Edward Jenner developed the first crude form of the CowPox vaccine and used it successfully to abort smallpox infection in a child named James Phipps. This eventually resulted in the development of smallpox vaccine and the subsequent eradication of the disease. Vaccines stimulate immune cells and produce memory immune cells, which results in recall response at the time of exposure to the infective agent. Vaccines are traditionally classified into live and inactivated vaccines. Avoid live vaccines in immune compromised status and in pregnancy. Inactivated vaccines can be either cellular vaccines or toxoids. Advancement in technology like recombinant DNA technology and conjugation helped in the mass production and in the development of more efficacious vaccine.
Disease specific vaccination
COPD patients: Pneumococcal and Annual Influenza vaccine.
Asplenic patients (Functional/Surgical): HiB, Pneumococcal and Meningococcal Vaccine.
CKD: Pneumococcal and Annual Influenza vaccines along with Hepatitis B vaccine.
CLD: Hepatitis B, Hepatitis A, Pneumococcal and Influenza Vaccine.
Vaccination in travellers
Travel related routine/recommended vaccines
For all destinations: Consider Hep A, Hep B, Typhoid, Influenza, Varicella
For certain risk areas – Yellow fever, Japanese Encephalitis, Meningococcal, Polio, Cholera, Rabies, Tick borne encephalitis vaccine needs to be considered according to the area of travel.
Good web sources for travellers include
A. WHO – International Travel Health
B. CDC – Health information for international travel known as Yellow book.
Recommended for all adolescents by CDC: TdaP / Td, HPV, MCV4, Influenza
Recommended catch up vaccines: Hep A, Hep B, MMR, Varicella
Immunization for healthcare workers
Health care providers are at increased risk for exposure to and acquisition of vaccine preventable diseases. Immunize all unless the person has a contraindication to vaccine administration and to be documented in the health care providers medical record.
Recommended: Hepatitis B, Influenza, MMR, Pertussis, Varicella
Offered: Polio, Meningococcal, BCG, Rabies, Typhoid, Hepatitis A
Adult Vaccine and its schedule
1. Hepatitis B: 20 mcg/dose administered on a Three dose schedule at 0, 1, and 6 months.
(Anti-HBs levels, 1-2 months after administration of the last dose of the primary vaccine series, if <10 mIU/ml revaccination with a second hepatitis B vaccination series, followed by anti-HBs testing 1-2 months after the third dose. Measure annual anti-HBs levels and administer a booster when anti-HBs levels decline to <10 mIU/ml).
2. Influenza: Annual vaccination against influenza. (Preferably to be given in the months of October- November or April-June)
3. Pneumococcal: Administer PCV13 at first visit Followed by PPSV23. (preferably after 1 year but in high risk individuals such as severe COPD, can be given as early as 8 weeks)
If age <65 yrs: Administer a second dose of PPSV23 at least 5 years after the first dose of PPSV23.
4. Tetanus /Diptheria/ Pertusis: A dose of Tdap followed by Td booster doses every 10 years.
5. Zoster: A single dose of zoster vaccine for adults aged ≥60 years.
6. HPV: For patients up to 26 years
For females: Bivalent HPV, Quadrivalent HPV, or 9vHPV and
For males: 4vHPV or 9vHPV
Three doses (0, 1 and at 4m)
7. Varicella: 2-doses (0 and 1-2m)
8. Typhoid: One dose every three years.
Live vaccines to be avoided in immune compromised (Varicella, oral Typhoid, MMR, HPV, Zoster)
Dr. Dipu T.S.
Clinical Assistant Professor, Internal Medicine
Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala