Immunization

Current UIP schedule

IAP Immunization Timetable 2012

I. IAP recommended vaccines for routine use

AGE

VACCINES

comments

Birth

BCG
OPV 0
Hep-B 1

Hepatitis-B: Administer Hep-B vaccine to all newborns

before hospital discharge

6 weeks

DTwP 1/DTaP 1
IPV 1
Hep-B 2
Hib 1
Rotavirus 1
PCV 1

Polio: All doses of IPV may be replaced with OPV if former is

unaffordable/unavailable
Additional doses of OPV on all supplementary immunization
activities (SIAs)
Two doses IPV instead of 3 for primary series if started
at 8 weeks, and 8 weeks interval between the doses
Rotavirus: 2 doses of RV-1 and 3 doses of RV-5

10 weeks

DTwP 2/DTaP 2
IPV 2
Hib 2
Rotavirus 2
PCV 2

14 weeks

DTwP 3/DTaP 3
IPV 3
Hib 3
Rotavirus 3
PCV 3

Rotavirus: Only 2 doses of RV1 are recommended at present.

6 months

OPV 1
Hep-B 3

9 months

OPV 2
Measles

12 months

Hep-A 1

For both killed and live hepatitis-A vaccines, 2 doses are recommended

15 months

MMR 1
Varicella 1
PCV booster

The risk of breakthrough varicella is lower if given 15 months onwards .

16 to 18 months

DTwP B1/DTaP B1
IPV B1
Hib B1

The first booster (4thth dose) may be administered as early as age 12

months, provided at least 6 months have elapsed since the third dose.

18 months

Hep-A 2

For both killed and live hepatitis-A vaccines 2

doses are recommended

2 years

Typhoid 1

Typhoid revaccination every 3 years, if Vipolysaccharide

vaccine is used.

4 to 5 years

DTwP B2/DTaP B2
OPV 3
MMR 2
Varicella 2
Typhoid 2

MMR: the 2nd dose can be given at anytime 4-8 weeks after
the 1st dose.
Varicella: the 2nd dose can be given at anytime 3 months after
the 1st dose

10 to 12 years

Tdap/Td
HPV

Tdap: is preferred to Td followed by Td every 10 years.

The final (third or fourth) dose in the

HepB vaccine series should be administered no earlier
than age 24 weeks and at least 16 weeks after the first dose

HPV: Only for females, 3 doses at 0, 1-2 and 6 months

BCG
Live attenuated
Intradermal
Danish 1331 strain for vaccine
production
Freeze dried

DPT
Park Williams 8
Diphtheria toxoid 24 Lf, Tetanus toxoid 5
Lf pertussis 20,000 million killed bacteria
6, 10, 14 weeks.. Boosters at 1.5 years
and 4-5 years
Deep IM anterolateral aspect of thigh
Contra in neurological disease,
convulsions
but acellular pertussis vaccine is ok

 DPT is a combination vaccine (not

polyvalent)
never frozen
Aluminium hydroxide is used as
adjuvant in DPT
Human albumin, hydrolysed gelatin,
neomycin, sorbitol
Thiomersal used as a preservative

Injected Polio vaccine

Type 1 40 D
Type 2 8 D
Type 3 32 D

OPV - Sabin
Vaccine associated paralytic polio 1
in 3 million
MgCl 2
Vaccine vial monitor indicate
potency of vaccine
Least stable vaccine
Lansing, Leon and Brunhilde

MMR

Live attenuated
Measles- Schwartz chick embryo cells
Mumps Urabe AM-9 - embryonic hen egg
Rubella- Wistar RA/ 3M human diploid
cells

Not given in neomycin allergy

Only live vaccine indicated in symptomatic
HIV patients

Measles

Edmonston Zagreb strain

9 months
Contra egg allergy
High efficacy
Should not be used > 4 hours after
reconstitution staph TSS
Kanamycin used

HPV
Gardasil (quadrivalent 16, 18, 6, 11),
Cervarix (16, 18)
Aluminium adjuvant present

Rota virus
Rotarix, Rotateq
Chances of intussusception if given
later.

Pneumococcal vaccine
PC 7
6, 10, 14 weeks
1 booster at 15-18 months
After 2 years PPV 23 polysaccharide vaccine
can be given
Indications HIV, Chronic pulmonary disease,
sickle cell disease, CSF leak, cochlear
implants, nephrotic syndrome in remission

 Vaccines containing letter T should

not be frozen DPT, TT, DT, Typhoid
Vi, Hepatitis B
Once frozen Al salts used as
adjuvants will get dessicated and act
as irritants
Shake test performed before use of
either single or multidose vials of

strains

Mumps Jeryll lynn

Typhoid Ty 21 a
Varicella Oka
Rabies- Pitts Moore strain
Yellow fever 17 D
Hep A HM 175
Rubella RA 27/3

 >2 live parenteral 4 weeks

minimum interval
Exception:- Live oral vaccines OPV,
Ty21a can be given simultaneously or
at any interval with parenteral live
vaccine

 Children on corticosteroids
>2mg/kg/day for 14 days should
not receive live virus vaccine until
steroids discontinued for 1 month

Varicella
Varicella (optional) one dose at 1213 years;
Or 2 doses > 13 years
Takahashi developed it from oka
strain

Hib
H influenza b capsular
polysaccharide
PRP-T and PRP-CRM 197 conjugate
Hib vaccine in india

JE
Nakayama strain
Not an outbreak response vaccine

 Freezer OPV, MMR, Measles

Top shelf BCG, MMR
Lower shelf hep B, varicella

 Dakar vaccine yellow fever

Vaccines indicated for Rheumatoid
Arthritis patients on chronic aspirin
therapy influenza, varicella

Adverse effects of vaccines

intussusception following human
rhesus rotavirus vaccine
febrile seizures following MMRV
vaccine
GBS following meningococcal
conjugate vaccines

 aluminium adjuvanted (DTPw, DTaP,

DT, Td, Tdap, TT, Hep B, Hep A,
inactivated combination vaccines,
HPV and PCV) more local adverse
effects
Vaccines susceptible to damage by
freezing

 Thiomersol (50% ethyl mercury) a

preservative in inactivated vaccines
particularly in multi dose vials has
been linked in the past to Autistic
spectrum disorders and
neurodevelopment disorders.

 BCG is the only currently used

human vaccine for which there is
conclusive evidence that T cells are
the main effectors.

Epidemiologic shift
This refers to an upward shift in age of
infection/disease in communities with partial
immunization coverage. Owing to vaccination,
the natural circulation of the pathogen
decreases and the age of acquisition of
infection advances. This is especially
important for diseases like rubella, varicella
and hepatitis A, wherein severity of
disease worsens with advancing age.

Freeze watch indicators

A freeze watch indicator
consists of a small vial of
red liquid attached to a
white card and covered in
plastic. The vial breaks if
the temperature where
the indicator is located
drops below 0C for more
than one hour.

Interpretation of the colour change of VVM is

as follows:
1. Inner square is white, or lighter than outer
circle: If the expiry date has not passed,
vaccine can be used.
2. Inner square matches colour of outer circle
or is darker than outer circle: vaccine
should be discarded, regardless of the
expiry date.

Major Changes in Recommendations

for IAP Immunization Timetable, 2012
Polio: Sequential IPV-OPV schedule is recommended for
primary polio immunization in place of combined
OPV+IPV schedule.
Hepatitis-B: Birth-6 weeks-6 months is recommended as
most preferred schedule instead of earlier 0- 6
weeks-14 weeks schedule.
History of intussusception in the past is added as an
absolute contraindication for rotavirus vaccine
administration.
Prematurity and very-low birth weight are added as
another high risk category for pneumococcal vaccination.
Guidelines are provided for influenza vaccination.

 IAP recommended vaccines for

High-risk* children (Vaccines
under special circumstances):
1. Influenza Vaccine, 2.
Meningococcal Vaccine, 3. Japanese
Encephalitis Vaccine, 4. Cholera
Vaccine, 5. Rabies Vaccine, 6. Yellow
Fever Vaccine, 7.Pneumococcal
Polysaccharide vaccine (PPSV 23).

1. BCG Vaccine
Should be given at birth or at first contact Catch up may be given up to 5
years

2. Hepatitis B (HepB) vaccine

Minimum age: birth Administer monovalent HepB vaccine to all newborns
before hospital discharge Mono- valent HepB vaccine should be used for
doses administered before age 6
weeks Administration of a total of 4 doses of HepB vaccine is permissible
when a combination vaccine containing HepB is administered after the birth
dose Infants who did not receive a birth dose
should receive 3 doses of a HepB containing vaccine starting as soon as
feasible The ideal minimum interval between dose 1 and dose 2 is 4
weeks, and between dose 2 and 3 is 8 weeks Ideally, the final
(third or fourth) dose in the HepB vaccine series should be administered no
earlier than age 24 weeks and at least 16 weeks after the first dose Hep B
vaccine may also be given in any of the following
schedules: Birth, 1, & 6 mo, Birth, 6 and 14 weeks; 6, 10 and 14 weeks; Birth, 6
weeks,10 weeks, 14 weeks, etc.

3. Poliovirus vaccines
OPV in place of IPV If IPV is
unaffordable/unavailable, minimum 3 doses
Additional doses of OPV on all SIAs IPV:
Minimum age: 6 weeks IPV: 2 instead of 3
doses can be also used if primary
series started at 8 weeks and the interval
between the doses is kept 8 weeks IPV
catch-up schedule: 2 doses at 2 months
apart followed by a booster after 6 months

4. Diphtheria and tetanus toxoids and pertussis (DTP) vaccine

Minimum age: 6 weeks The first booster (4thth dose) may be administered
as early as age 12 months, provided at least 6 months have elapsed since
the third dose DTwP/DTaP/Tdap/Td: Catch up
below 7 years: DTwP/DTaP at 0, 1 and 6 months; Catch up above 7 years:
Tdap, Td, Td at 0, 1 and 6 months.
5. Haemophilus influenzae type b (Hib) conjugate vaccine
Minimum age: 6 weeks Catch up in 6-12 months; 2 doses 1 month apart
and 1 booster; 12-15 months: 1 primary and 1 booster; above 15 months
single dose.
6. Pneumococcal vaccines
Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years
for pneumococcal polysaccharide vaccine [PPSV] Administer 1 dose of
PCV to all healthy children aged 24 through 59
months who are not completely vaccinated for their age For children who
have received an age-appropriate series of 7-valent PCV (PCV7), a single
supplemental dose of 13-valent PCV (PCV13) is
recommended for:
All children aged 14 through 59 months Children aged 60 through 71
months with underlying medical conditions Administer PPSV at least 8
weeks after last dose of PCV to children aged 2 years or
older with certain underlying medical conditions (certain high-risk PCV: Catch
up in 6-12 months: 2 doses 1 month apart and 1 booster; 12-23 months: 2
doses 2 months apart; 24 mo & above: single
dose PPSV: Revaccination only once after 3-5 years only in certain high risk

 7. Rotavirus (RV) vaccines

Minimum age: 6 weeks for both RV-1 [Rotarix] and RV-5 [Rota Teq]) Only two
doses of RV-1 are recommended at present The maximum age for the first dose in
the series is 14 weeks, 6 days; and 8
months, 0 days for the final dose in the series Vaccination should not be initiated
for infants aged 15 weeks, 0 days or older.
8. Measles
Minimum age: At completed months/270 completed days Catch up vaccination
beyond 12 months should be MMR Measles vaccine can be administered to
infants aged 6 through 11 months during
outbreaks. These children should be revaccinated with 2 doses of measles
containing vaccines, the first at ages 12 through 15 months and at least 4 weeks
after the previous dose, and the second at ages 4
through 6 years.
9. Measles, mumps, and rubella (MMR) vaccine
Minimum age: 12 months The second dose may be administered before age 4
years, provided at least 4 weeks have elapsed since the first dose.
10. Varicella vaccine
Minimum age: 12 months The risk of breakthrough varicella is lower if given 15
months onwards The second dose may be administered before age 4 years,
provided at least 3 months have elapsed
since the first dose For children aged 12 months through 12 years, the
recommended minimum interval between doses is 3 months. However, if the
second dose was administered at least 4 weeks after the
first dose, it can be accepted as valid.

11. Hepatitis A (HepA) vaccine

Minimum age: 12 months Two doses of both killed and live
HepA vaccines Administer the second (final) dose 6 to18 months
after the first.
12. Typhoid vaccine
Only Vi-PS (polysaccharide) vaccine is recommended Minimum
age: 2 years; Revaccination every 3 years Vi-PS conjugate
vaccine: data not sufficient to recommend for routine use of
currently
available vaccine
13. Influenza vaccine
Minimum age: 6 months for trivalent inactivated influenza
vaccine First time vaccination: 6 months to below 9 years: two
doses 1 month apart; 9 years and above single dose; Annual
revaccination with
single dose For children aged 6 months to below 9 years: For the
2012 season, administer 2 doses (separated by at least 4 weeks)
to those who did not receive at least 1 dose of the 201011
vaccine. Those
who received at least 1 dose of the 201011 vaccine require 1
dose for the 201112 season Best time to vaccinate: as soon as
the new vaccine is released and available in the market & just

 14. Meningococcal vaccine

Only meningococcal polysaccharide vaccine (MPSV) is available
Minimum age: 2 years Revaccination only once after 3 years in
those at continued high risk
15. Cholera Vaccine
Minimum age: one year (killed whole cell vibrio cholera (Shanchol)
Two doses 2 weeks apart for >1 year old
16. Japanese encephalitis (JE) vaccine
Recommended in endemic areas only Live attenuated, cell
culture derived SA-14-14-2 vaccine is preferred Minimum age: 8
months; can be co-administered with measles vaccine at 9 months;
single
dose Catch up vaccination: all susceptible children up to 15 yrs
should be administered during disease outbreak/ahead of
anticipated outbreak in campaigns.

 10 + years IAP guidelines

1. Tetanus and diphtheria toxoids and acellular pertussis (Tdap)

vaccine: Minimum age: 10 years for Boostrix and 11 years for
Adacel Persons aged
11 through 18 years who have not received Tdap vaccine should
receive a dose followed by tetanus and diphtheria toxoids (Td)
booster doses every 10
years thereafter Tdap vaccine should be substituted for a single
dose of Td in the catch-up series for children aged 7 through 10
years Tdap vaccine
can be administered regardless of the interval since the last
tetanus and diphtheria toxoidcontaining vaccine Catch up above
7 years: Tdap, Td, Td at
0, 1 and 6 months Tdap can also be administered safely to
pregnant women.
2. Human papillomavirus (HPV) vaccines: HPV4 [Gardasil] and
HPV2 [Cervarix] Minimum age: 9 years Either HPV4 (0, 2, 6
months) or HPV2
(0, 1, 6 months) is recommended in a 3-dose series for females
aged 11 or 12 years HPV4 can also be given in a 3-dose series for

3. Measles, mumps, and rubella (MMR) vaccine: The

minimum interval between the 2 doses of MMR vaccine is 4
weeks One dose if previously
vaccinated with one dose.
4. Varicella (VAR) vaccine: For persons without evidence of
immunity, administer 2 doses if not previously vaccinated
or the second dose if only 1 dose
has been administered For persons aged 7 through 12 years,
the recommended minimum interval between doses is 3
months. However, if the second
dose was administered at least 4 weeks after the first dose, it
can be accepted as valid For persons aged 13 years and
older, the minimum interval
between doses is 4 weeks.
5. Hepatitis B (HepB) vaccine: Administer the 3-dose series
to those not previously vaccinated For those with
incomplete vaccination, the
recommended minimum interval between dose 1 and dose 2
is 4 weeks, and between dose 2 and 3 is 8 weeks. The final

6. Hepatitis A (Hep A) vaccine: Administer 2 doses at least 6

months apart to unvaccinated persons For catch up vaccination,
pre vaccination screening
for Hepatitis A antibody is recommended in children older than 10
years as at this age the estimated sero-positive rates exceed 50%
Combination of Hep
B and Hep A may be used in 0, 1, 6 schedule.
7. Typhoid vaccine : Only Vi-PS (polysaccharide) vaccine is
recommended Vi-PS conjugate vaccine: data not sufficient to
recommend for routine use
of currently available vaccine A minimum interval of 3 years should
be observed between 2 doses of typhoid vaccine.
8. Influenza Vaccine : Administer 1 dose to persons aged 9 years
and older For children aged 6 months through 8 years For the
2012 season,
administer 2 doses (separated by at least 4 weeks) to those who did
not receive at least 1 dose of the 2010-11 vaccine. Those who
received at least 1 dose of
the 2010-11 vaccine require 1 dose for the 201112 season Annual
revaccination with single dose Best time to vaccinate: as soon as
the new vaccine

10. Pneumococcal Vaccines : Pneumococcal conjugate

vaccine [PCV] and pneumococcal polysaccharide vaccine
[PPSV] both are used in certain high risk
group of children A single dose of PCV may be administered
to children aged 6 through 18 years who have
anatomic/functional asplenia, HIV infection
or other immunocompromising condition, cochlear implant, or
cerebral spinal fluid leak Administer PPSV at least 8 weeks
after the last dose of PCV to
children aged 2 years or older with certain underlying medical
conditions, including a cochlear implant A single revaccination (with PPSV) should be
administered after 5 years to children with
anatomic/functional asplenia or an immunocompromising
condition.
11. Meningococcal Vaccine: Recommended only for certain
high risk group of children, during outbreaks, travelers to
endemic areas, and students
going for study abroad; Only meningococcal polysaccharide