Positive coefficients of C& A2 in equation (3) indicate the syner

Positive coefficients of C& A2 in equation (3) indicate the synergistic effect on % drug loading, while negative coefficients of A, B, AB, BC, AC, B2& C2 indicate the antagonistic effect on % drug loading. The “Pred R Squared” of

0.9709 is in reasonable agreement with the “Adj R-Squared” of 0.9945, indicating the adequacy of the model to predict the response of drug loading. The ‘Adeq Precision’ of 57.304 indicated an adequate signal. Therefore, this model is used to navigate JQ1 datasheet the design space. The 3-D surface plots for % drug loading are shown in Fig. 3. The effect of drug to lipid ratio on % drug loading is concentration dependent. A decrease in % drug loading from 25.82 (H7) to 16.11 (H8) was observed on increasing http://www.selleckchem.com/products/incb28060.html the drug to lipid ratio from 1:2 to 1:4 (Table 2) while stirring speed also have positive effect on % drug loading. Four formulations (OH1–OH4) were selected from point prediction software of design expert and their responses i.e. particle size, entrapment efficiency and drug loading were evaluated. The composition of all optimum check point formulations, their actual and predicted values for the responses and the % prediction error are shown in Table 4. The low value of % prediction error assures the validity of generated equations and thus depicts

the domain of applicability of RSM model. Finally, the optimum values of crotamiton drug to lipid ratio 1:2, surfactant concentration 1.625% w/v and stirring speed 3000 were selected. The optimized formulation (OH4) was further optimized by varying stirring time from 2 h to 2.5 h while maintaining all factors constant. A further decrease in particle size from 140.49 nm (OH4) to 115.1 nm (OPH) was observed on

increasing the stirring time from 2 to 2.5 h while % drug entrapment and % drug loading were not significantly affected (Table 5). A particle size, size distribution & zeta potential curve of optimized formulation (OPH) are shown in Fig. 4 and Fig. 5 respectively. The average particle size, PDI and zeta potential were found to be115.1 nm, 0.409 and −16.7 mV respectively. The entrapment efficiency and drug loading of optimized formulation (OPH) were found to be 71.56% and 26.35% respectively. The Morphology of optimized SLNs was roughly spherical in shape (Fig. 6). In this study, the haloperidol loaded SLNs were designed and prepared by the solvent emulsification diffusion technique. The SLNs were optimized using the 3-level 3-factor Box–Behnken statistical design. The optimized formulation (OPH) exhibited particle size115.1 nm, entrapment efficiency 71. 56% and drug loading 26.35%. The Morphology of optimized SLNs was roughly spherical in shape. All authors have none to declare. The authors express their gratitude to Vamsi labs ltd. Solapur, Maharashtra, India for providing gift sample Haloperidol.

Dans le cas d’un anticoagulant, une induction

Dans le cas d’un anticoagulant, une induction selleck inhibitor enzymatique aura pour effet d’exposer le patient à un risque d’accident thromboembolique artériel. Certains médicaments agissent à la fois sur la P-gp et sur l’isoenzyme CYP3A4 du cytochrome P450, en additionnant leur effet pharmacocinétique, dans le sens du surdosage ou du sous-dosage. Ces molécules sont synergiques, et en inhibant la P-gp et le cytochrome CYP3A4, elles entraînent, à deux niveaux, une augmentation de la concentration plasmatique du principe actif (ou inversement). La variation de concentration

plasmatique qui en résulte est donc notable, et peut être critique. La connaissance des molécules pouvant avoir un effet cliniquement significatif est indispensable à la bonne utilisation des NACO et à l’identification de situations à risque. Ainsi, les antifongiques azolés par voie systémique et les inhibiteurs de protéase sont à la fois inhibiteurs de la P-gp et du CYP 3A4, et leur utilisation est donc contre-indiquée

avec le rivaroxaban BTK inhibitor et l’apixaban. Bien que le dabigatran ne soit pas métabolisé par le CYP3A4, l’agence européenne du médicament contre-indique la co-administration d’antifongique azolé et d’inhibiteur de la protéase du VIH, du seul fait de leur action puissante sur la P-gp. D’autres molécules, au contraire, induisent à la fois la P-gp et le CYP 3A4, entraînant une diminution concrète de la concentration plasmatique de l’anticoagulant. Il s’agit principalement de la rifampicine, du millepertuis isothipendyl (Hypericum Perforatum, parfois utilisé dans des préparations de phytothérapies)

et de certains antiépileptiques, comme la carbamazépine et la phénytoïne. Leur utilisation doit se faire avec prudence avec le rivaroxaban et l’apixaban, et l’association est déconseillée avec le dabigatran, bien qu’il ne soit pas métabolisé par l’isoenzyme CYP 3A4 du cytochrome P450. Le praticien est parfois confronté à des situations particulièrement à risque pour le patient, et anxiogène pour lui, les relais d’un anticoagulant vers un autre. Ces relais peuvent se compliquer d’hémorragies, par interactions médicamenteuses pharmacodynamiques (addition d’effets anticoagulants) ou bien d’emboles artériels systémiques, en cas de fenêtre de non-traitement trop prolongée, lors de la disparition de l’effet anticoagulant d’une molécule. Une attention particulière est nécessaire lors de ces relais. Des recommandations ont été émises dans les RCP des NACO, et éditées par l’agence européenne du médicament. Ce relais est le plus simple et le plus intuitif. Le NACO (dabigatran, rivaroxaban ou apixaban) s’administre 0 à 2 heures avant l’heure prévue d’administration de l’autre traitement, ou au moment de l’arrêt de ce dernier dans le cas d’un traitement continu (héparine non fractionnée par voie intraveineuse).

, San Diego, USA) One μg of p24 equiv /ml corresponds to approxi

, San Diego, USA). One μg of p24 equiv./ml corresponds to approximately 1 × 107 infective viral particles/ml. Peripheral blood mononuclear cells (PBMCs) were obtained from HLA-A*0201/HLA-B*0702 positive HCMV seropositive adult healthy volunteers and all studies were performed in accordance with protocols approved by the Hannover Medical School Ethics Review Board. HCMV seropositivity

was assessed by the presence of HCMV-reactive immunoglobulin (Ig) G and/or IgM. CD14+ monocytes were isolated from PBMCs obtained from leukapheresis ABT-263 mw using CD14 isolation beads (Miltenyi Biotech, Bergisch-Gladbach, Germany). For production of conventional IL-4-DCs, monocytes were kept in culture with serum-free Cellgro

medium (Lonza, Basel, Switzerland) in the presence of recombinant human GM-CSF and IL-4 (50 ng/ml each, Cellgenix, Freiburg, Germany), whereas conventional IFN-α-DCs were maintained in the presence of 50 ng/ml GM-CSF and 1000 U/ml IFN-α (PBL InterferonSource, NJ, USA). Cytokines were replenished every 3 days. For lentiviral gene transfer, the monocytes were kept in culture with serum-free Cellgro medium in the presence of recombinant human GM-CSF and IL-4 (50 ng/ml Idelalisib solubility dmso each) for 8 h prior to transduction. For generation of SmyleDCs, 2.5 μg/mL p24 equivalent of ID-LV-G2α was used, whereas 2.5 μg/mL p24 equivalent of ID-LV-G24 was used for generation of SmartDCs. 5 × 106 CD14+ monocytes were transduced at the multiplicity of infection (M.O.I.) of 5 in the presence of 5 μg/ml protamine sulfate (Valeant, Dusseldorf, Germany) for 16 h. After transduction, the cells were washed twice with phosphate-buffered saline (PBS) and further maintained in culture with serum-free Cellgro medium. iDCs were harvested after 7 or 14 days of culture.

For in vivo experiments, transduced monocytes were resuspended in PBS, washed and directly used for mice injection. The number of viable counts was determined with trypan nearly blue exclusion. ELISA (Mabtech, Minneapolis, USA) was used to quantify the accumulated level of human cytokines GM-CSF, IFN-α and IL-4 secreted in the supernatant of iDC cultures. For detection of multiple cytokines secreted in iDC supernatants, in mixed lymphocyte reactions or in vitro T cell stimulation assays, we used multiplex luminex bead kit according to the manufacturer’s protocol (Milliplex Milipore, Billerica, USA). GM-CSF, IFN-α and IL-4 protein expression in transduced 293T cell lysates and supernatants was determined by Western blot analyses (Bio-Rad, Munich, Germany). Detection of intracellular HCMV pp65 expression in SmyleDCs and SmartDCs was performed by intracellular staining and flow cytometry. iDCs were maintained in culture for 7, 14 and 21 days and immune-labeled for DC surface antigens.

01 software ANOVA test was performed to determine significant di

01 software. ANOVA test was performed to determine significant difference in the in-vitro permeation. Maximum permeation was obtained by oleic acid with DT 9301 (Table 2). Oleic acid is unsaturated fatty acid which is able to form separate phases within bilayer lipids. Oleic acid enhances the permeation of water soluble drugs through epidermal layer of skin by interacting and changing the lipid domain of epidermal layer. It also increase void channels in stratum corneum leading to penetration enhancing ABT888 effect. Here, PG used

as a plasticizer and also having synergistic effect with oleic acid. The activity of PG resulted from solvation of α keratin within the stratum corneum, the occupation of proteinaceous hydrogen bonding sites reducing drug-tissue binding and thus enhancing the permeation of drug molecules.12 So for KPT-330 datasheet the present study oleic acid was used for the further formulation in combination with DT 9301. Adhesion is prerequisite property of matrix patch for easy and quick drug release through skin. In the present study, adhesiveness of the prepared patches decreased as the concentration of permeation enhancer increased from 5% to 15% w/w. By increasing the permeation enhancer concentration from 5% to 10% peel value decreased from 4.1 ± 0.4 N/2.5 mm (F8) to 2.8 ± 0.2 N/2.5 mm (F9) and tack value decreased from 1220 ± 30 gms to 1105 ± 10 gms. The peel and tack value of formulation code F9 were

found similar to experimental

peel and tack value of marketed formulation. Furthermore increase in permeation enhancer concentration from 10% (F9) to 15% (F10) showed the failure of adhesiveness (Table 3). Good shear strength obtained for the formulation code ALOX15 F6 to F9, but the value decreased in the formulation code F10 & F11, which were below the shear value of marketed product. So that from the obtained result formulation code F9 was found to be within the limits of the adhesion performance standards. The results of in-vitro permeation study were shown in Table 4. The release pattern depicted ( Fig. 1) that formulation code F6 showed slower release rate compared to other might be due to higher concentration of DT 9301 and due to the stronger polymeric matrix network of DT 9301 with FVS. The F6 formulation also showed the higher lag time of 8.57 h which was decreased by decreasing the total concentration of PSA & by using another polymer E RL 100 with DT 9301. 13 E RL 100 having hydrophilic nature & it contains quaternary ammonium groups which affect the release of drug from patch because of hydration of patch. E RL 100 having larger cavity size in its polymeric network which promotes the faster diffusion of drug from patch. As the concentration of oleic acid increased Q24 (cumulative amount of drug released per unit area at the end of 24 h) was also improved. Comparative in-vitro fluxes of all formulation codes were depicted in Fig. 2.

The company has to assess the epidemiologic data and balance the

The company has to assess the epidemiologic data and balance the costs. In Africa, opinion leaders support vaccine manufacturers, and investors can expect the economic improvement in the future. A. Muktadir from Incepta (Bangladesh), shared the story of how he started the business and illustrated the biggest challenges. One challenge comes from the PQ barrier because the local NRA is not considered fully functional. The simple motivation is to develop high quality vaccines for those people who need them. Dr. Muktadir expressed appreciation for the platform provided by DCVMN and expressed his interest in seeking partners for vaccine technology transfer to Bangladesh.

A. Poonawalla from Serum Institute Small molecule library of India, shared his successful business experience, and noted that patience and continuous investment are very important while fostering cooperation with international organizations, particularly to achieve PQ. Challenges such LY2157299 nmr as to integrate the manufacturers, the donors and the NGOs into one common philosophy do exist. He gave two suggestions to DCVMN members: to establish strong R&D and quality systems and to register the

products in as many countries as possible. All CEOs agreed that DCVMN created a remarkable and vibrant platform to share knowledge and communicate solutions to emerging issues. It was concluded that entrepreneurial thinking is important to make changes happen and the Network community

is serving a society where access to preventive vaccination will be fully met everywhere to assure supply of needed vaccines for future generations. The authors are employees of the respective indicated organizations, and have no conflict of interest to declare. DCVMN International did not provide any financial support to speakers or moderators to participate at this meeting. We are grateful to all speakers and moderators, whose gracious participation and contributions made the conference possible. We are indebted to the US Human and Health Services (HHS) Department for the in-kind support of the registration website. We are grateful to the local organizing committee and to all volunteers who helped preparing and during the conference, especially Ms. Lan Huong for coordination over of many logistic aspects of the conference. We thank Vabiotech and corporate partners for supporting DCVMN educational activities in 2013 with grants:Polyvac, Merck Millipore, Temptime, Bioengeneering, SGS, Alfa Wassermann, GEA, Bosch. This conference was partly supported by a grant of the Bill and Melinda Gates Foundation, Grant no. OPP1097005. “
“An update of Intravacc’s Sabin IPV technology Transfer Initiative to developing countries vaccine manufacturers as a Private Public Partnership directly under the Ministry of Health in The Netherlands was provided by A. Hamidi.

, 2012) Through this grant, the Santa Clara County Public Health

, 2012). Through this grant, the Santa Clara County Public Health Department led efforts aimed at decreasing youth access to tobacco and exposure to tobacco advertising. As CDC Director Thomas Frieden noted in his 2010 article, interventions that alter the environmental TSA HDAC context in ways that become more supportive of health and health behavior will be more effective in creating

long-term sustainable change (Frieden, 2010). The county’s goals were: to reduce illegal youth access to tobacco by implementing a policy requiring tobacco retailers in unincorporated Santa Clara County to obtain an annual permit to sell any type of tobacco product while increasing tobacco

enforcement; and to implement interventions to reduce youth exposure to tobacco near schools and other tobacco retailers. This paper evaluates the number and location of tobacco retailers, and the level of enforcement and compliance of tobacco sales regulations within unincorporated Santa Clara County following implementation of these structural interventions. Data was evaluated using three different methods: (1) geographic information systems1 (GIS) mapping of tobacco retailers; (2) observational surveys of the tobacco retail environment; and (3) enforcement surveys. Santa Clara County is located in the southern San Francisco Bay Area and Akt inhibitor has a population of 1.8 million residents (U.S. Census Bureau, 2010). The county is ethnically diverse with 35.2% Digestive enzyme white, 2.4% black, 26.9% Latino, and 31.7% Asian residents (U.S. Census Bureau, 2010). There are 15 incorporated cities in the County, ranging in size from 945,942 in San Jose to 3341

in Monte Sereno (U.S. Census Bureau, 2010). The population of the unincorporated portion of the county is 89,960 (U.S. Census Bureau, 2010). In California, there are approximately 36,700 licensed tobacco retail stores, one for every 254 children under age 18 (California Department of Public Health, California Tobacco Control Program, 2012). Santa Clara County has nearly 1600 retailers, which equates to about one for every 268 children under 18 (California Board of Equalization, 2010 and United States Census Bureau, 2010). To sell tobacco, California retailers must acquire a state-issued license from the California Board of Equalization, the statewide tobacco permitting administrative agency, at a one-time cost of $100, with no charge to renew. Tobacco retailers are spread throughout urban, suburban, and rural pockets of the unincorporated areas of Santa Clara County. In the Santa Clara County unincorporated areas, there were 36 tobacco retailers operating at the start of the intervention.

In order to evaluate the effectiveness of therapeutic interventio

In order to evaluate the effectiveness of therapeutic interventions and to guide management decisions, clear insight into the course of recovery after ankle sprain is needed. This information is helpful to inform patients about the expected clinical course and in the identification of relevant subgroups of patients with a better or worse prognosis. The factors predicting persistent complaints from ankle sprains are largely unknown (van Rijn et al 2008). Until now, only one

study has evaluated prognostic factors for incomplete recovery and re-sprains. Sporting activity at a high level was found to be a prognostic factor for residual symptoms (Linde et al 1986). Quisinostat However, this study showed methodological shortcomings and the full range and impact of residual complaints was not investigated (Braun 1999, Cross et al 2002, de Bie et al 1997, Linde et al 1986). Therefore our first research question was: 1. What are baseline prognostic factors for incomplete recovery, instability, re-sprains, and pain intensity during 12 months of follow-up in adult

patients who consulted primary care for an acute lateral ankle sprain? What is already known on this topic: Ankle sprains C646 manufacturer are common and a substantial proportion of these sprains do not fully resolve within one year. Ongoing instability and re-sprains are also common during the first year after the original sprain. What this study adds: At the time of the sprain, none of a range of demographic and clinical factors accurately predicts incomplete recovery or re-sprains at one year. However, among patients whose sprain has not resolved within three months, re-sprains and self-reported pain at rest at three months were predictors of incomplete recovery at one year. The data used for this study were derived from a

randomised clinical trial investigating the effectiveness of supervised exercises for acute ankle sprain in primary care (van Rijn et al 2007). Patients who had an acute injury of the lateral collateral ligaments of the else ankle and who presented themselves to one of the participating general practitioners or at an emergency department were considered for inclusion. The general practitioner or emergency department physician carried out a standardised clinical examination. Based on these findings (stability, intensity and location of swelling, pain, and haemorrhage), the injuries were graded as mild, moderate, or severe (Birrer et al 1999). After acquiring baseline information, each patient was randomised into either the usual care group or the physical therapy group. All participants (n = 102) in both groups received the same standard treatment from their physician (general information about early mobilisation, home exercises, early weight bearing, tape, bandage or brace). Participants in the physical therapy group participated additionally in an individual and progressive training program supervised by a physical therapist.

Data 7-Aryl-7H-bis [1] benzopyrano [4,3-b: 3', 4'-c] pyran-6, 8-

Data. 7-Aryl-7H-bis [1] benzopyrano [4,3-b: 3', 4'-c] pyran-6, 8-dione (4d): 0.5 g m.p 323 °C. IR (KBr): 1350, 1430, 1600, 1640–1650, 1700, 2820 cm-1. 1H NMR (CDCl3, 400 MHz): δ 7.5–7.9 (12H,m,ArH),4.98 (1H,s,-CH-). m/z 419 (M+), 392, 317, 265, 196, 121, 94 and 60. Same results were obtained when the reaction was carried out at water bath temperatures. A mixture of DMSO (10 ml), acetic anhydride (5 ml) and (1e) (1.5 g) was kept at room temperature for 9 days. A yellow crystalline product

which separated out was Selleck Anti-cancer Compound Library filtered, washed and crystallized from benzene and identified as 7-Aryl-7H-bis [1] benzopyrano [4,3-b: 3′, 4′-c] pyran-6, 8-dione (4e). The mother liquor upon addition of water and extraction with

ethyl INCB018424 nmr acetate afforded a solid which was crystallized from benzene and identified as (9). Data. 7-Aryl-7H-bis [1] benzopyrano [4,3-b: 3', 4'-c] pyran-6, 8-dione(4e): (0.5 g) IR (KBr): 1250, 1360, 1600, 1655 and 1720 cm−1. 1H NMR (DMSO-d6, CFT-20): δ 7.45–8. (12H,m,ArH),6.2 (1H,s,-CH-). m/z 422(M+), 409, 393, 317, 265, 176, 121 and 120. (Found C, 68.48; H, 2.58. C25H13NO7 required C,68.33; H, 2.96%). Product (9): m.p 271 °C; (1.6 g). IR (KBr): 1410, 1640, 1700, 1760, 2850 and 3350 cm−11H NMR (CDCl3 EM 390 90 MHz): δ 7–8.25(12H,m,ArH),4.75 (1H,s,-CH-), 3.77(2H,s,-CH2-), 2.84(1H,s,-OH-). m/z 487, 440, 365, 249, 175 and 121. (Found C, 64.18; H, 3.27. C26H17NO9 requires C,64.06; H,3.49%). At room temperature DMSO-acetic anhydride converts (1a) obtained easily by the reaction of 4-hydroxycoumarin with benzaldehyde,5 to a novel product (3) in excellent yields. On the basis of its mass spectrum and elemental analysis the molecular formula of the compound comes out to be C25H14O6 .Two structures (2a) and (3) were possible for the compound but the former is ruled out on the basis of proton magnetic resonance (pmr). The out 1H singlet at δ 4.73 can be assigned to the benzylic and allylic proton. The carbonyl bands at 1790, 1720 and 1680 cm−1

in the infrared spectrum are also at right values for saturated lactone, coumarin and benzoyl carbonyl groups respectively. The treatment of (la) with DMSO-acetic anhydride at 160 °C, proved destructive. At water bath temperature, however, a yellow crystalline solid (4a) gradually separated from the reaction mixture and was filtered off at the end of reaction. Its pmr spectrum shows in addition to thirteen aromatic protons, a singlet at δ 5.17 belonging to doubly allylic and benzylic methine proton suggesting structure (4a) for the compound which was further confirmed by infrared spectrum showing a broad signal at 1720 cm−1 and 1655 cm−1 for two, α–β-unsaturated lactone carbonyls and for enol ethers respectively.

The Secretariat maintains the technical content of the ACIP websi

The Secretariat maintains the technical content of the ACIP website, including updating ACIP recommendations, meeting minutes, current immunization schedules for children and adults [4] and [5] and other key information. The Secretariat (primarily the Assistant to the Director for Immunization Policy) is responsible for the overall guidance of ACIP WGs, particularly the CDC Lead and the ACIP WG Chair for each WG. This ensures a cohesive, standardized approach on the part of each WG in terms of policies and procedures. The ACIP Steering Committee, which has responsibility Alisertib for

general operating policy, procedures, and related matters affecting the ACIP as a whole, comprises 15 members who represent the three CDC Centers that have activities related to vaccines and immunization, as well as the current ACIP Chair and

a representative from FDA. Four meetings of the ACIP Steering Committee are organized annually by the Secretariat: three for the development of ACIP meeting agendas and one for the selection of new members. The Secretariat provides comprehensive orientation and training to new ACIP members once they are selected and also fields requests for the appointment of new liaison organizations, preparing justification for their inclusion (or exclusion) to present to the ACIP Steering Committee. These requests are then submitted to the Secretary Selleckchem Fulvestrant of HHS if the organization is deemed appropriate for official designation as a liaison; final selection and appointment of liaison organizations is made by the Secretary of HHS. ACIP meeting agendas are

prepared by the ACIP Secretariat following deliberation by the ACIP Steering Committee. Approximately 10 weeks prior to an upcoming meeting, suggestions for meeting topics are solicited from the ACIP WGs, ACIP members, ex officio members and liaison representatives, and academic consultants. Meeting topics may include items that do not require a vote but are presented for informational purposes, such as data on vaccine-preventable disease epidemiology, vaccine efficacy, and updates on outbreaks of vaccine-preventable diseases. Presentation of data on new vaccines typically occurs at ACIP meetings starting at least 2 years in advance of vaccine licensure either by the FDA; this allows committee members to be fully informed about all aspects of the vaccine at the time a vote is taken following licensure. Agenda items are reviewed by the ACIP Secretariat and discussed in depth at a meeting of the ACIP Steering Committee held 7 weeks before the ACIP meeting, with finalization and distribution of the meeting agenda 6 weeks before each meeting. The Secretariat prepares material concerning new initiatives (e.g., standardization of the approach to presentation of economic analyses, development of an explicit evidence-based format to be used for ACIP recommendations) to present to the ACIP Steering Committee and CDC leadership.

The results presented here are useful for policy analysis, given

The results presented here are useful for policy analysis, given the paucity of data on the interventions’ effect size across different subsets of the population: at the state level, in the rural and urban populations, and across the wealth distribution. Additional research is needed to introduce an infectious disease model into the ABM used here and to take into account the state fixed effects. We thank Ashvin Ashok for selleck products his research assistance. Conflicts of interest: None declared. Funding: This work was funded by the Bill and Melinda Gates Foundation through the Disease Control Priorities project at the University of Washington (grant no. 720165), Grand Challenges

Canada through the Saving Brains project, and Johns Hopkins University (purchase order no. 2002067649) through the cost-effectiveness of rotavirus vaccination in India grant. The funders had no role in study design, writing the

report, the decision to submit, or data collection, analysis, and interpretation. “
“Rotavirus infection occurs worldwide in children under five years of age. The infection may remain asymptomatic, cause self-limiting watery diarrhea or may lead to acute gastroenteritis with fever, vomiting and severe dehydration that may at times be fatal. Bouts of vomiting associated with severe rotavirus gastroenteritis Vemurafenib mw (SRVGE) also pose a hurdle to the clinical management of these cases with oral rehydration salt and sugar solution. Furthermore, no antiviral medicine is currently considered as “standard of care” for SRVGE. On the other hand, disease burden and cost implications of rotavirus diarrhea have been estimated to be enormous [1] and [2]. Due attention has therefore been paid by global health policy makers to tackle this challenging situation. Consequently, many countries have introduced rotavirus vaccines in their routine immunization program [3] and [4] after much deliberation. Key deciding

factors for introducing rotavirus vaccine Mephenoxalone in low-income countries have been cost of immunization, financial support from global alliance for vaccines and immunization (GAVI) and long-term sustainability of the program following withdrawal of external assistance [5]. In India, the issue continues to be debated. While one group of discussants opines that India should [6] introduce the vaccine in her routine immunization program, others take a contrary stance [7]. India’s national immunization program has evolved since the 1970s (Fig. 1) leading to the introduction of some vaccines and dropping of others based on scientific evidence and public health considerations. The rotavirus debate pivots on vaccine efficacy. While the indigenous Rotavac2 vaccine tested in India is being challenged [8], Rotarix3 and Rotateq4 – two vaccines that have undergone clinical trials in many developed and developing countries [9], [10] and [11] – have not undergone trial in India. However, the latter two are currently available through the private health sector.