Updated Immunization schedule for adult Indian population

Countries have discovered that vaccine-induced immunity does not have the same long-term stability as disease-induced immunity, which has resulted in an increase in the average age of onset of vaccine-preventable illnesses. Adults are now infected with several vaccine-preventable diseases that were previously only prevalent in children.

CD Alert newsletter the initiative by the Government of India, disseminated details regarding various aspects of communicable disease. In India, the number of HBsAg carriers is projected to be around 40 million and about 2 205,286 fatalities are caused by chronic hepatitis per year. Adults over the age of 18 years, as well as adolescents, represent a significant new target group for existing vaccination programmes.

BOTTLENECKS:

There is not enough scope of understanding on adult vaccine and its benefits.

There are concerns among certain health care practitioners and the general public concerning the efficacy and safety of numerous adult vaccinations.

Adult vaccination is selective rather than universal, with different vaccines targeting distinct groups of people.

Difficulty to reach healthy people.

CATEGORIES:

Immunizing by exposing to dead pathogen to induce non-natural immunity.

Increasing herd immunity, stopping transmission, and covering non-immune cohorts are all common goals of disease control programmes.

Combat particular hazards including travel, high-risk behaviour, and an immunocompromised state.

STRATEGIES FOR REACHING OUT TO ADULTS:

Improve provider and public knowledge to increase demand for adult vaccination.

Ascertain that the health-care system has sufficient capacity and methods for administering vaccinations to adults.

Ensure that appropriate funding mechanisms are in place to enable the increasing distribution of vaccinations to adults.

Maintaining continuous research.

VACCINES

1. CHOLERA VACCINE: There are two types of cholera vaccines: injectable dead whole cell vaccine and oral cholera vaccine. The injectable killed whole cell vaccine has been shown to have a low effectiveness rate (45%) and just a three-month protective period. There are two forms of oral cholera vaccinations: I a monovalent vaccine (not recommended for children under the age of two) and (ii) bivalent vaccines.

2. DIPHTHERIA, PERTUSSIS & TETANUS: WHO recommends that unvaccinated individuals aged 7 and up receive two doses of Td combination vaccine, spaced 1-2 months apart, and a third dose after 6-12 months, with subsequent boosters spaced at least 1 year apart, for a total of 5 appropriately spaced doses to achieve the same long-term protection. Adults who have completed a primary series and whose last immunisation was more than 10 years ago should obtain a booster dose of tetanus and diphtheria toxoid-containing vaccine. Since 1983, India's Expanded Program on Immunization policy has mandated that all pregnant women receive two doses of tetanus toxoid (TT2) throughout each trimester.

3. HEPATITIS A: HAV seroprevalence in India has ranged from 38 percent to 92 percent in various age categories, according to several research. Internationally, four inactivated HAV vaccinations are now available. The (HAV) vaccinations are administered through parenteral administration in a two-dose series spaced 6-18 months apart.

4. HEPATITIS B: According to a comprehensive assessment of the literature, the prevalence of Hepatitis A in India is estimated to be between 1-2 percent. According to a recent meta-analysis, the prevalence of Hepatitis A is 15.9% among tribal people and 2.4 percent among non-tribal people. Hepatitis B vaccination should be included in routine immunizations, according to the WHO. Three doses (if not previously vaccinated) are also advised for high-risk populations.

5. HUMAN PAPILLOMA VIRUS: Cervical cancer is the second most prevalent cancer in women globally, and the most common in India, with HPV being linked to >95 percent of cases. There are presently two vaccinations available. Quadrivalent (HPV types 6,11,16, and 18) is a vaccine for cervical precancers and malignancies that is approved for use in girls as young as 9 years old. In addition, the quadrivalent vaccination has been approved for the prevention of vulvar and vaginal pre-malignancies and cancers in females, as well as anogenital warts. Bivalent (HPV types 16 and 18) vaccines have been approved for use in girls as young as ten years old to prevent cervical pre-malignancies and cancers. The vaccination must be given before the HPV virus is exposed.

6. INFLUENZA: According to Ramamurty N et al, the monthly incidence of respiratory infections among the peadiatric age group in Chennai is 23% in urban areas and 17.7% in rural regions. The use of influenza vaccination in India is currently not advised due to a lack of epidemiological surveillance of influenza serotypes in our country. However, in response to the current influenza (H1N1) pandemic, the WHO strategic advisory group of experts (SAGE) has advised that health-care professionals receive H1N1 influenza vaccination as a first priority in order to preserve critical health infrastructure. The WHO is also testing a trivalent vaccine that protects against the H1N1 pandemic virus, seasonal H3N2 viruses, and influenza B viruses, as well as a bivalent seasonal vaccine that protects against H3N2 and influenza B viruses but may need to be supplemented with a monovalent H1N1 pandemic vaccine.

7. JAPANESE ENCEPHALITIS: The illness is prevalent in southern India, where cases occur intermittently throughout the year, whereas outbreaks occur in northern India during the summer and monsoon months. It is mostly a condition that affects youngsters in rural regions, however it can also affect individuals in semi-urban areas. The vaccines used to prevent Japanese encephalitis are (i) a mouse brain-derived inactivated vaccine based on the nakayama strain, and (ii) a PHK cell-cultured, live attenuated vaccine. The manufacture of the mouse brain derived inactivated vaccine at the Central Research Institute, Kasauli, ceased in 2007, and the vaccine is no longer accessible in India.

8. MENINGOCOCCAL MENINGITIS: The illness is prevalent in some Indian states, such as Delhi, and occasional instances have been documented in others, including Haryana, Uttar Pradesh, Rajasthan, Gujarat, West Bengal, and Orissa. In certain cases, meningococcal illness can be prevented by vaccination or chemoprophylaxis. For meningococcal meningitis, two types of vaccinations are used: polysaccharide vaccines and conjugate vaccines. A third kind, which is based on outer membrane protein [OMP], has not shown to be highly efficient and is not commonly utilised. A single dose of (group C conjugate meningococcal) vaccination can prevent group C illness in older children and adolescents.

9. PNEUMOCOCCUS: Pneumococcal pneumonia, bacteremia, and meningitis were linked with case fatality rates of 19 percent, 21 percent, and 34 percent, respectively, according to a research done by the International Clinical Epidemiology Network (INCLEN) on pneumococcal infection in India from 1993 to 1997. Furthermore, nearly a third (33%) of individuals with confirmed IPD were under the age of 5 years, while around 23% were above the age of 50. A 7-valent polysaccharide–protein conjugate vaccination (PCV-7) as well as an unconjugated polysaccharide vaccine covering 23 serotypes are now available on the worldwide market. The 7-valent polysaccharide–protein conjugate vaccination requires three doses before one year of age, followed by a booster after one year.

10. RABIES: According to estimates, rabies kills approximately 20,000 people in India each year, accounting for nearly a third of all global deaths (APCRI 2004). Animal bites are predicted to occur 17.4 million times each year; yet, many people do not seek post-exposure treatment. For rabies prophylaxis, cell culture rabies vaccinations are now utilised, which may be given intramuscularly or intradermally. Five doses of the vaccine are given in the deltoid muscle or the anterolateral portion of the thigh for post-exposure prophylaxis on days 0, 3, 7, 14, and 28. In high-risk groups such as veterinary workers, medical physicians, dog catchers, postmen, and wild life wardens, pre-exposure prophylaxis is suggested.

11. VARICELLA: The varicella vaccines now on the market are based on the Oka strain of VZV, which has been modified by successive propagation in several cell cultures. Seroconversion is found in around 95 percent of healthy infants after a single dose of the above-mentioned vaccinations. At this time, WHO does not recommend that poor countries include varicella vaccine in their regular immunisation programmes.

Source

CD Alert, monthly newsletter of the National Centre for Disease Control (NCDC), Directorate General of Health Services, Government of India, Adult Immunization, February – March 2011.