Diseases can be nipped in the bud with vaccination as a harm reduction approach

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India contributes to a major share of the child mortality due to infections such as measles

New Delhi, 18th February 2019: Statistics indicate that India accounts for one-third of all measles-related deaths worldwide. Measles is highly infectious and as per the WHO, a country needs to ensure that at least 95% of all children receive two doses of the vaccine. About 15% of vaccinated children fail to develop immunity from the first dose, meaning that if only 80% are fully immunized, an outbreak is likely.

Measles is a highly contagious viral diseases spread by contact with an infected person through coughing and sneezing. The infection is followed by high fever, rash that spreads over the body, cough, running nose and red watery eyes. Measles weakens the immune system and often leads to serious complications, including blindness, encephalitis, severe diarrhea and respiratory infections such as pneumonia.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Vaccination is an extremely effective harm reduction strategy. This, along with several other strategies, was also discussed at the first-ever harm reduction conference organized last month in New Delhi. Vaccinations are a way of taking the preventive approach as opposed to curing a condition once it has set in. The measles-rubella (MR) vaccine helps prevent two diseases. It is administered when the child is between 9 and 12 months and once again between 16 and 24 months. The government is providing this vaccine free of cost through its immunization programme. The need of the hour is large-scale awareness on the benefits of vaccination and encouraging more families to get their children immunized.”

Unlike measles, rubella is a mild viral infection that mainly occurs in children. A woman who is infected with the rubella virus during the early stage of pregnancy has a 90% chance of transmitting it to the fetus. Some issues that the virus can cause include hearing impairments, eye and heart defects and brain damage in newborns. It can also lead to spontaneous abortion and fetal deaths.

Adding further, Dr Veena Aggarwal Executive Editor IJCP group said, “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 (up to 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, the Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006 to 2010 and has now been incorporated under the Routine Immunization Programme.

Some common mistakes in taking medicines

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  • Prescribing liquid medications in teaspoons and tablespoons: A teaspoon (tsp) can be confused with a tablespoon (tbsp). Their sizes may vary. Hence, all liquid medications should be prescribed in millilitres (mL) and they should be taken with a dosing device such as a small cup which should have mL markings.
  • Pill splitting: Tablets that are not scored should not be split into two. They can crumble or are divided into unequal halves affecting the dose strength. Sustained or extended-release tablets and enteric- or film-coated tablets are generally not considered appropriate for tablet splitting. Film coating masks taste; therefore splitting film-coated tablets may unmask the taste.
  • Sound-alike drugs can cause confusion e.g. a hypertensive patient called up his family physician who asked him to take Amlopress AT but the patient took amlopress 80 mg. After sometime he developed dizziness, flushing, palpitation, nausea, abdominal pain. Another example of sound-alike drugs is the patient received Isoprin IV in place of Isoptin and nearly died.
  • Misinterpreting decimal pointsUsing a trailing zero after a decimal point e.g. do not write 5.0 mg. There are chances that the patient may get 50 mg; 5.0 mistaken as 50 mg if the decimal point is not seen. Lack of a leading zero before the decimal point, if the dose of a drug is less than one, may cause a decimal point to be missed. E.g. writing .25 mg may result in the patient taking 25 mg instead, so write 0.25 mg.
  • Mistaking “U” as zero. Do not write ‘U’ for units; always write the complete word ‘units’. E.g. 4U insulin may be mistaken to be 40 units of insulin when the doctor meant 4 U (4 units).
  • 8-2-8 mistake: The time interval should be written more clearly as 8am 2pm 8pm. Or, the patient may consider it to be the number of tablets to be taken 8 in the morning, 2 in the afternoon and again 8 at night.
  • Taking medicines with inadequate quantity of water or lying down immediately after taking the drug can cause pill esophagitis by direct esophageal mucosal injury. It is commonly seen with drugs such as nonsteroidal anti-inflammatories (NSAIDs), tetracycline, doxycycline, alendronate, antiviral drugs, iron supplements.
  • Some medicines need to be taken “before meals” or “on an empty stomach” because food can prevent absorption of some medicines and reduce their effectiveness. E.g. Levothyroxine and rifampicin should be taken on an empty stomach.
  • Taking medicines with fruit juices: Grapefruit, orange, and apple juices decrease the absorption of many drugs such as fexofenadine, cancer chemotherapy (etoposide), antibiotics (ciprofloxacin, levofloxacin), itraconazole, antihypertensives (atenolol), immunosuppressant (cyclosporine)
  • Skipping doses: This may be dangerous especially with antiepileptic drugs or anticoagulants.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

‘Register complaints of virginity test as sexual harassment case’, instructs Maharashtra government

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On Wednesday i.e. 06.02.2019, in a crackdown on the reported cases of a ‘virginity test’ being performed on newly-wed women of the Kanjarbhat community, the Maharashtra State Government has said it would soon take steps to ensure that such complaints are treated as cases of sexual harassment. The Minister of State for Home said that the state government would issue a notification directing police stations to register a case of sexual harassment in case a woman comes with a complaint of having been forced to take the ‘virginity test’.

A district-wise review of the action taken against caste panchayats, in cases of social boycott, will be conducted by the protection of civil rights (PCR) committees of the police. “Virginity test is a kind of sexual harassment of newly-married woman. If the victim in a virginity test incident is ready to file a complaint, it will be considered a case of sexual harassment and action will be taken accordingly by the investigation agency. Complaints in this regard can be filed with the concerned deputy commissioners of police (DCPs) or crime against women cells. The legal service authority will provide essential help to the victims”. The minister has agreed to issue a notification in this regard.

Some young members of the Kanjarbhat Community have been campaigning through a WhatsApp group against the practice, in which a newly-married woman is allegedly asked to provide proof of her virginity on the wedding night.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA