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Need and importance of adult immunisation in India

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Dr Girdhar Gyani, Director General, Association of Healthcare Providers (India) and past Secretary General Quality Council of India and Chairperson Advisory Board: Adult immunisation division, Immugard of VHS Logitech suggests that the proposed Health & Wellness centres will be most appropriate centres for adult vaccinations

Contrary to the common belief that vaccination is only for children, we all need vaccination to keep us healthy regardless of age. The specific immunisations one needs as an adult are determined by factors such as your age, lifestyle, health conditions and previous immunisation etc.

Communicable diseases such as tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, human papilloma virus, Japanese encephalitis, measles, mumps, rubella, meningococcus, pneumococcus, typhoid, influenza, and chickenpox are known to have contributed to increased morbidity and mortality among adults. In India more than 30 per cent of mortality figure is attributed to Communicable Diseases. Same percentage of disability adjusted life years (DALYs) is similarly attributed to communicable diseases. Besides causing loss of life, it has huge impact of productivity and economic growth of nation. Non-communicable diseases similarly contribute about 55 per cent of DALYs and even mortality.

Substantial improvements in adult vaccination are needed to reduce the health consequences of vaccine-preventable diseases. However, there is no focus on adult immunisation, which also is the most ignored part of healthcare services in India. The economically productive adult populations have been denied the full benefit of personal protection owing to non-availability of vaccines. Protecting adults by vaccination has never been considered in India as preventive strategy and it is time that India takes up this initiative on war footing.

Association of Healthcare Providers India (AHPI) has notified 10 adult vaccines to be launched on a priority basis 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.
  • PERTUSSIS (Whooping Cough) causes severe coughing spells, difficulty in breathing, vomiting and may cause rib fractures.
  • TETANUS (Lockjaw) it 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: 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: 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.

The action plan

Considering that there is hardly any awareness about adult vaccination, the very first stage should be, to develop the road map for sensitisation in the following order:

1-            Clinicians, Hospitals/ Nursing Homes:  We need to prepare final chart along with detailed guidelines, duly vetted by the committee of experts and circulate among all stake holders. Series of CMEs will be required to educate healthcare workforce in the public and private sector

2-            Industry: Occupational Health Hazard is recognised as key component by industry, which are prone to hazardous working conditions like chemical, sanitation, kitchen services, hospitals etc. The awareness among industry can be covered through respective industry associations by circulating soft copies of project and vaccination modalities.

3-            Community: This is the most important component in spreading awareness among society and community at large. This part can be effectively done by government, like being done in case of INDRADHANUSH. Corporate companies can play big role in mass communication under their CSR activities. Bottom-up approach will be effective, where we may begin from Gram Panchayats and RWAs etc.

In summary, India needs to immediately address the challenge of adult immunisation. The first phase of the drive is to generate mass awareness as stated above. The implementation plan can be considered in subsequent phase. Government may consider delivery of vaccines through designated infrastructure including PHCs, CHCs and District Hospitals. The proposed Health & Wellness centres will be most appropriate centres for such vaccinations. Private hospitals likewise will be utilised to provide vaccination at cost, which can be regulated. Adult vaccination must become part of routine immunisation because these vaccines can save millions of lives in India alone.

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