Adolescent immunisation in India: need of the hour- Part 1

Adolescent immunisation in India: need of the hour

Ananya Ray Laskar, Anita S Acharya Department of Community Medicine, Lady Hardinge Medical College, New Delhi. India Corresponding Author: Ananya Ray Laskar A-601, Abhyant Apartments, Vasundhra Enclave, Delhi-110096. India. Email: ananya.ray.laskar@gmail.com Abstract Although adolescents constitute one-fifth of India's population, the National Immunisation Programme in our country primarily focuses on the under five children, with barely a provision of tetanus toxoid (TT) vaccine for adolescents. While Universal Immunisation Programme has resulted in the decline in incidence of vaccine preventable diseases among children, several unimmunised adolescents have become more susceptible to these diseases. Hence, there is an urgent need to take a re-look at the National Immunisation Schedule to incorporate vaccines for adolescents. Vaccines may be categorised as routine, catch-up and optional vaccines according to the appropriateness and feasibility. Minor modifications such as TT vaccine may be replaced by Td for 10 and 16 years as part of routine immunisation. Hepatitis-B vaccine and Measles and Rubella vaccine may be given as catch-up vaccines. JE vaccine should be included for all adolescents in endemic states in view of the age shift in the incidence of the disease. More research and cost-effective analysis needs to be conducted for newer vaccines such as HPV and Hib. Effective planning of immunisation services for the adolescent will require careful weighing of the advantages and disadvantages of each individual vaccine. Resources need to be channelised to carry out the mammoth task of vaccinating the adolescents at the service delivery points keeping in mind the other issues of vaccine efficacy, cost, adverse events and maintenance of cold chain. Above all parents, service-providers, government as well as adolescents themselves have to be sensitised and made aware of vaccination for adolescents. Keywords : Adolescents; immunisation; vaccination; vaccines; India. Vaccines: “With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction …” [1] Background India is a country of young. It is home to 243 million adolescents (10-19 years old) constituting 20% of the total population of India [2]. Having the highest number of adolescents in the world– the key challenge that India faces, is ensuring the nutritional, health and educational needs of this population. Adequate immunisation of the adolescents would be one of the most cost-effective preventive health service and a vital health investment in this direction. Unfortunately, the National Immunisation Programme in our country has primarily focused on the under five children and pregnant women till now; tetanus toxoid being the only vaccine targeting the adolescent age group. There is also a dearth of research on this very relevant topic. In India the vaccines recommended for adolescents are largely underused, due to lack of awareness andnon-inclusion in the immunisation schedule, leaving our nation’s teens vulnerable to serious morbidity, and even death. Although Indian Academy of Pediatrics (IAP) guidelines do mention adolescent vaccination, health care providers are clueless due to its non-inclusion in the National Immunisation Schedule. Need for sensitisation Adolescent age-group presents special challenges for immunisation in relation to life-style and other social issues, whilst also offering special opportunities, such as vaccine delivery in the setting of educational institutions. Although many issues revolving around efficacy, safety and cost of introducing vaccines for adolescents at the national level are yet to be resolved, there is an urgent need to sensitise the policy makers as well as health care providers regarding this pertinent issue. A recently published 'National Vaccine Policy-2011' by Ministry of Health and Family Welfare, Government of India [3] gives guidelines to policy makers and programme managers regarding various strategies for strengthening Universal Immunisation Programme but the main focus is again on children and not the adolescents. Vaccines recommended for use in adolescents can be grouped into broadly three categories: 1) Routine immunisation for all adolescents: The first aim is to increase the duration of effectiveprotection derived from the vaccines already given earlier in life or 'booster effect', especially in the absence of primary immunisation. Many countries recommend the use of Td vaccines (containing adult type diphtheria toxoid) in adolescents. 2) “Catch-up” vaccines: which have been available for a longer time, are for administration to adolescents who were not immunised or were under-immunised as infants and toddlers. Disease control initiativesencompass immunising across a wide age range, with the aim of increasing herd immunity, interrupting transmission or catching-up on cohorts missed in the past. For instance, measles elimination in certain countries has targeted individuals from 9 months to 14 years. 3) Optional vaccines: Vaccines which may be given to a particular vulnerable group depending upon the risk-factor but need not be made mandatory in the National Immunisation schedule; such as Haemophilus influenzae (Hib) and Human Papilloma virus (HPV) vaccines. Special efforts may be appropriate to immunisethem before they enter the risk period. SOURCE- http://www.ijms.in/articles/3/1/adolescent-immunisation-in-india.html