The Geriatric Society of India, 2015

Indian Recommendations for Vaccination in Older Adults by the Geriatric Society of India, 2015¹

Indications

Both the vaccines are recommended for all individuals above the age of 50 years and for those with the following conditions:

1. Persons aged 50 years and above. 
2. Persons with certain underlying medical conditions, such as coronary artery disease, congestive heart failure, cardiomyopathy, diabetes mellitus, bronchial asthma, chronic obstructive pulmonary disease, cirrhosis of liver and CRF
3. Immunocompromised persons who are at high risk for pneumococcal infections, such as immunoglobin deficiency, HIV infection, leukaemia, lymphoma, multiple myeloma, Hodgkin’s disease, non-Hodgkin’s lymphoma, disseminated malignancy, who exhibit either a decreased responsiveness to vaccination or a greater decline in serum antibody concentrations.
4. Persons with organ or bone marrow transplantation.
5. Persons receiving long-term therapy with corticosteroids or immunosuppressive agents.
6. Persons who have undergone splenectomy, or exhibit anatomic asplenia or sickle cell disease as they exhibit reduced clearance of encapsulated bacteria from the blood stream.
7. Chronic smokers.
8. Persons suffering from sleep disorders.
9. Persons who are prone to nocturnal aspirations.

Schedule of Vaccination

PCV13 Is administered at a dose of 0.5 mL intramuscularly. The preferred site is the deltoid muscle of the upper arm.

• PCV13 may have an edge in those elderly patients who have previously received PPSV23 to maintain the immune protection.
• PCV13 may be the preferred vaccine in vaccine-native or previously vaccinated adults.
• In case both the vaccines are considered, PCV13 should be administered first, followed by PPSV23.
• For certain risk groups, like populations who are immunosuppressed or immunocompromised, if previously unvaccinated, a dose of PCV13 is recommended, followed by a dose of PPVS23 8 weeks later.

PPSV23 is given only once as a single dose to elderly persons.

Revaccination with PPSV23 may be recommended for persons exhibiting an increased risk of pneumococcal infection and to those who are likely to have a rapid decline in pneumococcal antibody levels provided that 5 years have elapsed since getting the first dose of pneumococcal vaccine.¹

Mass Gatherings

The PREVENT expert opinion in Saudi Arabia based on the available data and circumstances has concluded that in mass gatherings, there is greater vulnerability of pilgrims due to age and previous illnesses, intense crowding and air pollution, and hence, the pilgrims should be advised to receive pneumococcal vaccine.²

The consensus recommendation for India and Bangladesh for the use of pneumococcal vaccine in mass gatherings and for Hajj pilgrims recommends that³:

• PCV13 may be recommended 4 weeks before starting Hajj pilgrimage, depending on the economic status of the individuals
• PPSV23 may be administered in these individuals upon return from the pilgrimage based on their risk status

Similar recommendations have been made by the Geriatric Society of India, 2015, and the IAOH.^4,5
The IMA recommends mandatory PCV13 vaccination for Hajj pilgrims (adults aged >65 years).⁶

CRF, chronic renal failure; HIV, human immunodeficiency virus; IMA, Indian Medical Association; IAOH, Indian Association of Occupational Health; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal plain polysaccharide vaccine.

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