Optional vaccines: Are they really optional?

November 12, 2018Dr Gowri KulkarniBlog, Vaccination

Under the IAP (Indian Association of Pediatricians) there are 2 categories of vaccines available to be given to children and adults: essential and optional.

Essential vaccines include BCG, polio, DPT, measles, tetanus, hepatitis B, H influenza B, and in a few states, Japanese encephalitis. These are included in the Universal Immunization Programme (UIP) and under this program no child can be denied immunization.

Optional vaccines mean that one may choose to have it or not without any risk or disadvantage. We all know immunization against vaccine-preventable diseases is definitely beneficial for the individual. The merits of ‘optional’ vaccines for individual use must be considered on the basis of the degree of prevalence of the infection and disease; age prevalence of mortality, morbidity and sequelae of the disease; risk of severe disease in susceptible adults after weaning of vaccine-induced immunity; and the effects of childhood vaccination in modifying future epidemiology. Socioeconomic factors are of important consideration.

All optional vaccines are warranted to be given on account of high disease burden and the fact that they are safe and effectively reduce morbidity and mortality due to the disease. However affordability and availability if these vaccines make it difficult for the government to get them added to the UIP. By classifying a vaccine as optional the choice is left with the treating physician and parent to decide if the child needs it or not.

The optional vaccines include MMR, rotavirus, typhoid, Hib, chickenpox (varicella), hepatitis A, pneumococcal, meningococcal, influenza viral vaccines, HPV. Here is a quick look at each. From a public health perspective the priorities given to the optional vaccines are as follows:

Haemophilus type b conjugate (Hib)

Hib is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years. In 2000, Hib was estimated to have caused two to three million cases of serious disease, notably pneumonia and meningitis, and 386,000 deaths in young children.

Rotavirus

Rotavirus are the leading cause of severe diarrhea among infants and young children. It accounts for 1 in 6 deaths in children under age of 5 in India. This vaccine was introduced in the UIP in a few states in 2016.

Hepatitis B

Hepatitis B is an acute systemic infection with major pathology in the liver, caused by hepatitis B virus (HBV). More than 2 billion people worldwide have evidence of past or current HBV infection and 350 million are chronic carriers of the virus. Though under UIP, this is still not included as a adult vaccine for catch up immunization or re-immunisation in high risk adults.

Pneumococcal

Pneumonia caused by Streptococcus pneumoniae is a major cause of illness and death in children. It can also cause meningitis and otitis media in children. More than 2 million children die from pneumonia each year, accounting for almost one in 5 under-five deaths worldwide. 19% of global pneumococcal deaths are seen in India. As much as children, adults with chronic diseases like diabetes, asthma and renal impairment also need to take this vaccine.

Influenza virus

Flu vaccine is indicated for active immunization for the prevention of disease caused by influenza virus. This virus is highly contagious and causes grave morbidity and mortality especially in the immunocompromised states.

Human papilloma virus

HPV causes cervical cancer which is the second most common cancer in women worldwide. India accounts for the 1/3rd global cervical cancer deaths. Recommended in females from 10–45 years. In the west, this is recommended in young boys in the age group of 10–16 years as well.

Typhoid

Typhoid fever is the result of systemic infection mainly by S. typhi found only in man. According to the most recent estimates (published in 2014), approximately 21 million cases and 222,000 typhoid-related deaths occur annually worldwide.

Meningococcal meningitis

Meningococcal meningitis or cerebrospinal fever is an acute communicable disease caused by N. meningitidis. During 2005, about 8,367 cases of meningococcal meningitis were reported in India with about 485 deaths.

Hepatitis A

Hepatitis A is an acute infectious disease caused by hepatitis A virus (HAV). According to WHO about 50 persons per 100,000 are affected annually. Though the mortality is low, the morbidity and disease spread is very high and lead to outbreaks especially through contaminated water. This is recommended for children and adults.

Chickenpox

Chickenpox or varicella is an acute, highly infectious disease caused by varicella-zoster (V-Z) virus. it is a highly contagious disease with a secondary high rate of over 90%. Mortality rates in normal young children are estimated to be >2/100,000. Mortality risk for adults is 15 times higher.

MMR

MMR vaccine is an immunisation shot against measles, mumps, rubella. It is indicated for active immunization not only in children 12 months to 12 years age but even in adults who missed the dosage in childhood. A catch up dose at age 15 is recommended.

Japanese encephalitis

Japanese encephalitis (JE) is a mosquito-borne encephalitis caused by a group B arbovirus (Flavivirus) and transmitted by culicine mosquitoes. In India repeated outbreaks reported in Assam, AP, Bihar, Haryana, Kerala, Karnataka and is mandatory in certain districts under the UIP.

So the question remains, is optional really an option? In my opinion, immunisation definitely help in reducing the morbidity and mortality due to these vaccine preventable diseases. The total cost on health care will drop if these are made easily available to all children in the right manner which includes proper vaccine procurement, storage, administration and monitoring.