The uptake of flu and pneumonia shots, recommended for the elderly and those with low immunity, has increased dramatically in India over the last two years amid a rise in cases of pneumococcal sepsis being reported.
However, a project pushed for the government by the Association of Healthcare Providers of India (a body of private hospitals) to publicise adult vaccination and raise awareness in the general population on these vaccines has remained in limbo.
Pulmonologists and critical care specialists spread across the country say that unlike earlier times, when less than 30-40 percent of those recommended for vaccination actually received it, this number has gone up to 90 percent now.
“In comparison to the pre-COVID-19 era, more adults are now taking vaccines for influenza and pneumococcal disease,” said Dr Arjun Bhatnagar, consultant and interventional pulmonologist with Regency Health hospital in Lucknow.
“In fact, a number of people are visiting doctors on their own to ask if they should be vaccinated, which was unusual prior to the pandemic,” he said. “Others who have been urged by doctors to be vaccinated are less resistant than before.”
In India, these vaccines are approved and available in the private market for adults but are not part of the Universal Immunisation Programme even though the Pneumococcal Conjugate Vaccine (PCV) for kids under the age of five was rolled out across India in November, 2021 as part of the programme.
For high-risk population groups, the cost factor, however, means that even among those who need them, a large number does not receive them.
People who need flu and pneumonia vaccines
According to senior pulmonologist Dr Rohit Caroli, who is based in Noida, the flu vaccine is offered to all kids aged 2-10 years. It is also recommended to females aged 55 years and above and all males above 60 years.
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“In addition, patients who are immune-compromised, such as those with respiratory conditions and multiple co-morbidities, should take these vaccines irrespective of their age,” suggests Caroli.
Dr Jayalakshmi TK, consultant pulmonologist with Apollo Hospitals in Navi Mumbai, pointed out that while the immune system is the first line of defense against many diseases, vaccination helps to provide an extra layer of protection.
The World Health Organization says that immunity from vaccination wanes over time so annual vaccination is recommended to protect against influenza.
Among healthy adults, the influenza vaccine provides protection even when circulating viruses do not exactly match the vaccine viruses, according to the WHO.
“However, among the elderly, influenza vaccination may be less effective in preventing illness but reduces the severity of disease and incidence of complications and deaths,” it says.
Vaccination is especially important for people at high risk of influenza complications, and for people who live with or care for people at high risk.
The pneumonia vaccine, on the other hand, has to be taken every 3-5 years depending on the condition of the patient.
Experts say that it is beneficial to receive flu shots ahead of the monsoon and pneumonia shots ahead of winter season.
How do vaccines help?
The flu vaccine is usually given because influenza is infectious and can cause severe respiratory infections in those vulnerable. And while flu is confused with the common cold, it is capable of causing severe symptoms and can stay for a prolonged period.
There are four types of seasonal influenza viruses, types A, B, C and D. Influenza A and B viruses circulate and cause seasonal epidemics. The WHO recommends a flu shot that has all four strains. This vaccine is generally designed specifically for the northern and southern hemispheres and the one used in India includes the one designed for the southern hemisphere.
Dr Sreenivasan V, consultant and interventional pulmonologist with Gleneagles Global Health City, said that due to rapid climatic changes worldwide, the steep rise in incidence of influenza infections in all age groups, especially in risk groups, is very high, so the flu vaccine is really helpful.
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“Importantly, some studies have shown that flu shots reduce some of the most common complications in COVID-19 patients,” he pointed out.
Affordability issues
According to Caroli, while the annual flu shot costs about Rs 2,000-2100 each, the pneumococcal vaccine, which is recommended every 3-5 years for the high-risk group, costs about Rs 3,000-4,000.
Dr. V. Anil Kumar, professor and head of microbiology with Amrita hospital in Cochin, said that the incidence of pneumococcal pneumonia and pneumococcal sepsis in the population has increased over the last two years and this is a worrying trend.
Even though studies are needed to find out the precise cause for this trend, he said, vaccine uptake for pneumococci and influenza has not shown a proportionate increase because of affordability issues and the need for multiple doses.
Jayalakhsmi, too, pointed out that the National Popular Survey in 2017 showed that only about 2 percent of the people in India had been vaccinated for Influenza. Another study among healthcare workers in a north Indian city in India showed about 40 percent vaccination uptake if pre- employment mandatory vaccinations were excluded.
Girdhar J Gyani, director general of the AHPI, said that the association has been asking the Union health ministry to promote adult vaccination in a big way due to its low uptake despite there being numerous benefits.
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