Adult Immunization (Monograph) Alladi Mohan, SK Sharma, RK Singal, AK Agarwal
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1ADULT IMMUNIZATION
Editors S.K. Sharma, R.K. Singal, A.K. Agarwal
2
For Private Circulation Only
ADULT IMMUNIZATION (Monograph)
Vol. 1, March 2009
Editors: Drs S.K. Sharma, R.K. Singal, A.K. Agarwal
© All Rights Reserved.
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher.
This book contains views and opinions of a group of experts and does not represent the decisions or stated policies of the Association of Physicians of India or the Editor(s). The publisher disclaims responsibility for opinions expressed by authors and contents of the manuscripts.
Published by
Dr. R.K. Singal
Past-President, Association of Physicians of India
For the Association of Physicians of India
Unit No. 6 & 7, Turf Estate, Opp. Shakti Mills Compound
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3ADULT IMMUNIZATION
Editors S.K. Sharma New Delhi R.K. Singal New Delhi A.K. Agarwal New Delhi Associate Editors Alladi Mohan Tirupati Gautam Ahluwalia Ludhiana Principal Editorial Advisors Y.P. Munjal New Delhi S.K. Bichile Mumbai Members – Editorial Board Sujit Kumar Bhattacharya Indian Council of Medical Research Vinay Gulati New Delhi Pritam Gupta New Delhi D.G. Jain New Delhi Sanjay Jain Chandigarh Shashank R. Joshi Mumbai O.P. Kalra Delhi Sandhya Kamath Mumbai Jai P. Narain World Health Organization S.C. Sharma New Delhi
4ADULT IMMUNIZATION
Editors S.K. Sharma Chief, Division of Pulmonary, Critical Care and Sleep Medicine Professor and Head, Department of Medicine All India Institute of Medical Sciences Ansari Nagar, New Delhi - 110 029 R.K. Singal Past-President The Association of Physicians of India Senior Consultant, Internal Medicine BLK Memorial Hospital New Delhi - 110 005 A.K. Agarwal President The Association of Physicians of India Chief Consultant, Professor and Head Department of Medicine Postgraduate Institute of Medical Education and Research Dr. Ram Manohar Lohia Hospital New Delhi - 110 001 Associate Editors Alladi Mohan Chief, Division of Pulmonary, Critical Care and Sleep Medicine Professor and Head, Department of Medicine Sri Venkateswara Institute of Medical Sciences Tirupati - 517 507 (Andhra Pradesh) Gautam Ahluwalia Professor, Department of Medicine Medical Officer Incharge, Emergency Services Dayanand Medical College and Hospital Ludhiana - 141 001 (Punjab)
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Adult Immunization (Monograph)
© 2009, R.K. Singal for the Association of Physicians of India
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
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First Edition: 2009
9788184486735
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6Contributors 9Foreword
The scientists all over the world in their conquest against infective disorders, discovered immunization as a useful way to prevent some of these disorders before even the Koch's Principle was enunciated and the first anti-infective agent sulphonamide discovered.
A little over 300 years ago, Edward Jenner, a country doctor in England, started the concept of immunization which was to become one of the major and landmark discoveries in the field of Medicine. Not to take away even an iota of credit from the discovery of Edward Jenner, it would be pertinent to mention that the process of “variolation” was being practised much earlier in China, India, and Persia. The scientific growth in the process of immunization has advanced very significantly and vaccines and sera are available for prevention of various infective disorders including some of the viral disorders for which no definitive treatment is available till date. From the time in the year 1903 smallpox vaccine was licensed for use for general public, nearly 45 other vaccines and toxoids, apart from several immunoglobulin preparations, were introduced to fight some of the most dreaded medical conditions.
The importance of paediatric immunization is well-established and the immunization schedule has been well-documented as well as propagated. However, adult immunization has failed to elicit the required enthusiasm as well as practice by the practitioners of the modern system of medicine. In a country like USA, it is observed that only two percent of the adult population is immunized against various infective disorders against which we have effective vaccines, sera and toxoids available.
Dr. R.K. Singal, before relinquishing as the President of API, suggested and emphasized the importance of focusing the attention of Indian physicians to the importance of Adult Immunization. He was thus requested and entrusted the responsibility of editing and bringing out a monograph on the benefits of adult immunization and to focus on some of the newer vaccines which are in the pipeline. These newer vaccines when available shall also be able to prevent morbidity and mortality against very serious diseases like malaria and human immunodeficiency virus (HIV), not only benefiting the people in the subcontinent but globally. In this endeavour, he was associated with two stalwarts, Prof. S.K. Sharma and Prof. A.K. Agarwal who have very meticulously planned the contents of this monograph. The authors who were invited to contribute have immense practical experience and enough academic expertise to give a balanced view about the benefits of immunization in adults to physicians at large.
On going through this book, one is singularly impressed by the information provided in an encapsulated manner and the utility of various vaccines has been very well dealt with. However, it also focuses on vaccines which are under the process of investigation and may become available for human use in day-to-day clinical practice – especially malaria and HIV.
Before I conclude, I would once again compliment the Editors of this useful monograph because it is a timely and will act as a ready reckoner for students, teachers and practising physicians.
Dr. Y.P. Munjal
Editor-in-Chief
API Textbook of Medicine
10Preface
Immunization of adults against several diseases that are still a major public health problem in the developing countries, such as India, is a controversial issue. Reliable epidemiological data regarding the burden of diseases in general, and infectious diseases in particular, from India are lacking. Sparse published data are available regarding the efficacy and safety of various adult immunization strategies. Furthermore, there is paucity of data regarding objective monitoring of the adequacy of immunization (e.g. optimal antibody titre) against various infectious diseases.
Keeping these issues in mind, the present monograph has been conceived to give a balanced overview regarding the current state-of-the-art evidence on various aspects related to adult immunization and to provide a basis for rational scientific practice. It is hoped that practising clinicians and postgraduate students will find this monograph a valuable reference manual.
S.K. Sharma
R.K. Singal
A.K. Agarwal