Harmonizing Adult Vaccination Guidelines in India: Need of the Hour

A. Need for Adult Immunization

Vaccine-preventable diseases (VPDs) are among the various diseases that threaten India's healthcare system. From this group, influenza and pneumococcal diseases are of specific concern in India. (1) Interestingly, the proportion of adults who die of VPDs each year is 350-fold higher than the corresponding figures for children. (2) The emergence of newer medical challenges, coupled with the increasing geriatric population, necessitates a proactive approach to adult immunization. With projections indicating nearly 23% of India's population will belong to the 50-plus years' age group by the end of the next decade, the significance of adult immunization cannot be overstated. (3)

Lack of adult immunization, waning immunity, age-related factors (including immunosenescence), and epidemiological shifts are common factors that make adults more prone to VPDs (4). It has been established that vaccination reduces the incidence and severity of VPDs and the rate of VPD-related complications, subsequently limiting the socioeconomic burden and contributing to healthy ageing. (1)

B. Barriers to Adult Immunization

The benefits of adult immunization are indisputable, yet vaccination rates are below ideal levels. Adult vaccination coverage for influenza, pneumococcal disease, typhoid disease, and hepatitis B was assessed to be 1.5%, 0.6%, 1.9%, and 1.9%, respectively, in India, according to a population-based study. (5)

An Indian survey reported that 68% of adults were unaware of the vaccines recommended for them, and 38% of adults perceived immunization as only for children. (1) Lack of information about VDPs, non-availability of nationwide, uniform guidelines for adult immunization, clinical inertia, lack of immunization benefits among adults, and lack of well-coordinated adult immunization programs are some common barriers to adult immunization in India. (4)

C. Indian Consensus Guideline on Adult Immunization: The Vision

While several medical societies have published adult immunization guidelines, however, they vary based on age and risk-based conditions, making it difficult for a clinician to make a rational decision. The Association of Physicians of India (API) took up this mammoth task to bring 13 diverse medical societies-Cardiological Society of India, Clinical Infectious Disease Society, Federation of Obstetric & Gynaecological Societies of India, Geriatric Society of India, Heart Failure Association of India, Indian Association of Preventive & Social Medicine, Indian Chest Society, Indian Medical Association, Indian Rheumatology Association, Indian Society of Critical Care Medicine, Indian Society of Nephrology, Indian Society of Oncology, Research Society of Study of Diabetes in India- to build ‘The Indian Consensus Guideline on Adult Immunization 2024’ which addresses a crucial aspect of public health – Adult Immunization. The guideline provides insights into 21 vaccines, delving into the details of each vaccine, thereby, bridging the gaps in understanding and presenting a simplified strategy to provide clarity in decision-making for Adult Immunization. The guidelines also offer vaccine recommendations for different co-morbidities/chronic conditions which will aid clinicians to customize the vaccination schedule for their eligible patients.

The guideline was released by Vice President of India Shri Jagdeep Dhankar at the 79th Annual Conference of the Association of Physicians of India, APICON 2024, New Delhi (3).

Following the publication, the guideline will be disseminated to a larger audience and incorporated into the respective medical society website for easy implementation by the clinicians. (3)

To read about the guidelines, click here.

D. Take Home Messages

• The absence of national, consistent guidelines, along with the lack of sufficient and reliable data on vaccine-preventable diseases are common barriers to adult immunization in India.
• Adopting national guidelines, educating healthcare professionals, general public, and promoting a life-course approach to immunization could improve adult vaccination.
• The Association of Physicians of India, in collaboration with thirteen different professional associations, developed the Indian Consensus Guideline on Adult Immunization 2024.
• The guideline highlights the many advantages of adult immunization and stresses its clinical relevance and robust adoption in the eligible adult population.

References:

1. Vaid A, Rastogi N, Doherty TM, San Martin P, Chugh Y. Review of the unmet medical need for vaccination in adults with immunocompromising conditions: An Indian perspective. Hum Vaccin Immunother. 2023 Aug 1;19(2):2224186. doi: 10.1080/21645515.2023.2224186. PMID: 37402477; PMCID: PMC10321191.

2. Koul PA, Swaminathan S, Rajgopal T, Ramsubramanian V, Joseph B, Shanbhag S, Mishra A, Raut SK. Adult Immunization in Occupational Settings: A Consensus of Indian Experts. Indian J Occup Environ Med. 2020 Jan-Apr;24(1):3-15. doi: 10.4103/ijoem.IJOEM_50_20. Epub 2020 Mar 18. PMID: 32435109; PMCID: PMC7227733.

3. Association of Physicians of India. The New Indian Consensus Guideline on Adult Immunization. 2024 Retrieved on 9 May 2024 from https://apiindia.org/reader/immunization

4. Dash R, Agrawal A, Nagvekar V, Lele J, Di Pasquale A, Kolhapure S, Parikh R. Towards adult vaccination in India: a narrative literature review. Hum Vaccin Immunother. 2020 Apr 2;16(4):991-1001. doi: 10.1080/21645515.2019.1682842. Epub 2019 Dec 2.

5. Rizvi AA, Singh A. Vaccination coverage among older adults: a population-based study in India. Bull World Health Organ. 2022 Jun 1;100(6):375-384. doi: 10.2471/BLT.21.287390. Epub 2022 Apr 26. PMID: 35694621; PMCID: PMC9178419.

6. Ghia CJ, Rambhad GS. Developing Adult Vaccination Ecosystem in India: Current Perspective and the Way Forward. Health Serv Res Manag Epidemiol. 2021 Jul 7;8:23333928211030791. doi: 10.1177/23333928211030791. PMID: 34286048; PMCID: PMC8267034.