Adult Immunization SK Sharma, A Muruganathan, Dilip Mathai, Milind Y Nadkar
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1Adult Immunization
Editors A Muruganathan Dilip Mathai SK Sharma
A Publication of the Association of Physicians of India2
For Private Circulation Only
Adult Immunization
Editors: A Muruganathan, Dilip Mathai, SK Sharma
© 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 (API) or the Editor(s). The publisher disclaims responsibility for opinions expressed by authors and contents of the manuscripts.
Published by
A Muruganathan
President
The Association of Physicians of India (API)
For the Association of Physicians of India
Unit No. 6 & 7, Turf Estate, Opp Dr E Moses Road
Nr Mahalaxmi Station (W)
Mumbai, Maharashtra, India3
ADULT IMMUNIZATION
Editors
A Muruganathan
Tirupur
Dilip Mathai
Hyderabad
SK Sharma
New Delhi
Associate Editor
Milind Y Nadkar
Mumbai
Principal Editorial Advisor
YP Munjal
New Delhi
Members—Editorial Board
Shashank R Joshi
Mumbai
Bibhuti Saha
Kolkata
RK Singal
New Delhi
Vivek Pal Singh
New Delhi
Himanshu Chauhan
New Delhi
Siddharth N Shah
Mumbai
V Ramasubramanian
Chennai
RK Sharma
Lucknow
Anupam Prakash
New Delhi
TS Rao
New Delhi
YK Chawla
Chandigarh
AK Agarwal
New Delhi
Sumeet Singla
New Delhi
Ghan Shyam Pangtey
New Delhi
D Suresh Kumar
Chennai4
5ADULT IMMUNIZATION
Second Edition
Editors A Muruganathan MBBS MD FRCP (GLASG) FACP (USA) FICP President The Association of Physicians of India (2013–2014) Adjunct Professor The Tamil Nadu Dr MGR Medical University Chairman AG Hospital, 34 KPN Colony, 3rd Street Tirupur, Tamil Nadu, India Dilip Mathai Professor Department of Medicine and Adult Infectious Diseases Dean Apollo Institute of Medical Sciences and Research Apollo Health City Campus, Jubilee Hills Hyderabad, Andhra Pradesh, India SK Sharma Professor and Head Department of Medicine All India Institute of Medical Sciences New Delhi, India Associate Editor Milind Y Nadkar Hon General Secretary The Association of Physicians of India (API) Professor of Medicine and Chief of Rheumatology Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Principal Editorial Advisor YP Munjal Hon Editor API Textbook of Medicine Medical Director Banarsidas Chandiwala Institute of Medical Sciences Kalkaji, New Delhi, India Foreword Siddharth N Shah
6
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© 2014, A Muruganathan, Dilip Mathai, SK Sharma for the Association of Physicians of India
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Adult Immunization
First Edition: 2009
Second Edition: 2014
9789351521907
Printed at
7The Association of Physicians of India—Governing Body (2013–2014)
Vice Presidents
Members
Zonal Members
9Indian College of Physicians—Faculty Council (2013–2014)
Vice Deans
Elected Members
Ex-Officio Members
11Contributors
Reviewers
Special thanks to Mr K Venkatesan (MSc BEd), and Ms Madhvi Thakur for their help.
15Foreword
It gives me a great pleasure on writing a foreword on an important subject of Adult Immunization. It is a common concept that immunization is important only in the pediatric age group. However, protecting adults through vaccination has never been considered a preventive strategy. Adults do need a vaccination protocol because you may need booster dose of vaccines, some vaccines are for adults only, e.g. Shingles, preventive medicine recommend vaccines like hepatitis B for prevention of communicable diseases and due to frequency in travel, certain vaccines like yellow fever are recommended, which are discussed. Vaccines are recommended for adults on the basis of their age, prior vaccination, health conditions, lifestyle, occupation and travel. Current level of vaccines uptake for adults is low in our country.
The revised guidelines of Adult Immunization has important chapters dealing with setting up of Adult Immunization clinic, vaccines for various communicable disease, influenza, hepatitis and HIV vaccines. The guidelines also deal with immunization in pregnant women, newer vaccines and technical aspect of vaccination administration, vaccines for travelers and immigrants. The future of vaccines is adequately highlighted and vaccination for organ transplantation is discussed amongst others.
These guidelines will be useful to all physicians and postgraduates and will increase the awareness of administration of vaccines in a wide variety of conditions prevalent in our country.
I strongly recommended the medical profession to follow the suggested guidelines.
Vaccination is as important for adults as it is for children and yet many adults are not optimally vaccinated.
–National Foundation for Infectious Diseases
Siddharth N Shah
Editor-in-Chief
Journal of the Association of Physicians of India (JAPI)
Past-President Association of Physicians of India (API)
16
17Preface to the Second Edition
Vaccines are one of the greatest public health success stories of the 20th century. From drastically reducing infant and childhood mortality and morbidity, to the elimination of several killer diseases, vaccinations and immunizations constitute an important aspect of public health programmes of every country of the world. The most recent success story remains India's successful fight against polio, a ruthlessly paralyzing and sometimes fatal disease. India is now officially polio free, a commendable achievement, given the cultural, political, economic, geographic and physical odds faced.
There is a growing body of evidence that supports adult immunization and vaccinations. Part of this interest stems from the changing demographics of a growing elderly population, aging and a significant increase in life expectancy. Thus, while promoting lifestyle changes to prevent, detect and treat chronic disorders, such as diabetes and obesity, are both important and necessary, vaccinating adults needs to become a new national health priority for a range of reasons. Immunization is a time-tested approach to minimize morbidity and mortality due to infections. Unfortunately, in India, the potential of adult immunization remains untapped. Statistics on the incidence of several diseases and data on vaccine use in India is still scant.
Stalwarts of the Association of Physicians of India (API), Drs RK Singal, SK Sharma and AK Agarwal, tried to address this lacuna and came out with guidelines for adult immunization in India (2009). This was the first attempt to improve awareness regarding adult immunization. Since then, a lot of developments have taken place in the field of adult vaccinology. Taking the initiative to the next level, we decided to revise the guidelines with recent updates based on evolving evidence. To get a comprehensive idea, we requested experts from various fields, including practicing physicians, infectious diseases specialists, scientists and members of the Department of Biotechnology, Ministry of Science and Technology, the National Cooperative Development Corporation (NCDC) and the Indian Council of Medical Research (ICMR) to contribute to this initiative.
In this edition, we have included several new chapters of practical relevance including Setting- up an Adult Immunization Clinic, Principles of Immunization, Technical Aspects of Vaccination Administration, Cancer Vaccines, Newer Vaccines for Chikungunya and Hepatitis C, Adolescent Immunization, Immunization in Pregnant Women, Vaccines for Travellers, Immigrants and Migrants, Vaccination Recommendations for Solid Organ Transplantation and Chronic Kidney Disease, and several more.
We have tried to standardize the content and flow of each chapter stressing on the disease epidemiology, vaccine indications, and global scenario of the vaccine, vaccine safety and cost-effectiveness. We have included the recommendations for the Indian population. What is of utmost importance is educating family physicians and doctors on adult immunization protocols, schedules and enlightening them of the safety and risks of various vaccines available in the market.
This update is an effort at providing a comprehensive overview for the Indian population. These are not programmatic recommendations, but evidence-based guidelines for a practicing physician. We believe that this monograph will be a valuable reference manual for every postgraduate and doctor, and find a place in the chamber of every practicing physician.
A Muruganathan
Dilip Mathai
SK Sharma
18
19Preface to the First Edition
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 titer) 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 practicing clinicians and postgraduate students will find this monograph a valuable reference manual.
SK Sharma
RK Singal
AK Agarwal
20
21Acknowledgments
The publication of Adult Immunization was supported by an unrestricted educational grant from:
Entire team of contributors thanks Pfizer—Vaccines, MSD Pharmaceutical Pvt Ltd and Sanofi Pasteur for this kind gesture.