“Immunization is prevention — you cannot wait until an outbreak to vaccinate. Reducing spread of disease in communities by a simple vaccine is a wise step. Outbreaks are expensive.”
It is well recognized that vaccination is among the most cost-effective clinical preventive methods currently available in the world. Vaccination is recommended throughout life to prevent vaccine-preventable diseases and their sequel.
The government of India considers childhood vaccination as the first priority, and there is no focus yet on adult immunization. Thus, adult vaccination in India is the most ignored part of health care services. As
vaccines are crucial to prevent mortality of over 25% deaths caused by infections in older persons, there is an urgent need to address this problem.
Older adults need immunization for several reasons:
1. They may not have received the vaccines in their childhood
2. New vaccines for adults have become available
3. Immunity acquired in childhood can fade with age
4. Older adults or those who are chronically ill are more susceptible to vaccine-preventable diseases and complications
5. With age, the immune system becomes weaker - a phenomenon called immuno-senescence
6. Both herd immunity and cocoon immunity are enhanced by vaccinations leading to lessening or even eradication of infectious diseases
The World Health Organisation (WHO) had mandated that all senior citizens above 65 years of age must receive adult vaccination of flu, pneumonia, diphtheria, tetanus and acellular pertussis, and against herpes zoster.
However, pneumonia polysaccharide vaccine and herpes zoster vaccine need not be a priority on every country's schedule for those over 65 years. Some of these vaccines are expensive. Ideally, they should be part of a government health programme but individuals must consider taking them as per their needs.
In the debilitated elderly and in those with lowered immunity, infections can prove fatal. In others, prolonged hospitalisation and admission to the intensive care unit (ICU) with ventilator support is the order of the day. In my experience, nearly 40% of the elderly admitted to ICU for community acquired pneumonia ended up requiring ventilator assisted breathing. The mortality rate in these patients was quite high. Since community acquired pneumonia is a vaccine preventable disease, the pneumococcal and influenza vaccines are routinely advisable.
We, as doctors typically recommend inoculation against pneumonia, flu, shingles (herpes zoster), diphtheria, pertussis and tetanus. Here is a list of the vaccines that I recommend along with the approximate costs. These vaccines are easily available with any chemist or stockist and can be administered by your general practitioner.
1. Vaccine: Influenza
Disease prevented: Flu
Dosage: Single dose annually
Cost: Rs500 to Rs800
The influenza virus mutates, hence vaccines against the prevalent species is freshly manufactured. These vaccines are especially necessary in patients with chronic respiratory disorders or during a flu pandemic.
2. Vaccine: Pneumococcal
Disease prevented: Pneumonia
Dosage: Single dose
Cost: Rs1,200 to Rs4,000
A person needs one dose of 13-valent pneumococcal conjugate vaccine administered to immune-competent adults aged 65 years or older (PCV13), followed by one dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least a year after PCV13 and that is enough.
3. Herpes zoster (Zoster vaccine recombinant, adjuvant)
Disease prevented: shingles (or what is called Nagin in Maharashtra)
Dosage: two doses three to six months apart
Cost: Rs7,000-Rs8,000 per dose in India
For adults aged 60 years or above, two doses of recombinant zoster vaccine (RZV) only are administered two–six months apart regardless of past episode of herpes zoster or chicken pox. In India, we leave it to
the individual to take the herpes zoster vaccine since it is too expensive for universal immunisation. Two doses have to be taken for lifelong immunity.
4. Vaccine: Tetanus, diphtheria, pertussis (TT/Td/Tdap)
Disease prevented: Tetanus, diphtheria, pertussis
Cost: Rs150 to Rs200
5. H1N1 vaccine
Disease prevented: swine flu
Free immunization of high-risk individuals and those suffering from diabetes and hypertension is done by the state and only a single dose is required.
(Dr Rekha Bhatkhande is the former dean of Shushrusha Citizens’ Cooperative Hospital Ltd. She is also a social activist and President of the Family Welfare Agency as well as Dilasa Group of Senior Citizens.)