In India

Need for Adult Vaccination in India 

In countries with mass childhood vaccination through the NIP, a reduction in pneumococcal diseases is seen in the elderly due to herd effect. In these countries because of a reduction in diseases caused due to vaccine-type serotypes in the elderly, the coverage difference between PCV13 and PPSV23 is increasing. Such effect is yet to be seen in countries like India where mass childhood immunisation is in its early stages.¹

According to a study by Rodriguez et al., among the immunocompetent adults admitted with CAP in the ICU, 22.1% had a fatal episode, despite >95% of the cases receiving adequate antibiotic therapy.²

Even in industrialised countries, the overall CFR for pneumococcal bacteraemia may reach 15% to 20% among adults and 30% to 40% among elderly patients despite appropriate antibiotic therapy and intensive care.³ In some groups with predisposing conditions, the CFR may exceed 50%, even when appropriate treatment is given. It has been noted that irrespective of the regions of the world, pneumococci have been showing increasing resistance to one or more of the commonly used antibiotics.³

In spite of the advances in medical science and the extensive use of PPSV23, over the last decades, the 12% to 13% CFR for pneumonia among the hospitalised patients in the United States which begins to increase at around 45 years of age, has remained constant through the 1950s to the present.^4-7

The Geriatric Society of India has considered the role of both PPSV23 and PCV13 in the management of pneumococcal diseases in older adults above 50 years of age.⁸

CAP, community-acquired pneumonia; CFR, case fatality rate; ICU, intensive care unit; IPD, invasive pneumococcal disease; NIP, national immunisation programme; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal plain polysaccharide vaccine.
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