Anupam Sachdeva

Pneumococcal conjugate vaccine introduction in India’s Universal immunization program

For the first time, millions of children in India will receive protection for free against the leading cause of pneumonia, which kills more underfive children than any other infectious disease in the world [1] and in India – thanks to the launch of the pneumococcal conjugate vaccine (PCV). Until now, PCV was only available in the private sector in India, putting it beyond the reach of most of the population. By making it available under the Universal immunization program (UIP), the government of India is ensuring equitable access to those who need them the most – the underprivileged and underserved.

Dietary interventions for rare metabolic disorders–Now available in India!

he human body is a miracle machine, and metabolism is the most critical process that converts food to energy which in turn serves as fuel to stay healthy and fight diseases. When a with various industry partners and government bodies for the last year, and the efforts culminated in bringing IEM nutrition products to India. Last year in November, FSSAI in a landmark recommendation, allowed the import of foods for “Inborn errors of metabolism” and hypoallergenic conditions. Companies such as Abbott, Dannon, Mead Johnson and Nestle came forward through their global supply chain systems to expedite availability of nutrition products that could potentially save many children every year. An indicative list is provided in Table I.

An appeal to all pediatricians and members of Indian Academy of Pediatrics for the measles–rubella campaign

The phased MR campaign will target to vaccinate approximately 41 crore children in the age group of 9 months to <15 years across the country over a period of 2 years (2017-18), and is a massive public health undertaking. MR vaccine is a safe and effective vaccine that has been in use for over 40 years, and in more than 100 countries across the world. An additional MR campaign dose is a onetime opportunity to boost population immunity in our country to stop endemic circulation of both measles and rubella virus, through addressing the challenges of both vaccine failure and failure to vaccinate. The first phase of wide age-range MR vaccination campaign commenced in the five states: Tamil Nadu, Karnataka, Goa, Lakshadweep and Puducherry. The states have managed to vaccinate more than 3 crore children through schooland outreach-based vaccination approach.

Breastfeeding and breastmilk – A commitment, not an option

The infant mortality rate (IMR), defined as the probability of dying before one year of age expressed per 1000 live-births, acts as one of the most important indicator of children’s health and well-being in a country. These young children, being the future of a nation, are responsible for its social and economic development. Thus, it becomes imperative to provide these children with the best health and nutrition services at an early stage of life, so as to enhance their growth, nutritional status and overall development. National Family Health Survery (NFHS)-4 (2015-16) highlights that in India IMR is 41 per thousand live births with state-wise variation – highest in Uttar Pradesh (64) followed by Chhatisgarh (54), Madhya Pradesh (51), Assam (48) and Bihar (48). The states with the lowest rate of IMR are Kerala (6) followed by Goa (13). The IMR of other states and Union territories varies between 20 and 45 per thousand live births [1].

Whither National Medical Commission (NMC) Bill

The NITI Aayog has sent its draft of a new National Medical Commission (NMC) Bill 2016, which seeks to reform medical regulation in India. It is important that in participatory democracy we should have professionals self regulating them. The NITI Ayog, in this bill, is mentioning about replacing the current Medical Council of India (MCI) with a primarily nominated team with bureaucrats ruling the roost. Let us examine the arguments advanced by the NITI Aayog for this change.

54th National Conference of Indian Academy of Pediatrics 18–22 January 2017, Bengaluru

My Dear Chief Guest, Guest of Honor, Office bearers, Organizing team of Pedicon–2017, all delegates, Past Presidents of Indian Academy of Pediatrics (IAP), members of the media, and my fellow IAPians; Good Evening to all of you. I thank all IAPians for electing me as President–IAP–2017. It is a very big responsibility, and I hope that I come up to your expectations. IAP is the apex body of all pediatricians of the country for over 50 years. It has been looking after the interests of the children of our country, and has been in the forefront of all initiatives towards improving child health in our country. It goes to the credit of IAP that its members initiated the demand for exclusive breastfeeding for first six months, and also lead the initiative for promulgating the proceedings for Infant Milk Substitutes (IMS) Act – to just name a couple of things.

Point-of-care diagnosis in pediatric practice

Infectious diseases contribute to high morbidity and mortality of humans since times immemorial. Their potential to spread has resulted in epidemics and even pandemics of cholera, influenza, tuberculosis and plague. Their spread within the hospitals causing hospital-acquired infections in the growing population of susceptible hosts (e.g., those with cancer, autoimmune diseases and organ transplants) is another major concern for medical professionals. Apart from well-recognized bacterial diseases, we also have viral diseases (dengue, chikungunya, viral encephalitis), fungal infections (candidiasis), parasitic infections (malaria, echinococcosis, trypanosomiasis, taeniasis, schistosomiasis), and now emerging and re-emerging diseases. The exact burden of these diseases in the developing countries, including India, is unknown due to under-diagnosis, under-reporting and the lack of appropriate diagnostic facilities. Two major landmarks in the history of communicable diseases have been ‘hygiene revolution’ in the western world in early 19th century (‘Swachh Bharat’ in India 200 years later), and the discovery of antibiotics in the 20th century. However, the development of antimicrobial resistance (natural and induced) and lack of development of new molecules (discovery void) have led us to a post-antibiotic era of antimicrobial resistance in microbes – a matter of great public health concern leading to increased morbidity, mortality and increased healthcare costs. This has caught the attention of world community of medical professionals, economists, social scientists and various political bodies, including United Nations.

IPAN — The game changer

In this year, we are launching the IPAN (Indian Pediatric Access Network). The pilot will be launched in October, 2017 for 100 pediatricians, and then it will be scaled-up to 5000 members of the Indian Academy of Pediatrics (IAP) in the next one year, followed by rest of the members over the next two years. In Phase II, the IAP will involve the Government of India to include all district hospitals, and in Phase III, the Primary Health Care Centers.

Organ donation in children: The next frontier

In recent years, pediatric solid-organ transplantation has evolved into a well-established, usually successful procedure, with the gap between available organs and demand still growing. As protocols for organ donation were developed for adults, potential pediatric donors are lost to the donation pool [1]. Transplantation of Human Organs Act was passed in India in 1994, making it possible to retrieve organs from brain-dead donors, but only few pediatric donors are there so far. Unforeseen death, religious and cultural beliefs, fear of mutilation, and families not being aware about organ donation lead to denial for donation. Along with other issue like death certification and ethical dilemmas, parental consent remain the most important hurdle for organ donation in children [2]. It has been shown that supportive behaviors from medical staff based on training and educational programs, and treating parents with dignity and respect are essential predictors for getting consent. Practitioners involved in pediatric and neonatal organ transplantation should apply the four principles of biomedical ethics: autonomy, nonmaleficence, beneficence and justice [3].

Health promotion: Looking back... Moving forward

Health promotion is the process of enabling people to increase control over, and to improve, their health. It was 30 years ago that World Health Organization (WHO) had conducted its first conference on health promotion. At its conclusion, they adopted ‘Ottawa charter for health promotion’. It was a hinge between past and future as it pooled the principles and ideas that were evolving around five major strategies and expressed a vision of the future.