Achalasia cardia is an esophageal motility disorder rarely reported in children and more so in young infants. Common clinical presentations include vomiting, dysphagia, regurgitation, recurrent pulmonary aspiration and failure to thrive. Diagnosis is made by barium swallow study and esophageal manometry, which is the gold standard test. Pharmocological management and endotherapy often fails and results in recurrence of symptoms. Laparoscopic Hellers myotomy, with or without anti-reflux procedure is the standard treatment of choice for children. Per-oral endoscopic myotomy is utilized for treatment of achalasia in adults, but its safety, efficacy, and feasibility is not studied in children.

Background: Typhoid vaccines are not a part of national immunization schedule in India, current survey aimed to evaluate pediatricians’ perception, recommendation patterns, and preference regarding typhoid conjugate vaccine (TCV) in children and adults. Methods: This was an observational, cross-sectional survey amongst 500 pediatricians practicing at various healthcare setups/clinics/hospitals located across India. The perception, recommendation patterns, and preference of pediatricians regarding TCV were assessed using a pre-defined, structured, and self-administered questionnaire which consisted of 25 open- and close-ended questions. Results: TCV was highly recommended in children aged 9-24 months (61%), with only 57% of the recommended age group being vaccinated. The lowest TCV recommendations were observed in the age groups 5-12 years (35%) and 12-18 years (25%). The predominant barriers for parents who are not getting their >12 years old children vaccinated include lack of parent’s awareness that TCV can be given to adolescents (61%) and wrong assumption of parents that their child was vaccinated when young (56%). The top key factors influencing parents in getting their children vaccinated included advice of doctors, mention in the vaccination card, previous vaccination of elder sibling, and children suffering from typhoid. Conclusions: Overall pediatrician recommendations and parent acceptance rates of TCV for their children is low. Pediatricians included in the study believe that 2 doses of TCV are necessary for paediatric age group. Advice of the doctor, mention of TCV in vaccination card and awareness activities by pharmaceutical companies play a crucial role in improving the typhoid immunization rates with TCV.