Adult Vaccination: The Shots Grown-Ups Forget They Need
Vaccination is widely treated as a childhood matter. Several of the most valuable vaccines are given in adulthood, and uptake among Indian adults is very low even in groups at clear risk.
Influenza
Who: everyone over 6 months, and particularly adults over 65, pregnant women at any stage, people with diabetes, heart, lung, kidney or liver disease, obesity, immunosuppression, healthcare workers, and anyone living with a high-risk person.
When: annually, because circulating strains change and immunity wanes. In India, before the monsoon in most regions and before winter in the north.
Influenza is not a bad cold. It causes sudden fever, severe body aches and prostration, and it precipitates heart attacks, strokes and decompensation of chronic disease in older adults. Vaccination reduces hospitalisation and death even when the strain match is imperfect.
It cannot give you flu. The injectable vaccine contains no live virus.
Pneumococcal
Who: adults 65 and over, and younger adults with diabetes, chronic heart, lung, liver or kidney disease, no spleen or a non-functioning spleen, cochlear implants, CSF leaks, immunosuppression, HIV, smokers, and alcohol dependence.
Protects against pneumonia, bloodstream infection and meningitis. Conjugate and polysaccharide vaccines exist, and the current schedule depends on which products are available locally — ask your doctor which sequence applies.
Shingles (herpes zoster)
Who: adults 50 and over, and immunocompromised adults from 19, depending on the product.
Shingles is reactivation of the chickenpox virus. It causes a painful blistering rash in one band, and in a substantial minority leaves post-herpetic neuralgia, pain that can persist for months or years and responds poorly to treatment. Ophthalmic shingles threatens sight.
The recombinant vaccine is given as two doses and is highly effective, including in older adults. It is under-used in India largely because people do not know it exists.
Hepatitis B
Who: all unvaccinated adults are reasonable candidates; essential for healthcare workers, dialysis patients, people with chronic liver disease, diabetics, household and sexual contacts of carriers, people with multiple partners, people who inject drugs, and anyone with occupational exposure.
Three doses at 0, 1 and 6 months. Healthcare workers should have anti-HBs checked after completion to confirm response.
HPV
Who: ideally girls and boys aged 9 to 14 before exposure, with catch-up vaccination recommended up to 26 and considered up to 45 after discussion.
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Prevents cervical cancer and a proportion of anal, oropharyngeal, vulval, vaginal and penile cancers, plus genital warts. Cervical cancer remains one of the leading cancers among Indian women and is largely preventable through vaccination plus screening. An indigenous quadrivalent vaccine has substantially reduced the cost.
Tetanus and diphtheria
Who: everyone. A booster every 10 years, plus Tdap once in adulthood, and Tdap in each pregnancy between 27 and 36 weeks to protect the newborn against whooping cough.
After a wound, a booster is needed if the last dose was more than 5 years ago for dirty wounds or more than 10 for clean ones. Tetanus in adults is still seen in India and carries high mortality.
Others by situation
- MMR for adults without evidence of immunity, particularly women of childbearing age before pregnancy, since rubella in pregnancy causes severe fetal damage. Not given during pregnancy
- Varicella for adults without a history of chickenpox
- Hepatitis A for travellers, people with chronic liver disease and food handlers
- Typhoid for travellers and residents of high-risk areas
- Rabies pre-exposure for veterinarians, animal handlers, and travellers to remote areas; post-exposure after any bite or scratch regardless
- Meningococcal for travellers to the meningitis belt, Hajj pilgrims, people without a spleen, and students in some settings
- COVID-19 boosters per current national guidance
- Japanese encephalitis in endemic areas
- RSV vaccination for older adults, where available
Special groups
Pregnancy: influenza and Tdap are recommended; live vaccines are avoided.
No spleen or non-functioning spleen: pneumococcal, meningococcal, Hib and annual influenza are essential, since the risk of overwhelming infection is high and lifelong.
Immunosuppressed or on biologics: live vaccines are generally contraindicated; inactivated vaccines are ideally given before starting treatment. Household contacts should be vaccinated.
Diabetes: influenza, pneumococcal and hepatitis B are specifically recommended.
Travellers: plan 4 to 6 weeks ahead; some vaccines need multiple doses, and yellow fever certification is mandatory for entry from certain countries.
Common objections answered
- “I never get sick.” The vaccines above prevent illnesses that disproportionately harm you once you are older or develop a chronic condition
- “I had it as a child.” Immunity to some vaccines wanes; tetanus needs boosting, and several of these are adult-specific
- “Side effects.” Sore arm, mild fever and tiredness for a day or two are common; serious reactions are rare and are far outweighed by the diseases prevented
- “I’m pregnant.” Two vaccines are specifically recommended in pregnancy, and they protect the baby
Practical step
Ask at your next consultation for a vaccination review, bring any records you have, and keep an adult vaccination card. Most adults have never been asked about this.
This is general information. Schedules, products and recommendations differ by age, condition and local availability; confirm what applies to you with your doctor.