Vaccinations along all age groups in India

All about vaccination for all age groups.

1. Vaccination Dr. P K Maharana

2. Vaccination Schedule for Children At Birth BCG, Hep B1, OPV 6 weeks DTwP /DTaP1, Hib-1, IPV-1, Hep B2, PCV 1,Rota-1 10 weeks DTwP /DTaP2, Hib-2, IPV-2, Hep B3, PCV 2, Rota-2 14 weeks DTwP /DTaP3, Hib-3, IPV-3, Hep B4, PCV 3, Rota-3* 6 months Influenza-1 7 months Influenza -2 6-9 moths Typhoid Conjugate Vaccine 9 months MMR 1 (Mumps, measles, Rubella) 12-months Hepatitis A- 1 12-15 months PCV Booster 15months MMR 2, Varicella 16- 18 months DTwP /DTaP, Hib, IPV 18-19 months Hepatitis A- 2**, Varicella 2

3. Vaccination for Children ( Conti-1) D Tap = Diphtheria, Tetanus, Pertussis  Both DTaP and DTwP vaccines provide protection from tetanus, diphtheria, and severe pertussis. Tetanus & adult Diphtheria (Td) Hep. B1 = Hepatitis B Hib = Haemophilus influenzae type b (Hib)  PCV = Pneumococcal vaccine IPV=Inactivated poliovirus vaccine (IPV).   It is given by shot ( injection) in the leg or arm, depending on the patient’s age. Varicella = Chicken Pox Vaccine, Rotavirus Vaccine (RVV) ,Measles & Rubella (MR), Japanese Encephalitis (JE-1) 4-6 yrs DTwP /DTaP, IPV, MMR 3 9-15 yrs ( Girls) HPV (2 doses) 10 – 12 Years Tdap/ Td 2nd, 3rd, 4th and 5th Year Annual Influenza Vaccine

4. UNICEF Vaccination Guidelines At Birth : BCG, Hepatitis B, OPV 6 weeks : OPV1 , Pentavalent1, RVV1, PCV1 , IPV1 10 weeks: Pentavalent2, OPV2 , RRV2 14 weeks: Pentavalent3, OPV3 , RRV3, PCV2, IPV2 9-12 months: MR1, JE1, PCV booster. 16-24 months: MR2, JE2, DPT ( booster1), OPV(booster) 5-6 yrs: DPT ( booster2) 10yrs: TD ( tetanus, adult diphtheria) booster 16 yrs: TD ( booster)

5. Mode of Administration Simultaneous administration: ( i.e., administration of two or more vaccines on the same day) of all recommended vaccines is important because it increases the probability that an individual will be fully vaccinated at the appropriate age. It is also an important part of immunization practice when a health care provider is uncertain that a patient will return for additional doses of vaccine . As a general rule, almost all vaccines can be administered at the same visit. Exceptions to this described in the following slide.

6. Mode of administration ( Conti-1) PCV13 (Prevnar 13) vaccine and MenACWY -D (Menactra) vaccine should not be administered simultaneously to persons with functional or anatomic asplenia or HIV. Menactra brand meningococcal conjugate vaccine is thought to interfere with the antibody response to Prevnar 13. When both Prevnar 13 and Menactra are indicated, Prevnar 13 should be administered first, followed by Menactra at least 4 weeks later. PCV13 (Prevnar 13) vaccine and PPSV23 (Pneumovax 23) vaccine should not be administered at the same visit; studies show a better immune response when Prevnar 13 is administered before Pneumovax 23 . When both Prevnar 13 and Pneumovax 23 are indicated, Prevnar 13 should be administered first, and Pneumovax 23 should be administered either at least 8 weeks later or at least 1 year later, depending on the age and health conditions of the vaccine recipient. Varicella [Varivax] vaccine should not be administered simultaneously with smallpox vaccine.

7. Mode of administration ( conti-2) MMRV : There is an increased risk of febrile seizures following the first dose of the combination measles , mumps , rubella , varicella ( MMRV) vaccine compared with separate administration of MMR vaccine (MMR-II) and VAR vaccine (Varivax). For the first dose , MMR and Varicella vaccines should be administered separately for children age 12 through 47 months unless the parent or caregiver expresses a preference for MMRV vaccine.

8. Mode of Administration ( Conti-3) Non simultaneous Administration of Live Vaccines. If any combination of live, injected vaccines (MMR-II, ProQuad , Varivax) or live, attenuated influenza vaccine (LAIV [ FluMist ]) is not administered simultaneously, the vaccine doses should be separated by at least 4 weeks. Live vaccines administered by the oral route (e.g., typhoid TY21a, [ Vivotif ], rotavirus, and adenovirus vaccines) are not believed to interfere with parenteral or intranasal live vaccines or with each other. Therefore , they may be administered simultaneously with or at any time before or after other live vaccines.

9. Mode of administration ( Conti-4) This interval is intended to reduce or eliminate interference from the vaccine administered first with the vaccine administered later. If any two of these vaccines are administered at an interval of less than 4 weeks, then the vaccine administered second should be repeated in 4 weeks or serologic testing should be performed following MMR-II and ProQuad to confirm their effectiveness (serologic testing is not recommended following FluMist or Varivax vaccines).

10. Vaccines and Antibody-Containing Products Antibody , in the form of immune globulin, might be administered simultaneously with or around the same time, as post exposure prophylaxis ( hepatitis B, rabies, and tetanus ). The vaccine antigen should be administered at a site distant from where the immune globulin was injected. Immune response to some live attenuated vaccines can be affected by receipt of immune globulin, depending on the type of vaccine, amount of antibody, and timing of administration . Immune response to inactivated vaccines are generally not affected by antibody-containing products . So inactivated vaccines can be administered before, after, or at the same time as the antibody products . However, the presence of circulating antibody to a vaccine antigen might reduce or eliminate the immune response to that vaccine .

11. TYPBAR® TYPBAR® is a vaccine used for the prevention of Typhoid. Typbar® should be given intramuscularly in the deltoid (upper arm) muscle in adults and in children in the vastus lateralis (anterolateral thigh) up to 12 years of age. Inject 0.5 mL intramuscularly, Primary Series (first dose): 1 dose (0.5mL) in children 2 years of age and above, and adults. Reimmunization is recommended every 2 years, with a single dose, for travelers with repeated or continued exposure to S. Typhi.

12. HPV ( Human papilloma viruses ) Human papilloma viruses (HPVs) belong to the Papillomaviridae family and are non-enveloped double-stranded DNA viruses with over 200 types identified. All HPV types are epitheliotropic , infect squamous epithelia (skin and mucosa).  Do not spread through body fluids but through skin to skin contact or skin to mucous membrane. The virus invades its host through the anogenital and/or oropharyngeal mucosae. Sexual transmission is the most documented, but there have been studies suggesting non-sexual ways also.

13. Human papilloma viruses ( Conti-) It's so common that 80% of sexually active people will have HPV at some point in their lives . Most infected individuals will never know they have it because it doesn't cause any symptoms, but some HPV infections can progress to cancer later in life. About 40 of these 200 viruses spread through sexual contact. Of these 40, about 12 types can cause certain cancers .   HPV infection can cause cancer of the cervix, vagina, vulva, penis, anus and throat. It can also cause genital warts. The most frequent types worldwide are 16 (3.2%), 18 (1.4%), 31 (0.8%) and 58 (0.7%), all oncogenic papilloma viruses.

14. HPV Vaccine The vaccine is not a live vaccine, contains a viral particle that is the simulation of the virus. The HPV vaccine stimulates the body to produce antibodies against HPV. When the vaccinated person is exposed to the real virus, antibodies so produced, can kill the virus preventing it from creating an infection. Highly effective in preventing cervical cancer. (HPV types 16 and 18, which are together responsible for about 70% of all cervical cancer). The vaccine is safe. The vaccine itself cannot cause cancer or HPV infection.

15. Who should get it? The HPV vaccine is recommended for people ages 9 to 26 yrs. The vaccine works best when given between the ages of 9 and 12 years old. Getting vaccinated at a young age provides the best protection against HPV cancers. Present concept is to vaccinate up to 45yrs of age, depending on the sexual history .

16. Who should not get the HPV vaccine? People should not get the HPV vaccine if : 1. If pregnant. 2. Have had severe reactions to any ingredients in the vaccine or to a previous dose of the HPV vaccine. 3. Inform if you have any severe allergies, including yeast or latex allergies. 4. People with moderate to severe illnesses may be asked to wait to get the vaccine until they are well.

17. Side effects. After vaccination like any other vaccine some may have few side effects described below for a day or so . Fever. Headache or feeling tired. Muscle pain or joint pain. Nausea. Dizziness. Pain, swelling or redness at the injection site. Severe allergic reactions (rare). Dose not require any treatment .

18. Dose Prior to age of 15 : Needs two doses; of the HPV vaccine, (Should be given six to twelve months apart). Persons of 15 through 26 years old : Need 3doses . ( 1 st dose , a second dose one to two months after your first dose and the third dose six months after the first dose ). Persons above 26yrs ( 27-45 yrs ): 3doses. Immunocompromised: People of any age with a condition that causes them to have a weakened immune system should follow the HPV vaccine schedule that requires three shots, not two. It is intramuscular ( injection over deltoid).

19. Gadasil There are three HPV vaccines available ; Cervarix, protects against two types of HPV - 16 and 18. Gardasil, protects against four types of HPV – 6, 11, 16, and 18 Gardasil 9, protects against nine types of HPV - 6, 11, 16, 18, 31, 33, 45, 52 and 58 All of the vaccines protect against the two most common high-risk types of the virus: 16 and 18. These two strains are linked to over 70% of cervical cancers and 63% of penile cancers as well as most mouth, anus and throat cancers. In addition to types 16 and 18, Gardasil protects against types 6 and 11, responsible for around 90% of genital warts. Gardasil 9 protects against a further four types of HPV: 31, 33, 45, and 52 which cause an additional 15% of cervical cancers. The impact of the HPV vaccine In clinical trials, the HPV vaccine was over 99% effective at preventing pre-cancer caused by HPV types 16 or 18 in young women, which are linked to 70% of cervical cancers. It is estimated that by 2058, after 50 years of this vaccination programme, 64,000 cervical cancers and 50,000 other cancers will have been prevented.

20. Gardasil-9 Since 2017, Gardasil-9 has been the only HPV vaccine available in the United States. It provides the most comprehensive protection of any HPV vaccine. Gardasil-9 protects against infections associated with: HPV-16 & HPV-18 . These are the two most common high-risk strains of HPV. These strains cause 70% of cervical cancers, 90% of anal cancers and many cancers that can affect your throat and genitals. HPV-31, 33, 45, 52 & 58 . Together, these strains cause an additional 20% of cervical cancers. HPV-6 & HPV-11 . These strains cause 90% of genital warts. They’re considered low risk since they don’t cause cancer. Still, genital warts are a nuisance — and contagious. The vaccine can prevent you from ever having to deal with them yourself or having to tell a partner that you exposed them.

21. Gardasil ( Quadrivalent ) Prevents against HPV ( 16, 18, 6 & 11 four strains ) HPV-16 & -18 ( associated with 70% of cervical cancers, 90% of anal cancers and many cancers that can affect your throat and genitals ). HPV-6 & -11 ( associated with 90% of genital warts ).

22. Dose Schedule GARDASIL 9 is a shot that is usually given in the arm muscle. GARDASIL 9 may be given as 2 or 3 shots. For persons 9 through 14 years of age,  GARDASIL 9 can be given using a 2-dose. For the 2-dose schedule, the second shot should be given 6–12 months after the first shot. If the second shot is given less than 5 months after the first shot, a third shot should be given at least 4 months after the second shot. For the 3-dose schedule , the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot. For persons 15 through 45 years of age , GARDASIL 9 is given using a 3-dose schedule; the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot.

23. Cervarix ( Bivalent) The FDA approved Cervarix in 2009. Cervarix only protects against high-risk strains of HPV associated with cancer. Cervarix protects against infections associated with(HPV-16 &HPV-18). It doesn’t protect you from the strains that cause genital warts.

24. CERVAVAC ( Quadrivalent) CERVAVAC: (Contains HPV types 16,18, 6 &11) by Serum Institute, Quadrivalent. Indicated in girls and women 9 through 26 years of age. Between 9-14yrs ,  should be administered according to a 2-dose schedule ( 0.5 ml at 0, 6 months ). Individuals 15 to 26 years of age CERVAVAC ®   should be administered according to a 3-dose ( 0.5 ml at 0, 2, 6 months ) schedule. The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period.

25. Can you get the HPV vaccine at any age? The current recommendations advise getting vaccinated up until age 45, depending on your sexual history. It’s best to get vaccinated around 11 or 12, before becoming sexually active and when your immune response to the vaccine is strongest. People as young as 9 can safely receive the vaccine.

26. Should I get the new HPV vaccine if I had an old one? The CDC doesn’t currently recommend additional vaccinations because the earlier versions protect against the most high-risk strains of HPV.

27. CDC recommendations of HPV vaccine Most HPV infections clear on their own within a year or two, but persistent infections can lead to development of precancers or cancers, usually after several decades. HPV vaccine effectiveness is highest in people who have never had sex. ‚ ‚HPV vaccination is not routinely recommended for adults 27-45 years of age. ‚ HPV vaccination prevents new HPV infection, it does not treat existing HPV infection or disease. ‚Most adults who have had sex have been exposed to HPV before. ‚ HPV vaccine effectiveness might be low among people with more risk factors for HPV, such as having had sex with more than one person or having certain immunocompromising conditions

28. Oral vaccine ( Typhoid) Oral vaccine: Can be given to people at least 6 years old. It consists of four pills taken every other day and should be finished at least 1 week before travel.

29. Typhoid Conjugate Vaccine Typhoid conjugate vaccine, consisting of the purified Vi antigen linked to a carrier protein, is given as a single injectable dose in children from 6 months of age and in adults up to 45 years or 65 years (depending on the vaccine). Typhoid conjugate vaccine has longer-lasting immunity than the older typhoid vaccines. WHO  recommends  typhoid conjugate vaccines (TCVs) for use in routine immunization in typhoid-endemic countries. As at March 2023, WHO has prequalified two conjugate vaccines for the prevention of typhoid.

30. Guidelines for Travelers The following recommendations will help ensure safety while travelling: Ensure food is properly cooked and still hot when served. Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk. Avoid ice unless it is made from safe water. When the safety of drinking water is questionable, boil it, or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent (usually available at pharmacies). Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet. Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.

31. Hep A vaccine Natural infection or immunization with Hepatitis vaccine provides life long immunity. Dose is 0.5 mL IM up to age 18 years or 1 mL IM for adults (age ≥ 19 years). New CDC clinical guidance provides for the vaccination of the following: Infants aged 6–11 months traveling outside the United States, Children 1 st dose between 12-23 months, second dose after 6 month s. Children & adolescents between 2-18yrs of age . All adults who have not been vaccinated earlier. International travelers. Persons with immunocompromising conditions. Persons with chronic liver disease, People who are homeless, Direct contact with others who have hepatitis A. Persons with HIV infection, Men who have sexual contact with other men. Pregnant women, Post exposure prophylaxis and vaccination during outbreaks. No serious adverse effects have been reported . Mild effects include pain, erythema, swelling, and occasionally induration at the injection site .

32. Preparations of (HEP A) Vaccines VAQTA and HAVRIX.   The vaccine should be administered intramuscularly into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm. 0.5ml below 19yrs, 1ml 19yrs & above. HepA vaccine should be stored and shipped at temperatures ranging from 36°F to 46°F (2°C to 8°C) and should not be frozen (205).

33. TREATMENT AFTER EXPOSURE TO HEPATITIS A Close personal contacts of a person with hepatitis A (confirmed by blood testing). Household contacts ( family members). Sexual partners. People who have shared illicit drugs (injection and noninjection). All classroom contacts of the child with hepatitis A. Food handlers. Not vaccinated earlier: Vaccine or immune globulin should be given as soon as possible (within two weeks of exposure).

34. Immune globulin ( Hepatitis A )   People who are at risk for hepatitis A but who are allergic to components of the hepatitis A vaccine , or who prefer not to receive the vaccine, should consider taking a dose of immune globulin. It provides temporary protection against hepatitis A and reduces the risk of infection by more than 90 percent. Immune globulin is given in a single injection shortly before travel. A single dose provides protection for about two months. People who plan to travel for more than two months in areas where hepatitis A is endemic should have an additional dose(s) of immune globulin.

35. Varicella Vaccine Two doses of the vaccine are about 90% effective at preventing chickenpox in individuals 12 months older. Preschool-age children (older than 12 months): One dose School-age children , adolescents & adults : Two doses . From 12 months to 12 years: 0.5 mL subcutaneously for one dose between 12 to 15 months, then 0.5 mL subcutaneously between the ages of 4 and 6. If ages 7 to 12 at series start, the second dose may be administered as soon as 4 weeks after the initial dose. If ages 13 and older at the series start, the vaccine is administered 0.5 mL subcutaneously for 2 doses 4 to 8 weeks apart.

36. Contraindications for Varicella Severe reaction to previous dose of vaccine . Contraindicated in individuals who are immunosuppressed or immunodeficient in any of the following ways: Severe combined immunodeficiency , lymphoma, leukemia, AIDS, blood dyscrasias, hypogammaglobulinemia, agammaglobulinemia, IgA deficiency, malignant neoplasms affecting the bone marrow or lymphatic system, patients receiving steroids, chemotherapy, or X-rays as a treatment for cancer or X-rays. Any patient showing clinical signs of infection with HIV. Any person who has a family history of congenital or hereditary immunodeficiency in first-degree relatives unless there is demonstrable immunocompetence of the potential vaccine recipient

37. Shingles Vaccine (Recombinant zoster vaccine) CDC recombinant zoster vaccine (RZV, Shingrix) to prevent shingles( Herpes zoster) and related complications in adults 50 years and older . Shingrix is more than 90% effective at preventing shingles and PHN ( Post Herpetic Neuralgia). Two Doses 2-6 months apart. There is no maximum age for getting Shingrix. Shingrix is also recommended for adults 19 years and older who have weakened immune systems because of disease or therapy . It does not contain the live virus and is safe for people who are immunocompromised. One should get Shingrix even if in the past had shingles, received Zostavax*, received varicella (chickenpox) vaccine . It is not necessary to screen, either verbally or by laboratory serology, for evidence of prior varicella.

38. Who should not get the vaccine for Shingles Have ever had a severe allergic reaction; to any component of the vaccine or after a dose of Shingrix. Currently have shingles. Currently are pregnant . ( Women who are pregnant should wait to get Shingrix ).

39. Side Effects of Shingles Vaccine Serious side effects : Rare, common are sore arm with mild or moderate pain, redness, swelling at the site of injection. May feel tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people. Guillain-Barré syndrome (GBS), a serious nervous system disorder, has been reported very rarely after Shingrix.

40. Booster vaccines A booster is an extra dose of a vaccine that you have had previously. It 'boosts' your immune system.   For Tetanus, Diphtheria, Pertussis .

41. Adult vaccination Hepatitis A Hepatitis B Chicken pox ( Varicella) DPT booster Shingles after 50yrs

42. Vaccinations for senior Citizens Flue Vaccine: Shingles Pneumococcal Booster DPT Hepatitis B

43. Pneumococcal Vaccination Who should get? 1.Children younger than 5 years old 2.Adults 65 years or older. 3.People 5 through 64 years old with certain risk conditions.

44. Pneumococcal Vaccination Vaccines help prevent  pneumococcal disease , which is any type of illness caused by  Streptococcus pneumoniae  bacteria. There are two kinds of pneumococcal vaccines recommended in the United States: Pneumococcal conjugate vaccines ( PCVs , specifically PCV15 and PCV20) Pneumococcal polysaccharide vaccine ( PPSV23 ) CDC recommends   PCV15 or PCV20  for children younger than 5 years old. (PPSV23) for adults 65yrs and above.

45. Pneumococcal Vaccine up to 2yrs of age. Routine Vaccination CDC recommends  PCV15 or PCV20  for children younger than 2 years old . Most children receive 4 doses total, 1 dose at each of the following ages: 2 months 4 months 6 months 12 through 15 months Children who started with an earlier PCV called PCV13 can finish with PCV15 or PCV20. Age:   Children younger than 2 years old should not get PPSV23.

46. Children 2 Through 4 Years Old Without Certain Risk Conditions For these children who are   unvaccinated  or received an  incomplete PCV series with <3 doses before age 2 years: Give 2 doses of PCV15 or PCV20. Give the second dose at least 8 weeks after the first.

47. Certain Risk Conditions Conditions: Cerebrospinal fluid leak Chronic heart disease, particularly cyanotic congenital heart disease and cardiac failure Chronic kidney disease, excluding maintenance dialysis or nephrotic syndrome* Chronic liver disease Chronic lung disease, including moderate persistent or severe persistent asthma Cochlear implant Decreased immune function from disease or drugs (i.e., immunocompromising conditions*) Diabetes mellitus

48. Immunocompromising conditions Includes: Maintenance dialysis or nephrotic syndrome Congenital or acquired asplenia, or splenic dysfunction Congenital or acquired immunodeficiency † Diseases or conditions treated with immunosuppressive drugs or radiation therapy ‡ HIV infection Sickle cell disease or other hemoglobinopathies

49. Pneumococcal (vaccination in Adult)    The goal of vaccination in adults is to prevent invasive pneumococcal disease (IPD; eg, bacteremic pneumonia, meningitis) and nonbacteremic pneumonia. 1 . All adults ≥65 years of age. 2. Adults aged 19 to 64 years with: - Predisposing chronic medical conditions (eg, chronic lung disease, chronic liver disease, diabetes mellitus) - Increased risk of meningitis (eg, cochlear implant, cerebrospinal fluid [CSF] leak) - Immunocompromising conditions (eg, human immunodeficiency virus [HIV] infection, hematologic malignancies) and other conditions associated with altered immunocompetence. 3 . Functional or anatomic asplenia, chronic renal disease, and nephrotic syndrome)

50. Older Adults with certain Risk Conditions (between19 -64 years) 1. CDC recommends   PCV15 or PCV20  for adults who never received a PCV and are of age with certain risk conditions . 2. If PCV15 is used, this should be followed by PPSV23, one year later, then the vaccination is complete . 3. If PCV 20, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete. Also applies to people who received PCV7 at any age and no other pneumococcal vaccines. Adults 65 years or older have the option to get PCV20 if they have already received PCV13, at any age ( but not PCV15 or PCV20 ).

51. Who should not get this vaccine? Do not get a PCV shot if you have ever had a severe allergic reaction after Any type of PCV (PCV7, PCV13, PCV15, or PCV20) Any vaccine containing diphtheria toxoid (for example, DTaP). Age:   Children younger than 2 years old should not get PPSV23.

52. Types of vaccines Two types of pneumococcal vaccines are available for clinical use : 1.  P neumococcal polysaccharide vaccine  (PPSV) - PPSV23 (Pneumovax23 ® ) 2. Pneumococcal conjugate vaccine (PCV - PCV15 (Vaxneuvance ® ) - PCV20 (Prevnar 20 ® )

53. PCV15 ( Vaxneuvance ® ) This vaccine to children at 2, 4, 6, and 12 through 15 months old and to older children up to 5yrs. This vaccine also to adults 19-64 years of age who needs it. This vaccine helps protect against 15 types of pneumococcal bacteria that commonly cause serious infections in adults.

54. PCV 20 ( Prevnar 20 ) Prevnar 20* : 1. Given to children at 2, 4, 6, and 12 through 15 months old and to older children who need it up to 5yrs of age. 2. Also give this vaccine to adults 19-64 years who need it. 3. Can be given after 65 yrs but need to be followed by PPSV23 after one year . The vaccine helps protect against 20 types of pneumococcal bacteria that commonly cause serious infections in adults.

55. PPSV23 ( Pneumovax23 ) Protects against 23 types of Bacteria. Adults 65 yrs and above. Also to vaccinate children 2 through 18 years old with certain conditions. Also to adults who have received PCV15 before 65 years. May be given it to adults who have also received an earlier vaccine called PCV13. Never below 2yrs.

56. Adult Vaccination Approach to healthy older adults and those with predisposing medical conditions  —  The ACIP recommends the 20-valent PCV ( PCV20 ) alone ( single dose ), or If 15-valent PCV (PCV15) followed by the 23-valent PPSV (PPSV23) one year after PCV15. For most adults, including healthy older adults, those with predisposing medical conditions, and those with a history of IPD, we prefer to administer PCV20, when available, due to the simplicity and lower cost of a single-dose vaccine .

57. Pneumococcal Vaccination CDC recommends routine administration of pneumococcal conjugate vaccine ( PCV15 or PCV20 ) for all adults 65 years or older who have never received any pneumococcal conjugate vaccine or whose previous vaccination history is unknown. If PCV15 is used, this should be followed by a dose of PPSV23 one year later. Everyone 19 through 64 years or older with certain underlying medical conditions or other risk factors should receive a pneumococcal conjugate vaccine, either PCV15 or PCV20. If PCV15 is used, this should be followed by a dose of PPSV23.

58. Vaccination of Adults 65 Years or Older Routine Recommendation CDC recommends routine administration of pneumococcal conjugate vaccine (PCV15 or PCV20) for all adults 65 years or older who have never received any pneumococcal conjugate vaccine or whose previous vaccination history is unknown If PCV15 is used, this should be followed by a dose of PPSV23 one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition†, cochlear implant, or cerebrospinal fluid leak. If PCV20 is used, a dose of PPSV23 is NOT indicated .

59. 65 Yrs and more PCV 20 Or PCV15 after one year PPSV23.

60. Infants and children who have not previously received PCV7 or PCV13 A. Indian Academy of Pediatrics recommends 3 doses: - at 6, 10 and 14weeks & a booster at15 month. ( Total 4) B. Infants receiving their first dose at age < 11 month should receive 3 doses of PCV13 at intervals of approximately 4 weeks with a booster at 15 month. ( Total 4 doses) C . Children Aged 12–23 Months should receive 2 doses with an interval of at least 8 weeks between doses. D. Unvaccinated healthy children aged 24–59 mo should receive a single dose of PCV13.

61. Pneumococcal vaccination in India Child hood vaccination 4doses ( 6,10,14 weeks Booster 12-15 months ) Prevnar*( Pfizer) Pneumosil *( Serum institute of India)

62. Indian Chest Society and National College of Chest Physicians of India The ICS-NCCP (2019) guidelines Vaccination with PPSV23 in all adults older than 65 years is recommended because of the overall higher incidence of invasive pneumococcal disease in this age group. Vaccination with PCV13 first, followed by PPSV23 , is recommended for individuals having immunocompromising conditions, functional or anatomic asplenia, cochlear implant, CSF leak, or history of invasive pneumococcal disease. However, in this group of patients, the decision regarding administering PCV13 before PPSV23 can be discussed between the physician and the patient on a case‑to‑case basis. For adults with chronic conditions such as chronic heart disease, chronic liver disease, poorly controlled diabetes mellitus, chronic lung disease, and in current smokers and those with alcohol abuse, the decision to administer PCV13 preceding PPSV23 should be taken jointly by the physician and the patient, on a case‑to‑case basis. Because re-vaccination with PPSV23 may cause hypo responsiveness, it must solely be based on clinical judgmen

63. Difference between Conjugate & PPSV vaccines Plain polysaccharide vaccine–PPSV23 Contains capsular polysaccharide antigens of bacteria. A T cell-independent immune response, characterized by: •  Formation of predominantly IgM antibodies •  Poor affinity maturation of antibodies •  No evidence of immune memory An important concern is the phenomenon of “ hyporesponsiveness ” following revaccination, which is a lower immune response obtained on subsequent vaccination. ( This has been attributed to depletion of memory B lymphocyte pool during immune response). Protein-polysaccharide conjugate vaccine–PCV13 Capsular polysaccharides conjugated to a carrier protein. A T cell-dependent immune response, characterized by: •  Formation of predominantly IgG antibodies (capable of a more potent response) •  High affinity maturation of antibodies •  Good evidence of immune memory. Upon subsequent exposure, the memory cells launch a rapid, stronger, and longer-lasting secondary response.

64. Govt. of India Under UIP, immunization is being provided free of cost against 12 vaccine preventable diseases: Nationally against 10 diseases - Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Rotavirus diarrhea, Hepatitis B and Meningitis & Pneumonia caused by Haemophilus Influenzae type B Sub-nationally against 2 diseases – ( Pneumococcal Pneumonia and Japanese Encephalitis ) ; of which Pneumococcal Conjugate vaccine is nationally expanded today, while JE vaccine is provided only in endemic districts.