What is the next vaccine given after TdaP at 10 years according to the Indian Association of Paediatrics vaccination schedule?

Vaccination Schedule After TdaP at 10 Years According to IAP

According to the Indian Association of Paediatrics (IAP) vaccination schedule, the Human Papillomavirus (HPV) vaccine is the next vaccine to be administered after TdaP at 10 years of age.

Vaccination Sequence After TdaP

The vaccination sequence following TdaP administration at age 10 years follows this order:

1. TdaP at 10 years (already administered)
2. HPV vaccine - First dose can be administered as early as age 9 years, but is typically given at ages 11-12 years 1, 2, 3
3. Meningococcal conjugate vaccine (MCV4) - Administered at age 11-12 years 4

HPV Vaccination Details

Dosing Schedule:

• Standard schedule: 2 doses (0,6 months) for those initiating vaccination before age 15 years
• The second dose should be administered 2 months after the first dose and the third dose 6 months after the first dose if using the 3-dose schedule 4

Efficacy and Evidence:

• Recent evidence shows high efficacy of HPV vaccination in preventing persistent HPV 16/18 infections, with vaccine efficacy of:
  • 95.4% for single-dose regimen
  • 93.1% for two-dose regimen
  • 93.3% for three-dose regimen 2

Cost-effectiveness:

• Single-dose HPV vaccination has been found to be highly cost-effective in India with an ICER of US$406 per DALY averted 5

Important Considerations

Timing of Administration:

• If both HPV and MCV4 are indicated but only one vaccine is available, the available vaccine should be administered and the other given when it becomes available 4
• A minimum interval of 1 month between TdaP and MCV4 is suggested if simultaneous administration is not feasible 4

Special Populations:

• For children with chronic conditions (such as nephrotic syndrome or diabetes), the vaccination schedule remains the same, with HPV following TdaP 6

Common Pitfalls to Avoid:

1. Incorrect spacing: Ensure proper intervals between vaccines to maintain optimal immune response
2. Missing the HPV opportunity: HPV vaccination is critical for cervical cancer prevention in India, where cervical cancer burden is high 3
3. Confusing adult and pediatric formulations: Remember that Boostrix (TdaP) is licensed for children beginning at 10 years of age, while Adacel is licensed for children beginning at 11 years of age 4

Future Booster Considerations

After completing the adolescent vaccination series, tetanus and diphtheria protection should be maintained with Td boosters every 10 years 4.

Remember that HPV vaccination combined with regular cervical screening represents the most effective strategy for cervical cancer prevention, which is particularly important in the Indian context 3.