For Adults
Adult Immunization Schedule 2019
Immunization schedule for adults according to the Advisory Committee on Immunization Practices (ACIP) guidelines from Centers for Disease Control and Prevention, guidelines from WHO and Association of Physicians of India – Expert panel.
Other vaccines are recommended for persons with a risk factor (medical, occupational, lifestyle, or other indication).
Influenza vaccine
Influenza vaccine has to be taken yearly as Influenza virus constantly mutates and therefore, a new batch containing the best match viral strains with the circulating viruses is prepared every year. The vaccine takes 2 weeks after administration to become effective in providing immunity. Since the peak influenza season begins in October and lasts till May, October-November is the best time to receive the vaccination.
Killed Inactivated Influenza Virus (IIV) vaccine (given intramuscularly) and nasal spray vaccines containing live attenuated virus) are available in India.
Who should receive the vaccine?
Adults of age 50 years and above are recommended to take the vaccine. High-dose Inactivated Influenza Vaccine (IIV) is an option for person aged ≥65 years. A single dose of inactivated flu vaccine in dose of 0.5 ml is given intramuscularly into the deltoid muscle
Vaccination is also indicated in high-risk persons, e.g., those with Lung, liver, heart and kidney disorders, Diabetes, hematological diseases, diseases that impair respiratory functions, and immunosuppression. Pregnant women (after first trimester) should take the vaccine. These individuals should not receive the nasal spray vaccine
People employed in nursing homes or health care facility and household contacts of children <5 years are recommended to take the yearly flu shots
Who should receive the vaccine?
Adults who are not immunized earlier in childhood or are incompletely immunized
Adults in contact with infants or children suffering from Diptheria or Pertussis and had taken the last dose of Td vaccine dose more than 2 years ago
Persons working in health care
During Pertussis outbreak
Pregnant woman
Schedules depending on person’s age and immunization status:
Unvaccinated adults (who never received primary immunization of DTP vaccines) should receive the first 2 doses of Tdap at 4 weeks minimum gap followed by a third dose after 6-12 months of the second dose
Incompletely vaccinated (i.e., less than 3 doses) adults should receive the remaining doses
Persons in contact with infants suffering from diphtheria or pertussis should take a Td booster if last Td vaccine dose was taken more than 2 years ago
Persons who have received a Tdap vaccine dose in adolescence should receive Td boosters every 10 years
Senior citizens aged > 64 years should receive Td instead of Tdap
Pregnant womenAll the women should receive 1 dose of Tdap vaccine in pregnancy during 27-36 week of gestation even if Td or Tdap vaccination has been done recently.
Varicella vaccine
Two vaccines, both containing an attenuated live VZV are currently available in India.
Highly recommended vaccine:
Females in reproductive age group
People at high risk for exposure to varicella, i.e., health care workers, household contacts, etc.
Schedule:
All healthy adults who have never had chickenpox should receive 2 doses (0.5 ml) in deltoid area subcutaneously. 2 doses are administered 4-8 weeks apart.
Human papillomavirus vaccine
Vaccine is indicated for prevention of cervical cancers and genital warts. It is most effective before any commencement of sexual activity in life.
Adults till 26 years of age can take this vaccine.
Schedule:
Three doses of 0.5 ml of HPV vaccine is administered at 0,1 and 6 months schedule.
Zoster vaccine
A single dose of zoster vaccine is recommended for adults aged ≥60 years regardless of whether they report a prior episode of herpes zoster. Only severe immune deficient persons should not be vaccinated.
Measles, Mumps, Rubella (MMR) vaccine
Live attenuated MMR vaccine is recommended for all adults except
Those who have already suffered from all the three diseases in past.
Those who have received 2 doses of measles, mumps and rubella (MMR) vaccine in the childhood
Especially recommended vaccine
For health care workers
In the setting of outbreaks
Recent exposure to these infections
Women of childbearing age and college students
Schedule:
Two doses of 0.5 mL vaccine (measles or mumps) in deltoid muscle is given at minimum gap of 28 days. 1 dose of rubella is sufficient.
Pneumococcal vaccine
Pneumococcal vaccine is available in two forms:
Pneumococcal Polysaccharide Vaccine (PPSV23)
Vaccine recommended for following group of adults:
Immunocompetent adults over the age of 65
Patients with HIV, lupus, cancer and those on chemotherapy or radiotherapy, long-term steroid, asplenia, or splenectomy
Patients with CKD, chronic obstructive pulmonary disease (COPD), cirrhosis and diabetes
Schedule:
A single dose is recommended in these persons. Adults > or equal to 65 years of age previously vaccinated with a dose of PPSV 23 should receive one dose of PCV 13 vaccine after 1 year. An additional dose of PPSV23 if required should be administered after 6-12 months of PCV13 dose and at least 5 years after a recent PPSV23 dose.
Pneumococcal Conjugate Vaccine (PCV13)
PCV is approved in several countries all over the world, including the United States, Europe, and India. It can be used in adults aged >50 years for the prevention of pneumonia and/or invasive disease caused by Streptococcus pneumonia serotypes included in the vaccine.
Schedule:
One dose of PCV 13 vaccine to unvaccinated adults older than or equal to 65 years of age. One dose of PPSV23 should follow the PCV dose after 6-12 months. The minimum gap allowed between the 2 vaccines is 8 weeks if 6-12 months gap cannot be followed.
Hepatitis A
Adults at high risk for acquiring hepatitis A should take the vaccine:
Who use illicit drugs
Who work with HAV-infected primates or with HAV in a laboratory
Who receive clotting factor concentrates
Persons infected with other hepatitis viruses
Persons with CLD who are not already immune to HAV
Persons who have received, or are awaiting a liver transplant
Food handlers
Men who have sex with men.
Patients at end-stage renal disease (ESRD)
Schedule:
Monovalent Hep A vaccine should be administered in a 2-dose schedule at either 0 and 6-12 months (Havrix), or 0 and 6-18 months (Vaqta).
If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 21-30, followed by a booster dose at 12 months.
Hepatitis B
Adults at high risk of contracting the HBV infection should take the vaccine if not vaccinated or do not have proof of vaccination in childhood
Intravenous drug users
Persons living with chronic hepatitis B virus (HBV) infected patient
Inmates and staff of institutions for developmentally disabled persons in long-term care facilities
Persons at risk for occupational exposure to HBV (such as dialysis staff, laboratory staff dealing with blood samples, blood bank staff, nurses working in intensive care units, operation theaters, and surgeons and other doctors at high-risk
HIV positive patient
Patients with chronic liver disease (CLD)
Patients with chronic kidney disease (CKD)
Hemophiliacs
Leukemia patients
Patients suffering from aplastic anemia and hemoglobinopathy
Patients awaiting major surgeries
Homosexuals; promiscuous heterosexuals; commercial sex workers; and sex partners of hepatitis B surface antigen (HBsAg)-positive persons
Schedule :
Hepatitis B vaccine should be administered in a 3 dose series. The second dose should be given at least 1 month after the first dose and the third dose should be given at least 2 months after the second dose or at least 4 months after the first dose. Administer the missing doses to the persons who are not completely vaccinated as per the above schedule keeping in mind the minimum gaps
If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively, a 4-dose Twinrix schedule may be used, administered on days 0, 7, and 21–30, followed by a booster dose at 12 months.
Patients receiving hemodialysis or having immunocompromising conditions should take 1 dose of 40 mcg/mL Recombivax HB along with 2 doses of 40 mcg/mL Engerix-B on a 3 dose schedule at 0, 1, and 6 months.
Booster doses of HBV vaccine are not required in persons with normal immune status. A booster dose may be administered when HB antibody levels decline to <10 mIU ml and >65 years.
Meningococcal Vaccine
Vaccination is indicated in specific situations, such as during an outbreak.
Recommendations for adults belonging to these groups:
Health care workers and laboratory workers
Close contacts of cases
Personnel living in dormitories, military recruits and jail inmates
Immuno compromised individuals, such as those suffering from terminal complement component deficiency, splenectomy, systemic lupus erythematosus, HIV, and multiple myeloma
Active and passive smokers
Schedule:
A single dose of Bivalent Meningococcal vaccine (A + C) may be given to these adults. 2 doses separated by 2 months for adult <55 years.
For travelers, a single dose is recommended 10-14 days before the scheduled visit depending on the prevalent serotype in the visiting country.
As a national policy, the National Institute of Communicable Diseases, New Delhi, administers quadrivalent (A, C, Y, and W135) polysaccharide vaccine to the Haj pilgrims to fulfill the requirements of the Government of Saudi Arabia.
Haemophilus influenzae (Hib)
Adults at high risk should get the vaccine:
Patients with asplenia, HIV, hematological malignancies, CSF leak and trauma
Diabetics
Pregnant
Alcoholic
Immunosuppressed due to bone marrow or kidney transplant, cancer, radiation, or chemotherapy should be vaccinated
Patients taking corticosteroids
Schedule:
A single 0.5 ml dose of haemophilus influenza b (HiB) conjugate vaccine should be administered intramuscularly.