Adult Vaccination Booklet

INDIAN CONSENSUS
GUIDELINE ON
ADULT IMMUNIZATION
Editors:
Dr. Girish Mathur
Dr. Agam Vora
In Association with
• Cardiological Society of India (CSI) • Indian Medical Association (IMA)
• Clinical Infectious Diseases Society (CIDS) • Indian Rheumatology Association (IRA)
• Federation of Obstetric and Gynecological • Indian Society of Critical Care Medicine
Societies of India (FOGSI) (ISCCM)
• Geriatric Society of India (GSI) • Indian Society of Nephrology (ISN)
• Heart Failure Association of India (HFAI) • Indian Society of Oncology (ISO)
• Indian Association of Preventive • Research Society for Study
and Social Medicine (IAPSM) of Diabetes in India (RSSDI)
• Indian Chest Society (ICS)
Preface
It is with immense pride and a sense of accomplishment that we present to you a monumental stride in the realm of healthcare
– Indian Consensus Guideline on Adult Immunization developed by the Association of Physicians of India (API).
This endeavour marks a historic collaboration, bringing together representatives from 13 diverse professional organizations namely
Cardiological Society of India, Clinical Infectious Disease Society, Federation of Obstetric & Gynaecological Societies of India,
Geriatric Society of India, Heart Failure Association of India, Indian Association of Preventive & Social Medicine, Indian Chest
Society, Indian Medical Association, Indian Rheumatology Association, Indian Society of Critical Care Medicine, Indian Society of
Nephrology, Indian Society of Oncology, Research Society of Study of Diabetes in India. For the first time, these collective efforts
converge to address a crucial aspect of public health – adult immunization.
As we navigate the complexities of healthcare in India, it is evident that the landscape is evolving rapidly. The emergence of new
medical challenges, coupled with the increasing geriatric population, necessitates a proactive approach to immunization. With
projections indicating that nearly 23% of our population will belong to the 50-plus age group by the end of the next decade, the
significance of adult immunization cannot be overstated.
The myths and misconceptions surrounding adult vaccination persist, both among citizens and healthcare providers. It is against
this backdrop that API has been actively engaged in the field for over a decade. We have published guidelines, disseminated
knowledge through articles in our esteemed Journal ( JAPI), and now, with these Consensus Guideline, we aim to bridge the
existing gaps in understanding and implementation.
Under the astute leadership of Dr. Girish Mathur, representatives from various medical associations convened, engaging in rigorous
brainstorming sessions, comprehensive literature reviews, and meticulous comparisons of national and international guidelines.
The outcome is a comprehensive resource that not only addresses the concerns of healthcare providers but also provides clear,
consensus-based recommendations for each vaccine.
These guideline delve into the specifics of each available vaccine, offering insights into recommended practices and providing a
unified voice amid the existing plethora of guidelines. We acknowledge the challenges healthcare workers face, particularly when
managing patients with multiple co-morbidities. Hence, these guideline offer a consolidated approach, ensuring clarity in
decision-making for healthcare providers.
As the Secretary of the Association of Physicians of India, I extend my gratitude to all the contributors, collaborators, and
stakeholders who have played a pivotal role in making this initiative a reality. Your dedication and commitment to advancing
healthcare in our nation are commendable.
I invite you to delve into this Consensus Guideline, share your insights, and actively participate in the ongoing dialogue. Your
feedback is invaluable as we strive to continually update and enhance this guideline to meet the dynamic healthcare landscape.
Wishing you an enlightening and enriching journey through these guidelines.
Warm regards,
Dr. Agam Vora Dr. Girish Mathur

Secretary General Immediate Past President
Association of Physicians of India Association of Physicians of India
Inauguration of the Indian Consensus Guideline
on Adult Immunization by
the honourable Vice President of India
Shri Jagdeep Dhankhar
on the 22nd February at APICON 2024, New Delhi, India
in the presence of Dr. Girish Mathur, Dr. Milind Nadkar,
Dr. Rajesh Upadhyay, and Dr. Agam Vora.
02
Association of Physicians India
Dr. Girish Mathur Dr. Mangesh Tiwaskar

MD, FICP, FRCP (Lon, Glas, Edin), FACP, FIACM, FRSSDI MD (Medicine), FRCP (Lon/Glas/Edin./Ire.), FACP, FICP,
Senior Consultant, Internal Medicine, Kota FGSI, FDI, Dip. in Advanced Diabetology (Denmark)
Immediate Past President, Association of Physicians Consultant Physician and Diabetologist, Shilpa
of India (API) Medical Research Center, Mumbai
Editor-in-Chief – Journal of Association of
Physicians of India
Dr. Milind Nadkar On Editorial Board – Medicine Update,
MBBS, MD (Internal Medicine) International Journal of Diabetes
Professor and Head, Department of Medicine, Guest Editor – Insulight Journal,
Chief of Rheumatology Services, Seth GS Medical World Journal of Anaemia
College and KEM Hospital, Mumbai MRCP Examiner for Royal Colleges of Physicians UK
President, Association of Physicians of India (API)
Dr. Shashank R. Joshi

Dr. Agam Vora MD, DNB, DM (Endocrinology), FACC, FACE, FACP, FRCP
MD, Chest & TB, FICP, FCCP Consultant Endocrinologist, Lilavati Hospital, Mumbai
(USA) and (India), FGSI, FRCP (London) Honoured Padma Shri by the Government of India
Medical Director - Vora Clinic & Brahmakumari President of the Indian Academy of Diabetes,
Global Hospital, Mumbai
Chairman, AACE (India Chapter)
Hon. General Secretary, Association of
Past President of API, ESI, Past Dean of ICP
Physicians of India (API)
Dr. Jyotirmoy Pal Dr. Amit A. Saraf

MD, FRCP (London, Edinburgh, Glasgow),
MD, FRCP, FICP, FACP, WHO Fellow
FACP (Philadelphia), FICP, FCPS
Professor of Medicine, COM and Sagore Dutta
Director, Dept of Internal Medicine
Medical College, Kolkata
Jupiter Hospital, Mumbai
Dean, Indian College of Physicians
Hon. Treasurer, Association of
President Elect, Association of Physicians of Physicians of India (API)
India 2024 -25
03
Cardiological
Society of India
Dr. Vijay Harikisan Bang Dr. Pratap Chandra Rath
MBBS, MD, DM, FCSI, FESC, FACC, FSCAI (USA) MBBS, MD (General Medicine), DM (Cardiology)
Senior Interventional Cardiologist | Director and HOD Cardiology, Apollo Hospitals, Hyderabad
Heart Care Services and Bhubaneswar.
Fellow of American College of Cardiology, Fellow of the American College of Cardiology, European
Cardiological Society of India, European Society Society of Cardiology and Indian College of Cardiology.
of Cardiology, Society for Cardiac Angiography Visiting faculty of the Dept. of Cardiology, University of
and Intervention Rouen, France; Adjunct Professor in the School of
President of Cardiology Society of India (CSI) Medicine, The University of Queensland, Australia;
Honorary Visiting Professor – Gandhi Medical College,
Bhopal, Madhya Pradesh. Health Sciences, at the
Dr. Debabrata Roy University of Queensland, Australia, and the Apollo
Hospitals Educational and Research Foundation (AHERF).
MBBS, MD, DM (Cardiology) Course Director at Hyderabad Valves and the Course
Member of Cardiological Society of India, Association of Co-director at India Live, and Hyderabad Live.
Physicians of India, Indian Medical Association, American President Elect of Cardiology Society of India (CSI)
College of Cardiology, European Society of Cardiology,
Coronary Angiography and Intervention, American Heart
Association, American Heart Association, Secretary of
Cardiological Society of India-West Bengal branch.
Consultant at the prestigious Rabindranath Tagore
International Institute of Cardiac Sciences in Kolkata, India.
Honorary Secretary of Cardiology Society of India (CSI)
04
Clinical Infectious
Diseases Society
Dr. Venkatasubramanian Dr. Dilip Mathai
Ramasubramanian MBBS, MD, PhD, FCAMS, FRCP, (Lond),
FICP, FIDSA, Hon. FFTM RCPS (Glasg)
MD, FRCP (Glas), DTM & H (Lon), DGUM (Lon) Postgraduate Research Institute for
Fellow of the European Society of Clinical Microbiology Medical Education (PRIME)
& Infectious Diseases Pondicherry Institute of Medical Sciences (PIMS)
Fellow of the Infectious Diseases Society of America Puducherry
Director - The Capstone Clinic Madras Medical Mission (MMM) Hospital, Chennai
Consultant Infectious Diseases & Tropical Medicine, Director of Medical Education and Quality:
Apollo Hospitals Naruvi Hospitals, Vellore
Adjunct Prof Infectious Diseases - Sri Ramachandra Founder Director, Center for Infectious Diseases, Vellore
Institute of Higher Education & Research, The President, AIDS Society of India 2023
Tamilnadu Dr MGR Medical University, Saveetha Member Governing Council, Clinical Infectious Diseases
Medical College and Apollo Hospitals Educational & Society-India
Research Foundation Convener NBE, FNB - ID Specialty Board
Past President - Clinical Infectious Diseases Society Member ANBAI, Training the Trainers NBE Teachers Board
of India
Dr. Pricilla Rupali

MD, DTMH, FRCP
Senior Professor and Head of the Department of
Infectious Diseases at Christian Medical College
in Vellore, India.
Hon. Secretary, The Clinical Infectious
Diseases Society (CIDS)
05
Federation of Obstetric
and Gynaecological
Societies of India
Dr. Hrishikesh Pai Dr. Nandita Palshetkar
MD FRCOG (UK-ons) MSc (USA), FCPS, FICOG MD,FCPS, FICOG,FRCOG (UK)
Trustee, International Federation of Obstetrics & Medical Director and Founder Bloom IVF
Gynecology (FIGO)Asia Oceania Region 2023-25 Professor in OBGY at D. Y. Patil Medical College,
Prof of Reproductive Medicine, D Y Patil University Navi Mumbai
Medical Director, Bloom IVF Group Teacher for Super Specialty Degree, Reproductive
Consultant Gynecologist Lilavati Hospital Mumbai and Medicine MUHS
Fortis Hospital New Delhi and Mohali Organizing chairperson - AICOG 2025 Mumbai.
Immediate past President, Federation of Obstetrics (ALL INDIA CONGRESS OF OBSTETRICS & GYNAECOLOGY)
and Gynaecological Societies of India (FOGSI ) President – Federation of Obstetrics and Gynaecological
Societies of India - FOGSI (2019-2020)
President – Indian Society of Assisted Reproduction –
Dr. Jaydeep Tank ISAR (2022-2024)

President – Indian Association of Gynaecological
MBBS, MD, DGO, DNB, FCPS(Mid. & Gynae) Endoscopy – IAGE (2017-2018)
Obstetrician and Gynecologist, IVF Consultant President – Association of Maharashtra Societies of
Past Secretary General Federation of Obstetrics and Obstetrics and Gynaecology, AMOGS (2020 - 2022)
Gynaecological Societies of India (FOGSI) President – Mumbai Obstetrics and Gynaecological
Vice President, Mumbai Obstetrics and Society - MOGS (2016-2017)
Gynaecological Society (MOGS), Chairperson – Maharashtra Chapter of ISAR -
Chair, International Federation of Obstetrics and MSR (2016 - 2018)
Gynaecology (FIGO) Working Group for safe abortion. FOGSI Representative to FIGO (2022-Present)
Deputy Secretary, Asia Oceania Federation of FIGO Project Head - PPH – AMPLI
Obstetrics and Gynaecology (AOFOG)
Co-Chair - REI Committee of SAFOG
Ex Chair, Publication and News letter committee Asia
Oceania Federation of Obstetrics and Gynaecology
(AOFOG)
Ex Chair, Reproductive Endocrinology and Infertility Dr. Madhuri Patel
Committee – Asia Oceania Federation of Obstetrics MD, IVF specialist
and Gynecology (AOFOG) Gynecologist and Obstetricians Mumbai.
Ex Chairman, MTP committee (FOGSI) 2004 - 09. Secretary General, Federation of Obstetric and
Vice President, Forum For Enhancement of Quality in Gynaecological Societies of India (FOGSI)
Healthcare. (FEQH)
President Elect, of Federation of Obstetric and
Gynaecological Societies of India (FOGSI)
06
Geriatric Society of India
Dr. Kaushik Ranjan Das Dr. A K Singh
MBBS; DFM; DGC;PGCC(GM) Specialty: Internal Medicine
Founder Secretary, GSI Eastern Zonal Branch, Member of IMA
Founder Vice Chairman GSI West Bengal Branch. Member of IPA
President Geriatric Society of India. President Elect of Geriatric Society of India (GSI)
Dr. O. P. Sharma
MBBS, MD
Sr. Consultant, Geriatric Medicine at Indraprastha Apollo
Hospitals, New Delhi
Association of Physicians of India
Cardiology Society of India
Geriatric Society of India
Association of Gerontology, India
Honorary Secretary, Geriatric Society of India (GSI)
Heart Failure
Association of India
Dr. Abraham Oomman Dr. Harikrishnan
MD, DM (Cardiology)
DNB (Cardiology) MNAMS, FSCAI, FACC, FHFA Sivadasanpillai
Senior Consultant Cardiologist & HF Specialist, MD, MBBS, DM, FRCP Professor, Cardiology
Apollo Hospitals, Chennai Member of Pulmonary Vascular Research Institute, UK,
Presented Scientific Paper at the American Heart Cardiological Society of India
Association & European Society of Cardiology PH - LEADER (The Public Health Leadership and
Scientific Sessions. Implementation Academy) Programme - Emory University,
President, Heart Failure Association of India (HFAI) Atlanta, USA - 2014 -15.
Commonwealth Fellowship in Coronary Interventions,
Leeds University,U.K.-2005-6.
Past President, Heart Failure Association of India (HFAI)
07
Indian Association of
Preventive and Social Medicine
Dr. Madhu Gupta Dr. Lalit Sankhe
MBBS, MD (Community Medicine), PhD (Health, MBBS, MD
Medicine, Life Sciences, Maastricht University, The Associate Professor, Department of Community Medicine,
Netherlands), Member American Academy of Family Grant Medical College and Sir J.J. Group of Hospitals,
Physicians, FIAPSM, MIAPSM, MIPHA Mumbai
Professor of Community Medicine, Department of Member, Indian Association of Preventive and Social
Community Medicine and School of Public Health, Medicine (IAPSM)
Postgraduate Institute of Medical Education &
Research (PGIMER)
Chairperson, Indian Association of Preventive and
Social Medicine (IAPSM)
Dr. Veena Kamath

MBBS, MD
Head of the Department of Community
Medicine, Kasturba Medical College, Manipal
Member, Indian Association of Preventive and
Social Medicine (IAPSM)
Indian Chest Society ICS

INDIAN CHEST SOCIETY
Dr. Richa Gupta Dr. Deepak Talwar

MD, FCCP MD, DM, FCCP,
Professor and Head of the department of Senior Consultant & Chairman -
Respiratory Medicine, Christian Medical College Metro Respiratory Center Pulmonology & Sleep Medicine
Hospital, Vellore, TN. Member, Indian Society of Critical Care Medicine
Faculty, Academy for Infection Management
Member, International Society of
Critical Care Medicine (USA)
Member, European Society of Enteral &
Parental Nutrition (Europe)
Member, European Respiratory Society (Europe)
Instructor for FCCS Course
08
Indian Medical Association
Dr. R V Asokan Dr. Anilkumar
A practising General Physician running a 43 bedded
hospital, in Punalur, in Kollam district of Kerala State. J Nayak
Former Secretary General, IMA and Chairman, End TB
MBBS, MS (Orthopaedic) Gold Medalist
Initiative. He was the IMA State Secretary of Kerala
for 3 years and later it’s State President. Dean, Medical Faculty Hemchandracharya North Gujarat
University (HNGU), Patan
National President – Indian Medical Association (IMA)
Professor & Head of the Department, Department of
Orthopaedic Surgery, Banas Medical College and
Research Center, Palanpur, Banaskantha District Senator,
Dr. Jayesh Lele H.N.G. University, Patan
Hony. Secretary, Indian Red Cross Society,
Ex-National Secretary,
Mehsana District Branch
IMA Hospital Board of India, 2016-20
Co-ordinator, Indian Red Cross Society,
Hon. Secretary General, IMA HQ 2020-22
North Gujarat Zone
President IMA Maharashtra 2015-16
Hon. Secretary General, Indian Medical
Senior National Vice President, Indian Medical Association (IMA) Association (IMA)
Indian Rheumatology
Association
Dr. Chandrashekara S Dr. Vinod Ravindran
MD, DM (Clinical Immunology) MD, MSc-Rheumatology (UK),
Consultant Rheumatologist CCT-Rheumatology (UK), FRCP
ChanRe Rheumatology & Immunology Consultant Rheumatologist, Centre for
Center & Research, Bengaluru Rheumatology, Calicut, Kerala
President, Indian Rheumatology Association Adjunct Professor of Medicine, KMC, MAHE,
Manipal, Karnataka
Secretary, Indian Rheumatology Association
Dr. B G Dharmanand
MBBS, MD (Internal Medicine), DM
(Rheumatology/Clinical Immunology) Dr. Aman Sharma
Consultant Rheumatologist Manipal Hospital MD, FRCP(London)
Past President, IRA, Karnataka chapter Professor, Clinical Immunology and Rheumatology
Services, Department of Internal Medicine,
Immediate Past President, Indian Rheumatology
Postgraduate Institute of Medical Education
Association
and Research, Chandigarh.
President-Elect, Indian Rheumatology Association
09
Indian Society of
Critical Care Medicine
Prof. Sheila Nainan Myatra Dr. Rajesh Pande
MD, FCCM, FICCM B.SC, MBBS, MD, PDCC(Cardiac Anaesthesia), FCCM, FICCM
Professor of Critical Care Medicine, Tata Memorial Presently working as a Principal Director & HOD in Critical
Hospital, Mumbai, India. Care Medicine Department at BLK-Max Super Speciality
Chair of the Intensive & Critical Care Medicine Hospital, New Delhi.
Committee of the World Federation of Societies Consultant in Critical Care Medicine & Casualty
of Anaesthesiologists (WFSA) Co-ordinator: Sir Ganga Ram Hospital, New Delhi
President of the Indian Society of Critical Care Ex-Chairman, Indian Society of Critical Care Medicine,
Medicine (ISCCM) 2023-2024 Delhi-Noida Chapter
Ex-Vice Chancellor, Indian College of Critical Care Medicine
General Secretary National, Indian Society of
Critical Care Medicine
Indian Society of Nephrology

Dr. Sanjeev Gulati Dr. H.S Kohli
MBBS, MD(Paeds), DNB(Paeds) MD,DM,FAMS,FISN, FRCP (London)
DM(Nephrology), DNB(Nephrology) Nephrologist Renal Specialist,
Executive Director Nephrology and Kidney The Institute of Medical Education and
Transplant Fortis Group of Hospitals NCR Research General Hospital, Chandigarh, Punjab
Ex-Vice President, Indian Society of Organ Transplantation President Elect, Indian Society of Nephrology (ISN)
Secretary, North Zone Chapter of the
Indian Society of Nephrology
Ex-President, Delhi Nephrology Society Dr. Umesh Khanna
President, Indian Society of Nephrology (ISN) MBBS, DNB
Nephrologist/Renal Specialist Member,
Indian Society of Nephrology.
Dr. Shyam Bihari Bansal Member, Indian Society of Organ Transplantation.
DM, FISN, FISOT, FASN, FRCP (London) Member, National Kidney Foundation, India. Served
Former Secretary, Delhi Nephrology Society on the Managing Committee and as Chairman of
Executive member, Indian Society of Organ Transplantation Public Education Cell.
Director and Head, Department of Nephrology Assistant Editor, Journal of Renal Sciences.
Medanta-Medicity, Gurgaon Editorial Board member: Enigma - magazine of
Goregaon Medical Association.
Secretary, Indian Society of Nephrology
10
Indian Society of Oncology
Dr. Ramesh S. Bilimagga Dr. Rajendra Toprani

MBBS, MD MS, M Ch. (Surgical Oncology)
Medical Director of the HCG Group of hospitals. Senior Consultant, Head & Neck Surgical Oncologist
He was the National President AROI (Association of Director, Department of Surgical Oncology
Radiation Oncologists of INDIA). Senior Radiation Director, Aastha Oncology Associates
Oncologist with over thirty-seven years of experience Director, HCG Cancer Center, Ahmedabad
in the field. He is a Fellow of International College of
Surgeons (Indian Section) and Fellow of Indian College Trained Robotic Surgeon and underwent training for
of Radiation Oncology. Trans Oral Robotic Surgery (TORS) with Prof.
Weinstein at UPENN at Philadelphia in 2016.
President of Indian Society of Oncology (ISO)
Fellow at M.D. Anderson Cancer Centre, Houston,
USA. His areas of interest are Oral & Laryngeal
Cancers, Thyroid and Parotid Tumors. He has
Dr. Arvind Krishnamurthy expertise in voice preserving Laryngectomies and
MBBS-SB, DNB, MCh (Surgical Oncology), Trans Oral Endoscopic Laser Surgery (TOLS) for which
MS (General Surgery) he attended an advanced workshop in Endoscopic
Fellow of The International College Of Surgeons (FICS) Laser Surgery in Kiel, Germany in 2009.
Fellowship of Association Of Indian Surgeons (FAIS) President Elect of Indian Society of Oncology (ISO)
Member of Indian Medical Association (IMA), Association
Of Surgeons Of India (ASI), Indian Society Of Oncology
(ISO), Indian Association Of Surgical Oncology (IASO),
Association Of Foundation Of Head And Neck Oncology
(FHNO), Indian Association Of Bronchology (IAB), Indian
Thyroid Society (ITS), Indian Association Of Cardiothoracic
Surgeons (IACTS)
Honorary Secretary of Indian Society of Oncology (ISO)
11
Research Society for the Study
of Diabetes in India
Dr. Rakesh Kumar Sahay Dr. Sanjay Agarwal
MD, DM, FACE, FICP, FAMS MD, FACE, FACP
Associate Editor, IJDDC, Editorial board member of IJEM Head, Dept.of Medicine & Diabetes, Ruby Hall,
Immediate Past President, Head, Dept.of Diabetes, Obesity & Metabolic
Endocrine Society of India (2021-22) Diseases, Sahyadri Hospitals
President of South Asian Federation of Secretary General – Research Society for Study of
Endocrine Societies (2024-25) Diabetes in India (RSSDI)
Section Editor, Tropical Endocrinology,
Endotext – online textbook of Endocrinology
President, Research Society for Study of Diabetes in India
Dr. Brij Mohan Makkar

MD, FIAMS, FICP, FRSSDI, FRCP(GLASG,EDIN), FACP(USA), FACE(USA)
Member by invitation to American Diabetes Association,
A member of European Association for Study of Diabetes(EASD),
European Association for Study of Obesity(EASO),
and Canadian Obesity Research Network.
Immediate Past President of National Research Society for
Study of Diabetes in India (RSSDI)
12
Contents
Introduction....................................................................................14
Harmonization of Adult Immunization in India........................15
Method of Consensus Development..........................................16
High Risk Group..............................................................................16
What are Vaccines ? ......................................................................17
Anthrax.............................................................................................21
Chickenpox......................................................................................22
Chikungunya....................................................................................23
Cholera.............................................................................................24
Corona Virus Disease 2019 (COVID-19).....................................26
Diphtheria, Pertussis and Tetanus..............................................28
Haemophilus influenzae type b (Hib) Infection........................29
Hepatitis A.......................................................................................30
Hepatitis B.......................................................................................32
Human Papilloma Virus.................................................................33
Influenza..........................................................................................34
Japanese Encephalitis...................................................................35
Measles, Mumps and Rubella......................................................36
Meningococcal Disease.................................................................37
Pneumococcal Disease..................................................................38
Poliomyelitis....................................................................................40
Rabies...............................................................................................41
Respiratory Syncytial Virus..........................................................42
Typhoid.............................................................................................43
Shingles (Herpes Zoster)..............................................................44
Yellow Fever....................................................................................45
Closing the Gap: Bridging the Need for
Childhood Vaccines into Adult Healthcare................................46
Indian Consensus Recommendations.........................................47

Indian Consensus Recommendation for Risk Conditions.......54
Indian Consensus Recommendation Based on Age.................55
Upcoming Vaccines........................................................................58
Conclusion.......................................................................................62
Appendix..........................................................................................63
References.......................................................................................78
13
Introduction
One of the most economical public health deaths. This situation has serious implications
measures now accessible is vaccination. for the nation, highlighting the need to
Vaccines help protect the community by halting evaluate the need for adult vaccination.
the transmission of infectious diseases, in The need for adult immunization is crucial to
addition to preventing the vaccinated person protect individuals from vaccine-preventable
from contracting a potentially serious illness. diseases and reduce the burden of illness in the
Immunization is a tried and tested method of adult population. Here are some key reasons
managing and eradicating infectious diseases highlighting the importance of adult
that can be fatal. Furthermore, vaccination is immunization:
estimated to help avert between 2 and 3
million deaths annually.1 It is one of the health • Vaccines are effective in preventing various
initiatives with the highest return on infectious diseases, including but not limited
investment, and it can reach even the most to influenza, pneumonia, Shingles (Herpes
vulnerable populations. Zoster), hepatitis, and tetanus.
India has had a well-defined pediatric • VPD can lead to serious health
immunization schedule active since 1978. It is complications, hospitalizations, and even
one of the biggest vaccination campaigns in death, particularly in older adults or those
the world and is called the ‘Universal with underlying health conditions.
Immunization Program’ (UIP). • When a significant portion of the population
Every year, the UIP aims to immunize about is immunized, it creates herd immunity,
2.7 crore newborns with all primary doses and which provides indirect protection to those
an additional 10 crore children between the who are unable to receive vaccines due to
ages of one and five with booster doses. medical conditions or age.
Additionally, TT vaccinations are given to • Vaccines not only protect individuals but also
almost 3 crore expectant mothers annually. help in reducing the transmission of
The beneficiaries are immunized as part of 90 infectious diseases.
lakh vaccination sessions annually. • Adult immunization plays a crucial role in
The Government of India (GoI) observes 16 maintaining a healthy workforce and
March as National Vaccination Day to celebrate preventing disease outbreaks in community
the efforts towards paediatric vaccination. settings.
Considerable work is done in this field to • As individuals age, their immune systems
protect our children from Vaccine-Preventable may weaken, making them more
Diseases (VPD). That said, adult vaccination is susceptible to infections.
an area that is greatly neglected.
• As life expectancy increases and healthcare
The prevalence of diabetes and other metabolic becomes more accessible, the percentage of
Non-communicable Diseases (NCDs) in India is the population that is elderly also increases.
significantly higher than previously believed. Given that vaccine-preventable diseases are
Although the diabetes epidemic appears to be more likely to be contracted as a result of
stabilizing in the more developed states of the this demographic shift, immunization
country, it continues to rise in most other campaigns are crucial for
states.2
NCDs are associated with increased risk of reducing the risks infectious pathogens pose
infection and related hospitalizations and to the public health.
14
• International travel exposes individuals to increased need of immunization; also, inclusion
different infectious diseases prevalent in under reimbursement and insurance (both
other countries. public and private sector) schemes can play an
There is a pressing need to address the issue of important role as a milestone in making this
adult immunization in India. While several dream a reality in the foreseeable future. Since
aspects concerning the effectiveness, safety, the field of medicine is constantly evolving,
and financial implications of implementing physicians are advised to consult the most
adult vaccines at a national scale remain recent locally approved summary of product
unresolved, raising awareness among health characteristics (SmPC) or prescribing
planners and healthcare providers about this information before administering any vaccine.
important issue is important. Most major While every effort was made to provide the
health societies in India have rolled out their most stringent guidance to a clinician for
respective adult vaccine programs, however, a appropriate use of vaccines, local or regional
standardized schedule for adults is lacking. This outbreaks similar to the one experienced
is an attempt to have a standardized schedule during the COVID-19 pandemic can take us all
that one may refer to for adult immunization by surprise, so one is always advised to refer to
and a call to the Government of India (GoI) for the local, regional or national guidance for
inclusion of adult immunization in the ‘UIP’ with managing loco-regional outbreaks.
focus on specific high-risk subgroups in
Harmonization of
Adult Immunization in India
The synchronization of vaccination guidelines (IRA), Heart Failure Association of India (HFAI),
in India from different medical societies marks Cardiological Society of India (CSI), The
a significant step towards developing a rational Federation of Obstetric and Gynaecological
and systematic approach to vaccination. By Societies of India (FOGSI), Clinical Infectious
aligning recommendations and protocols from Diseases Society (CIDS), Indian Society of
different medical societies, the aim is to Oncology (ISO) and Indian Association of
formulate consistent and clear guidance for Preventive and Social Medicine (IAPSM).
healthcare professionals and the public. This concerted initiative does not merely
Representatives from multiple medical streamline vaccine distribution,
societies in India were invited to brainstorm administration and monitoring, but also
and collaborate to come out with a harmonized amplifies India's potential to aptly deal with
guidance document that one may refer to in public health challenges, creating a platform
times of need. Medical societies invited include for open communication and knowledge
Indian Medical Association (IMA), Research sharing between medical societies. The
Society for the Study of Diabetes in India establishment of a central coordination body
(RSSDI), Geriatric Society of India (GSI), Indian with representatives from different societies
Society of Nephrology (ISN), Indian Society of optimized the synthesis of this guidance
Critical Care Medicine (ISCCM), Indian Chest document. Government involvement is ess
Society (ICS), Indian Rheumatology Association
15
essential to create a regulatory framework vaccination as a standard procedure, allowing
that promotes collaboration and its integration into national and state-level
standardization. All reasonable efforts will be policies for the efficient application of
made to obtain endorsement for adult protocols.
Method of Consensus Development

Through the use of the Nominal Group on adult immunization and future vaccines.
Consensus methodology, these harmonization Through this initiative, national immunization
efforts guarantee an inclusive decision-making programs were to be in line with international
process in which the opinions of all guidelines, such as those provided by the
stakeholders are heard. This encourages a fairer Center for Disease Control (USA) and World
and better-informed consensus by preventing Health Organization (WHO). The literature
any one viewpoint from overshadowing others. review has established a strong basis for the
Currently, there can be confusion due to the creation of unified vaccination
disparate vaccination recommendations from recommendations in India by incorporating
multiple societies. important themes. Using a comprehensive
Recognizing the urgent need for approach guarantees that the
collaboration, the Association of Physicians of recommendations not only tackle the issues
India brought together various societies (as surrounding adult vaccination today, but also
mentioned above) and their representatives continue to be flexible in response to changes
for this harmonization project. Stakeholders in the field of vaccine development and
addressed the unique needs of various international immunization programs. The
patient groups served by different specialties consensus gains a practical aspect from the
in a series of in-person and virtual roundtable collaboration of medical societies, which
discussions, offering input in person or via makes them applicable and efficient in the
email. A thorough literature review was various healthcare environments throughout
conducted in the hope of creating unified the nation.
immunization guidance for India, with a focus
High Risk Group

In the adult population, a subgroup with a high Additionally, adults harbouring chronic medical
risk of vaccine-preventable diseases, are disorders, including cardiovascular, hepatic
individuals with compromised immune metabolic, or respiratory disorders, are at an
systems, such as those suffering from increased risk of serious outcomes following an
conditions like Human Immunodeficiency Virus infection. Advancing years, particularly beyond
(HIV) | Acquired Immunodeficiency Syndrome 65, increases vulnerabilities to certain diseases.
(AIDS), neoplastic disorders, or Chronic alcoholics (referred to as alcoholism in
post-transplantation states. the tables below) are at risk of a weakening
immune system and developing hepatic
16
disorders, making them susceptible to group, warranting specialized vaccination
infectious diseases. Healthcare professionals, strategies. For all these reasons, vaccination is
due to their occupational exposure, and crucial for protecting from illnesses that may
travelers to regions where particular diseases have serious consequences on an individual’s
are endemic, also fall within this high-risk health.
What are Vaccines?

Vaccines are biological substances that viruses), or fragments of those pathogens.
stimulate the immune system to develop Vaccines can also contain synthetic
immunity against specific diseases. They are components that mimic the structure of the
typically composed of weakened or inactivated pathogen.3
forms of pathogens (such as bacteria or
Types of Vaccines Available

1. Live Attenuated Vaccines
2. Inactivated or Dead Vaccines
3. Acellular or Subunit Vaccines

a. Toxoid Vaccines
b. Conjugate Vaccines
c. Split Virion Vaccine
d. Protein Subunit Vaccines
4. Recombinant Vaccines
a. mRNA vaccines
b. pDNA vaccines
5. Viral Vector vaccines
17
18
Figure 1. Vaccines development journey5
1st
polysaccharide
In-vitro vaccines
cell culture Meningococcus, Glycoconjugate
Salk and Sabin pneumococcus chemistry
polio vaccines Hib vaccine
1970’s
1st 1st
combination 1950’s 1980’s recombinant
vaccines antigen
Diphtheria, th entury vaccines
20 c
tetanus, HBV
pertussis 1948 1981
1st
Toxoid therapeutic
vaccines vaccines
Diphtheria 1900’s 2010 Prostate
and tetanus cancer
toxoids
1 9th c e
ury
nt
ury
nt
Reverse
Killed 1886 e vaccinology
21th century
vaccines 1 8th c 1721 Introduction 2013

of variolation Meningo-
Cholera, coccus B
plague, to Europe
typhoid 1885 from Asia
1762
st
Smallpox
1 live-
attenuated
vaccine 1st
successful
Live-attenuated vaccine
rabies
Smallpox
List of vaccines discussed in this consensus
1. Anthrax 18. Rabies
2. Chickenpox 19. Respiratory Syncytial Virus
3. Chikungunya 20. Measles
4. Cholera 21. Mumps
5. Corona Virus Disease 2019 22. Rubella
6. Diphtheria 23. Typhoid
7. Pertussis
8. Tetanus
9. Haemophilus Influenzae Type B 24. Shingles (Herpes Zoster)
10. Hepatitis A 25. Yellow Fever
11. Hepatitis B
12. Human Papilloma Virus
13. Influenza
14. Japanese Encephalitis
15. Meningococcal
16. Pneumococcal
17. Poliomyelitis
19
Inactivated Live-attenuated mRNA | Subunit, Toxoid Viral vector
vaccines vaccines pDNA vaccines recombinant, vaccines vaccines
polysaccharide,
and conjugate
vaccines
Hep A Chickenpox COVID-19 Hib Diphtheria COVID-19
Influenza Chikungunya Hep B Tetanus
(Injectable only) Influenza HPV
Polio Japanese Encephalitis Pertussis (Tdap)
(Injectable only) MMR Pneumococcal
Rabies Smallpox Meningococcal
Yellow fever Shingles
(Herpes Zoster)
20
Anthrax
Vaccine type: Cell-free filtrates of microaerophilic cultures of an avirulent, nonencapsulated

strain of Bacillus anthracis. Live Attenuated Vaccine
Route of administration: Intramuscular (IM) for preexposure | Subcutaneous (SC) for postexposure
Dose: 0.5 mL | 0, 1, and 6 months | Booster if risk persists: 6 months after primary dose series
Storage: 2°C – 8°C
Guideline recommendations for Anthrax Vaccine in adults
API6 RSSDI7 ISN8 GSI9 IMA10 FOGSI11,12 NHM13 CDC14,15
- - - - - - - People at increased
risk of exposure or
have been exposed
Indian Consensus Recommendations:
Age 18 - 49 years
Age
≥50 Pregnancy Immuno- HIV Asplenia, CKD| Heart| CLD| DM HCP Traveller Mass
yrs compromised infection complement HD lung alcoholism gathering
deficiencies disease
NR NR NR NR NR BR BR BR BR BR BR NR
R: Recommended | NR: Not recommended | BR: May be considered after benefit risk evaluation | AR: With additional risk |
CKD: Chronic kidney disease | HD: Haemodialysis | DM: Diabetes mellitus | CLD: Chronic liver disease | HCP: Health care personnel |
CV: Cardiovascular | ICU: Intensive care unit
Key considerations:
• Not recommended for general use, should only be used in people at increased risk of exposure or in people
who have been exposed
• Livestock handlers in endemic areas
• Laboratory workers at risk of exposure
• Pre-exposure prophylaxis for adults aged 18–65 years at high risk for exposure, intramuscularly (IM) at 0, 1, and
6 mo. with boosters at 6 and 12 mo. after completion of the primary series and at 12-month intervals thereafter
if the risk persists
• Post-exposure prophylaxis in combination with antimicrobials for adults aged 18–65 years with suspected or
known exposure subcutaneously (SC) at 0, 2, and 4 weeks
21
Chickenpox
Vaccine type: Live attenuated

Route of administration: Intramuscular injection (IM)
Dose: 2 doses 0.5 ml at least 4-8 weeks apart
Storage: Should be stored between 2°C and 8°C.
Guideline recommendations for Chickenpox vaccines in adults
API6 RSSDI7 ISN8 GSI9 IMA10 FOGSI11,12 NHM13 CDC14
At risk At risk Recommended At risk If no Preconception At risk At risk
-OR- No evidence of or not
evidence of immunity recommended
immunity during
pregnancy
Age 18 - 49 years
Age
NR NR NR NR R R R R R R NR NR
Key considerations:
• Routinely recommended in adults without evidence of immunity
• Recommended in adults who are at potential risk of exposure such as Individuals or students residing in hostel,
HCPs and household contacts
• Post-exposure vaccination: Recommended within a few days to a few weeks of exposure.
• Incomplete vaccination: One dose
• Not-vaccinated: Two doses
22
Chikungunya
On the 9th of November ’23, USFDA approved the first chikungunya vaccine, for individuals 18 years of age and
older who are at increased risk of exposure to chikungunya virus; following two clinical studies conducted in North
America in which about 3,500 participants 18 years of age and older received a dose of the vaccine with one study
including about 1,000 participants who received a placebo.16

Dose: 0.5 mL | 1 dose
Contraindication: History of allergic reaction to any component of the vaccine, immunodeficient or
Immunosuppressed due to disease or medical therapy (e.g., from hematologic and solid tumors, receipt of
chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV
infection who are severely immunocompromised).
Guideline recommendations for Chikungunya vaccines in adults

- - - - - - - -
Age 18 - 49 years
Age
R NR NR NR NR BR BR BR BR BR R BR
Key considerations:
• For individuals 18 year or older at increased risk of exposure to chikungunya virus
**Not yet approved | available for clinical use in India**
23
Cholera
Killed Whole-Cell Killed Whole-Cell Killed Whole-Cell Live

Monovalent (O1) Bivalent (O1 and Bivalent (O1 and Attenuated
Vaccine with a O139) Vaccine O139 without Vaccine CVD
Recombinant without the Cholera Toxin B 103-HgR
Cholera Toxin B Cholera Toxin B Subunit) BivWC
Subunit WC-rBS Subunit BivWC
Route of Oral Oral Oral Oral
administration
Recommended 2 doses in adults 2 doses at an 2 doses at an Single dose;

age of and children ≥6 interval of 2 weeks; interval of 2 weeks ≥10 days before
vaccination years of age, 3 earliest onset of potential
doses for children protection 7–10 exposure
aged <6 years; ≥1 days after
week before completion
potential exposure
2 doses in adults
and children ≥6
years of age, 3
doses for children
aged <6 years; ≥1
week before
potential exposure
Recommended Adults and children Adults and children Adults and children Adults and
age of ≥2 years of age ≥1 year of age ≥1 year of age children aged
vaccination ≥6 years
24
Cholera
Route of administration: Oral

Guideline recommendations for Cholera vaccine in adults
18–65 years (1 dose - 2 doses - At risk - All age groups 18–65 years
if traveling to 1-6 weeks (2 doses) (In a resource-limited (1 dose if traveling
an endemic region) apart set up prioritize to an endemic
high-risk group) region)
Age 18 - 49 years
Age
NR NR NR NR NR NR NR NR NR BR R R
Key considerations:
• Routine administration is not recommended
• Recommended as 2 doses, at least 2 weeks apart only in:
• Travelers
• Potential exposure to cholera patients
• Exposure to contaminated water and food, particularly those staying in areas with limited access to health care
facilities
• During natural calamity
• During endemic|outbreak
25
Corona Virus Disease 2019 (COVID-19)
List of COVID-19 Vaccines Approved by CDSCO in India17

Vaccine Age group and dosing schedule Route & storage
ChAdOx1 nCoV-19 Corona Virus vaccine For ≥18 years age Intramuscular, 2-8°C
Recombinant) (COVISHIELD) Two doses, 4 to 6 weeks apart
(Overseas Data available for 12 weeks)
Whole-Virion Inactivated SARS-CoV-2 For ≥18 years age Intramuscular, 2-8°C
Vaccine (COVAXIN) Two doses, Day 0 & 28
Gam COVID Vac (component I & II) For ≥18 years age Two doses, Intramuscular, -18°C
(SPUTNIK-V) Day 0 (comp I) & Day 21 (comp II)
mRNA-1273COVID-19 vaccine For ≥18 years age Intramuscular,
(Moderna vaccine) Two doses, Day 0 & 28 -25ºC to -15ºC
COVID-19 vaccine (Ad26.COV2-S) For ≥18 years age Intramuscular,
[recombinant] ( Janssen Vaccine) Single dose -25ºC to -15ºC & 2-8°C
Novel Corona Virus-2019-nCov vaccine For ≥12 years age Intradermal, 2-8°C
(recombinant DNA) (ZyCoV-D) Three doses (Day 0, 28 and 56)
Gam COVID Vac (component I & II) For ≥18 years age Two doses, Day 0 Intramuscular, -18°C
(SPUTNIK-V) (comp I) & Day 21 (comp II)
Whole-Virion Inactivated SARS-CoV-2 For 12 to 18 years age Intramuscular, 2-8°C
Vaccine (COVAXIN) Two doses, Day 0 & 28
>6 to <12 years
Two doses, Day 0 & 28
SARS-CoV-2 vaccine containing Receptor For ≥18 years age Two doses, Day 0 & 28 Intramuscular, 2-8°C
Binding Domain (RBD) of SARS-CoV-2
gene (CORBEVAX) For ≥12 years age Two doses, Day 0 & 28
>5 to <12 years – Two doses, Day 0 & 28
SARS-CoV-2 rS Protein (COVID-19) For ≥18 years age Intramuscular, 2-8°C
recombinant spike protein Nanoparticle Two doses, Day 0 & 21
Vaccine [COVOVAX]
For ≥12 years age
Two doses, Day 0 & 21
Recombinant adenoviral vector vaccine For ≥18 years age Intramuscular, -18°C
containing particles of S gene of the Single dose
SARS-CoV-2 virus (SPUTNIK Light)
Lyophilized mRNA Vaccine for Injection For ≥18 years of age Intramuscular, 2-8°C
(COVID-19) [HGCO-19] Two doses, Day 0 & 28
BBV154 - Adenovirus vectored, For ≥18 years of age Intranasal
intranasal vaccine (iNCOVACC)
26
Corona Virus Disease 2019 (COVID-19)
Guideline recommendations for COVID-19 vaccines in adults

2-dose series - At risk - - 2-dose series 2-dose series 2 or 3 dose series
followed by (2 doses) even during followed by booster followed by booster
booster in special pregnancy in special situations in special situations
situations
Age 18 - 49 years
Age
R R R R R R R R R R R R
Key considerations:
• At the time of pandemic or local epidemic situations: Routine administration is strongly recommended for all,
even during pregnancy – 2 doses – at least 4 weeks apart
• Additional booster doses: for all older adults and adults with significant comorbidities or severe obesity (high
priority-use group) – At least 12 mo. after the previous dose
Note:
• The recommendations for use are limited to pandemic or local epidemic situations only. Please refer to the latest
government recommendations for the frequency of repeat| booster doses.
• There are no head-to-head to head studies comparing the different vaccines available for the prevention of
COVID-19, please check local availability and the most recent government notification for the selection of vaccine.
27
Diphtheria, Pertussis and Tetanus (Tdap)
Vaccine type: Tdap: Diphtheria and tetanus toxoids and acellular pertussis antigens | Td: Diphtheria
(reduced dose) and tetanus toxoids
Dose: 0.5 ml | 1 dose 10 yearly
Contraindication: History of allergic reaction
Guideline recommendations for Tdap vaccines in adults
If not Recommended 1. If not vaccinated, 3 Tdap for If not Pre-concepti If not If not
vaccinated doses of Td at 0,1 all adults vaccinated onal period vaccinated vaccinated
immediately, and 6-12 mo. apart, aged 65 immediately, if at risk immediately, immediately,
then every TdaP can be used as years and then every Tdap during then every then every
10 years one of the doses, older 10 years pregnancy 10 years. 10 years
then every 10 yrs. During
2. For age ≥65 yrs pregnancy
administer the first 2 doses of TT
dose of TdaP
followed by Td every
10 yrs.
Age 18 - 49 years
Age
Vaccine ≥50 Pregnancy Immuno- HIV Asplenia, CKD| Heart| CLD| DM HCP Traveller Mass
Td R BR R R R R R R R R R R
Tdap BR R BR BR BR BR BR BR BR BR R BR
Key considerations:
• Un-vaccinated: 1 dose of Tdap, then 1 dose of Td or Tdap 4 weeks later, and a third dose of Td or Tdap 6–12 mo.
later (Tdap preferred as the first dose), with Td or Tdap every 10 years thereafter.
• During each pregnancy, it is recommended to receive one dose of Tdap, preferably between the gestational
weeks of 27 and 36.
• Wound management: 3+ doses of tetanus-toxoid vaccine - Tdap|Td if >10 years since last dose for clean|minor
wounds, >5 years for other wounds. Prefer Tdap for those without previous Tdap history.
28
Haemophilus influenzae type b (Hib) infection
Vaccine type: Lyophilized killed | Conjugate Vaccine (capsular polysaccharide bound to carrier protein)
Available as: Pentavalent|bivalent combination or hexavalent injection

Dose: 0.5 ml | 1 dose | For HSCT Recipients 3 doses at least 4 weeks apart
Guideline recommendations for Hib vaccines in adults
At risk* - At risk* - At risk* - Not At risk*
(1 or 3 doses) (1 dose) (1 or 3 doses) recommended (1 or 3 doses)
*At Risk: asplenia, HIV, hematological malignancies, corticosteroid use, CSF leak, trauma, diabetes,
pregnancy, alcoholism, immunosuppression due to bone marrow or kidney transplant, cancer, radiation, or
chemotherapy should be vaccinated.

Age 18 - 49 years
Age
R - R (3 doses AR AR R R R R NR NR NR
for HSCT)
Key considerations:
• Vaccination is a part of primary immunization
• Adults at high risk such as patients with immunocompromised state, CSF leak, trauma, diabetes, pregnancy,
alcoholism, cancer, radiation, or chemotherapy: 1 dose
• Elective splenectomy If unvaccinated: 1 dose (at least 14 days before splenectomy)
• Functional or anatomic asplenia If unvaccinated: 1 dose
• HSCT Recipients: 3 doses at least 4-week intervals; 6–12 mo. after transplant, regardless of Hib vaccine history
29
Hepatitis A
Available vaccines and relevant population to receive them.

Protects against Dosing schedule Relevant populations
HAV Two doses 6 mo. apart Age 19 years and above

HAV Two doses 6 mo. apart Travel to endemic area
Vaccine type: Inactivated vaccine

Dose: 0.5 ml | 2 doses, 6 months apart
Contraindicated during pregnancy
Guideline recommendations for HepA vaccines in adults
At risk* Recommended At risk* - Adults (1 dose of - Not At risk*
(2 doses, (2 doses, live or 2 doses of recommended (1 or 3 doses)
6 mo. apart) 6 mo. apart) inactivated at 0
& 6 mo.)
*At Risk: Chronic liver disease (e.g., persons with hepatitis B, hepatitis C, cirrhosis, fatty liver disease,
alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate
aminotransferase [AST] level greater than twice the upper limit of normal), Undergoing liver transplant,
HIV infection, Men who have sex with men, Injection or non-injection drug use, Persons experiencing
homelessness, Work with hepatitis A virus in research laboratory or with non-human primates with
hepatitis A virus infection
30
Hepatitis A

Age 18 - 49 years
Age
AR AR AR R AR AR AR R AR AR AR NR
Key considerations:
• At risk for hepatitis A virus infection: 2-dose series HepA 6–18 mo. apart or 3-dose series HepA-HepB (0, 1, 6 mo.
[minimum intervals: dose 1 to dose 2: 4 weeks | dose 2 to dose 3 – 6 mo.])
• Travel in countries with high or intermediate endemic hepatitis A (HepA-HepB may be administered on an
accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 mo.)
• Booster dose if required, should be given at any time between 6 mo. and 5 years, but preferably between 6
and 12 mo.
31
Hepatitis B
Vaccine type: Recombinant DNA or plasma-derived inactivated subunit vaccine

Route of administration: Deep Intramuscular injection (IM) in the Deltoid region; avoid buttocks
Dose: 1 ml | 3 doses at 0, 1, 6 months
Storage: Stored between 2°C and 8°C.
Note: Revaccination is recommended every 5 years for high-risk individuals (Immunocompromised,
HCPs, CKD on hemodialysis etc.)
Contraindication: History of allergic reaction | allergic reaction Baker’s yeast
Guideline recommendations for HepB vaccines in adults
At risk* (3 For 19-59 years At risk* - Adults (3 doses Preconception At risk* -OR- At risk* (2, 3, or
doses at 0, 3 dose series is (3 doses) at 0, 1 & 6 mo.) or at high risk seeking 4 doses
1 & 6 mo.) recommended; during protection depending on
Revaccinati for ≥60 years 3 pregnancy (including the type of
on every 5 dose series can post-exposure vaccine)
years be considered prophylaxis)
*At Risk:
• Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease,
autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater
than twice the upper limit of normal)
• HIV infection
• Men who have sex with men
• Injection or non-injection drug use
Age 18 - 49 years
Age
AR R R R R R R R R R R NR
Key considerations:
• At risk for hepatitis B virus infection: 3-dose series HepB (0, 1, 6 mo. [minimum intervals: dose 1 to dose 2: 4
weeks | dose 2 to dose 3 – 6 mo.])
• Travel in countries with high or intermediate endemic hepatitis A (HepA+HepB may be administered on an
accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 mo.)
32
Human Papilloma Virus
Vaccine type: Recombinant protein capsid liquid vaccine

Vaccines available in India: Bivalent (HPV2) protects against HPV 16 and 18 | Quadrivalent (HPV4)
protects against HPV 6,11, 16 and 18 | Nanovalent (HPV9) protects against HPV 6,11
Dose: 1 ml | 2 or 3 doses at 0, 1 & 6 months
Note: There is currently no recommendation for HPV use in pregnancy.
Consider delaying HPV until after pregnancy
Guideline recommendations for HPV vaccines in adults
Women ≤26 Can be 9–14 years: 2 - Females 9–14 9–26 years; Females Age ≥15 yrs.:
years (3 doses); considered doses 6 mo. years: 2 doses next dose(s), before the 3-doses at 0,
men ≤21 years apart >15 years, 0, 6 mo.; 15–45 Delay after onset of 1–2 mo., 6 mo.)
(3 doses) 3 doses at 0, 1, years: 3 doses pregnancy sexual activity
and 6 mo. (0, 1-2 & 6 mo.) (3 doses)
Age 18 - 45 years
Age
NR NR R R R R R R R R NR NR
Key considerations:
• Before the first sexual encounter
• HPV vaccination is advised for all people up to age 26: Depending on the age at the first immunization or the
condition, a 2- or 3-dose series:
• Age 15 or older at the time of the initial vaccination: 3-dosage series given over the course of 0, 1, and 6 mo.
(minimum intervals: 4 weeks between doses 1 and 2, 12 weeks between doses 2 and 3, and 5 mo. between
doses 1 and 3; repeat dose if given too soon).
• Age 9 to 14 years at the time of the initial vaccination and 1 or 2 doses given no more than 5 mo. apart: 1 extra
dosage -Aged 9 to 14 at the time of the first vaccination and 2 doses received at least 5 mo. apart: Complete
HPV vaccine series; no further dose is required
• Adults age 27–45 years: Based on shared clinical decision-making, 2- or 3-dose series as above
• Immunocompromising diseases: Such as HIV infection: 3-dose series, even for those who start immunization at
age 9 to 14
**All above recommendations are for females <45 years of age and before the first sexual encounter**
33
Influenza
Vaccine type:
• Inactivated Influenza Vaccine (IIV) includes recombinant trivalent and quadrivalent influenza vaccines.
Intra Muscularly route
• Live attenuated influenza vaccine (LAIV). Intranasal Route
Dose: 0.5 ml | 1 dose | Annually
Coadministration:
If 2 or more of the following live virus vaccines are to be given – LAIV, MMR, Var, and|or yellow fever they should
be given on the same day. If they are not given on the same day, space them by at least 28 d (30 d for yellow
fever). Other inactivated and subunit e.g., PCV13, Shingles (Herpes Zoster) etc. can be added as needed| indicated.
Contraindications for LAIV:
Age ≥50yrs, pregnant women, history of allergic reaction to any excipients of the vaccine or eggs,
immunocompromised, received antiviral therapy in ≤48hrs, caregivers of immunocompromised patients
requiring isolated environment, patients with asthma, Guillain Barre Syndrome, chronic conditions, etc.
Guidelines Recommending the Influenza Vaccine
Yearly (1 dose); Yearly 1 dose Yearly Routinely Yearly, at risk, At risk, Not Yearly (1
Also, during (1 dose) for at risk, once a including during including recommended dose); during
pregnancy (IIV) including during year pregnancy (IIV) during pregnancy
pregnancy (IIV) pregnancy (IIV) (1 dose)
Age 18 - 49 years
Age
IIV|RIV R R R R R R R R R R R R
LAIV NR NR NR NR NR BR BR BR BR R R R
Key considerations:
• Adults who have not received the vaccine should continue to receive it throughout the entire influenza season, especially
during times when the virus is active in the neighbourhood e.g. before the monsoon season in South India or before the
winter season in Northern India
• All adults, including pregnant women: 1 dose annually
• All adults: IIV or RIV4 -OR- • For adults up ≤49 yrs age: LAIV
Note: Close contacts and caregivers who care for severely immunocompromised persons (i.e., those who require
care in a protective environment) should receive IIV, ccIIV, or RIV rather than LAIV.
At the time of preparing these guidelines trivalent influenza vaccine is not available in India, if and when available trivalent
vaccine should be preferred over tetravalent vaccine, as B/Yamagata strains have not been found in India since March 2020.
Although there has been co-circulation of two influenza B virus lineages in past, B/Yamagata-lineage circulation has not been
verified since March 2020. The use of quadrivalent live-attenuated vaccines may lead to its detections. All type B viruses
identified after March 2020 have been linked to the B/Victoria lineage. A global effort is required to identify the lineage of type
B influenza viruses in order to determine whether or not B/Yamagata-lineage viruses are extinct
34
Japanese Encephalitis

Route of administration: subcutaneous injection (SC)
Dose: 0.5 ml | Inactivated vaccine: 2 doses at least 4-week apart
Contraindication: Pregnancy
Note: Live vaccine should not be given during epidemic season
Guideline recommendations for JE vaccines in adults
- - - - One dose, Delay - Not Inactivated vaccine: 2 doses at 4-week
pregnancy by 3 recommended gap starting the primary series at≥6
mo., Live vaccine months of age in endemic settings*
should not be
For immunocompromised individuals,
given during
Healthcare workers and Migrants to JE
epidemic season
endemic area.

Age 18 - 49 years
Age
BR BR BR BR BR BR BR BR BR AR R BR
Key considerations:
• Vaccination is recommended for travelers who plan to stay in endemic areas for a month or longer during the
transmission season, even if they stay primarily in urban areas.
• For short-term travelers (less than a month), vaccination should be considered if they plan to spend long periods
outdoors in rural or agricultural areas, engage in outdoor activities, or be in areas without adequate protection such
as air conditioning, screens, etc. or mosquito nets.
• It should also be considered for travelers visiting areas with ongoing outbreaks or uncertain travel destinations,
activities and travel duration.
• However, vaccination is not currently recommended for short-term travelers whose plans relate exclusively to
urban areas.
• Can be administered during Kumbh Melas if stay is longer than 1 month.
• Patients with chronic illness or immunodeficiency who live in or move to endemic areas.
• Pregnant women traveling or staying in endemic areas always weigh the benefit-risk ratio before administration
35
Measles, Mumps and Rubella
Vaccine type: Live-attenuated combined vaccine

Available Combinations: MR= Measles & Rubella | MMR= Measles, Mumps & Rubella |
MMRV= Measles, Mumps, Rubella & Varicella
Route of administration: subcutaneous injection (SC)
Dose: 0.5 ml | 2 doses 4 weeks apart
Precautions
• Moderate or severe acute illness with or without fever.
• If blood, plasma, and|or immune globulin were given in past 11 mo., wait for 3 mo. before vaccinating.
• History of thrombocytopenia or thrombocytopenic purpura.
Note: The MMR vaccine is not advised if the patient is pregnant because it is a live attenuated vaccine and could
potentially harm the foetus. But in case a pregnant woman receives the MMR, the pregnancy should NOT be
terminated on that basis since, there is no proof that the MMR or MMRV vaccines pose a teratogenic risk.
Pregnant women may receive the MMR vaccine during measles or rubella outbreaks since the possible
advantages of vaccination outweigh the dangers. Since the MMR vaccine is safe during breastfeeding,
non-immunized patients should receive it after delivery.
Co-administration: If 2 or more of the following live virus vaccines are to be given – MMR, LAIV, Var, and| or
yellow fever – they should be given on the same day. If they are not given on the same day, space them by at
least 28 d (30 d for yellow fever). May use as post-exposure prophylaxis if given within 3 d of exposure.
Guideline recommendations for MMR vaccines in adults
26–55 years - Unimmunized - 2 doses 4-8 MMR for routine 2 doses of Rubella vaccine 19–59
(2 doses 28 (1 dose) weeks apart, preconception| - HCPs; in the setting of years
days apart) if previously postnatal outbreaks; recent exposure (1 or 2
immunised (pregnancy should to these infections | doses)
1 dose be deferred women in child bearing
for 3 mo.) age; and college students.
Age 18 - 49 years
Age
NR NR NR NR R BR BR BR BR R NR NR
Key considerations:
• Is part of routine vaccination
• If unvaccinated: 2 doses at least 4 weeks apart
• If woman of childbearing-age is found to be rubella susceptible and is not pregnant, give 1 dose of MMR; if she
is pregnant, the dose should be given postpartum
36
Meningococcal disease
Vaccine type: Purified bacterial capsular polysaccharide (PBCP) | Conjugate Vaccine

Route of administration: PBCP Subcutaneous | Conjugate vaccine intramuscular injection (IM)
Dose: 0.5 ml | 1 dose
Guideline recommendations for Meningococcal vaccines in adults
At risk* - High risk Travelers - Adults (1 dose); - Not Adolescent or
(Immunoco and epidemic At risk* (2 doses recommended Travelers to high risk
mpromised <16 years: 2 doses 4 weeks apart) countries: 1 dose
individuals, >16 years: Single At risk* 2 dose
high-risk dose series, at least
travelers 8 weeks apart,
and mass booster every
gatherings): 5 years if risk
1 dose continues
*At Risk:
International travelers, Men who have sex with men, People who use or inject drugs (all those who use
illegal drugs), People with occupational risk for exposure, People who anticipate close personal contact
with an international adoptee, People experiencing homelessness, People with CLD & People with HIV
Age 18 - 49 years
Age
Men
ACWY AR AR AR R R AR AR AR AR AR R R
Key considerations:
• Dose 0.5cc Subcutaneous injection given in 1 dose in most adults
• Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement compo-
nent deficiency, complement inhibitor (e.g., eculizumab, ravulizumab): 2-dose at least 8 weeks apart and
revaccinate every 5 years if risk remains
• Travel to countries with hyperendemic or epidemic meningococcal disease, or mass gatherings, or microbiolo-
gists routinely exposed to Neisseria meningitidis: 1 dose and revaccinate every 5 years if risk remains
• First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older)
or military camps: 1 dose
• It is recommended only up to the age 55 years
37
Pneumococcal Disease
Vaccine type:
• Pneumococcal Polysaccharide Vaccine (PPSV):
It provides protection against 23 serotypes of Streptococcus pneumoniae serotypes viz.;
1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F.
• Pneumococcal Conjugate Vaccine 13 (PCV13): PCV13 provides protection against 13 serotypes of
S. pneumoniae viz.; 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14,18C, 19A, 19F and 23F.
S. pneumoniae viz.; 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F and 33F.
S. pneumoniae viz.; s 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F.
Note:
According to research by Greenberg et al. among treatment-naive individuals an initial single dose of
PCV13 increases the anti-pneumococcal response to subsequent administration of PPSV23 for several
common vaccine serotypes. This happens because the conjugated PCV13 vaccination, when given
sequentially with PPSV23, recalls and enhances the immune response. On the other hand, following
administration of PCV13 for all serotypes results in a reduced response when PPSV23 is first adminis-
tered before PCV13. The study assisted in offering a plausible justification for the advice to administer
PCV13 first and PPSV23 later.19
**PCV15 and PCV20 are currently not registered | available in India**
Route of administration: PPSV: Intramuscular or subcutaneous injection | PCV13: intramuscular injection

Dose: PCV13- 0.5ml | PPSV23- 0.5ml | 1 dose of PCV13 followed by PPSV23 1 year later
Co-administration: Adults can receive pneumococcal vaccines (any PCV13 or PPSV23) with herpes zoster
vaccines, seasonal influenza vaccines etc. at the same time if required.
Guideline recommendations for Pneumococcal vaccines in adults
API6 RSSDI7 ISN8 GSI9 IMA10 ICS20 NHM13 CDC14
≥19 years ≥50 years: ≥19 years: For >50 Adults Adults ≥19 Not routinely Not previously received a
(Chronic 1 dose Single years (1 dose); years with recommended dose of PCV13, PCV15, or
conditions, PCV13 dose of PCV13 At risk* chronic PCV20 or whose previous
Immunocom followed PCV13 first followe (2 doses conditions vaccination history is
promised): by PPSV23 followed d by 4 weeks and unknown: 1 dose PCV15
1 dose PCV13 (1 year by PPSV23 PPSV23 apart) Immunocomp OR 1 dose PCV20.
followed by later) after 8 (one romised If PCV15 is used,
PPSV23 8 Booster: weeks. year conditions: administer 1 dose PPSV23
weeks later. if needed Administe gap) A single dose at least 1 year after the
≥5 years r 1 dose of PCV13 is of PCV13 PCV15 dose (may use
≥50 years: after PPSV23 ≥5 recomm followed by
1 dose PCV13 previous minimum interval of 8
years ended PPSV23 ≥ 8 weeks for adults with an
followed by PPSV23 later. in all weeks later is
PPSV23 immunocompromising
dose adults > recommended condition).
(1 year later) 50 years
38
Pneumococcal Disease

Age 18 - 49 years
Age
R - R R R R R R R AR R R
Key considerations:
• Recommended for all, especially those with increased risk irrespective of age (for adults) 1 dose of PCV13
followed by PPSV23 1 year later
• Above 50 years: PCV 13 followed by PPSV23, 1 year later
• At-risk: PCV 13 followed by PPSV23, 1 year later
• High-risk: PCV 13 followed by PPSV23, 8 weeks later
• PCV15 and PCV20 are recommended for adults (Once Approved & Available)
• Above 50 years: 1 dose of PCV20 only, OR PCV 15 followed by PPSV23 1 year later
• At-risk: 1 dose of PCV20 only, OR PCV 15 followed by PPSV23 1 year later
• High-risk: 1 dose of PCV20 only, OR PCV 15 followed by PPSV23 8 weeks later
39
Poliomyelitis
Vaccine type: Live Attenuated (OPV) | Inactivated Polio Vaccine (IPV)

Route of administration: OPV Oral | IPV intramuscular injection (IM)
Dose: IPV 0.5 ml | OPV: 2 drops | 3 doses 0, 1 and 6-12 months
Storage: IPV: Should be stored between 2°C and 8°C OPV: Highly heat sensitive and should be kept
frozen during storage (after thawing it can be kept between 2 °C and 8 °C for up to 6 mo.)
Contraindication: Pregnancy
Guideline recommendations for Polio vaccines in adults
IPV: 3 doses Recommended Unimmunized: 3 - 2 doses - Not routinely At risk*
(6, 10-14 weeks)- doses of IPV|OPV of IPV recommended (3 doses 0,
>2mo. of age IPV- spaced by 1 month 1-2 & 6-12 mo.)
bOPV schedule-1 or 2 Immunized: Single
doses of IPV followed dose of IPV
by ≥2 doses of bOPV
*At Risk:
Travelers who are going to countries where polio is an epidemic or endemic (For additional information,
see Polio: For Travelers), Laboratory and healthcare workers who handle specimens that might contain
polioviruses, Healthcare workers or other caregivers who have close contact with a person who could be
infected with poliovirus, Adults who are identified by public health authorities as being part of a group or
population at increased risk of exposure because of an outbreak.
Age 18 - 49 years
Age
NR NR NR NR NR NR NR NR NR BR R NR
Key considerations:
• Previously vaccinated: one lifetime booster dose of IPV
• Travelers to countries where polio is an epidemic or is endemic.
• Laboratory and healthcare workers who handle specimens that might contain polioviruses.
• Healthcare workers or other caregivers who have close contact with a person who could be infected with poliovirus.
• Unvaccinated or incompletely vaccinated adults: 3 doses
• First dose at any time, followed by second dose at least 1 month later & third dose 6-12 mo. after second dose
40
Rabies
Categories of contact with suspect rabid animal21

Category I - Touching or feeding animals, animal licks on intact skin (no exposure)
Category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure)
Category III - single or multiple transdermal bites or scratches, contamination of mucous membrane or
broken skin with saliva from animal licks, exposures due to direct contact with bats (severe exposure)
Vaccine type: Concentrated, purified cell culture & embryonated egg-based vaccine
Available as: Human diploid cell vaccine | Purified chick embryo cell vaccine |
Purified duck embryo cell vaccine | Purified Vero cell rabies vaccine
Route of administration: Intramuscular injection (IM) | Intradermal injection
(for resource limited setup e.g., government hospitals receiving several at risk patients in a day)
Dose: 0.5 ml PVRV | 1 ml HDCV or PCEC or PDEC
Contraindication: History of allergic reaction | Egg allergy | pregnancy & lactation | Immunocompromised
Guideline recommendations for Rabies vaccines in adults
Pre-exposure: 3 - Pre-exposure: 3 doses Post-exposure Pre-exposure - - At risk*
doses (0, 7, 28 days (0,7, and 28 days) (5 doses at (3 doses- 0,7 & (1 or 3
for high-risk groups) Postexposure: 5 doses day 0,3,7,14 28 days) Post- doses)
Postexposure: 5 (0,3, 7, 14 and 28 days) and 28) exposure
doses (0, 3, 7, 14, (4 doses- 0, 3, 7
and 28 days) & 14|28 days)
Age 18 - 49 years
Age
R NR NR NR NR NR NR NR NR BR R NR
(5Dose)
Key considerations:
• Pre-exposure high risk
• Work as a veterinarian or animal handler • Are a veterinary student • Study or explore caves • Study the rabies virus
• Are traveling to other countries where rabies is common • Joggers, walkers and pet owners should be encouraged
• For pre-exposure 3 doses at 0, 7 & 21 – 28 days
• For post-exposure 4 doses 0, 3, 7 and between 14 – 28 days
• For Elderly post-exposure 5 doses at day 0, 3, 7, 14 and 28
41
Respiratory Syncytial Virus
USFDA recently approved RSV vaccine on the basis of robust results showing reduced risk for severe RSV-associated
lower respiratory tract disease (LRTD).22,23
Vaccine type: Recombinant Vaccine with Adjuvant | Recombinant Vaccine without Adjuvant
Contraindication: History of allergic reaction | Egg allergy | Immunocompromised
Guideline recommendations for Respiratory Syncytial Virus vaccines in adults
- - - - - - - Age 60 years or older: Based on shared clinical
decision-making, 1 dose - Pregnant at 32 weeks 0
days through 36 weeks and 6 days gestation from
September through January in most of the
continental United States*: 1 dose
Age 18 - 59 years
Age
R R* NR NR NR NR NR NR NR NR NR NR
*If available only non adjuvant vaccine may be considered.
Key considerations:
• For the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus in individuals 60
years of age and older
• For pregnant person at 32 weeks 0 days through 36 weeks and 6 days gestation at risk of RSV infection - Only
Recombinant Vaccine without Adjuvant should be used
**Not yet approved for clinical use in India**
42
Typhoid
Vaccine Type:
Inactivated Vi Polysaccharides Typhoid conjugate Live typhoid vaccine
typhoid vaccine Vaccine (ViPS) vaccine (TCV)
Dose: 0.5 ml Dose: 0.5 ml Dose: 0.5 ml Route: orally

Route: IM Route: IM Route: IM Dose: One capsule is taken every
Time: At least Booster: Every Age: 2 years other day, for a total of 4 capsules
2 weeks 3 years and older Age: 6 years and older.
Booster: Every Booster: Maybe Booster: Every 5 years, if at risk
2 years before given after 3 yrs. Contraindications: Pregnant women,
travel if risk continues history of allergic reaction to any
excipients of the vaccine,
immunocompromised
If available Typhoid Conjugated Vaccine should be preferred
Guideline recommendations for Typhoid vaccines in adults
1 dose ViPS Recommended Outbreak or - ≤18 years: TCV 1 - - Outbreak or high-risk-
repeat high-risk travelers dose; >18 years: ≤18 years: TCV 1 dose
2 yearly OR (3 doses, ViPS 3 yearly travelers (3 doses,
1 dose TCV repeat 3-yearly) repeat 3-yearly)-
up to 45 yrs. >18 years
Age 18 - 59 years
Age
BR BR BR BR BR BR BR BR BR BR R R
Key considerations:
• Professional food handlers
• Unvaccinated Adults age 18 through 45 yrs may be given TCV in endemic areas
• Travelers at risk of exposure
• During outbreaks
• In pregnant females always weigh the benefit vs. risk before giving the vaccine*
*Do not use live vaccine if pregnant.
43
Shingles (Herpes Zoster)
Vaccine type: Recombinant zoster vaccine

Route of administration: deltoid or anterolateral thigh area subcutaneous injection
Dose: 2 doses 0.5 ml | 2-6 months apart
Storage: Do not expose to direct sunlight or heat, should be stored between 2°C and 8°C.
Guideline recommendations for Shingles vaccine in adults
≥50 years >50 years ≥60 years (2 doses - - - - ≥50 years (2 doses
(1 dose – Live & above 2-6 mo. apart) 2-6 mo. apart)
or 2 doses (2 doses)
Recombinant)
Age 18 - 49 years
Age
R NR R R AR AR R AR AR AR NR NR
Key considerations:
• Routinely recommended for all people above 50 years of age: 2 doses 2-6 months apart
(minimum gap 4 weeks)
• Recommended in patients with immune compromising conditions including
HIV: 2 doses 2-6 months apart (minimum gap 4 weeks)
44
Yellow fever
Vaccine type: Live attenuated vaccine

Contraindication: History of allergic reaction | Egg allergy | pregnancy & lactation | Immunosuppression#
Contraindication:
• Symptomatic HIV infection or AIDS • Malignant neoplasms • Primary immunodeficiencies
• Transplant: solid organ transplant, bone marrow transplant recipients within 2 years of transplant,
or persons whose transplants occurred >2 years ago but who are still taking immunosuppressive drugs
• Immunosuppressive or immunomodulatory therapy: For example, corticosteroids, alkylating agents,
antimetabolites, TNF-α inhibitors, IL-1 blocking agents, monoclonal antibodies targeting immune cells
• Recent radiation therapy
Guideline recommendations for yellow fever vaccine in adults
1 or 2 doses based - - - At risk, booster every - Traveler 1 or 2 doses based
on immune status 10 years if risk persists on immune status
Age 18 - 49 years
Age
NR NR NR NR NR NR NR NR NR NR R NR
Key considerations:
• Not routinely recommended • Travel to certain high-risk countries: 1 dose
• Usually not recommended during pregnancy, and should try to postpone travel; however, if travel cannot be
avoided 1 dose can be administered after a thorough benefit vs. risk evaluation
• For most people, a single dose of yellow fever vaccine provides long-lasting protection and a booster dose of
the vaccine is not
• vaccinated before nine months of age • on immunosuppressive therapy
• HIV|AIDS • Laboratory workers who handle wild-type yellow fever virus
** Make sure to check the updated list of recognised centres by the government of India for
Yellow Fever Vaccine24**
45
Closing the Gap: Bridging the Need
for Childhood Vaccines into Adult
Healthcare
Rotavirus and Bacille Calmette-Guérin (BCG) rotavirus vaccination to prevent severe gastro-
vaccines have historically been utilized primari- enteritis and related complications. Further
ly in pediatric populations for the prevention of studies are needed to evaluate the efficacy,
rotavirus gastroenteritis and tuberculosis (TB), safety, and cost-effectiveness of rotavirus
respectively. However, their use in adults has vaccination in these populations.26
not been routinely recommended due to BCG Vaccine: High-risk groups such as health-
various factors including perceived low disease care workers, individuals with HIV infection,
burden, incomplete efficacy data, and potential and those living in settings with a high preva-
safety concerns. Nevertheless, emerging lence of tuberculosis may benefit from BCG
evidence suggests potential benefits of these vaccination to reduce the risk of TB infection
vaccines in adult populations, particularly in and disease progression. Future research
specific high-risk groups.25,26 should focus on optimizing BCG vaccination
Rotavirus Vaccine: Immunocompromised strategies in adults, including the development
adults, older adults, and individuals with under- of novel vaccine formulations and delivery
lying medical conditions may benefit from methods.25
Consensus Recommendations
In the proposed classification framework, prioritizing targeted vaccination strategies to
vaccine recommendations are stratified into reduce disease impact effectively.
three tiers: Vital, Essential, and Desirable. Desirable recommendations include vaccines
Vital recommendations encompass vaccines offering additional health benefits, but may
critical for public health, targeting diseases require individual risk assessment and careful
with high morbidity and mortality rates, consideration of factors like cost-effectiveness.
emphasizing universal coverage to achieve This framework enables nuanced prioritization
herd immunity. of vaccines, optimizing resource allocation, and
Essential recommendations focus on controlling informing public health policies for maximal
diseases with moderate to high burdens, impact on population health.
46
Indian Consensus Recommendations
Health Care Personnel
Vaccines Dose Frequency Recommendation Rank
Influenza 1 Annually Desirable
Typhoid 1 3-7 years in endemic Essential
setup
Tdap 1 Every 10 years Vital
Hepatitis B 3 doses (0, 1 and 6 mo.) Every 5 years Vital
MMR 2 doses to non-immunized -- Vital
(at least 28 days apart)
Covid-19 1 Annually Essential
Chickenpox 2 doses -- Vital
Pneumococcal PCV13 followed by PPSV23 booster dose Essential
PPSV23 1 year later after 5 years
Patients with Chronic Conditions

Diabetes Mellitus
Influenza
(inactivated) 1 Annually Desirable
HPV Female: 2 or 3 doses ≤26 years -- Vital
Males: 2 or 4 doses ≤21 years -- Vital
Tdap | Td 1 Every 10 years Vital
Hepatitis B 2 doses -- Vital
Pneumococcal PCV13 followed by 1 PPSV23 booster dose
PPSV23 1 year later after 5 years Essential
MMR 1 or 2 doses depending -- Vital
on the condition
Chickenpox 2 doses 4 – 8 weeks apart -- Vital
Shingles 2 doses 4-8 weeks apart -- Essential
(Herpes Zoster) (patients on chemotherapy)
47
Chronic Liver Disease | Alcoholism
Influenza
Hepatitis B 2 doses --
Pneumococcal 1 dose PCV13 followed by 1 booster dose of Essential
1 dose of PPSV23 1 year later PPSV23 after 5 years
on the condition
Chickenpox 2 doses 4 – 8 weeks apart -- Vital
Meningococcal 2 doses 4 weeks apart -- Desirable
Heart or Lung Disease
Influenza
Pneumococcal PCV13 followed by 1 PPSV23 booster Essential
PPSV23 1 year later dose after 5 years
on the condition
Chickenpox 1 or 2 doses depending -- Vital
on the indication
Meningococcal 2 doses 4 weeks apart -- Desirable
(age >50 years)
48
CKD | Haemodialysis
(inactivated)
Hepatitis B 3 doses 0, 1, and 6 months and Vital
a booster after 5 years
Pneumococcal PCV13 followed by 1 PPSV23 booster Essential
PPSV23, 8 weeks later dose after 5 years
MMR 1 dose -- Vital
on the indication
Asplenia | Complement Deficiency | Sickle Cell Disease
(inactivated)
Pneumococcal 1 dose of PCV13 followed 1 PPSV23 booster dose Essential
(PCV13 + PPSV23) by PPSV23 at least 8 weeks later after 5 years
on the condition
on the indication
Hemophilus 1 -- Essential
influenzae type B
49
Individuals with Cancer
(inactivated)
Tdap 1 minimum 3 mo. Td every 10 years Vital
after chemotherapy
Hib 1 at least 3 mo. Essential
after chemotherapy
Pneumococcal PCV13: 1 dose at least 3 mo. 1 PPSV23 booster dose Essential
(PCV13 + PPSV23) after chemotherapy after 5 years may be
PPSV23: 1 dose at least 8 weeks considered
after PCV13
MMR 2 doses 4 -8 weeks apart -- Vital
Chickenpox 2 doses 4 -8 weeks apart -- Vital
Immunocompromised Recipients of Hematopoietic

Individuals Stem Cell Transplant (HSCT)
In general, most inactivated vaccines are safe Several factors, including the donor's immune
for immunocompromised individuals, and status, type of transplant, time since
these individuals should receive all age- transplant, ongoing immunosuppressive
appropriate vaccines, including the annual treatment, and the presence of graft-
influenza vaccine, pneumococcal vaccines versus-host disease, can influence the
(PCV13 and PPSV23), hepatitis B vaccine, and immunization process for individuals. It is
the meningococcal conjugate vaccine. advisable to undergo a full reimmunization
However, live vaccines such as MMR, varicella, process starting with inactivated vaccines at
and the oral polio vaccine are usually least one year after bone marrow
contraindicated in this population due to the transplantation.
risk of vaccine-associated infections
50
Recipients of HSCT
Vaccines Dose Schedule Recommendation Rank
TD|TdaP 3 6 – 12 mo. after transplant Vital
Hepatitis B 3 6 mo. after transplant Essential
Hib 2 6 – 12 mo. after transplant followed by Essential
booster dose 2 – 6 mo. later
HPV 3 6 mo. after transplant Vital
Influenza 1 4 – 6 mo. after transplant Desirable
IPV 3 6 – 12 mo. after transplant Desirable
Meningococcal 2 6 mo. after transplant Essential
conjugate
MMR 2 4 – 8 weeks apart Vital
Pneumococcal 3 3 – 6 mo. after transplant, Essential
(PCV13) at least 4 weeks apart
Pneumococcal 1 At least 8 weeks after the last dose of PCV13 Essential
(PPSV23) and 12 months after the HSCT
Chickenpox 2 4 – 8 weeks apart Vital
Shingles 2 3–12 months after transplantation Desirable
(Herpes Zoster) 2 – 6 mo. apart
Recipients of Solid Organ Transplant

An accelerated immunization schedule is recommended in donor and recipient. Below is the
recommended schedule for patients and donors undergoing solid organ transplant:27
Vaccines Recipient & Donor Comments Recommendation

Rank
Inactivated vaccines
Pneumococcal PCV13 followed by PPSV23, Booster dose with
(PCV13, PPSV23) 8 weeks later PPSV23 after 5 years Vital
Meningococcal 2 doses, 8 weeks apart Should be given before Essential
in those at risk splenectomy, before eculizumab
Hib Complete As in normal Essential
schedule individuals
Influenza 1 dose annually 1 – 3 mo. after transplant, Desirable
later results in better protection
Hepatitis A 2 doses, 6 mo. apart If travelling to South Asia Desirable
Hepatitis B 3-4 doses before transplant Booster dose if antibody Desirable
titre <10mU|ml | Serology testing
4-weeks after complete dose
51
Vaccines Recipient & Donor Comments Recommendation
Rank
Inactivated vaccines
IPV Complete Schedule If not vaccinated previously Desirable
Tdap 1 dose – 2 weeks before Booster every 10 years Vital
Transplant
HPV 3 doses at 0, 2, 6 mo. For age 11-26 years, if schedule Vital
not completed earlier
Shingles 2 doses Not Preferred pre-transplant, if not Essential
(Herpes Zoster) recommended possible give 6-12
mo. after transplant
Typhoid Polysaccharide - Required: Before travel Desirable
1 dose (Booster after 3 years)
Conjugated -
1 dose (No booster required)
COVID-19 2 doses 4 weeks apart Booster as required Essential
(or as per individual vaccine
recommendation)
Live Vaccines
MMR Should be complete Contraindicated after transplant Vital
before transplant
Varicella Pretransplant 2 doses Contraindicated after transplant Vital
1 month apart
Yellow Fever Contraindicated Avoid travelling to Africa and
South America if not vaccinated;
if travel is necessary,
must travel with yellow card
with stamp and reason
not vaccinated
52
HIV Infection or Other Immunocompromising Conditions
HIV positive and other immunocompromised states
Vaccines Dose Booster Recommendation Rank
(inactivated)
Typhoid 1 3-7 years in endemic setup Desirable
Tdap|Td 1 Td every 10 years Vital
Hepatitis B 3 doses (0, 1 and 6 mo.) -- Essential
Pneumococcal PCV13 followed by Booster doses of PPSV23 after Vital
PPSV23 8 weeks later 5 years and at age 65 years
MMR 2 doses 4 weeks apart CD4 count ≥200 cells|mm 3
Vital
for at least 6 mo.
Contraindicated for CD4
count <200 cells|mm3
Varicella 2 doses 3 mo. apart CD4 percentages ≥15% and Vital
CD4 count ≥200 cells|mm3
HPV-9 3 doses For individuals ≤26 years Vital
of age ay 0, 6 and 12 mo.
Shingles 2 2 – 6 mo. apart Essential
(Herpes Zoster) (min gap 4 week)
During Pregnancy
Vaccines Pregnant females Dose Recommendation Rank
Influenza Recommended 1 Desirable
(Flu) (IIV):
Tdap At least one dose of Tdap vaccine is 1 Vital
recommended during each pregnancy,
preferably between 27 and 36 weeks
of gestation
COVID-19 Vaccine Recommended during pandemic 1 Essential
or local epidemics
Hepatitis B Recommended. 3 Essential
53
Indian Consensus Recommendation
for Risk Conditions
Pregnancy Immuno- HIV Asplenia, CKD| Heart | lung CLD DM HCP Traveller Mass
compromised infection complement HD disease gathering
deficiencies alcoholism
Anthrax
Chickenpox
Chikungunya
Cholera
COVID-19
Td
Tdap
Hib
Hep A
Hep B
HPV
IIV4 or RIV4
LAIV4
Japanese
Encephalitis
MMR
MenACWY
PCV13
PPSV23
Polio
Rabies
RSV
Typhoid
Shingles
(Herpes
Zoster)
Yellow Fever
Legend to read the table
Recommended Not Recommended Benefit Risk Ratio Additional Risk Factor No Guidance
54
Indian Consensus Recommendation
Based on Age
Age 18 – 26 years 27 – 49 years 50 – 64 years ≥65 years
Anthrax
Chickenpox
Chikungunya
Cholera At risk
COVID-19 During pandemic or epidemic
Hib
Hep A
Hep B
HPV 3 doses 2 doses
IIV4 or RIV4
LAIV4
Japanese
Encephalitis
MMR
MenACWY
PCV13
PPSV23
Polio
Rabies (post-
4 doses 5 doses
exposure)
RSV Above 60 years
TdaP|Td 1st dose of Tdap followed by booster dose of Td|TdaP every 10 years
Typhoid At risk
Shingles
(Herpes
Zoster)
Yellow Fever If risk of exposure or traveling to an endemic country
Recommended Not Recommended Benefit Risk Ratio Additional Risk Factor No Guidance
55
Recommendation for traveling to India
List of recommended vaccines
Routine: MMR, DTaP, varicella (chickenpox), polio, Covid-19, pneumococcal and influenza
vaccine status is up-to-date
Hepatitis A: Risk of contracting hepatitis A through contaminated food or water is high
Typhoid: Recommended for Travelers at risk of exposure
Hepatitis B (if needed): If one might have intimate contact with locals or require medical
treatment during your stay
Japanese Encephalitis: If one plans to spend an extended period (>1 month) in rural or
agricultural areas, especially during the monsoon season
Rabies: Plan or risk of animal exposure, pre-exposure vaccine may be given (3 doses at 0,7
and 28 days)
Cholera: Plan to visit or stay in outbreak-prone areas
Polio: OPV is mandatory for people coming from these countries Afghanistan, Ethiopia,
Israel, Kenya, Nigeria, Pakistan and Somalia at least 6 weeks before planned travel to India
and is valid for 1 year
Meningococcal Meningitis: 1 dose is recommended 10-14 days before planned travel date
Yellow Fever: It is mandatory for Travelers coming from Africa and South America. 1 dose in
a life time is sufficient
Students travelling from India to international destinations

It is recommended to visit individual country’s immunization recommendations well in advance
before travel to check for latest recommendations. However, some of the common vaccines
recommended for international Travelers include:
Routine Vaccines
Diphtheria, tetanus and pertussis Meningococcal
Hepatitis B Pneumococcal
Haemophilus influenzae type B Polio
Human papillomavirus Rotavirus
Influenza (seasonal) Tuberculosis
Measles, mumps and rubella (MMR) Varicella
56
MMR: Either evidence of protective antibodies or MMR vaccination is mandatory for
adolescents seeking college admissions in Europe and US
Hepatitis A: Recommended for Travelers to areas with poor sanitation and limited access to
clean water and food safety
Typhoid: Recommended for Travelers visiting regions with an increased risk of
typhoid fever
Yellow Fever: Mandatory for Travelers visiting certain countries with yellow fever
transmission and may require an International Certificate of Vaccination or Prophylaxis
(ICVP) for entry
Rabies: Considered for Travelers with potential exposure to animals or remote areas
with limited access to medical care (Pre-exposure 3 dose schedule should be followed
at 0, 7 and 28 days)
Japanese Encephalitis: Recommended for Travelers to areas with Japanese Encephalitis
transmission, especially during the transmission season
Meningococcal Meningitis: Recommended for Travelers visiting regions with a risk of
meningococcal disease, especially during mass gatherings or outbreaks.
Polio (Inactivated Polio Vaccine - IPV): Recommended for Travelers to areas with ongoing
polio transmission
Cholera: The oral cholera vaccine may be considered for Travelers visiting areas with active
cholera outbreaks
COVID-19 Vaccine: Given the ongoing global pandemic, COVID-19 vaccination is essential for
international travel and may be required by most countries
Recommendation for Pilgrims

Mandatory vaccines for mass gathering within India (e.g., Kumbh mela)
For everyone Prolonged Stay
Typhoid
d Hepatitis B
Hepatitis A Japanese Encephalitis
Influenza Pneumococcal
Mandatory vaccines for mass gathering outside India (e.g., Hajj, Umrah etc.)
For everyone Prolonged Stay
Quadrivalent Meningococcal Vaccine Pneumococcal
Influenza
Polio 57
Upcoming Vaccines
Dengue characteristics for a dengue vaccine, which
include a satisfactory short- and long-term
Several countries have licensed the first safety profile without antibody-dependent
live-attenuated chimeric yellow-fever| enhancement. The vaccine should provide
tetravalent dengue vaccine (CYD-TDV), known protection against all four serotypes of dengue,
as Dengvaxia. However, the vaccine has shown reduce the risk of severe diseases and deaths,
low efficacy in children and individuals who induce a sustained immune response, and be
have not been previously exposed to dengue, effective regardless of the individual's previous
and it has even increased the risk of severe serostatus or age.29
dengue in such individuals. To address these
issues, a heterologous prime-boost regimen Live attenuated dengue vaccine constructs28
using sequential immunization with DENVax Legend
and Dengvaxia has been proposed. This 5’UTR S’utrm E NS1 NS2a|b NS3 NS4a|b NS5 3’UTR
DENV-1
Sanofi
DENV-2
regimen targets all four serotypes of dengue DENV-3
DENV-4
and eliminates the adverse effect of YFV
antibody-dependent enhancement (ADE). 5’UTR S’utrm E NS1 NS2a|b NS3 NS4a|b NS5 3’UTR Known
attenuating
Additionally, combining inactivated vaccines Takeda

mutation
with alum and live attenuated vaccines in a

heterologous prime-boost regimen may 5’UTR S’utrm E NS1 NS2a|b NS3 NS4a|b NS5 3’UTR
enhance the immune response. However, the

NIH
lack of an ideal animal model for dengue poses

challenges in vaccine development, and the
macaque model is being considered for
studying immunological responses similar to Human Immunodeficiency
those observed in humans.28
Virus (HIV)
In an interview with ‘The Hindu’, Dr. Nivedita
HIV, a retrovirus with an enveloped structure
Gupta, the Head of Virology at the Indian
and a single-stranded RNA genome, leads to
Council of Medical Research (ICMR), provided
the development of acquired
details about two potential vaccines. The
immunodeficiency syndrome (AIDS) in its late
vaccine developed by the Serum Institute of
stage. Primary infection with HIV can present
India has initiated phase 1|2 studies in the
symptoms within two to four weeks of the
pediatric population. On the other hand,
virus entering the body. Subsequently, a
Panacea's vaccine is planning to conduct a
prolonged chronic infection ensues, which can
phase III randomized, double-blind,
persist for many years. AIDS is primarily
placebo-controlled trial involving 10,335
characterized by the occurrence of
healthy adults aged 18-80 years at 20
opportunistic infections and tumours, which
ICMR-funded sites. The phase III protocol has
often result in fatality if left untreated. Several
received approval from the Drugs Controller
Vaccines have been developed and are
General of India in January 2023, and the
undervaluation for efficacy and safety viz.; The
company is working towards scaling up vaccine
eOD-GT8 60mer (mRNA-1644) vaccine,
production. The trials are expected to
developed by IAVI and Scripps Research in
commence in August-September of this year.
collaboration with Moderna, safely induced
The ICMR has outlined the desirable
58
targeted immune responses in 97% of vaccines are currently in clinical evaluation,
recipients in the Phase I clinical trial (IAVI RTS, S|AS01 stands as the first vaccine to
G001).30,31 The germline-targeting vaccine complete Phase 3 trials and be administered to
design priming strategy, demonstrated in the children through routine immunization
Phase 1 clinical study IAVI G002, supports the programs in phased pilot introductions.39 It
development of boosting regimens to generate received positive scientific opinion from the
VRC01-class bnAb responses against HIV. European Medicines Agency in 2015 and
Another Phase 1 clinical study (IAVI G003) is national regulatory authorization for use in
currently ongoing to investigate the eOD-GT8 Ghana, Kenya, and Malawi as part of the
60mer mRNA Vaccine in African populations. Malaria Vaccine Implementation Programme in
Moderna Inc. is advancing three Phase I clinical 2019. Another trial utilized the high initial
trials for HIV vaccines, including efficacy of RTS, S|AS01 by administering three
mRNA-1644|IAVI G002, mRNA-1644|IAVI G003, primary doses at monthly intervals followed by
and mRNA-1574|NIAID.32 Vir Biotechnology, Inc. annual single doses during the intense high
is developing VIR-1388,33 a T cell vaccine based transmission season. This combined approach
on the human cytomegalovirus vector of the vaccine and seasonal malaria
platform, for HIV prevention. HOOKIPA Pharma's chemoprevention was superior to either
preclinical studies demonstrated that their intervention alone. Promising candidates
2-vector therapy for Arenaviral therapeutic approaching late-stage clinical evaluation
vaccines induces a stronger immune response include R21|MatrixM targeting PfCSP protein
and reduces viral load.34 AELIX Therapeutics S.L. and PfSPZ, an attenuated whole sporozoite
reported positive results from the phase 1 vaccine.40 Various technologies such as DNA
clinical study of their therapeutic HIV vaccine, and mRNA-based vaccines, adjuvants, virus-like
HIVACAT T-cell immunogen (HT,I), published in particles, and vesicle-based platforms are
Nature Medicine.35 CD40. HIVRI. Env, developed being explored for the development of malaria
by the Vaccine Research Institute, is undergoing vaccines.40-42 WHO has issued guidelines and
a phase 1 clinical study.36 Uvax Bio, LLC's HIV-1 preferred product characteristics to support the
vaccine candidate will enter a Phase 1 clinical ongoing research and advancement of
trial sponsored by the U.S. NIH in early 2024. recombinant malaria vaccines, with updates
Additionally, research has shown the potential underway to incorporate recent progress in the
of a single-component, self-assembling protein field.
nanoparticle (1c-SApNP) displaying native-like
Env trimers as vaccine candidates.37 Tuberculosis
In a phase 2b placebo-controlled study
Malaria published in NEJM 2019, M72|AS01E vaccine was
In a recent update, The WHO released the evaluated in patients with latent M.
recommendations for RTS, S|AS01 vaccine,38 is tuberculosis infection. Most participants had
the pioneering malaria vaccine resulting from a previously received the BCG vaccine. M72|AS01E
long-standing collaboration between public provided 54.0% protection for M.
and private entities that dates back to 1983. tuberculosis–infected adults against active
While other candidates for P. falciparum malaria pulmonary tuberculosis disease, without
evident safety concerns.43 In an announcement
59
made on Wednesday 28th June 2023, the pharmaceutical companies, including Takeda,
26,000-person, Phase 3 study, set to begin next Moderna, and Walter Reed Army Institute of
year, will test the vaccine’s efficacy and safety. Research (WRAIR). These candidates were in
If proven effective, would be the first new various stages of preclinical and clinical
tuberculosis vaccine in over a century.44 development.46
Norovirus Vaccine: Vaxart and Takeda were
Leprosy among the companies working on oral
National Leprosy Eradication Program (NLEP) norovirus vaccine candidates. These candidates
initiated the implementation of the were in different phases of clinical trials.47
Mycobacterium Indicus Prani (MiP) vaccine Group B Streptococcus (GBS) Vaccine: Several
project in India in 2016. Extensive trials, both in companies, including Pfizer, GlaxoSmithKline
hospitals and among the general population, (GSK), and Sanofi Pasteur, were involved in the
have demonstrated the dual benefits of the development of GBS vaccine candidates. These
MiP vaccine, showcasing its candidates were in the preclinical and early
immunotherapeutic and immune-prophylactic clinical stages.48
effects in individuals with multibacillary leprosy
and their contacts. This vaccine has proven Staphylococcus aureus Vaccine: Several
effective in diminishing the bacillary load, private sector players are working on
improving histopathological lesions, achieving Staphylococcus aureus vaccine candidates
complete granuloma clearance, reducing targeting hospital-acquired infections. These
reactions and neuritis, and shortening the candidates are in different stages of clinical
duration of multidrug therapy (MDT) for leprosy trials.49
patients. In a new project conducted under the Bacterial lysates: Bacterial lysates are
collaboration of Indian Council of Medical immunostimulants derived from bacterial cells
Research (ICMR) and NLEP, the MiP vaccine is that have been ruptured or lysed. These lysates
administered to the index leprosy patient in contain a variety of bacterial components such
addition to the standard MDT. Concurrently, as proteins, nucleic acids, and cell wall
family members and contacts of the index case fragments, which can activate the immune
receive the MiP vaccine twice, spaced six mo. system and stimulate a protective response
apart, with the objective of fortifying their against bacterial infections. Bacterial lysates
immunity to prevent leprosy upon exposure to have been used as immunotherapeutic agents
Mycobacterium leprae from an infected in some medical settings, especially in
patient. The immunization of the index case respiratory conditions like recurrent respiratory
aims to expedite the clearance of bacteria and infections and chronic obstructive pulmonary
clinical lesions, while MiP vaccination in disease (COPD). While bacterial lysates have
contacts is designed to enhance their shown potential in boosting immune
immunity, providing protection against the responses, their clinical efficacy is still a subject
development of clinical disease upon exposure of ongoing research and debate. The available
to M. leprae from infected individuals.45 evidence is not yet sufficient to recommend
bacterial lysates as a standard treatment for all
Other vaccines being individuals or for the prevention of bacterial
infections.50
developed
Zika Virus Vaccine: Various candidates were
under development by different
60
Personalized Vaccines before vaccination and then received nine
doses of the personalized vaccine over several
for Cancer mo. Results showed that half of the patients
Researchers led by Dr. Vinod Balachandran at had a strong immune response, with T cells
Memorial Sloan Kettering Cancer Center have recognizing the neoantigens. Those with a
developed a personalized mRNA cancer strong response remained cancer-free after a
treatment vaccine for pancreatic ductal year and a half, while those with a weaker
adenocarcinoma (PDAC), the most common response experienced recurrence within an
and deadly form of pancreatic cancer. In a small average of just over a year. The study
clinical trial, tumour samples from 19 patients demonstrates the potential of personalized
were sequenced to identify neoantigens, and vaccines to activate the immune system
personalized mRNA vaccines were created against pancreatic cancer and paves the way
based on these findings. Participants received for further research and larger clinical trials.
immune checkpoint inhibitor atezolizumab
61
Conclusion
In conclusion, it is fair to say that adult vaccination and work together to overcome
vaccination plays a vital role in safeguarding barriers to immunization. Efforts should be
individual and public health. The consensus made to increase awareness, improve access to
statement emphasizes the importance of vaccines, and address vaccine hesitancy
immunization in adults, highlighting the through education and evidence-based
numerous benefits it offers. By ensuring high communication.
vaccination rates among adults, we can By embracing the consensus statement on
effectively prevent and control infectious adult vaccines and implementing its
diseases, protect vulnerable populations, and recommendations, we can achieve a healthier
reduce the burden of illness within and more resilient society, where preventable
communities. diseases are kept at bay, and individuals can
Healthcare professionals have a crucial role in enjoy a higher quality of life. Investing in adult
promoting adult vaccination and leading by vaccination is an investment in the well-being
example. By prioritizing their own and future of our communities.
immunizations, they not only protect Disclosures and Acknowledgements
themselves but also serve as advocates for
patients and the broader population. Conflict of interests: The authors declare no
Compliance with occupational health conflict of interest and the content is developed
requirements and adherence to recommended and designed by the the Association of
vaccination schedules contribute to a safer Physicians of India in collaboration with the
healthcare environment and reduce the risk of representatives and office bearers of CSI, CIDS,
workplace outbreaks. FOGSI, GSI, HFAI, IAPSM, ICS, IMA, IRA, ISCCM,
ISN, ISO and RSSDI.
Further, adult vaccination goes beyond
individual protection, fostering herd immunity Acknowledgements: The consensus task force
and preventing the transmission of diseases to would like to acknowledge the research,
those who are more susceptible, such as the medical writing, and publishing support of the
elderly, infants, and individuals with ProAdWise Communications team and Dr
compromised immune systems. This collective Gaurav Chaudhry for bringing out this
effort is essential for minimizing the impact of document.
vaccine-preventable diseases on public health.
In light of these considerations, it is crucial for
healthcare providers, policymakers, and the
public to recognize the significance of adult
62
Appendix
Screening Checklist for Contraindications to Vaccines for Adults
Patient Information: The following questions will help us determine which vaccines you may be
given today. If you answer “yes” to any question, it does not necessarily mean you should not be
vaccinated. It just means we need to ask you more questions. If a question is not clear, please ask
your healthcare provider to explain it.
Question Yes No Don’t

know
1. Are you sick today?
2. Do you have allergies to medications, food, a vaccine ingredient, or latex?
3. Have you ever had a serious reaction after receiving a vaccine?
4. Do you have a long-term health problem with heart, lung, kidney, or
metabolic disease (e.g., diabetes), asthma, a blood clotting disorder, no
spleen, complement component deficiency, a cochlear implant, or a spinal
fluid leak? Are you on long-term aspirin therapy?
5. Do you have cancer, leukaemia, HIV|AIDS, or any other immune system
problem?
6. Do you have a parent, brother, or sister with an immune system problem?
7. In the past 3 mo., have you taken medicines that affect your immune
system, such as prednisone, other steroids, or anticancer drugs; drugs for the
treatment of rheumatoid arthritis, Crohn’s disease, or psoriasis; or have you
had radiation treatments or anticoagulants (blood thinning medications)?
8. Have you had a seizure or a brain or other nervous system problem?
9. During the past year, have you received a transfusion of blood or blood
products, or been given immune (gamma) globulin or an antiviral drug?
10. Are you pregnant or is there a chance you could become pregnant during the
next month?
11. Have you received any vaccinations in the past 1 month (4 weeks)?
12. Are you travelling internationally in foreseeable future?
63
Information for Healthcare receive any IIV, RIV, or LAIV that is otherwise
appropriate for the patient’s age and health
Professionals about the status; ccIIV and RIV do not contain egg antigen.
Screening Checklist for When administering an influenza vaccine other
than ccIIV or RIV to a person with a history of
Contraindications to severe allergic reaction to egg, or who required
Vaccines for Adults emergency medical intervention (e.g.,
epinephrine), vaccination should occur in a
Are you interested in knowing why we included clinic, health department, or physician office;
a certain question on the screening checklist? If vaccine administration should be supervised by
so, read the information below. If you want to a healthcare provider who is able to recognize
find out even more, refer to individual vaccine and manage severe allergic conditions.
section.
Have you ever had a serious reaction after
Are you sick today? [all vaccines] receiving a vaccine? [all vaccines]
There is no evidence that acute illness reduces History of anaphylactic reaction (see question
vaccine efficacy or increases vaccine adverse 2) to a previous dose of vaccine or vaccine
events. However, as a precaution with component is a contraindication for subsequent
moderate or severe acute illness, all vaccines doses. Under normal circumstances, vaccines
should be delayed until the illness has are deferred when a precaution is present.
improved. Mild illnesses (e.g., upper respiratory However, situations may arise when the
infections, diarrhoea) are NOT contraindications benefit outweighs the risk (e.g., during a
to vaccination. Do not withhold vaccination if a community pertussis outbreak).
person is taking antibiotics.
Do you have a long-term health problem
Do you have allergies to medications, food, with heart, lung, kidney, or metabolic
a vaccine ingredient, or latex? [all vaccines] disease (e.g., diabetes), asthma, a blood
An anaphylactic reaction to latex is a clotting disorder, no spleen, complement
contraindication to vaccines that contain latex component deficiency, a cochlear implant,
as a component or as part of the packaging or a spinal fluid leak?
(e.g., vial stoppers, prefilled syringe plungers, Are you on long term aspirin therapy? [MMR,
prefilled syringe caps). If a person has VAR, LAIV] A history of thrombocytopenia or
anaphylaxis after eating gelatin, do not thrombocytopenic purpura is a precaution to
administer vaccines containing gelatin. A local MMR vaccine. LAIV is not recommended for
reaction to a prior vaccine dose or vaccine people with anatomic or functional asplenia,
component, including latex, is not a complement component deficiency, a cochlear
contraindication to a subsequent dose or implant, or CSF leak. Underlying health
vaccine containing that component. For conditions of the heart, lung, kidney, or
information on vaccines supplied in vials or metabolic disease (e.g., diabetes) and asthma
syringes containing latex, see are considered precautions for the use of LAIV.
www.cdc.gov/vaccinespubs/pinkbook/downlo Aspirin use is a precaution to VAR.
ads/appendices/B/latex-table.pdf; for an
extensive list of vaccine components, see Do you have cancer, leukemia, HIV|AIDS, or
www.cdc.gov/vaccines/pubs/pinkbook/downlo any other immune system problem? [LAIV,
ads/ appendices/B/excipient-table-2.pdf. MMR, VAR]
People with egg allergy of any severity can Live virus vaccines (e.g., LAIV, MMR, VAR) are
64
usually contraindicated in elerswith-additional-considerations/immunoco
immunocompromised people. However, there mpromised-travelers. The use of live virus
are exceptions. For example, MMR vaccine is vaccines should be avoided in persons taking
recommended and VAR vaccine may be these drugs. To find specific vaccination
considered for adults with CD4+ T-lymphocyte schedules for stem cell transplant (bone
counts of greater than or equal to 200 cells|µL. marrow transplant) patients.
Immuno-suppressed people should not receive
LAIV. Have you had a seizure or a brain or other
nervous system problem? [influenza,
Do you have a parent, brother, Td|Tdap]
or sister with an immune system problem? Tdap is contraindicated in people who have a
[MMR, VAR] history of encephalopathy within 7 days
MMR or VAR vaccines should not be following DTP|DTaP. An unstable progressive
administered to persons who have a family neurologic problem is a precaution to the use
history of congenital or hereditary of Tdap. For people with stable neurologic
immunodeficiency in first-degree relatives (i.e., disorders (including seizures) unrelated to
parents and siblings), unless the immune vaccination, or for people with a family history
competence of the potential vaccine recipient of seizure, vaccinate as usual. A history of
has been substantiated clinically or verified by Guillain-Barré syndrome (GBS) is a
a laboratory. consideration with the following: 1) Td|Tdap: if
GBS has occurred within 6 weeks of a tetanus
In the past 3 mo., have you taken medicines toxoid vaccine and decision is made to continue
that affect your immune system, such as vaccination, give Tdap instead of Td if no history
cortisone, prednisone, other steroids, or of prior Tdap; 2) Influenza vaccine (IIV|LAIV): if
anticancer drugs; drugs for the treatment of GBS has occurred within 6 weeks of a prior
rheumatoid arthritis, Crohn’s disease, or influenza vaccine, vaccination should generally
psoriasis; or have you had radiation be avoided unless the benefits outweigh the
treatments? [LAIV, MMR, VAR] risks (for those at higher risk for complications
Live virus vaccines (e.g., LAIV, MMR, VAR) from influenza).
should be postponed until after chemotherapy
or long-term high-dose steroid therapy has During the past year, have you received a
ended. For details and length of time to transfusion of blood or blood products, or
postpone, see references in Notes above. Some been given immune (gamma) globulin or an
immune mediator and immune modulator antiviral drug? [MMR, VAR]
drugs (especially the anti-tumor necrosis factor Certain live virus vaccines (e.g., MMR, LAIV,
agents adalimumab, infliximab, etanercept, VAR) may need to be deferred, depending on
golimumab, and certolizumab pegol) may be several variables. Consult General Best Practice
immunosuppressive. A comprehensive list of Guidelines for Immunization (referenced in
immunosuppressive immune modulators is Notes above) for current information on
available in CDC Health Information for intervals between antiviral drugs, immune
International Travel (the “Yellow Book”) globulin or blood product administration and
available at live virus vaccines.
wwwnc.cdc.gov/travel/yellowbook/2020/trav
65
Are you pregnant or is there a chance you pregnancy due to a lack of safety data in this
could become pregnant during the next population; pregnant people needing hepatitis
month? [HPV, HepB, IPV, LAIV, MenB, B vaccination should receive Engerix-B or
MMR, VAR] Recombivax-HB, which are known to be safe
Live virus vaccines (e.g., MMR, VAR, LAIV) are and effective during pregnancy. HPV vaccine is
contraindicated one month before and during not recommended during pregnancy.
pregnancy because of the theoretical risk of Have you received any vaccinations
virus transmission to the fetus. Sexually active in the past 4 weeks?
women in their childbearing years who receive [LAIV, MMR, VAR, yellow fever]
live virus vaccines should be instructed to avoid
pregnancy for one month following receipt of People who were given either LAIV or an
the vaccine. IPV and MenB vaccination should injectable live virus vaccine (e.g., MMR, VAR,
be limited to those with an elevated risk of yellow fever) should wait 28 days before
exposure during pregnancy. IIV and Tdap are receiving another live virus vaccination (30
both recommended during pregnancy. Two days for yellow fever). Inactivated vaccines
brands of hepatitis B vaccine (Heplisav-B and may be given at any spacing interval if they are
PreHevbrio) are not recommended during not administered simultaneously.
Abbreviations:
LAIV: Live attenuated influenza vaccine | HPV: Human papillomavirus vaccine | IIV: Inactivated influenza vaccine | ccIIV: Cell culture inactivated influenza
vaccine | IPV: Inactivated poliovirus vaccine | MMR: Measles, mumps, and rubella vaccine | RIV: Recombinant influenza vaccine | Td|Tdap: Tetanus,
diphtheria, (acellular pertussis) vaccine | VAR: Varicella vaccine | MenB: meningitis B | HIV: Human immunodeficiency virus vaccine
66
Storage best practices for refrigerated
vaccines-celsius (C)
1 Unpack vaccines immediately
• Place the vaccines in trays or containers for

proper airflow.
• Put vaccines that are first to expire in front.
• Keep vaccines in original boxes with lids closed
to prevent exposure to light.
• Separate and label vaccines by type and public
(VFC) or private.
2 Store vaccines at ideal temperature: 5˚C
Refrigerated vaccines
Never freeze Too Cold! Within Too Warm!
refrigerated vaccines! Take Action! Range Take Action! Report out-of-range
Exception: MMR temperatures
can be stored in -4˚C -1˚C 2˚C 8˚C 10˚C immediately!
a refrigerator or
freezer 5˚C
3 Use vaccine storage best practices

DO DON’T
Do make sure the Don’t use
refrigerator door is dormitory-style
properly closed! refrigerator.
Do replace crisper bins Don’t use top shelf
with water bottles to help for vaccine storage.
maintain consistent Don’t put food or
temperature. beverages in this
Do lable water bottles refrigerator.
“Do Not Drink.” Don’t put vaccines on
Do leave 2 to 3 inches door shelves or on
between vaccine containers the floor of
and refrigerator walls. refrigerator.
Do post “Do Not Unplug”
signs on refrigerator and
near electrical outlet.
67
Vaccines Exposure to heat | light Exposure to cold
Heat and light sensitive vaccines
OPV Sensitive to heat Not damaged by freezing
Measles | MR Sensitive to heat and light Not damaged by freezing
BCG, RVV and JE Relatively heat stable Not damaged by freezing
but sensitive to light
Freeze sensitive vaccines
Hep B | Penta | PCV Relatively heat stable Freezes at -0.5˚C
(should not be frozen)
IPV, DPT, and TT Relatively heat stable Freezes at -3˚C
(should not be frozen)
At the PHC level, all vaccines are kept in the ILR for a period
of one month at temperature of +2˚C to +8˚C
Vaccines sensitive to heat Vaccine sensitive to freezing
BCG (after reconstitution) Most sensitive Hep B Most sensitive
OPV PCV
IPV Penta
MR IPV
Rotavirus DPT
JE TT
DPT
BCG (before reconstitution) Least sensitive Least sensitive
TT
PCV: Pneumococcal conjugate vaccine. RVV: Rotavirus vaccine. JE: Japanese encephalitis. Penta: DTwP+HiB+HepB. DTwp: Diphtheria, tetanus, whole cell
pertussis; HIB: Haemophilus conjugate type B. HepB: Hepatitis B.
68
Frequently Asked Questions
on Adult Immunization51,52
1. Why are vaccinations important for adults? 5. Can adults get vaccinated if they have
Vaccinations are essential for adults to protect certain medical conditions?
themselves from preventable diseases and to In many cases, adults with certain medical
help reduce the spread of infections to conditions can and should get vaccinated.
vulnerable populations. Vaccines can also However, the suitability of specific vaccines
provide immunity to certain illnesses, which is may depend on the individual's health status
especially important as we age and our and medical history. Those with severe
immune systems may weaken. allergies to vaccine components or a history of
adverse reactions to vaccines may need to
2. Which vaccines are recommended for avoid certain vaccinations.
adults?
The specific vaccines recommended for adults 6. Can pregnant women receive vaccines?
can vary based on factors such as age, health Some vaccines are safe and recommended
status, and lifestyle. However, some common during pregnancy, such as the influenza vaccine
vaccines recommended for adults include and the Tdap vaccine. However, other live
influenza (flu) vaccine, Tdap (tetanus, vaccines, like the MMR (measles, mumps, and
diphtheria, and pertussis) vaccine, rubella) vaccine, are typically not given during
pneumococcal vaccine, shingles vaccine, and pregnancy. Pregnant women should consult
HPV (human papillomavirus) vaccine for certain their healthcare provider to determine which
age groups. vaccines are appropriate for them.
3. How often do adults need to be vaccinated? 7. Are there any vaccines recommended for
The vaccination schedule for adults can vary Travelers?
depending on the type of vaccine and Yes, some vaccines are recommended for
individual risk factors. In general, some Travelers, especially if they are visiting areas
vaccines require periodic boosters, while others with specific infectious disease risks. These
may be given once or twice in a lifetime. It's may include vaccines for diseases such as
essential to consult with a healthcare provider yellow fever, typhoid, hepatitis A, and others.
to determine the appropriate vaccination Travelers should consult a healthcare provider
schedule for each person. well in advance of their trip to discuss
recommended vaccinations.
4. Are vaccines safe?
Most people experience minimal side effects 8. Are vaccines covered by insurance?
from vaccinations, such as soreness at the Many health insurance plans cover
injection site or mild flu-like symptoms. Serious recommended vaccinations for adults.
side effects are rare. It's crucial to discuss any However, coverage may vary depending on the
concerns about potential side effects with a specific insurance policy. It's best to check with
healthcare provider before receiving a vaccine. the insurance provider to determine coverage
details.
69
9. Do vaccines have damaging and long-term 11. Giving more than one vaccine at a time
side-effects that are yet unknown. can can increase the risk of harmful side-effects,
vaccination be fatal? which can overload an individual’s immune
The 1998 study which raised concerns about a system.
possible link between measles-mumps-rubella Scientific evidence shows that giving several
(MMR) vaccine and autism was later found to vaccines at the same time has no adverse
be seriously flawed, and the paper has been effect on immune system. People are exposed
retracted by the journal that published it. to several hundred foreign substances that
Vaccines are very safe. Most vaccine reactions trigger an immune response every day. The
are usually minor and temporary, such as a sore simple act of eating food introduces new
arm or mild fever. Very serious health events antigens into the body, and numerous bacteria
are extremely rare and are carefully monitored live in the mouth and nose. One is exposed to
and investigated. One is far more likely to be far more antigens from a common cold or sore
seriously injured by a vaccine-preventable throat than they are from vaccines. Key
disease than by a vaccine. For example, in the advantages of having several vaccines at once
case of polio, the disease can cause paralysis, is fewer clinic visits, which saves time and
measles can cause encephalitis and blindness, money, and individuals are more likely to
and some vaccine-preventable diseases can complete the recommended vaccinations on
even result in death. While any serious injury or schedule. Also, when it is possible to have a
death caused by vaccines is one too many, the combined vaccination, e.g. for measles, mumps
benefits of vaccination greatly outweigh the and rubella, that means fewer injections.
risk, and many, many more injuries and deaths
would occur without vaccines. 12. Is it better to be immunized through
disease than through vaccines?
10. Vaccine-preventable diseases are almost Vaccines interact with the immune system to
eradicated in our country, so there is no produce an immune response similar to that
reason to be vaccinate? produced by the natural infection, but they do
Although vaccine preventable diseases have not cause the disease or put the immunized
become uncommon in many countries, the person at risk of its potential complications. In
infectious agents that cause them continue to contrast, the price paid for getting immunity
circulate in some parts of the world. In a highly through natural infection might be mental
inter-connected world, these agents can cross retardation from Haemophilus influenzae type
geographical borders and infect anyone who is b (Hib), birth defects from rubella, liver cancer
not protected. In western Europe, for example, from hepatitis B virus, or death from measles.
measles outbreaks have occurred in
unvaccinated populations in Austria, Belgium,
Denmark, France, Germany, Italy, Spain,
Switzerland and the United Kingdom since
2005. So, two key reasons to continue
vaccinating are to protect ourselves and to
protect those around us. Successful vaccination
programmes, like successful societies, depend
on the cooperation of every individual to
ensure the good of all. We should not rely on
people around us to stop the spread of disease;
we, too, must do what we can.
70
Precautions & Contraindications
for vaccines53-55
Vaccines Contraindicated or Not Recommended Precautions
Influenza, egg- • Severe allergic reaction (e.g., • Guillain-Barré syndrome (GBS)
based, inactivated anaphylaxis) after previous dose of within 6 weeks after a previous
injectable (IIV4) any influenza vaccine (i.e., any dose of any type of influenza
egg-based IIV, ccIIV, RIV, or LAIV of vaccine
any valency) • Moderate or severe acute illness
• Severe allergic reaction (e.g., with or without fever
anaphylaxis) to any vaccine
component3 (excluding egg)
Influenza, cell • Severe allergic reaction (e.g., • GBS within 6 weeks after a previous
culture-based anaphylaxis) to any ccIIV of any dose of any type of influenza
inactivated valency, or to any component 3 of vaccine
injectable [(ccIIV4), ccIIV4 • Persons with a history of severe
Quadrivalent] allergic reaction (e.g., anaphylaxis)
after a previous dose of any
egg-based IIV, RIV, or LAIV of any
valency. If using ccIV4, administer in
medical setting under supervision of
health care provider who can
recognize and manage severe
allergic reactions. May consult an
allergist.
• Moderate or severe acute illness
with or without fever
Influenza, Severe allergic reaction (e.g., • GBS within 6 weeks after a previous
recombinant anaphylaxis) to any RIV of any valency, dose of any type of influenza
injectable [(RIV4), or to any component 3 of RIV4 vaccine. Persons with a history of
Quadrivalent] severe allergic reaction (e.g.,
anaphylaxis) after a previous dose of
any egg-based IIV, ccIIV, or LAIV of
any valency. If using RIV4,
administer in medical setting under
supervision of health care provider
who can recognize and manage
severe allergic reactions. May
consult an allergist
71
Influenza, live • Severe allergic reaction (e.g., • GBS within 6 weeks after a previous
attenuated [LAIV4, anaphylaxis) after previous dose of dose of any type of influenza
Quadrivalent] any influenza vaccine (i.e., any vaccine
egg-based IIV, ccIIV, RIV, or LAIV of any • Asthma in persons aged 5 years old
valency) or older
Influenza, live • Severe allergic reaction (e.g., • Persons with underlying medical
attenuated [LAIV4, anaphylaxis) to any vaccine conditions (other than those listed
Quadrivalent] component3 (excluding egg) under contraindications) that might
• Anatomic or functional asplenia predispose to complications after
wild-type influenza virus infection
• Immunocompromised due to any cause [e.g., chronic pulmonary,
including, but not limited to, cardiovascular (except isolated
medications and HIV infection hypertension), renal, hepatic,
• Close contacts or caregivers of severely neurologic, hematologic, or
immunosuppressed persons who metabolic disorders (including
require a protected environment diabetes mellitus)] M
• Pregnancy • Moderate or severe acute illness
• Cochlear implant
• Active communication between the
cerebrospinal fluid (CSF) and the
oropharynx, nasopharynx, nose, ear, or
any other cranial CSF leak
• Received influenza antiviral
medications oseltamivir or zanamivir
within the previous 48 hours, peramivir
within the previous 5 days, or baloxavir
within the previous 17 days.
Haemophilus • Severe allergic reaction (e.g., • Moderate or severe acute

influenzae anaphylaxis) after a previous dose or illness with or without fever
type b (Hib) to a vaccine component
• History of severe allergic reaction to
dry natural latex
Hepatitis A (Hep A) • Severe allergic reaction (e.g., • Moderate or severe acute
anaphylaxis) after a previous dose or illness with or without fever
to a vaccine component3 including
neomycin
Hepatitis B (Hep B) • Severe allergic reaction (e.g., • Moderate or severe acute
anaphylaxis) after a previous dose illness with or without fever
or to a vaccine component3
including yeast
• Pregnancy: are not recommended
due to lack of safety data in
pregnant persons. Use other
hepatitis B vaccines if HepB is
indicated
72
Hepatitis A- • Severe allergic reaction (e.g., • Moderate or severe acute
Hepatitis B vaccine anaphylaxis) after a previous dose or illness with or without fever
[Hep A-Hep B, to a vaccine component3 including
(Twinrix®)] neomycin and yeast
Human • Severe allergic reaction (e.g., • Moderate or severe acute

papillomavirus anaphylaxis) after a previous dose or illness with or without fever
(HPV) to a vaccine component3
• Pregnancy: HPV vaccination not
recommended
Measles, mumps, • Severe allergic reaction (e.g., • Recent (≤11 mo.) receipt of
rubella (MMR) anaphylaxis) after a previous dose antibody-containing blood product
or to a vaccine component (specific interval depends on
• Severe immunodeficiency (e.g., product)
hematologic and solid tumors, • History of thrombocytopenia or
receipt of chemotherapy, congenital thrombocytopenic purpura
immunodeficiency, long-term • Need for tuberculin skin testing or
immunosuppressive therapy or interferon-gamma release assay
patients with HIV infection who are (IGRA) testing
severely immunocompromised)
• Pregnancy with or without fever
• Family history of altered
immunocompetence, unless verified
clinically or by laboratory testing as
immunocompetent
Meningococcal • Severe allergic reaction (e.g., • Moderate or severe acute
ACWY (MenACWY) anaphylaxis) after a previous dose or illness with or without fever
to a vaccine component 3
• For MenACWY-D and MenACWY-CRM
only: severe allergic reaction to any
diphtheria toxoid–or CRM197–
containing vaccine
• For MenACWY-TT only: severe allergic
reaction to a tetanus
toxoid-containing vaccine
Meningococcal B • Severe allergic reaction (e.g., • Pregnancy

(MenB) anaphylaxis) after a previous dose • For MenB-4C only: Latex sensitivity
or to a vaccine component
73
Pneumococcal • Severe allergic reaction (e.g., • Moderate or severe acute illness
conjugate (PCV13, anaphylaxis) after a previous dose or with or without fever
PCV15 & PCV20) to a vaccine component3
• Severe allergic reaction (e.g.,
anaphylaxis) to any diphtheria-toxoid–
containing vaccine or to its vaccine
component
Pneumococcal • Severe allergic reaction (e.g., • Moderate or severe acute

polysaccharide anaphylaxis) after a previous dose illness with or without fever
(PPSV23) or to a vaccine component
Haemophilus • Severe allergic reaction (e.g., • Moderate or severe acute illness
influenzae anaphylaxis) after a previous dose or with or without fever
type b (Hib) to a vaccine component
• History of severe allergic reaction to
dry natural latex
Tetanus, diphtheria, • Severe allergic reaction (e.g., • Guillain-Barré syndrome (GBS)
and acellular anaphylaxis) after a previous dose within 6 weeks after a previous
pertussis (Tdap) or to a vaccine component3 dose of tetanus-toxoid–containing
Tetanus, diphtheria vaccine
• For Tdap only: Encephalopathy
(Td) • History of Arthus-type
(e.g., coma, decreased level of
consciousness, prolonged seizures), hypersensitivity reactions after a
not attributable to another previous dose of diphtheria-toxoid–
identifiable cause, within 7 days of containing or
administration of previous dose of tetanus-toxoid–containing vaccine;
DTP, DTaP, or Tdap defer vaccination until at least 10
years have elapsed since the last
tetanus-toxoid–containing vaccine
• For Tdap only: Progressive or
unstable neurological disorder,
uncontrolled seizures, or progressive
encephalopathy until a treatment
regimen has been established and
the condition has stabilized
Chickenpox • Severe allergic reaction (e.g., • Moderate or severe acute illness
anaphylaxis) after a previous dose or with or without fever
to a vaccine component3
• Severe immunodeficiency (e.g.,
hematologic and solid tumors, receipt
of chemotherapy, congenital
immunodeficiency, long-term
immunosuppressive therapy or
patients with HIV infection who are
severely immunocompromised)
• Pregnancy
• Family history of altered
immunocompetence, unless verified
clinically or by laboratory testing as
immunocompetent
74
Shingles • Severe allergic reaction (e.g., • Moderate or severe acute illness
(Herpes Zoster) anaphylaxis) after a previous dose with or without fever
or to a vaccine component • Current herpes zoster infection
Respiratory • History of a severe allergic reaction • Potential Risk of Preterm Birth
Syncytial Virus (e.g., anaphylaxis) to any • Immunocompromised individuals
component of the vaccine
Polio • History of a severe allergic reaction • Pregnancy
(e.g., anaphylaxis) to any component • Moderate or severe acute
of the vaccine illness with or without fever
Cholera • History of a severe allergic reaction • Pregnancy & Breast Feeding
(e.g., anaphylaxis) to any component of • Altered Immunocompetence
the vaccine
• aged <2 years or in adults aged ≥65 yrs
Chikungunya • History of a severe allergic reaction • History of anthrax disease

(e.g., anaphylaxis) to any component • Pregnancy & Breast Feeding
of the vaccine
• Altered Immunocompetence
Yellow Fever • History of a severe allergic • Pregnancy
reaction (e.g., anaphylaxis) to • Breastfeeding
any component of the vaccine
• Adults ≥60 years of age
• Thymus disorder associated with
abnormal immune cell function • Asymptomatic HIV
• Immunosuppression from the • infection with CD4+
following: • value of 200|mm3 – 500|mm3
• Symptomatic HIV infection
or AIDSa
• Malignant neoplasms
• Primary immunodeficiencies
• Transplantation
• Immunosuppressive or
• immunomodulatory therapy
• Radiation therapy
75
Diary for
Adult Immunization
76
Adult Vaccination Diary
Name
Date of Birth Age ____ years, ___ mo.
Contact Number
Annual Vaccines
Dose 1 Dose 2 Dose 3 Repeat Dose Dose Frequency
COVID-19 Today Not Applicable Not Applicable 1 year Annually, only during
pandemic| epidemic
Influenza Today Not Applicable Not Applicable 1 year Annually
Repeat Doses
Dose 1 Dose 2 Dose 3 Repeat Dose Dose Frequency
Meningococcal Today 14 days (for high Not Applicable 5 year 5-yearly, if at risk
Conjugated risk conditions)
Meningococcal Today 6 mo. Not Applicable 2 year 2-3 years later,
PBCP if at risk
Pneumococcal Today 1 year Not Applicable 5 yrs (PPSV23, Not Applicable
(PCV13+PPSV23) (PCV13) (PPSV23) if needed)
TdaP|Td Today Not Applicable Not Applicable 10 year 10-yearly
Once in Life-time Dose 1 Dose 2 Dose 3 Repeat Dose Dose Frequency

Hib Today Not Applicable Not Applicable Not Applicable Once in lifetime
Hepatitis A Today 6-12 mo. Not Applicable Not Applicable Once in lifetime
Hepatitis B Today 1 mo. 6 mo. Not Applicable Once in lifetime
Chickenpox Today 1 mo. Not Applicable Not Applicable Once in lifetime
HPV Today 1 mo. 6 mo. Not Applicable Once in lifetime
MMR Today 1 mo. Not Applicable Not Applicable Once in lifetime
RSV Today Not Applicable Not Applicable Not Applicable Once in lifetime
Shingles Today 2 mo. Not Applicable Not Applicable Once in lifetime
(Herpes Zoster)
Other Vaccines
Please refer to section
___________ Today on individual vaccines
77
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INDIAN CONSENSUS

Wishing you an enlightening and enriching journey through these guidelines.

Dr. Agam Vora Dr. Girish Mathur

Dr. Girish Mathur Dr. Mangesh Tiwaskar

Dr. Shashank R. Joshi

Dr. Jyotirmoy Pal Dr. Amit A. Saraf

Dr. Pricilla Rupali

Dr. Jaydeep Tank ISAR (2022-2024)

Dr. Veena Kamath

Indian Chest Society ICS

Dr. Richa Gupta Dr. Deepak Talwar

Indian Society of Nephrology

Dr. Ramesh S. Bilimagga Dr. Rajendra Toprani

Dr. Brij Mohan Makkar

Indian Consensus Recommendations.........................................47

Method of Consensus Development

High Risk Group

What are Vaccines?

Types of Vaccines Available

3. Acellular or Subunit Vaccines

vaccines 1 8th c 1721 Introduction 2013

Vaccine type: Cell-free filtrates of microaerophilic cultures of an avirulent, nonencapsulated

Vaccine type: Live attenuated

Vaccine type: Live attenuated

Guideline recommendations for Chikungunya vaccines in adults

**Not yet approved | available for clinical use in India**

Killed Whole-Cell Killed Whole-Cell Killed Whole-Cell Live

Recommended 2 doses in adults 2 doses at an 2 doses at an Single dose;

Route of administration: Oral

List of COVID-19 Vaccines Approved by CDSCO in India17

Guideline recommendations for COVID-19 vaccines in adults

Route of administration: Intramuscular injection (IM)

Indian Consensus Recommendations:

Available vaccines and relevant population to receive them.

HAV Two doses 6 mo. apart Age 19 years and above

Vaccine type: Inactivated vaccine

Indian Consensus Recommendations:

Vaccine type: Recombinant DNA or plasma-derived inactivated subunit vaccine

Vaccine type: Recombinant protein capsid liquid vaccine

Vaccine type: Live attenuated

Indian Consensus Recommendations:

Vaccine type: Live-attenuated combined vaccine

Vaccine type: Purified bacterial capsular polysaccharide (PBCP) | Conjugate Vaccine

Route of administration: PPSV: Intramuscular or subcutaneous injection | PCV13: intramuscular injection

Indian Consensus Recommendations:

Vaccine type: Live Attenuated (OPV) | Inactivated Polio Vaccine (IPV)

Categories of contact with suspect rabid animal21

Dose: 0.5 ml Dose: 0.5 ml Dose: 0.5 ml Route: orally

Vaccine type: Recombinant zoster vaccine

Vaccine type: Live attenuated vaccine

Patients with Chronic Conditions

Immunocompromised Recipients of Hematopoietic

Recipients of Solid Organ Transplant

Vaccines Recipient & Donor Comments Recommendation

Students travelling from India to international destinations

Recommendation for Pilgrims

Additionally, combining inactivated vaccines Takeda

with alum and live attenuated vaccines in a

enhance the immune response. However, the

lack of an ideal animal model for dengue poses

Not yet approved | available for clinical use in India