Importance of adult immunization in India

The COVID-19 pandemic is a wake-up call to raise awareness of the importance of adult immunization on a war footing, writes Jayantilal B. Chowhan, Chairman of Vardhman Health Specialities

About Author: An accomplished pharmaceutical entrepreneur, Jayantilal B. Chowhan is the Chairman to the Board of Vardhman Health Specialities. Following a career span of more than five decades, Mr. Chowhan foraged into Indian market at a time when Pharma industry was taking baby steps. He has been instrumental in the launch of Coactive Technology Company — VHS Logitech which has been designed to create unique solutions for Supply Chain Management – cold chain for pharma industry. He has also ventured in medical devices business and started ‘Robomed’; the high end and lifesaving medical devices.

In the world’s second most populous country, India, much ground has been covered in childhood vaccination – thanks to awareness campaigns and education. However at the other end of the spectrum there seems to be complete lack of knowledge and importance of adult immunization – an area that is neglected primarily because of lack of awareness. In a country with about 1.4 billion population, unvaccinated adults act a storehouse of infection spreader to vulnerable sections (read: infants / children, aged). As much as childhood inoculation is important for preventing many diseases, it must be borne in mind that vaccination of adults is equally important for the self and community well-being. The COVID-19 pandemic is a wake-up call to raise awareness of the importance of adult immunization on a war footing.
Why low prevalence of adult immunization:
While the reasons for the low number of vaccinations among adults could be multiple, it is no brainer to assume that sheer lack of awareness of the impact of not taking vaccines stands out distinctly. Secondly, misconception that vaccines taken in childhood is enough for a lifetime. Other reasons like vaccine hesitancy, cost, safety and risk also emerge as possible reasons for low adult immunization prevalence. For instance, although HPV vaccination is recommended for girls aged 9–18 years and for adults up to various ages in a survey of 210 Indian physicians, only 47% knew that HPV vaccines were approved for use in India and only 30% said they would recommend HPV vaccination. In a 2014 study of medical/paramedical students in a teaching hospital in India, only 7% had received HPV vaccination, and 49% of the unvaccinated students said that they would be unwilling to be vaccinated due to concerns about efficacy (30%), safety (26%), cost (22%), and low perceived risk (15%).
Why adult immunization?
It is estimated that more than 25% of mortalities are due to infections which are vaccine preventable. It is of utmost importance to debunk the age-old myth that they are protected for life after getting their childhood doses of vaccines. On the contrary, adults MUST keep up with their vaccines and boosters to stay healthy. With age, waning immunity, prevalence of other chronic ailments augments the probability of contracting some of the infections and diseases which in turn can have a dominos effect on vulnerable sections of the society like infants and aged. Specifically, better coverage could result in reduced incidence rates, hospital admissions, health costs, and an improved quality of life.
How to increase adult immunization coverage:
As in all healthcare programs, the key to achieving the maximum ‘strike rate’ lies in awareness and education among the masses. And adult immunization is no different. The need of the hour is a high decibel campaign with multiple stakeholders like the government, hospitals, dispensaries and probably even medical stores working in tandem to achieve the desired result. If statistics are anything to go by, over 2/3rd of Indian adults are not aware of adult vaccination, many thinking that vaccines are only for children. Key components of the campaign should include:
  1. Age-wise demarcation of and frequency of vaccines that should mandatorily be taken
  2. Debunking pre-conceived misconceptions and myths about adult inoculation, more so its after effects and vaccine efficacy
  3. List of hospitals and medical centres where adult inoculations are available
  4. Health implications and possible ailments one can contracts if the appropriate vaccine is not taken
  5. Use an omni channel approach for percolation of information and messaging
What steps are being taken to increase adult immunization coverage?
In an effort to propel adult immunization, the Association of Healthcare Providers India (AHPI) has launched Project Triveni in an effort to drive adult immunization. “Under project Triveni within next 3 months, we will be working closely with the Hospitals to set up Centre of Excellence for adult immunization. It will have access to people about the information on various adult vaccination available in the country while also addressing key questions like the list of next adult vaccines that should be taken, the next level vaccine available, where they are available and the scientific information of the product in the light of the current expectations and conditions”, by Jayantilal B Chowhan, Founder and chairman Robo Med. Project Triveni envisages to set up these Centres of Excellence in two phases. In the first phase, 25 CoEs will be established with plans to ramp it up to 250 in the second phase.
What are the vaccines one must take in the adult stage?
The Association of Healthcare Providers India (AHPI) has notified 10 ‘priority vaccines’ keeping in view the sudden surge in some of the communicable diseases which if left untreated at the appropriate time can be life threatening not to mention the economic implication which can be very high. In a nutshell the names of the various vaccinations identified by AHPI, based on established CDC guidelines are:
INFLUENZA: Influenza (flu) is a highly infectious illness caused by a virus and can be experienced by otherwise healthy adults and may cause significant morbidity. The illness can be complex among people who are suffering from asthma, diabetes, lung, kidney and heart disease.
DIPTHERIA PERTUSSIS TETANUS: Diphtheria, Pertussis and Tetanus are three potentially life threatening diseases caused by bacteria. Diphtheria can lead to breathing problems, heart failure, paralysis, and even death. Pertusis (Whooping Cough) causes severe coughing spells, difficulty in breathing, vomiting and may cause rib fractures. Tetanus (Lockjaw) can lead to tightening of muscles in the head and neck so patient can’t open his mouth, swallow, or sometimes even breathe. Tetanus kills about 1 out of every 10 people who are infected even after receiving the best medical care.
HEPATITIS A: Hepatitis A is an infectious liver disease caused by Hepatitis A virus (HAV). The virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.
HEPATITIS B: This vaccine gives protection against the Hepatitis B virus, which is a major cause of serious liver disease, including cirrhosis and liver cancer. Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person.
HUMAN PAPILLOMA VIRUS: HPV infection is one of the most common sexually transmitted infections. HPV is associated with >95 per cent cervical cancers which is the second most common cancer among women
MEASLES, MUMPS, RUBELLA: Measles: Measles is the most deadly rash/fever illnesses and spreads very easily. Mumps is a viral disease caused by the mumps virus. Initial signs and symptoms often include fever, muscle pain, headache and tiredness followed by painful swelling of one or both parotid salivary glands. Rubella vaccination is important to prevent the occurrence of congenital rubella infection which is an important cause of deafness, blindness and mental retardation. Women of child bearing age should consider vaccination with rubella if not immunised during childhood.
MENINGOCOCCAL: Meningococcal disease is an acute bacterial disease caused by Gram negative capsular diplococcal bacteria, the meningococcal (Neisseria meningitides). It is a serious infection that affects the brain membrane (meninges) and can lead to serious brain damage.
PNEUMOCOCCAL: The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections leading to pneumonia, septicaemia (a kind of blood poisoning) and meningitis. At their worst, they can cause permanent brain damage, or even kill.
VARICELLA: Varicella Vaccine also known as ‘Chicken pox vaccine’ offers protection against chicken pox. Adults who are at higher risk include healthcare workers, day-care workers, teachers, college students etc.
SHINGLES: Shingles (herpes zoster) is a painful skin rash that develops on one side of the face or body. Anyone 60 years or older should get the vaccine, regardless of whether they recall having had chickenpox, which is caused by the same virus as shingles.
Needless to say, the clarion call for adult vaccinations is emerging clearer than ever before warranting an urgent call-for-action to step up efforts on this front and create a healthier community, society and nation.

Disclaimer: The views expressed by the author are his own and can’t be attributed to the Editorial Team of the BioVoice News.