Dear Moderator,
Last year you have given considerable space for intradermal vaccines and introduction of newer vaccines, I am enclosing here a PATH study on intradermal vaccines and two responses for further discussion on the forum for your approval please, Here is the link to article, that says:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970554/?tool=pmcentrez
My comment on this is as follows; I congratulate PATH and other associates for working on a low cost intradermal solution for vaccination especially in Asia and Africa, but like to put straight some of the issues ;
1. The prospectus of some of the vaccines that are likely to be effective in low doses through intradermal route is a welcome development and need to be further explored to implement them as soon as possible, for example the use of IPV, yellow fever, H1N1,Hep A and also rabies vaccine (ARV) need to be immediately demonstrated and put to use, and the vaccines that are showing partial results like Hep B need to be seen if we can enhance their antigen content or adjuvant to make them intradermal compliant. let's see if newer vaccines like HPV and meningitis vaccines can be delivered through low cost intradermal for wider availability and cost effectiveness.
2. Label amendment is a major issue that all the companies resist tooth and nail, WHO/PATH need to push it or force it through incorporating in tender that label should read for ID use. After many years labels have not been amended for ID use for Anti-rabies vaccine in India and other countries, even government units are not doing so.
3. Small vials option as suggested in the paper may be the option but also pooling of children for vaccination is other alternative that we are using effectively to give intradermal anti-rabies vaccination.
4. Devices like jet injectors are costly option as shown by the paper in case of hepatitis B and a clear agenda of the device manufacturers to penetrate into the market, and should not be promoted. The logic that needle and syringes are costly option and an addition to needle stick injuries and bio-medical waste is not on sound footing becasue suppose we vaccine a million children with Im method like at present and later we vaccinate the same no. of children with Id method the needle stick injuries cost and cost of handling bio medical waste is similar, how come the cost comes when we talk of Id route and not come whaen we talk of IM route, on the way to discussion we forget that we are comparing Im with Id and not ID with needle and syringe and ID with injector devices!