Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024)

Parvaiz A Koul; Agam C Vora; Surinder K Jindal; Venkatasubramanian Ramasubramanian; Varsha Narayanan; Surya Kant Tripathi; Digambar Bahera; Harway Bhaskar Chandrashekhar; Ravindra Mehta; Narendra Raval; Prabhakar Dorairaj; Prashant Chhajed; Akash Balki; Rohan Ketan Aurangabadwalla; Abhijeet Khandelwal; Mahendra Kawedia; Satya Prakash Rai; Ashok Grover; Manish Sachdev; Surajit Chatterjee; Velamuru V Ramanaprasad; Aratrika Das; Mahavir Madhavdas Modi

doi:10.4103/lungindia.lungindia_8_24

Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024)

Lung India. 2024 Jul 1;41(4):307-317. doi: 10.4103/lungindia.lungindia_8_24. Epub 2024 Jun 28.

Authors

Parvaiz A Koul¹, Agam C Vora², Surinder K Jindal³, Venkatasubramanian Ramasubramanian⁴, Varsha Narayanan⁵, Surya Kant Tripathi⁶, Digambar Bahera⁷, Harway Bhaskar Chandrashekhar⁸, Ravindra Mehta⁹, Narendra Raval¹⁰, Prabhakar Dorairaj¹¹, Prashant Chhajed¹², Akash Balki¹³, Rohan Ketan Aurangabadwalla¹⁴, Abhijeet Khandelwal¹⁵, Mahendra Kawedia¹⁶, Satya Prakash Rai¹⁷, Ashok Grover¹⁸, Manish Sachdev¹⁹, Surajit Chatterjee²⁰, Velamuru V Ramanaprasad²¹, Aratrika Das²², Mahavir Madhavdas Modi²³

Affiliations

¹ Professor, Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
² Medical Director, Vora Clinic, Mumbai, Maharashtra, India.
³ Medical Director, Jindal Clinics, Chandigarh, India.
⁴ Senior Consultant, Infectious Diseases, Apollo Hospital, and Founder Capstone Clinic, Chennai, Tamil Nadu, India.
⁵ Medical Affairs Consultant, GC Chemie Pharmie Ltd, Andheri West, Mumbai, Maharashtra, India.
⁶ Professor and Head, Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
⁷ Director, Pulmonary Medicine, Fortis Health Care, Mohali, Punjab, India.
⁸ Director, Jain Institute of Pulmonary and Sleep Medicine, Bhagwan Mahavir Jain Hospital, Bengaluru, Karnataka, India.
⁹ Chief of Pulmonology and Critical Care, Apollo Hospitals, Bengaluru, Karnataka, West Bengal, India.
¹⁰ Consultant Pulmonologist, Raval Chest Day Care Clinic, Ahmedabad, Gujarat, India.
¹¹ Preventive Interventional Cardiologist, Ashwin Clinic, Annanagar, Chennai, Tamil Nadu, India.
¹² Director, Institute of Pulmonology, Medical Research and Development, and Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India.
¹³ Director, Shree Hospital and Critical Care Center, Indore, Madhya Pradesh, India.
¹⁴ Consultant, Respiratory Medicine, Apollo Hospitals, Navi Mumbai, Maharashtra, India.
¹⁵ Professor and Head of Department of Respiratory Diseases, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
¹⁶ Consultant Chest Physician, Jehangir Hospital, Pune, Maharashtra, India.
¹⁷ Consultant, Pulmonary and Sleep Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
¹⁸ Consultant Diabetologist, Grover's Clinic, Preet Vihar, Delhi, India.
¹⁹ Consultant Diabetologist, Advance Diabetes and Asthma Care Center, Mumbai, Maharashtra, India.
²⁰ Assistant Professor, Respiratory Medicine, Institute of Post Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India.
²¹ Interventional Pulmonologist and Sleep Specialist, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
²² Senior Chest Consultant, R N Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India.
²³ Consultant Pulmonologist, Ruby Hall Clinic, Pune, Maharashtra, India.

Abstract

Introduction: Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing.

Methods: Nation Against Pneumococcal Infections - Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake.

Outcome: The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms.

Conclusion: These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.