precipitate heart attack or stroke in patients with known heart disease or those who are at risk of heart disease. It can also increase the risk of sudden cardiac death. People who are training for the marathon are thus at risk of acute cardiovascular or respiratory events which may potentially be life threatening. In September 2015 it was reported that six runners and one race official suffered heart attacks during 2105 Beijing Marathon. About 30 000 runners participated in the marathon. Shortly after the fastest runners were finishing the US embassy in Beijing recorded an Air Quality Index AQI of 175. It classes levels between 151 and 200 as unhealthy and advises people to reduce prolonged or heavy exertion during such periods. In the 2014 Beijing Marathon too the runners participated in the event with a blue warning air quality is unsuitable for outdoor activities for air pollution issued by the government http www.scmp.com news china society article 1859890 six runners and race official suffer heart attacks during beijing . AQI Air quality Health implications for healthy people 0 50 Excellent No health implication 51 100 Good No health implication 101 150 Slightly polluted Slight irritation may occur. Avoid marathon 151 200 Moderately polluted Reduce strenuous outdoor exercises No sports No Marathon or Cyclathon No Cricket matches 201 300 Severely polluted Reduce outdoor activities in schools and others no cycling no jogging no running. Prolonged exposure can harm lung and heart patients. 300 Heavily polluted Avoid outdoor activities No long walks. Prolonged exposure can cause lung injury 400 Hazardous Reduce indoor activities and even ordinary walks should be restricted. The health impacts may be experienced even during light physical activity.