Pentavalent DTP vaccine: need to be incorporated in the vaccination program of India

Hemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis among infants and young children and the second leading cause of bacterial pneumonia deaths among children under 5 y. The overall case-fatality rate for Hib meningitis is 20-29%, and nearly 30% of surviving children suffer from major disabilities, while all invasive Hib disease (including meningitis) has a case fatality rate of 16% in India. Using the estimates from the Hib study, ~215,000 new cases of Hib pneumonia occur yearly in Indian children under the age of 5 y and result in over 61,000 deaths. This level of mortality is because of poor access to health services and poor health-seeking behavior by population, lack of laboratory infrastructure, and difficulty to diagnosis Hib disease among affected children. Disease burden is difficult to calculate. Even for those affected children who do reach healthcare facilities, the lack of quality health services and increasing prevalence of antibiotic-resistance makes treatment difficult for these children. Even in countries that have poor immunization coverage, indirect benefits of the Hib vaccine have been reported due to the herd effect. The Hib vaccine thus should be effective in India where Universal Immunization Programme (UIP) coverage is poor. Following the World Health Organization (WHO) recommendation that Hib-containing Pentavalent DTP vaccine (a combination vaccine that protects against five killer diseases: diphtheria, pertussis, tetanus, hepatitis B [hepB] and Hib) should be administered to every child in the world, the Government of India asked the National Technical Advisory Group on Immunization (NTAGI) to study the need for HepB and Hib vaccines in the Indian population. The India Ministry of Health and Family Welfare introduced Pentavalent DTP vaccines in the UIP with the aim of reducing the burden of Hib-related morbidity and mortality.