What is the burden of vaccine-preventable disease globally?

Thousands of individuals die every year due to complications of flu, hepatitis B, and the human papillomavirus. There are almost 18 deaths every hour due to these preventable infections worldwide. Tetanus, Diphtheria, Hepatitis B, and herpes zoster are still common in some areas of the world, including India. Pneumococcal pneumonia is prevalent in those with chronic respiratory conditions and those who have poor immunity, as in diabetes or chronic alcoholism, or HIV-infected individuals.

What are the common barriers to immunization in adults?

Lack of importance of diseases that can be prevented, lack of recommendations from health care providers, lack of knowledge of vaccine safety, lack of regulation or legal requirements, and lack of publicly funded vaccination are the common aspects. Fear of injections and the cost involved can be a barrier.

How should an adult be vaccinated?

A quadrivalent influenza vaccine is recommended annually throughout life. Against Streptococcus pneumonia, PCV 13 vaccine is once in a lifetime followed by PPSV 23 after 2 months, and repeat PPSV 23 once every 5 years. HPV against papilloma 2 doses, 0 and 6 months for 9 to 14 years of age, those 15 to 45 years would require 3 doses, 0, 1, and 6 months.HPV is not given in pregnancy. Herpes zoster vaccine is recommended for all above 60 years. 2 doses are given 2 to 6 months apart.

What about diphtheria, pertussis, and tetanus?

In the age group of more than 19 years, Tdap once at 10 to 18 years, Td 10 yearly. Tdap during each pregnancy. Indian Medical Association adds Tetanus Toroid/ TD early during pregnancy as a recommendation. If you think vaccination is only for children, you are mistaken. You may require certain vaccines even if you are an adult. Vaccines to consider in adults are COVID-19, flu or influenza, Hepatitis B, Human papillomavirus, Pneumococcal vaccine and Tetanus, Diphtheria, and Whooping cough, and against herpes zoster.

What about Measles, Mumps, and Rubella?

In the age group 19 to 60 years, two doses one month apart are recommended. One dose if previously immunized. Pregnancy should be deferred for 3 months after this immunization.

What about immunization in special situations?

Against Hepatitis A, 2 doses at 0 and 6 months, Hepatitis B 3 doses are recommended. Combination of Hepatitis A and B ..3 doses are recommended. Typhoid one dose every 3 years is recommended. Against Cholera, 2 separate oral vaccines are recommended. Meningococcal vaccine, 2 doses in those where the spleen is removed. Varicella two doses 4 to 8 weeks apart are suggested in individuals above 50 years.

Which vaccines are used where HIV itself is an indication?

Pneumococcal vaccination, Hepatitis, And B vaccination if not already vaccinated. Meningococcal vaccination and zoster vaccine are also recommended. In addition, vaccination against COVID-19, seasonal influenza vaccine, tetanus toxoid, Diphtheria and IIPV upto age 26 years if not immunized earlier.

Which adult population should be vaccinated?

Vaccination against COVID-19, annual flu shots, and zoster vaccine in the elderly is always strongly recommended. For individuals with HIV, Diabetes, COPD, chronic asthma, cancer, transplant patients, chronic liver and kidney disorders, and in pregnancy your family doctor shall recommend appropriate vaccination.
We have a very large adult population. The incidence of Diabetes, and chronic heart, liver, and lung diseases are on the rise. All other individuals with low immunity as the elderly, pregnant women, HIV, and those with cancer and transplants are recommended to get vaccinated. All these individuals are at a greater risk of infection. Returning travellers are at increased risk. Appropriate vaccination is strongly recommended after consultation with your health provider.

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Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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