Open in a separate window Influenza vaccine The available vaccine in India is a killed virus vaccine to be given intramuscularly. As the influenza virus constantly mutates, a new batch is prepared every year. The vaccine becomes effective against influenza virus 2 weeks after administration. Since the peak influenza season begins in October and lasts till May, October-November are the best times to receive vaccination. Vaccination is indicated in high-risk subjects, e. Side effects include allergic reactions, Guillain Barre syndrome.
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Open in a separate window Influenza vaccine The available vaccine in India is a killed virus vaccine to be given intramuscularly. As the influenza virus constantly mutates, a new batch is prepared every year. The vaccine becomes effective against influenza virus 2 weeks after administration. Since the peak influenza season begins in October and lasts till May, October-November are the best times to receive vaccination.
Vaccination is indicated in high-risk subjects, e. Side effects include allergic reactions, Guillain Barre syndrome. High-risk individuals see above should not receive nasal spray live flu vaccine. The vaccine provides adequate protection against HINI infection. Antibody monitoring is not required. Two types of quadrivalent vaccines are available.
These vaccines do not protect against meningococcus groups B or meningitis due to other organisms. MCV4 conjugated is preferred for adults who are aged 55 years or younger as well as for adults aged 56 years or older who a are vaccinated previously with MCV4 and are recommended for revaccination, or b for whom multiple doses are anticipated.
MPSV4 is preferred for adults aged 56 years or older who have not received MCV4 previously and who require a single dose only e. For travelers, a single dose is recommended 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 polysaccharide vaccine to the Haj pilgrims to fulfill the requirements of the Government of Saudi Arabia.
Tissue culture vaccines TCV such as human diploid cell vaccine, purified chicken embryo cell vaccine PCECV , and newer and less expensive vero cell-purified rabies vaccines are now available. TCV are used for pre- and post-exposure prophylaxis. They are easy to administer, highly immunogenic, and have a good margin of safety. The reconstituted tissue culture vaccines 0.
Antibody titers should be monitored every 6 months in persons working with live virus in diagnostic, research, and vaccine production laboratories.
In other professions at permanent risk of exposure to rabies, such as veterinarians, animal handlers, and wildlife officers, antibody titers in the serum should be monitored annually. Booster dose should be administered when the titer falls below 0. The duration of immunity by two injection vaccination course is years.
Postexposure prophylaxis A person who is exposed and has never been vaccinated against rabies should get five doses of rabies vaccine at 0, 3, 7, 14, and 28 days. A person who has been previously vaccinated should get 2 doses — 1 on 0 day and another on 3rd day. When needed, the rabies immunoglobulin should be infiltrated as much as possible into and around the wounds and the remaining should be given intramuscularly at a site away from the site where vaccine has been administered.
Management of re-exposure On reexposure, 2 booster doses should be administered on days 0 and 3 irrespective of category of exposure or time that has elapsed since previous vaccination. All subjects who have received incomplete vaccination should be treated as fresh cases.
If feasible, antibody titers should be monitored and boosters given if titer is less than 0. Immunosuppressed patients should avoid activities for which rabies preexposure prophylaxis is indicated.
Antibody titer is checked after immunization in an immunosuppressed person. Sera should be collected around day 14 of vaccine series and at the time of completing prophylaxis. Human papillomavirus vaccine The vaccine protects against human papillomavirus HPV types responsible for most cervical cancers and genital warts. It is most effective when administered before onset of sexual activity. In age group years, 2 doses are recommended at an interval of 6 months.
Tetanus, diphtheria, and pertussis vaccine Full dose diphtheria, tetanus, and pertussis are used in children DPT. Acellular pertussis vaccine DTaP should be used for older children instead of whole cell vaccine DTwP because it is associated with less neurological complications. Two new tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines Tdap are available for use in those who are more than 10 years of age.
The dose is 0. DTaP acellular pertussis or DTwP whole cell pertussis vaccine should be used for first booster at 18 months while Tdap low dose diphtheria and acellular pertussis may be used for the second booster at 5 years and years.
For adults between 18 and 64 years who have completed their primary vaccination schedule, a booster dose of Td vaccine is indicated once every 10 years till the age of 65; one dose of Tdap vaccine may be administered in place of Td vaccine.
The Tdap vaccine can substitute any one of the Td doses. For adults who have not received Tdap vaccine and are likely to come in contact with infants suffering from diphtheria or pertussis, a single dose of Tdap vaccine should be given 2 weeks before the contact with the infant if 2 years or more have elapsed since the last dose of Td vaccination.
Health care personnel, especially those in direct contact with the patients, who have not received Tdap vaccine should receive a single dose of Tdap vaccine if 2 years or more have elapsed since the last dose of Td vaccination. Women planning pregnancy should receive one dose of Tdap vaccine if they did not receive it previously. Pregnant women who have received the Td vaccination more than 10 years ago should receive one dose of Td vaccine in the second or third trimester of pregnancy.
Pregnant women who have received Td vaccination during the preceding 10 years should receive one dose of Tdap in the immediate postpartum period if the last dose of Td was administered more than 2 years ago.
For pregnant women who have never received previous vaccination, three doses of Td vaccine are indicated; in the second or third trimester of pregnancy, two doses are administered at least 4 weeks apart, and the third dose is given months after the second dose.
Modified dose vaccine is not effective post transplant and full dose is needed. The Tdap vaccine is contraindicated in adults with a history of encephalopathy not attributable to an identifiable cause within 7 days of administration of a vaccine with pertussis component; these persons should receive Td vaccine.
In adults with moderate or severe acute illness and those with unstable neurologic conditions e. Haemophilus influenzae The vaccine antigen is polyribose phosphate or outer membrane protein OMP , and carrier is tetanus toxoid conjugate or diphtheria CRM protein.
Adults at high risk such as patients with asplenia, HIV, hematological malignancies, corticosteroid use, CSF leak, trauma, diabetes, pregnancy, alcoholism, immunosuppression due to bone marrow or kidney transplant, cancer, radiation, or chemotherapy should be vaccinated. A single 0. Universal immunization for hepatitis A is not recommended. The following groups of adults are considered at high risk for acquiring hepatitis A: persons who use illicit drugs; persons who work with HAV-infected primates or with HAV in a laboratory; people 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; and men who have sex with men.
Hepatitis A vaccine is indicated for all transplant candidates with CLD or those patients of end-stage renal disease ESRD who have chronic hepatitis B or C because of increased risk of fulminant hepatic failure.
The lyophilized oral Ty21a vaccine is available in two formulations: A liquid suspension in sachets or enteric coated capsules. The Vi polysaccharide vaccine is a subunit vaccine composed of purified Vi capsular polysaccharide.
This series should be repeated once in every 3 years as a booster dose. The capsule formulation should be taken orally with safe water. The sachet should be given with ml of safe water with buffer to protect the B-subunit against gastric acidity. The Vi vaccine is given as a single subcutaneous or intramuscular dose of 0. Typbar conjugate vaccine is now recommended between 9 and 12 months. Entire community at risk should be vaccinated during an outbreak. If immunization of the entire community is not possible, individuals aged years should be specifically targeted.
Ty21a should not be used during pregnancy. Vaccination policy for renal disease patients is same as for normal population. Live oral typhoid is contraindicated in transplant recipient. Cholera Vaccines for cholera are available as injectable killed whole cell vaccine; and oral cholera vaccine. The injectable killed whole cell vaccine has a poor efficacy with short-lasting protection and is not recommended. Dukoral is administered in three separate doses, 1—6 weeks apart for 2—6-year-old children and as two separate doses, 1—6 weeks apart for those aged over 6 years.
With effect from , the production of the mouse brain-derived inactivated vaccine has been stopped. The live attenuated vaccine is currently in use in India. It is administered subcutaneously as a single 0. The issue of adult immunization against JE in case of major outbreaks needs to be reviewed. Varicella vaccine Two vaccines, both containing an attenuated live VZV are currently available in India.
For people older than 13 years, the two doses are administered weeks apart. For those already immunized, booster doses are not needed if titers are adequate. In resource-limited countries at least the females in reproductive age group, people at high risk for exposure to varicella, i. It is also contraindicated in those with gelatin allergy, neomycin allergy, people on radiotherapy or chemotherapy, people who have received blood products or transfusions during past 5 months.
Varicella vaccination has been shown to be effective in patients with nephrotic syndrome and should be given to all patients with negative varicella titers.
It is ideally administered when in remission or on low-dose alternative days or off corticosteroid therapy. It is recommended for all CKD patients and those on dialysis. Patient groups at risk for severe disease and complications from varicella can receive varicella zoster immunoglobulin VZIG.
These include those with immune-deficiency disorders; neoplastic diseases; on immunosuppressive treatment and pregnant women. Patients should be monitored for varicella for 28 days after exposure as VZIG prolongs incubation period.
It is not routinely recommended for adult immunization. The vaccine is recommended for pediatric solid organ transplant candidates before transplantation.
Indian Academy of Pediatrics IAP recommended immunization schedule for children aged 0 through 18 years — India, and updates on immunization. Indian Pediatr. Yewale V, Choudhury P, editors. IAP Guidebook on Immunization. Recommended adult immunization schedule - United States, National Center for Immunization and Respiratory Diseases. Adult Immunization. J Assoc Physicians India. Guidelines for the Management of CKD. Indian J Nephrol.
IAP Advisory Committee On Vaccines & Immunization Practices
The site contain information about the latest recommendations by the committee on different vaccines, yearly vaccination schedule, and details including agenda, proceeding, recommendations, of all the meetings conducted by the committee and its sub-committees. The site is designed to provide impetus to vaccination drive all over the country and counteract any misinformation campaign against vaccination. Resources on the website include detailed publications of the ACVIP, other useful vaccination related activities of international agencies like WHO, CDC, National Vaccine Policy, links to the key national and international websites pertaining to vaccination, and latest news items in the field of vaccination. The site also provides an opportunity to pediatricians, health care professionals and parents to directly seek opinion of the vaccine experts through direct interaction.
Dilemmas in Immunization?