Prevention is better than cure, this time honoured idiom applies everywhere in all walks of life, probably much more in the health sphere.
Vaccination is the most effective preventive medicine. It’s affectivity against diseases which are known to kill and disable people in millions such as small pox measles mumps rubella etc, are scientifically validated. Whereas It’s use in children has nearly reached almost all segments of our country it’s value in adults unfortunately has not .The only problem with this remedy or medicine is that you have to be educated enough to understand it’s potential and extraordinary value.
Multitudes of scientific studies have shown that Immunisation through vaccine in young adults with certain known co morbidities and in apparently healthy elderly (> 65 yrs) without any co morbidity increases the life it’s quantity as well as quality. Bronchopneumonia due to streptococcus pneumonie popularly known as pneumococcal bacteria many a times comes as a fatal terminal disease at old age and this is largely preventable.
Flu fever contracted due to influenza virus H1N1/ H2N3 or various subtypes, leads to viral pneumonia much like COVID. In old and immunocompromised individuals they are often alone or at times superimposed with pneumococcal bacterial pneumonia turns out to be a lethal illness. Fortunately both these diseases are now preventable easily by effective vaccination.
Pneumococcal vaccine has two types and the one known as polysaccharide vaccine PPSV 23 which is against 23 serotypes of bacteria needs to be given to all the adults (above 18 yrs ) with comorbidities such as Diabetes Kidney or liver disease etc. Healthy Elderly (above the age of 65) even without any disease or co morbidities must take PPSV 23 for at least once if they have not taken it before this age range. If the elderly have some other comorbidities also then they should first take PSV13 followed by PPSV 23 after a year gap.
The other vaccine PCV 13 is an adjuvant vaccine which is against 13 serotypes of pneumococcal bacteria but it is far more potent than PPSV 23 .This has to be given to those above 19 yrs of age who are suffering from malignancies or immunodeficiency disease states including sickle cell anemia and asplenia.
It’s preferable to first administer PCV 13 followed by PPSV 23 with an interval of one year and to repeat PPSV 23 every fifth year in consultation with physician.
Influenza vaccine is another very useful vaccine which has to be given every year generally just before fall or winter. It should be of quadruple variety and should be recently launched.
Vaccination against vaccinia virus which causes chickenpox and zoster is becoming very important due its increasing prevalence in older and immunocompromised individuals due to its associated morbidities and occasional fatalities .It has to be given once or twice depending on the circumstances decided by the treating physician.
Popular childhood vaccines such as Diptheria Pertussis Tetanus and MMR if not taken before must be given even in adults. Most importantly tetanus vaccine must be given every tenth year and early in each pregnancy.
Vaccine against papilloma virus which causes a lethal cancer of cervix (entry part of uterus in females) is a preventable cancer by the early use of vaccine against papillomavirus, is available in India. It also helps in preventing anal cancer and warts in both male and female.
Vaccine against typhoid fever is available but it has not found much acceptance in India surprisingly despite its value in our poor hygienic conditions which is responsible for this fever.
Covid 19 has brought a new dimension to the need of adult (and elderly) immunisation as this is further complicated by the superimposition of the above preventable diseases.
There are many myths surrounding the use of vaccines and many a times even so called educated amongst us fall prey to such propaganda.
Besides understanding its value it’s the cost which is an important limiting factor in Indian conditions for its extensive use. And that’s the reason why it is not part of the universal immunisation schedule which is supported by our government as its welfare responsibility.
It’s high time we recognise the importance of immunisation especially for the elderly and sick young adults.
The Author is Currently Professor of medicine at Manipal Tata Medical College and Formerly Professor and Head, RIMS.