Vaccines for Older Adults in India: A Practical Schedule

Why vaccinate in later life

• Older adults are more likely to develop severe disease from influenza, pneumococcus, shingles, covid and other infections.
• Vaccines protect against complications such as pneumonia, heart attack and stroke after infection, hospital stays and loss of independence.
• Chronic conditions make infections more dangerous; see pneumonia in older adults: prevention and recovery.
• Protection fades: some vaccines need boosters, and some adults missed childhood vaccines.
• Protecting others: older people living with babies, pregnant women or immunocompromised people benefit them as well.

Vaccines commonly discussed

The list below is general. Check the current schedule and your parent's needs with the doctor.

### Influenza (flu)

• Recommended yearly for older adults and people with chronic illness by many professional bodies, because flu viruses change.
• Best given before the local flu season. In much of India, flu peaks around the monsoon and winter, and timing varies by region, so ask the doctor.
• The vaccine reduces the risk of serious illness, hospital admission and some heart complications.
• Common side effects: a sore arm, mild fever, tiredness for a day or two.

### Pneumococcal vaccines

• Protect against a bacterium that causes pneumonia, meningitis and blood infection.
• Recommended for older adults and for those with chronic heart, lung, kidney, liver or diabetes conditions, and some other groups.
• Different vaccine types exist, with different schedules; ask the doctor which type and whether more than one dose is needed.
• See vaccines that protect older lungs.

### Tetanus, diphtheria (and whooping cough) boosters

• Tetanus can follow even minor wounds, cuts or injuries from soil, rusty objects or animal bites, and is life-threatening.
• Adults generally need a booster about every ten years, and sooner after a dirty wound if the last dose was more than five years ago; ask the doctor or hospital at the time of injury.
• If your parent has never been vaccinated, a short primary series may be advised.

### Shingles (herpes zoster)

• Recommended in many countries for older adults to reduce the risk of shingles and the long-lasting nerve pain that can follow; see shingles and nerve pain in older adults.
• Availability and cost in India vary. Recombinant (non-live) vaccines are usually preferred, especially for people with weakened immunity.

### Covid-19

• Recommendations about doses and boosters change as variants and national guidance evolve. Ask the doctor or check the latest government guidance for older adults and high-risk groups; see covid vaccines available in India.

### Hepatitis B

• Considered for older adults with diabetes, liver or kidney disease, those on dialysis, health and care workers and others at risk.
• A blood test may be done first; a series of doses is needed.

### Hepatitis A and typhoid

• May be considered, particularly for travel, outbreaks, or in people with chronic liver disease. Ask the doctor.

### Rabies

• Not a routine vaccine, but after any animal bite or lick on broken skin, wash the wound well with soap and running water for at least fifteen minutes and see a doctor or hospital immediately for assessment and post-exposure treatment. Do not wait.

### Others

• Depending on travel, occupation, health and local outbreaks, the doctor may advise other vaccines.
• RSV vaccines for older adults exist in some countries; ask whether they are advised and available for your parent.

Who needs extra care or advice

• Weakened immune system: cancer treatment, steroid-type or immune-suppressing medicines, transplant, advanced kidney disease, HIV. Live vaccines are generally avoided; non-live vaccines may be less effective, and timing may be planned around treatment. Ask the specialist.
• Blood thinners or bleeding disorders: injections may need a fine needle and longer pressure afterwards; see atrial fibrillation and blood thinners: a family guide.
• Previous severe allergic reaction to a vaccine or ingredient: tell the doctor beforehand.
• Current illness with fever: usually wait until recovered; a mild cold is often not a barrier. Ask.
• Frailty or advanced illness: the doctor can weigh benefits, practicalities and wishes; see frailty in older adults: what it means and what helps.
• Egg allergy and other special situations: ask the doctor or vaccinator.

Practical points

• Go with a doctor's advice and a reputable clinic or hospital that stores vaccines properly (cold chain) and records the batch number.
• Carry the list of medicines and conditions; tell the vaccinator about allergies and past reactions.
• Eat normally, drink fluids, and wear a loose, short-sleeved shirt.
• Wait for fifteen to thirty minutes at the clinic after the injection in case of immediate reaction.
• Several vaccines can often be given on the same day, in different arms or sites; ask the doctor about the best schedule.
• Do not take medicine "in advance" to prevent side effects; ask the doctor if needed.
• Do not skip vaccines because of one heard rumour. Ask the doctor about worries; they are often addressed by looking at evidence.

After the injection: what to expect

Common and mild: soreness, redness or swelling at the injection site; tiredness; mild fever; muscle aches; headache, for a day or two.

What helps: rest, fluids, moving the arm gently, a cool cloth on the arm. Check temperature if feverish; see digital thermometers: choosing and using them for older people. Ask the doctor or pharmacist before using any fever or pain medicine, particularly for people with kidney, stomach or heart problems or on blood thinners.

Call the doctor if: fever lasts more than two days, redness or swelling spreads or worsens, severe pain, or your parent seems unusually unwell.

Call 112 or go to hospital at once for: difficulty breathing, wheezing, swelling of the face, lips or throat, hives all over the body, dizziness, a very fast pulse, collapse or confusion within minutes to hours of the vaccine. These are signs of a serious allergic reaction, which is rare and is treatable by medical staff.

Report unexpected reactions to the doctor, who can notify national surveillance for adverse events following immunisation.

Keeping a vaccination record

Keep a single page or card in the health file, in the phone and with a relative: - Vaccine name and type. - Date and dose number. - Batch number and clinic. - Next dose due. - Reactions.

See keeping a health record at home and emergency contact card and medical summary. Take the record to doctor visits, and when travelling or being admitted to hospital.

Costs and access

Prices and availability vary across cities, public and private clinics, and brands. Government hospitals, some state programmes, and employer or insurance schemes may offer certain vaccines at low or no cost; ask local health officials and see government schemes for senior citizens and health insurance for senior citizens in India. Some insurance plans may cover vaccines; check the policy. Do not buy vaccines from unlicensed sellers, and make sure the vial and expiry are checked by the vaccinator.

Other protection that works alongside vaccines

• Hand washing, clean air and ventilation, especially in monsoon and winter; see infection control for home caregivers.
• Good nutrition and activity; see how much protein do older adults need.
• Quit smoking, manage diabetes, heart and lung disease well; see COPD at home guide.
• Early medical review for fever, cough or breathlessness.
• Keep household members vaccinated.

When to ask a professional

Ask the doctor or a geriatrician which vaccines your parent needs, in which order and when, and what to expect. Ask a pharmacist about storage and sourcing. Ask about vaccines before planned surgery, chemotherapy or travel. Seek urgent help for severe reactions.