Tips for telephone and electronic medical consultation.

The world is gradually shrinking in terms of time, and communications, while expanding in terms of population and distances. Patients demand and expect telephone and e-mail consultations and medical professionals are only too happy to oblige. However, a telephone consult is never so satisfying for the patients and well as the doctor as a face consult. Besides much essential information, cues and clues to diagnosis may be missed only with an audio input from patients. A telephone consult should be offered only to know the patient, and only after a prior face consult. It should be ensured that the patient can definitely understand, and follow the directions, and manage the disorder at home. While a telephone consultation may be considered convenient and short, there may be several disadvantages of such consultation, a wrong diagnosis and an inappropriate prescription being just two of them. Telephone etiquette should be followed by the staff and the physician. A triage system may be set up to filter calls that need to be necessarily answered by the physician himself. Telephone consults should be charged, and should be followed by a face consult as soon as possible. E-mail consultations are governed essentially by the same principles that govern telephone consultations. There is a slight advantage of e-mail consultation in that reports can be submitted online, including radiological reports. However, confidentiality is an important and uncertain issue in cyber space. A memorandum of understanding maybe signed between the patient and the physician. The information provided on e-mail should be of a general nature and a face consult should precede e-mail consultation. Patients may be referred to web resources for information. Telemedicine is a useful tool to obtain a medical diagnosis and to provide medical advice, and is likely to be used vastly in the near future.

Indian Academy of Pediatrics (IAP) recommended immunization schedule for children aged 0 through 18 years, India, 2013 and updates on immunization.

JUSTIFICATION: There is a need to review/revise recommendations about existing vaccines in light of recent developments in the field of vaccinology where new developments are taking place regularly at short intervals. PROCESS: Following an IAP ACVIP meeting on 3rd and 4th August, 2013, a draft of revised recommendations for the year 2013 and updates on certain new vaccine formulations was prepared and circulated among the meeting participants to arrive at a consensus. OBJECTIVES: To review and revise recommendations for 2013 Immunization timetable for pediatricians in office practice and issue statements on new vaccine formulations. RECOMMENDATIONS: The major change in the 2013 Immunization timetable was made in the recommendations pertaining to pertussis immunization. Taking in to the consideration of recent outbreaks of pertussis in many industrialized countries using acellular pertussis (aP) vaccines and subsequent finding of faster waning of the same in comparison to whole-cell pertussis (wP) vaccines and superior priming with wP vaccines than aP vaccines, the committee has now recommended wP vaccines for the primary series of infant vaccination. Guidelines are now also issued on the preference/selection of a particular aP vaccine in case it is not feasible to use wP vaccine, and use of Tdap vaccine during pregnancy. The administration schedule of monovalent human rotavirus vaccine, RV1 has been revised to 10 and 14 weeks from existing 6 and 10 weeks. Recommendation is made for the need of booster dose of live attenuated SA-14-14-2 JE vaccine. Updates and recommendations are issued on new typhoid conjugate vaccine, inactivated vero-cell culture derived SA-14-14-2 JE vaccine, inactivated vero-cell derived Kolar strain, 821564XY JE vaccine, and new meningococcal conjugate vaccines. This year the recommended immunization schedule with range for persons aged 0 through 18 years is being published together instead of two separate schedules. A subcategory of general instruction is added in footnotes. The comments and footnotes for several vaccines are revised and separate instructions for routine vaccination and catch-up vaccination are added in the footnotes section wherever applicable.

Pertussis vaccines: position paper of Indian Academy of Pediatrics (IAP).

Pertussis continues to be a major public health problem in both developing and developed countries. Data on exact burden and incidence of pertussis in the developing countries including India is sparse. However, the disease is widespread, even if not adequately measurable. Pertussis incidence has been increasing steadily in the last decade especially in industrialized countries. Outbreaks are reported from many developed countries in recent years despite widespread use of acellular pertussis vaccines with high coverage. The current status of coverage with pertussis vaccines is still sub-optimal in many states of the country. There is scarcity of data on vaccine efficacies of both whole-cell and acellular pertussis vaccines from India and other developing countries. Most of the recommendations on pertussis vaccination are based on the experience gained from the use of them in industrialized countries. Taking in to the consideration the recent evidence of faster waning of acellular pertussis vaccines in comparison to whole-cell vaccines and superior priming with whole-cell than acellular pertussis vaccines, Indian Academy of Pediatrics has now revised its recommendations pertaining to pertussis immunization in office practice. The Academy has now proposed whole-cell pertussis vaccines for the primary series of infant vaccination. Guidelines are also now issued on the preference of a particular acellular product. The Academy has also recommended use of Tdap during each pregnancy to provide protection to the very young infants. It urges the Government of India to initiate studies on the quality of available pertussis vaccines in India and to set indigenous national guidelines for the manufacturers to produce and market different pertussis vaccines in the country.

Haemophilus influenza type b disease and vaccination in India: knowledge, attitude and practices of paediatricians.

BACKGROUND: Haemophilus influenza type b (Hib) causes significant morbidity and mortality among young children in India. Hib vaccines are safe and efficacious; nevertheless, their introduction to India's national immunization programme has been hindered by resistance from certain sectors of academia and civil society. We aimed to ascertain the attitudes and perceptions of Indian paediatricians towards Hib disease and vaccination. MATERIALS AND METHODS: A cross-sectional survey of knowledge, attitude and practices on Hib and vaccines was undertaken among 1000 Indian paediatricians who attended 49 th National Conference of Indian Academy of Pediatrics in 2012 through use of a 21-point questionnaire. RESULTS: 927 (93%) paediatricians completed the survey. 643 (69%) responded that Hib is a common disease in India. 788 (85%) reported prescribing Hib vaccine to their patients and 453 (49%) had done so for the past 5-15 years. Hib vaccine was used in combination with other vaccines by 814 (88%) of the participants. 764 (82%) respondents thought Hib vaccine effective while 750 (81%) thought it to be safe. Fever, pain and redness were the most frequently reported post vaccination side-effects. 445 (48%) paediatricians ranked universal use of Hib vaccine in the national immunization programme as the most important strategy to prevent and control Hib disease in India. CONCLUSION: The excellent profile as reported by a large number of paediatricians from throughout India further strengthens evidence to support expanded use of currently available Hib vaccines. These findings should encourage the Government of India to initiate mass use of this vaccine nationwide.