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

Tdap (Tetanus toxoid, diphtheria toxoid and acellular Pertussis) vaccine

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 women

• All 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:

1. 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).

2. 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 :

1. 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

2. 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.

3. 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.

4. 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:

1. 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.

2. For travelers, a single dose is recommended 10-14 days before the scheduled visit depending on the prevalent serotype in the visiting country.

3. 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.

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