Friday, 5 August 2011

Vaccines for preteens and teens must to make up for the immunity loss gained through vaccination in infancy and early childhood

By Syed Akbar
Hyderabad: Vaccines for adolescents and teenagers? This may surprise many parents. But 
the Indian Academy of Paediatrics in its latest vaccination guide recommends that 
preteens and teens should be given booster doses of certain vaccines to keep them in good 
health and free from dangerous diseases. Vaccination of preteens and teens will also make 
up for the loss of immunity in case they are not given vaccines in their infancy or early 
childhood. Vaccination can be carried out till the boy or the girl is 18 years old.

While the American Academy of Paediatrics recommends four vaccines for preteens and 
teens, the Indian Academy of Paediatrics in its vaccination guide for 2011 recommends 
just two vaccines. According to AAP, vaccines for tetanus, diphtheria and pertussis 
(Tdap), human papillomavirus (HPV), human influenza and meningococcal conjugate vaccine 
(MCV4) should be given to adolescents. However, IAP feels that Tdap and HPV are 
sufficient. HPV is given only to girls in their preteens or teens.

“Vaccines aren't just for babies. As kids get older, the protection provided by some of 
the vaccines given during childhood can begin to wear off. Older kids can also develop 
risks for certain infections as they enter the preteen and teen years. The preteen and 
teen vaccines not only help protect them, but also their friends, community and family 
members. Teens may need to catch-up on vaccines they missed when they were a preteen. 
Teens may also need a booster of a vaccine that requires more than one dose to be fully 
protected,” says the latest recommendation by the AAP and the Centers for Disease Control 
and Prevention (CDC) of the USA.

The Indian Academy of Paediatrics is of the view that adolescence should be considered an 
appropriate age for catch up immunisation as well as for administration of certain 
vaccines which may not have been available earlier. Preferred age for administration is 
at 10-12 years, but catch up may be done till 18 years.

“The vaccination guide book of the Indian Academy of Paediatrics recommends only two 
vaccines for routine use in adolescents - Tdap and HPV (in case of girls),” points out Dr 
Sharmila Asthana, consultant paediatrician, Apollo Hospitals. She, however, adds that 
meningococcal vaccine is suggested in case of an outbreak. “MCV is not given routinely to 
all children or adolescents. Influenza vaccine is also given only in special 
circumstances (if a child has compromised lung function as in asthma) and is not 
recommended for routine use in all adolescents.”

According to Dr Sharmila, vaccines can be given as catch up for those adolescents, who 
missed some of the childhood vaccines.

Doctors however, warn that adolescents may experience mild side effects, which include 
redness and soreness in the region of vaccination. A few of them might faint after 
getting a shot. Sitting or lying down for about 15 minutes after a vaccination can help 
prevent fainting. Most side effects are very minor, especially compared with the serious 
diseases that these vaccines prevent, argues the CDC.

Senior physician Dr B Hari Kishan clears the myth that vaccines are only for children. 
“Many people, particularly adolescents, become ill or disabled or die from diseases that 
could easily have been prevented by vaccines. Some childhood vaccinations may not protect 
them for the whole of their lives so they need a booster,” he adds.

He also recommends vaccination for adults, as since newer vaccines are developed 
regularly, some adults might not have been vaccinated as children. Dr Hari Kishan points 
out that older people are more likely to have a serious disease from common infections 
like pneumococcal pneumonia.

“Some vaccines are vital for most adults, especially older people. Others may depend on a 
person’s health status, lifestyle and occupation. Vaccines such as pertussis contain 
inactivated bacteria or viruses. Others contain only the antigens that are important for 
protection. For example, tetanus and diphtheria vaccines contain inactivated toxins 
(toxoids), and pneumococcal vaccine contains the capsular polysaccharide”.

Diphtheria and tetanus vaccine is recommended for all those who have not received it in 
childhood. If vaccinated previously, needs a booster dose one in 10 years. Pneumococcal 
vaccine is recommended for all above 55 years age, people with diabetes, asthma, COPD and 
kidney and liver diseases.

In case of hepatitis A doctors recommend that people living in hostels and who eat 
outside frequently should take the vaccine. But hepatitis B vaccine is recommended for 
all (if not vaccinated previously). Vermicelli (chicken pox) should be given for people 
living in crowded places and healthcare personnel. Typhoid vaccine should be administered 
for all, especially schoolchildren, hostel dwellers and people, who eat out frequently.
-------------------
Some facts
===========
 * It is wrong to believe that vaccines are meant for children and infants only. Preteens 
and teens should be given booster or doses of vaccines. Both Indian Academy of 
Paediatrics and American Academy of Paediatrics recommend that vaccines can be given to 
boys and girls up to the age of 18. This will boost their immunity if they were given 
vaccine in their childhood. If not given in their childhood, the vaccines will provide 
new immunity against diseases.

* Tdap vaccine that gives protection against tetanus, diphtheria and pertussis or 
whooping cough should be given to adolescent even if they were vaccinated in early 
childhood. Teens, who have missed the booster dose in preteens and vaccination in early 
childhood, should also be vaccinated. Human Papillomavirus vaccine (HPV) is given to 
adolescent girls.

* While American Academy of Paediatrics recommend Tdap, meningococcal conjugate vaccine, 
HPV and swine flu vaccine for adolescents, Indian Academy of Paediatrics says Tdap and 
HPV are sufficient.

* According to the Centers for Disease Control and Prevention (CDC) of the USA, whooping 
cough can make preteens and teens sick enough to miss several weeks of school and other 
activities. It can also be passed on to others, including babies, who can die from it.

* Meningococcal meningitis can become deadly in 48 hours or less. Even with treatment, 
people die in about 10 per cent of cases. About 20 per cent of survivors of meningococcal 
disease have a long-term disability such as deafness, brain damage, or an amputated arm 
or leg. AAP says preteens should receive this vaccine at age 11 or 12 and then get a 
booster at age 16. Teens who received MCV4 for the first time when they are 13 through 15 
years old will need a one-time booster dose when they are 16 through 18 years old.

* The human papillomavirus (HPV) vaccines protect girls and young women against the types 
of HPV that cause most cervical cancer. One HPV vaccine also prevents anal cancer and 
genital warts in both females and males, says CDC.

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