Vaccinations

Other Vaccines

Meningococcal Vaccine

  • Recommended only for certain high risk group of children, during outbreaks, and international travelers, including students going for study abroad and travelers to Hajj and sub-Sahara Africa.
  • Both Meningococcal conjugate vaccines (Quadrivalent MenACWY-D, Menactra by Sanofi Pasteur and monovalent group A, PsA–TT, MenAfriVac by Serum Institute of India) and polysaccharide vaccines (bi- and quadrivalent) are licensed in India. PsA–TT is not freely available in market.
  • Conjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd protection and their increased immunity, particularly in children ≤2 years of age.
  • As of today, quadrivalent conjugate and polysaccharide vaccines are recommended only for children 2 years and above. Monovalent group A conjugate vaccine, PsA–TT can be used in children above 1 year of age.

Cholera Vaccine

  • Minimum age: one year (killed whole cell vibrio cholera (Shanchol))
  • Not recommended for routine use in healthy individuals; recommended only for the vaccination of persons residing in highly endemic areas and traveling to areas where risk of transmission is very high like Kumbh mela, etc.
  • Two doses 2 weeks apart for >1 year old.

Japanese Encephalitis (JE) Vaccine

Routine vaccination:

  • Recommended only for individuals living in endemic areas.
  • The vaccine should be offered to the children residing in rural areas only and those planning to visit endemic areas (depending upon the duration of stay).
  • Three types of new generation JE vaccines are licensed in India : one, live attenuated, cell culture derived SA-14-14-2, and two inactivated JE vaccines, namely 'vero cell culture-derived SA 14-14-2 JE vaccine' (JEEV by BE India) and 'vero cell culture-derived, 821564XY, JE vaccine' (JENVAC by Bharat Biotech).

Live attenuated, cell culture derived SA-14-14-2:

  • Minimum age: 8 months.
  • Two dose schedule, first dose at 9 months along with measles vaccine and second at 16 to 18 months along with DTP booster.
  • Not available in private market for office use.

Inactivated cell culture derived SA-14-14-2 (JEEV by BE India):

  • Minimum age: 1 year (US-FDA: 2 months).
  • Primary immunization schedule: 2 doses of 0.25ml each administered intramuscular on days 0 and 28 for children aged >1 to ≤3 years.
  • 2 doses of 0.5 ml for children ≤3years and adults aged >18 years.
  • Need of boosters still undetermined.

Rabies Vaccine

  • Practically all children need vaccination against rabies.

Following two situations included in 'highrisk category of children' for rabies vaccination and should be offered 'Pre-exposure Prophylaxis' (Pre-EP):

  • Children having pets in home.
  • Children perceived with higher threat of being bitten by dogs, risk of stray dog menace while going outdoor.
  • Only modern tissue culture vaccines (MTCVs) and IM routes are recommended for both 'post-exposure' and 'pre-exposure' prophylaxis in office practice.
  • Post-exposure prophylaxis (PEP) is recommended following a significant contact with dogs, cats, cows, buffaloes, sheep, goats, pigs, donkeys, horses, camels, foxes, jackals, monkeys, mongoose, squirrel, bears and others. Domestic rodent (rat) bites do not require post exposure prophylaxis in India.

Post-exposure Prophylaxis:

  • MTCVs are recommended for all category II and III bites.
  • Dose: 1.0 ml intramuscular (IM) in anterolateral thigh or deltoid (never in gluteal region) for Human Diploid Cell Vaccine (HDCV), Purified Chick Embryo Cell (PCEC) vaccine, Purified Duck Embryo Vaccine (PDEV); 0.5 ml for Purified Vero Cell Vaccine (PVRV). Intradermal (ID) administration is not recommended in individual practice.
  • Schedule: 0, 3, 7, 14, and 30 with day ‘0’ being the day of commencement of vaccination. A sixth dose on day 90 is optional and may be offered to patients with severe debility or those who are immuno-suppressed.
  • Rabies Immunoglobulin (RIG) along with rabies vaccines are recommended in all category III bites.
  • Equine Rabies Immunoglobulin (ERIG) (dose 40 U/kg) can be used if human rabies immunoglobulin is not available.

Pre-exposure Prophylaxis:

  • Three doses are given intramuscular in deltoid/ anterolateral thigh on days 0, 7 and 28 (day 21 may be used if time is limited but day 28 preferred).
  • For re-exposure at any point of time after completed (and documented) pre or post exposure prophylaxis, two doses are given on days 0 and 3.
  • RIG is not required during re-exposure therapy.

Yellow Fever Vaccine

  • Yellow fever vaccine is a vaccine used against yellow fever.
  • Yellow fever vaccine is contraindicated by the manufacturer in infants ≤9 months old due to the risk of encephalitis. Travelers with infants ≤9 months should be strongly cautioned against traveling to areas with epidemic yellow fever.
  • Travelers should also take precautions against mosquito bites when in areas with yellow fever transmission.
  • Travelers should get vaccinated for yellow fever before visiting areas where yellow fever is found.
  • If you continue to live or travel in yellow fever-endemic areas, you should receive a booster dose of yellow fever vaccine after 10 years.