What vaccinations are recommended for adults in India?

Recommended Adult Vaccinations in India

All adults in India should receive routine vaccinations including annual influenza, tetanus-diphtheria (Td) boosters every 10 years, hepatitis B for those under 60 years, and age-appropriate pneumococcal, zoster, and HPV vaccines to reduce morbidity and mortality from vaccine-preventable diseases. 1

Core Adult Vaccinations

For All Adults

• Influenza vaccine: Annually for all adults 2, 1
• Tetanus-diphtheria (Td/Tdap): One dose of Tdap, followed by Td or Tdap booster every 10 years 2, 1
• Hepatitis B: Recommended for all adults under 60 years of age; for those ≥60 years, discuss with healthcare provider 2, 1

Age-Based Recommendations

• Pneumococcal vaccine:

  • Ages 19-64 with risk factors: One dose of PPSV23 (Pneumovax) 2
  • Ages ≥65: Second dose of PPSV23, at least 5 years after prior dose 2
  • Adults with immunocompromising conditions: PCV13 followed by PPSV23 2

• Herpes Zoster vaccine (Shingrix):

  • Recommended for adults ≥50 years: Two-dose series 2, 1

• Human Papillomavirus (HPV) vaccine:

  • Women through age 26 and men through age 21 (extended to 26 years for MSM and immunocompromised): 2-3 dose series 2, 1
  • Adults 27-45 years: Consider after discussion with healthcare provider 2

Risk-Based Recommendations

Medical Conditions

• Chronic liver disease: Hepatitis A and B vaccines 2, 1
• Diabetes: Hepatitis B vaccine 2
• Chronic lung/heart disease: Pneumococcal vaccine 2
• Immunocompromised conditions: Modified vaccination schedule with avoidance of live vaccines 2
• Asplenia: Influenza, pneumococcal, Haemophilus influenzae b, and meningococcal C vaccines 2

Occupational Risk

• Healthcare personnel: Hepatitis B, annual influenza 2
• Laboratory workers handling specific pathogens: Relevant vaccines based on exposure 2

Behavioral Risk

• Men who have sex with men: Hepatitis A and B vaccines 2
• Injection drug users: Hepatitis A and B vaccines 2
• Multiple sexual partners: Hepatitis B vaccine 2

Travel Risk

• International travelers: Vaccines based on destination (hepatitis A/B for endemic areas) 2, 1

Implementation Challenges in India

Current adult vaccination coverage in India is extremely low, with studies showing less than 2% coverage for most vaccines 3, 4, 5. The highest coverage was reported for diphtheria and tetanus vaccine (2.75%), followed by typhoid (1.84%), hepatitis B (1.82%), and influenza (1.59%), with pneumococcal vaccine having the lowest coverage (0.74%) 4.

Disparities exist based on socioeconomic factors, with higher vaccine uptake among:

• Urban residents
• Wealthier households
• Those with more years of education
• Males 5

Practical Considerations

1. Timing of vaccination:

   • Administer during stable health status 2
   • For patients on immunosuppressive therapy, vaccinate before starting B-cell depleting biologics when possible 2

2. Documentation:

   • Maintain complete vaccination records to avoid unnecessary revaccination 1

3. Special populations:

   • Pregnant women: Tdap recommended during each pregnancy; avoid live vaccines 1
   • Immunocompromised: Avoid live vaccines; may need modified schedules 2

Improving Vaccination Coverage

To increase adult vaccination coverage in India, a combination of interventions is recommended:

• Increasing community awareness about vaccine-preventable diseases
• Enhancing access to vaccination services
• Implementing provider reminder systems 6
• Actively engaging healthcare systems and community organizations 3
• Developing affordable, safe, country-appropriate vaccines 3

Adult immunization in India remains largely neglected despite its importance in preventing infectious disease morbidity and mortality. Targeted policies and programs are urgently needed, particularly for those with chronic diseases who are at higher risk for complications from vaccine-preventable diseases.