Correlation of Interferon-gamma and Interleukin-28B levels in patients with chronic hepatitis C viral infection with or without Schistosoma mansoni coinfection

Abstract

Background: India's national Expanded Programme on Immunization(EPI) launched in 1978 offers vaccines such as BCG, DPT, OPV, and measles vaccine free of cost, while pediatricianrecommended non-EPI vaccines are available for purchase in the country. On September 1 st 1994 the Pediatric Department, Christian Medical College, Vellore expanded immunization services from 2 afternoons/week into a daily full-time walk-in immunization clinic offering both EPI and non-EPI vaccines. In this study we analyze time trends in vaccination provided by this clinic over two decades.Methods & Materials: Manually entered records till 1 st January 1996 and subsequent computerized clinic records were accessed for information on vaccine types and doses delivered from 1 st January 1995 to 31 st December 2014.Results: The number of children attending the clinic showed a >2-fold increase from 31045 in 1995 to 89439 in 2014, averaging >7000/month and nearly 250/day in 2014. EPI vaccines increased proportionately for DPT (13313 in 1996 to 30641 doses in 2014), 4-fold for BCG(2650 in 1996 to 11610 in 2014) and over 5-fold for OPV(10452 in 1996 to 52200 in 2014). Hemophilus influenzae type b(Hib) vaccine was made available as a single vaccine from June 1997, as a quadrivalent(DPT-Hib) vaccine from September 1999 and as a pentavalent(DPT-Hepatitis B-Hib) vaccine from December 2002, nearly a decade before pentavalent vaccine provision on the national programme in 2011. Hib vaccine doses increased 6-fold from 4420 doses in 1998 to 28415 in 2014, with >15000 doses administered annually from 2001 and >20000 doses annually from 2008. The proportion of DPT and Hib administered as a combination vaccine increased from 3.7% in 1999 to 92% for DPT and 99% for Hib in 2014. Number of injections received at each child-visit did not exceed 2, and the average cost of a visit providing combination vaccines was kept to <500 INR(<10 USD).Conclusion: Affordability and ease of access were the keys to sustained growth in vaccine provision from this private not-forprofit clinic of a tertiary care centre, and similar strategies can be used to improve immunization coverage in the country. Hib disease reduction in our community was documented by us earlier, attributable to Hib vaccine provision from this clinic.