Why adult immunization should be a part of healthcare policy

A health worker inoculates a woman with the jab of Covishield Covid-19 coronavirus vaccine during a special vaccination drive organised for government school teachers, staff members and their families in Srinagar, India. Image: Tauseef Mustafa / AFP

Vaccination is advised throughout one's life to protect against various infectious diseases and their complications. Adulthood entails letting go of some of our childhood habits, but vaccines are not one of them. To maintain optimal immunity, many of the immunizations that we received as children, must be repeated when we are adults. Adulthood comes with a new set of duties, but it also comes with a new set of immunizations.

Immunization protection becomes increasingly essential for one's health in adulthood because of job exposure, travel, and increased risk factors that come with age. It also protects you from developing and transferring diseases that can be prevented with vaccines. People may believe that vaccines are too expensive or that they are protected for life after getting their childhood doses of vaccines. But adults must keep up with their vaccines and boosters to stay healthy.

What is the mechanism of immunity?

To resist invading pathogens that could make you sick or harm you, the body develops a defence mechanism—your immune system. Your body needs to be exposed to various microorganisms to strengthen your immune system. When your body is initially exposed to a germ, it generates antibodies to help you fight it. However, this takes time, and you usually become ill before your antibodies have developed. These antibodies remain in your body once you have them. As a result, the antibodies will target that germ the next time you're exposed to it and you won't get sick.

Why do we require adult immunization?

Most of the immunizations we get as children to help us develop immunity to infectious diseases do not last a lifetime. To preserve protection, tetanus and diphtheria immunizations, for example, must be renewed with a new vaccine and booster shots every ten years. Adult vaccines may be required for a variety of reasons like:

• Some adults never had their childhood vaccines.
• Vaccines and vaccine recommendations evolve throughout time. When some people were children, certain immunizations may not have been available.
• Immunity can deteriorate with time.
• We become more susceptible to severe diseases caused by common viruses such as the flu as we get older.
• As adults, we may work in the healthcare sector or another occupation that exposes us to infectious diseases.

Is there anyone unable to receive vaccines?

Some people are unwilling, but some are unable to take vaccines. Bodies of a small percentage of people do not respond to a particular vaccine. Because of such instances, it’s necessary that everyone else gets vaccinated. For the majority of people, this serves to maintain a 'herd immunity'. It suggests that if most individuals are immune to a disease due to immunizations, the sickness will cease to spread.

What are the recommended adult immunizations?

One of the most famous is the Advisory Committee on Immunization Practices (ACIP) recommendation that all adult females, under the age of 26, receive the human papillomavirus (HPV) vaccine. According to the same guidelines, males aged 13 to 21 years, who have not been vaccinated, should be vaccinated. Males under the age of 26 who have intercourse with men, and whose immune systems may be impaired should get vaccinated. Other noteworthy changes include:

• Influenza - Once every year
• Pneumococcal - For people above 60 years, two doses one year apart, then once every five years.
• Tdap - Once in a lifetime for people above 18 years / during every pregnancy (irrespective)
• Td - Once every ten years
• Hepatitis B - Three doses
• Hepatitis A - Two doses
• HPV - All women between 9-35 years; a three-dose schedule
• Typhoid - Once every five years
• Covid-19 - Two doses

Is it essential to get vaccinated if travelling aboard?

Vaccination protects travellers from dangerous infections. Depending on where you travel, one may contract uncommon diseases, such as yellow fever. Specific vaccinations may be required to go to certain locations. Vaccination will keep one safe and healthy while on the road. It also ensures that one does not transmit any major diseases to the family, friends, or community. Some vaccines to be considered if travelling aboard:

Travel abroad (study/ long stay)

•    Meningococcal (two doses)
•    Tdap (one dose)
•    Influenza (one dose)
•    MMR (two doses)
•    Covid-19 (two doses)

Vaccines to be considered while travelling to exotic locations are:

•   Japanese encephalitis (one dose)
•   Yellow Fever (one dose)
•   Cholera (one dose)
•   Meningococcal (two doses)
•   Typhoid vaccine
•   Covid-19 vaccine (both doses)

Waning immunity of Covid-19 vaccines:

Low antibody levels do not mean low immunity. There are only a few centres in the world that can measure the amount of neutralizing antibodies. Neutralizing antibodies help us determine if the antibody levels are good enough to protect our body from another infection from Covid-19. We need to know if we need booster vaccines or regular yearly Covid-19 vaccines to stay away from the scare. Yet, we do not have enough evidence suggesting if a Covid-19 booster vaccine is required or whether it should be given based on the antibody levels.

Need for change in healthcare policies:

Vaccines are critical for preventing mortality since infections account for more than a quarter of all fatalities. Vaccines for adults are suggested for a variety of reasons. To lessen the health implications of vaccine-preventable diseases in adults, significant improvements and increases in adult immunization are required. In India, incomplete and inadequate immunization against various infectious illnesses results in substantial and avoidable hospitalization and treatment costs. Childhood vaccination is a top goal for the Indian government and the World Health Organization (WHO), but adult immunization is not prioritised.

India must address the issue of adult immunization right away. Although many questions surrounding the efficacy, safety, and cost of introducing vaccinations for adults at the national level are unanswered. Healthcare policy planners and healthcare providers must be made aware of this critical topic. The Ministry of Health and Family Welfare of India must develop adult immunization policies and procedures. There must be a concerted effort to include vaccines in the national immunization schedule to reduce the number of adults suffering from infectious diseases. Adult vaccination should be made a standard aspect of immunization since these vaccinations can save millions of lives in India alone.

The thoughts and opinions shared here are of the author.