Adolescence, according to the WHO, is defined as the age range of 10 to 19 years. Adolescent immunization aims to vaccinate 16-year-olds and older individuals against several infectious diseases that take millions of lives each year. This is due to the fact that vaccinating teenagers against infectious diseases is among the most crucial, useful, and reasonably priced preventative measures available.
Therefore, the recommendations for adolescent immunization are intended to boost their vaccination rate, which will aid in hastening the endeavour to control or eradicate the disease. However, teenage vaccination rates in India need to be improved, and this can be done by fortifying the country’s health care delivery system. As a result, this article discusses what are adolescent vaccines, the recommended vaccines for 16-year-olds, and the adjustments needed for the teenage vaccination schedule.
What exactly are adolescent vaccines? Why are they essential?
Vaccinations can successfully and safely protect individuals against diseases that could be life-threatening. Adolescent vaccines are those designed specifically to protect teenagers and young adults against several infectious diseases and illnesses.
These vaccines are essential for controlling the spread of harmful illnesses and shielding teens’ health at a critical stage in their physical and mental development by preventing deadly infections. These vaccines guard teenagers against illnesses like influenza, meningococcal infection, and HPV-related cancers. Since adolescent immunization lowers the chance of illness (unlike the notion that the vaccines are not safe) in the near term but enhances health over time by averting infectious or chronic conditions, disabilities, and even death, a rigorous immunization schedule for teenagers is crucial.
Which vaccines are recommended for sixteen-year-old teenagers?
Adolescent immunization regimens help limit outbreaks of viral diseases that affect teenagers.
It is strongly advised that all teenagers receive the HPV, dengue, mumps/MMR, Td/Tdap, hepatitis A, typhoid, varicella, and hepatitis B vaccinations; however, meningococcal, pneumococcal polysaccharide vaccine (PPSV), influenza, rabies, cholera, and yellow fever vaccinations are given under specific circumstances. Adolescent vaccines in India include the following:
The HPV Vaccine: This vaccine, which is designed specifically for adolescents, needs to stay at the top of the priority list given the high incidence of cervical cancer in India, which accounts for about 25% of all cervical cancer-related fatalities worldwide.
India has a higher age-standardised incidence ratio of 22.9 per 100,000 women annually for cervical cancer than both Southeast Asia (16.3 per 100,000) and the global incidence of 14 per 100,000. Since 2016, a few Indian states have already launched HPV vaccination pilot programmes. The use of HPV vaccines for cervical cancer should be promoted due to the availability of highly effective vaccines and an age-based schedule, which should be more economical and compliant.
Tetanus-diphtheria-pertussis or the Tdap vaccine: Up until now, the Tdap and HPV vaccines have been deemed “mandatory” for adolescents (included in the IAP-ACVIP guidelines). Although statistics regarding the prevalence of pertussis in Indian teenagers is lacking, it would be wise to incorporate the vaccine into their routine regimens. Using Tdap during pregnancy to prevent pertussis in very young infants is another important indication of the vaccine.
Recommended Vaccines include:
Critical role of the Dengue vaccine: Dengue fever, one of the most common infectious diseases in tropical and subtropical regions of the world, affects endemic countries more severely in terms of health and the economy than 17 other disorders combined, including hepatitis B and JE. Given that the cases of dengue fever occur annually in more than 100 countries, it necessitates the implementation of disease-control strategies to halt the dengue virus’s spread.
Although it can afflict people of any age, teens and adults are the main populations affected by dengue. According to recent reports, the majority of dengue cases occur in the age range of 9–45 years, with the 15–24 age group having the highest prevalence. Thankfully, dengue has recently been designated as a VPD.
The World Health Organisation reports that Sanofi Pasteur’s Dengvaxia® (CYD-TDV) and Takeda’s Qdenga® (TAK-003) dengue vaccines are both licensed. In addition, the Laboratory of Infectious Diseases at the National Institutes of Allergy and Infectious Diseases (NIAID) in the US is almost finished with the clinical development of a new dengue vaccine.
Dengue vaccines, however, do not prevent every case of dengue. Dengue vaccination should be considered a component of a comprehensive plan to manage the illness, one that also addresses vector control, appropriate case care, community involvement, and education.
Comprehensive vector management must remain a key component of dengue prevention programmes. This is because the dengue mosquito vectors also transmit other important viruses, such as the Zika, Chikungunya, and yellow fever viruses.
The vaccine for mumps also needs to be included in the schedule of adolescent immunization. Mumps is most common in children over five years old in India, especially in the adolescent age range. Although the duration since vaccination appears to influence the risk of outbreaks in teenagers and there is a significant decline in immunity after mumps vaccination, a dose of MMR/mumps at 4-6 years of age may not be sufficient to halt outbreaks in older teenagers (15–18 years of age). Therefore, regardless of prior immunization history, all adolescents must receive a single dose of the mumps/MMR vaccine.
The HAV Vaccine: The rate at which the Hepatitis A virus infects people in terms of endemicity is shifting. Due to this, the average age of infection has increased, which has raised the percentage of infections that cause serious illness in adults and adolescents.
According to studies conducted in India, HAV seroprevalence ranges from 38% to 92% across all-age categories, with adults and adolescents having a greater attack rate. Teenagers are particularly prone to contracting HAV infections due to their propensity for dining out and frequent restaurant visits. When administering a vaccination, a high priority is the catch-up immunization of adolescents.
Vaccine for Hepatitis B: Hepatitis B is believed to have an intermediate endemicity in India, where estimates of prevalence range from 2–7%, with 4% being the norm. Although horizontal transmission is the most common method of transfer, perinatal transmission—from mother to child—represents a significant risk factor. Adolescents are particularly susceptible to contracting the virus through sexual activity, which increases the risk of the infection spreading. For this, the Hepatitis B vaccination can be added to the list of vaccines for 16-year-olds.
Vaccines for Typhoid and Varicella: In India and certain other Southeast Asian countries, typhoid fever is very common. Children and teens between the ages of five and fifteen are most likely to be affected by this condition. Adolescents should have a typhoid vaccination because, like those who have hepatitis A, they are more likely to contract the disease.
Likewise, the epidemiology of varicella-zoster virus (VZV) infection varies in tropical nations where adult and adolescent infections are widespread. Furthermore, compared to early childhood, varicella sickness is a significantly more serious illness with higher morbidity and fatality rates in adolescents and adults. Furthermore, there could be major health risks for the foetus and newborn child if there is a VZV infection during pregnancy. Therefore, the varicella vaccine needs to be a crucial part of adolescent vaccines in India.
Why does adolescent immunization in India need special attention?
In India, adolescent vaccination is a crucial yet often undervalued aspect of public health. Although childhood vaccination programmes have made great progress, teenagers are not given the same level of attention when it comes to immunising them against diseases that can be prevented.
The IAP-ACVIP has amended its recommendations for the 2023–24 vaccination schedule for children ages 0 through 18 years, taking into consideration the shift in epidemiology. The modifications include the following:
- The HPV vaccine is recommended for boys; 9vHPV should be administered in a two-dose schedule to teenagers aged 9 to 14;
- A dose of the Td vaccine should be administered to those aged 16 to 18;
- and patients transferring from the National Immunisation Programme to the IAP schedule should adhere to the injectable polio vaccine (IPV) guidelines.
Please be advised that, due to the development of new vaccine technologies, the rapidly evolving field of vaccines, and the shifting epidemiology of certain diseases that can be prevented by vaccination, India’s teenage immunisation schedule is subject to regular revision. In addition, the administration of vaccines for common vaccine-preventable diseases like dengue, mumps, hepatitis A, and typhoid should be handled differently from that of immunisations against diphtheria, tetanus, and pertussis.
Adolescent immunization in India is essential for safeguarding the health of the younger generation against VPDs. However, obstacles such as vaccine scepticism, logistical impediments, and insufficient persistence prevent teenagers from receiving vaccinations at the appropriate rate.
To tackle these issues, a variety of approaches are being used, such as community participation initiatives, school-based vaccination programmes, and improving healthcare infrastructure. Additionally, integrating vaccination services into school health programmes and leveraging digital platforms might be useful measures for enhancing teenage vaccine accessibility and uptake.
Thus, by prioritising teenage vaccination, India may contribute to the accomplishment of more expansive public health goals while simultaneously protecting this vulnerable population from diseases like influenza, tetanus, and HPV infections.
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