Need for adult vaccination
Dr Parvinder Chawla

Booster shots of tetanus and diphtheria should be taken every 10 years, even by adults

Immunisation has been one of the most successful and cost effective medical interventions ever developed. The world today is free of smallpox and almost at the verge of eradicating polio thanks to this intervention. Over the last 100 years, the average life expectancy in India has more than doubled. From 31 years in 1947, it had increased to 65 years in 2011. Apart from other factors, childhood vaccination has contributed significantly towards this gain.

Medicine has evolved as we have vaccines against many more diseases now. Certain cancers, too, can now be prevented with vaccination.

Another major development has been the development of the concept of adult vaccination. This was introduced in the developed countries more than 20 years ago. In India, this concept has been relatively new and slow to catch up. Many of us are not sure as to what all diseases can be prevented through vaccination in adults. Unfounded concerns about the possible adverse reactions also hold us back from accepting this concept. The cost of the vaccine per say is probably not a major deterrent especially when we compare that with the cost of treating the related disease if and when it occurs.

In 2008, for the first time in India, an expert group meeting was held for evolving consensus recommendations on adult immunisation in India. These recommendations were released in 2009. According to these recommendations, tetanus and diphtheria booster is recommended after every 10 years for all adults. One of these boosters should include the booster for pertussis (whooping cough) too. HPV vaccination which offers protection against cervical cancer, anal cancer and genital warts is recommended for adolescents and can be given up to the age of 26 years. Hepatitis B vaccination offers protection against hepatitis B virus-related chronic liver disease and liver cancer. It is recommended for all adults at high risk of acquiring this infection. Pneumococcal vaccine which protects against pneumonia caused by a bacterium called pneumococcus is indicated for all adults at the age of 65 years. It is also recommended for those between 19-65 years for those with a chronic medical disease like diabetes or heart, lung or kidney disease. In addition, those who smoke or consume large amount of alcohol should also get this vaccine. This organism is the common cause of pneumonia in the adults and this vaccine decreases the chance of not only pneumonia but also blood infection and brain infection (meningitis) caused by this bug.

Childhood vaccination has been shown to avert about 2-3 million deaths every year

Today, vaccines are available for 25 diseases. Seven of these diseases are covered through the routine childhood vaccination offered to every child in India free of cost. Diphtheria, pertussis or whooping cough, tetanus, tuberculosis, polio and measles are being covered for more than three decades now, while hepatitis B was added to the mandatory list in India in 2002.

Childhood vaccines against eight more diseases are recommended by the Indian Academy of Paediatrics (IAP) for all children. These vaccines are not included in the universal immunization program because of financial constraints. These are vaccines against:

z Mumps and rubella (covered together along with the second dose of measles in the MMR vaccine).

z Haemophilus influenza type b (Hib) which causes meningitis (brain fever) and pneumonia.

z Rotavirus which is the commonest cause of severe diarrhea in childhood.

z Pneumococcus which cause pneumonia and meningitis.

z Typhoid

z Chicken pox

z Hepatitis A

In addition, vaccine against HPV (Human Papilloma Virus) is recommended by IAP for all adolescents. This vaccine offers protection against cervical cancer, many other types of genital cancers and genital warts.

Apart from the 16 above mentioned diseases, vaccines against four more are recommended in certain high-risk groups. These are influenza, meningococcal meningitis, Japanese encephalitis and cholera.

The incidence of diphtheria, pertussis, tetanus, tuberculosis, polio and measles decreased drastically after vaccination was made mandotary. Though the measles and polio vaccination offered life-long immunity, immunity against diphtheria, tetanus and pertussis was seen to wane with time. The concept of adult immunisation was thus born more than two decades ago. The first adult immunisation guidelines were released in US in 2003 and have been updated annually since then.

The practice of adult immunisation is still to become a way of life in India. Some vaccines are indicated for all adults. Booster shots of tetanus toxoid along with diphtheria toxoid (at a reduced dose as compared to childhood dose) should be taken every 10 years. One of these 10 yearly boosters prior to the age of 64 years should contain the acellular pertussis vaccine too. Contrary to the common belief, pertussis (whooping cough) can occur in adults too. In fact, a prolonged cough may be the only manifestation of pertussis in adults.

Vaccine against a virus called HPV has been shown to markedly decrease the incidence of cervical cancer in women and some other genital cancers and genital warts in men too. The ideal age for receiving this vaccine is 9-11 years, but may be given up-to the age of 26 years.

Childhood vaccination has been shown to avert about 2-3 million deaths every year. This is despite of one in every five children still not getting vaccinated. Fifty per cent of these unvaccinated children are from just three countries across the globe, India being one of them. Time has perhaps come to take our childhood vaccination coverage to the next level, and embrace the concept of adult vaccination too.

The writer is consultant, internal medicine, Fortis hospital, Mohali

HOME