By Dr. Hemant Pathare
Vaccination is commonly associated with childhood, but protection against infectious diseases should continue throughout life. Adult vaccination plays a crucial role in preventing serious illnesses, reducing complications, and protecting vulnerable populations.
Evolution of Immunisation in India
India’s immunisation journey began with the Expanded Programme on Immunisation (EPI) in 1978. This programme focused on protecting children from six major diseases:
- Tetanus
- Diphtheria
- Pertussis
- Poliomyelitis
- Typhoid
- Childhood Tuberculosis
In 1985–86, the programme was expanded under the Universal Immunisation Programme (UIP). The scope widened to include:
- Measles vaccination for children
- Rubella and adult diphtheria vaccines for pregnant women
Today, growing medical evidence highlights the importance of vaccination beyond childhood, especially among adults.
Measles Vaccination for Adults
Measles vaccination is part of India’s immunisation program. Current consensus guidelines recommend that adults between 18 and 49 years should also receive the measles vaccine if they are not adequately immunised.
This is particularly important because immunity gaps can lead to outbreaks among adults.
Hepatitis B and High-Risk Groups
The Hepatitis B vaccine is strongly recommended for adults, including those with and without co-morbid conditions such as:
- Chronic kidney disease
- Chronic liver disease
Certain professional groups face higher exposure risks. Healthcare workers (HCWs) are particularly vulnerable due to occupational exposure to blood and body fluids. Studies indicate that about 37% of Hepatitis B infections among healthcare workers occur due to percutaneous occupational exposure.
Vaccination therefore becomes a critical preventive measure.
Pneumococcal Disease in Adults
Among bacterial infections affecting adults, pneumococcal disease is one of the most significant.
The highest rates of invasive pneumococcal disease (IPD) occur in two age groups:
- Children under 2 years
- Adults aged 65 years and above
In older adults, mortality rates are higher due to:
- Declining immune function
- Presence of multiple co-morbidities
Vaccination offers an effective opportunity to prevent severe complications.
HPV Infection and Cancer Risk
Human Papillomavirus (HPV) is a sexually transmitted infection commonly acquired through unprotected sexual contact during adolescence or adulthood.
HPV infection can lead to ano-genital cancers in both males and females after a long latent period.
Research in India shows that HPV prevalence ranges from 93% to 98% among patients with cervical cancer in regions such as Odisha, Andhra Pradesh, and Delhi.
Despite this, screening levels remain very low:
- Only 2% of women in urban areas undergo cervical cancer screening.
- Only 1.7% in rural areas undergo screening.
Vaccination during adolescence and early adulthood can significantly reduce this risk.
Age-Wise Adult Vaccine Recommendations
Age Group: 18–49 Years
Recommended vaccines include:
- Chickenpox
- Cholera (for individuals at risk)
- COVID-19 (during pandemic or epidemic situations)
- Hepatitis B
- HPV
- Influenza
- MMR (Measles, Mumps, Rubella)
- Meningococcal vaccine
- Rabies (post-exposure)
- Tdap booster every 10 years
- Yellow fever (for travel to endemic countries)
Additional vaccines may be required if risk factors are present:
- Typhoid
- Japanese Encephalitis
- Haemophilus Influenzae type B (Hib)
- Hepatitis A
- Rabies (pre-exposure)
Age Group: 50–64 Years
Recommended vaccines include:
- Hepatitis B
- Influenza
- Meningococcal vaccine
- Pneumococcal vaccine
- Tdap booster every 10 years
- Shingles vaccine
- Rabies (post-exposure)
- COVID-19 (during outbreaks or pandemics)
- Yellow fever (for international travel)
Additional vaccines depending on risk:
- Typhoid
- Japanese Encephalitis
- Hib
- Hepatitis A
- Cholera
- Rabies (pre-exposure)
Age Group: 65 Years and Above
Recommended vaccines include:
- Hepatitis B
- Influenza (annual)
- Pneumococcal vaccine
- Tdap booster every 10 years
- Shingles vaccine
- RSV vaccine (recommended for individuals above 60 years)
- Rabies (post-exposure)
- COVID-19 vaccination during epidemics
- Yellow fever for travel to endemic countries
Additional vaccines for risk groups:
- Typhoid
- Japanese Encephalitis
- Hib
- Hepatitis A
- Rabies (pre-exposure)
Vaccination Before Organ Transplant
Patients preparing for heart or lung transplants must receive several vaccines before surgery to reduce the risk of infection once they begin immunosuppressive therapy.
Recommended vaccines before transplantation include:
- Pneumococcal vaccine
- Influenza vaccine
- Measles, Mumps, Rubella (MMR)
- Hepatitis A
- Hepatitis B
- HPV
- Diphtheria, Pertussis, Tetanus
- Meningococcal vaccine
- Chickenpox vaccine
- Varicella Zoster (Shingles) vaccine
- COVID-19 vaccine
The antibodies produced through vaccination help maximize protection against infections after surgery, when immunity is suppressed due to medications.
The Way Forward
Adult vaccination is a powerful yet underutilized tool in preventive healthcare. Increasing awareness among adults, healthcare workers, and policymakers is essential to reduce the burden of infectious diseases.
Routine consultation with healthcare providers can help determine which vaccines are appropriate based on age, medical history, lifestyle, travel plans, and occupational exposure.
Vaccination should not stop in childhood. It is a lifelong shield for health and well-being.
Prevention today ensures protection for tomorrow.
