Children Vaccination/Immunization
Vaccinations not only protect your child from deadly diseases, such as polio, tetanus, and diphtheria, but they also keep other children safe by eliminating or greatly decreasing dangerous diseases that used to spread from child to child.
Vaccinating children against diseases helps protect our community’s and our children’s health, and are considered a high priority.
- Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization (EPI)
- The programme gained momentum in 1985 and was expanded as Universal Immunization Programme (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90.
In India, currently two kinds of immunization schedules are available.
National Immunization Schedule
One, which is called as National Immunization Schedule (NIS), given by the Government, free of cost, all over the country. This includes the bare minimum vaccines which every child in India must receive, keeping public health as a focus. National Technical Advisory Group of Experts on Immunization (NITAG) advises government about use of available vaccines in NIS. While preparing an immunization schedule for such a large country, they consider various factors such as cost involved, delivery chain feasibility, availability of vaccines, etc.
Indian Academy of Pediatrics Immunization Schedule
Academy of Pediatrics (IAP) Immunization Schedule. This also include many additional vaccines too, which are needed and are available in the country, but not yet a part of NIS. Advisory Committee of Experts on Vaccines and Immunization Practices (ACVIP) is the highest body of IAP for preparing and regularly updating this schedule. IAP immunization schedule is currently the best possible immunization schedule available in India for keeping an individual child as focus, irrespective of cost involved. Information about these two immunization schedules (which is being regularly updated) can be obtained from their respective websites, which are being regularly updated (www. mohfw.gov.in; www.acvip.com). As a parent, you are expected to know about these immunization schedules, so that you could take the best possible decision for your child immunization. Timely vaccination will go a long way in protecting your child from various deadly diseases existing in community. You are expected to follow your country specific immunization schedule, wherever you live.
Vaccines are given in such way that the vaccination precedes the age at which a disease occurs. Vaccination being an essential need for every child, must be started immediately after birth. The current immunization schedules, both National Immunization Schedule (NIS) and IAP Immunization Schedules, have been summarized in Tables 1 and 2, respectively.
TABLE 1
|
National Immunization Schedule |
||||
|
Vaccine |
When to give |
Dose |
Route |
Site |
|
For Infants |
||||
|
BCG |
At birth or as early as possible till one year of age |
0.1ml (0.05ml until 1 month of age) |
Intra -dermal |
Left Upper Arm |
|
Hepatitis B Birth dose |
At birth or as early as possible within 24 hours |
0.5 ml |
Intramuscular |
Anterolateral side of mid thigh-LEFT |
|
OPV Birth dose |
At birth or as early as possible within the first 15 days |
2 drops |
Oral |
- |
|
OPV 1,2 & 3 |
At 6 weeks, 10 weeks & 14 weeks |
2 drops |
Oral |
- |
|
IPV (inactivated Polio Vaccine) |
14 weeks |
0.5 ml |
Intramuscular |
Anterolateral side of mid thigh-RIGHT |
|
Pentavelant 1,2 & 3 |
At 6 weeks, 10 weeks & 14 weeks |
0.5 ml |
Intramuscular |
Anterolateral side of mid thigh-LEFT |
|
Rota Virus Vaccine |
At 6 weeks, 10 weeks & 14 weeks |
5 drops |
Oral |
- |
|
Measles 1st Dose |
9 completed months-12 months. (give up to 5 years if not received at 9-12 months age) |
0.5 ml |
Subcutaneous |
Right Upper Arm |
|
Vitamin A, 1st Dose |
At 9 months with measles |
1 ml (1 lakh IU) |
Oral |
- |
|
For children |
||||
|
DPT 1st booster |
16-24 months |
0.5 ml |
Intramuscular |
Anterolateral side of mid thigh-LEFT |
|
OPV Booster |
16-24 months |
2 drops |
Oral |
|
|
Measles 2nd dose |
16-24 Months |
0.5 ml |
Subcutaneous |
Right Upper Arm |
|
Vitamin A (2nd to 9th dose) |
16 months with DPT/OPV booster, then, one dose every 6 month up to the age of 5 years) |
2 ml (2 lakh IU) |
Oral |
- |
|
DPT 2nd Booster |
5-6 years |
0.5 ml. |
Intramuscular |
Left Upper Arm |
|
TT |
10 years & 16 years |
0.5 ml |
Intramuscular |
Upper Arm |
TABLE 2
IAP Immunization Timetable 2014
IAP recommended vaccines for routine use
|
Age (completed wks/mo/y) |
Vaccines |
Comments |
|
Birth |
BCG |
Administer these vaccines to all newborns before hospital discharge |
|
OPV 0 |
||
|
Hep-B 1 |
||
|
6 weeks |
DTwP 1 |
DTP: |
|
IPV 1 |
• DTaP vaccine/combinations should preferably be avoided for the primary series |
|
|
Hep-B 2 |
• DTaP vaccine/combinations should be preferred in certain specific circumstances/conditions only |
|
|
Rotavirus 1 |
||
|
PCV 1 |
• No need of repeating/giving additional doses of whole-cell pertussis (wP) vaccine to a child who has earlier completed their primary schedule with acellular pertussis (aP) vaccine-containing products |
|
|
Polio: |
||
|
• All doses of IPV may be replaced with OPV if administration of the former is not feasible |
||
|
• Additional doses of OPV on all supplementary immunization activities (SIAs) |
||
|
• Two doses of IPV instead of 3 for primary series if started at 8 weeks, and 8 weeks interval between the doses |
||
|
• No child should leave the facility without polio immunization (IPV or OPV), if indicated by the schedule |
||
|
Rotavirus: |
||
|
• 2 doses of RV1 and 3 doses of RV5 |
||
|
• RV1 should be employed in 10 and 14 week schedule, instead of 6 and 10 week |
||
|
• 10 and 14 week schedule of RV1 is found to be far more immunogenic than existing 6 and 10 week schedule |
||
|
10 weeks |
DTwP 2 |
Rotavirus: |
|
IPV 2 |
• If RV1 is chosen, the first dose should be given at 10 weeks |
|
|
Hib 2 |
||
|
Rotavirus 2 |
||
|
PCV 2 |
|
|
|
14 weeks |
DTwP 3 |
Rotavirus: |
|
IPV 3 |
• Only 2 doses of RV1 are recommended at present |
|
|
Hib 3 |
• If RV1 is chosen, the 2nd dose should be given at 14 weeks |
|
|
Rotavirus 3 |
||
|
PCV 3 |
||
|
6 months |
OPV 1 |
Hepatitis-B: |
|
Hep-B 3 |
• 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 |
|
|
9 months |
OPV 2 |
MMR: |
|
MMR-1 |
• Measles-containing vaccine ideally should not be administered before completing 270 days or 9 months of life |
|
|
• The 2nd dose must follow in 2nd year of life |
||
|
• No need to give stand-alone measles vaccine |
||
|
Typhoid: |
||
|
9-12 months |
Typhoid Conjugate Vaccine |
• Currently, two typhoid conjugate vaccines, Typbar-TCV and PedaTyph available in Indian market |
|
• PedaTyph is not yet approved; the recommendation is applicable to Typbar-TCV only |
||
|
• An interval of at least 4 weeks with the MMR vaccine should be maintained while administering this vaccine |
||
|
• Should follow a booster at 2 years of age |
||
|
12 months |
Hep-A 1 |
Hepatitis A: |
|
• Single dose for live attenuated H2-strain Hep-A vaccine |
||
|
• Two doses for all killed Hep-A vaccines are recommended now |
||
|
15 months |
MMR 2 |
MMR: |
|
Varicella 1 |
• The 2nd dose must follow in 2nd year of life |
|
|
PCV booster |
• However, it can be given at anytime 4-8 weeks after the 1st dose during 2nd year |
|
|
16 to 18 months |
DTwP B1/DTaP B1 |
Varicella: |
|
IPV B1, Hib B1 |
• The risk of breakthrough varicella is lower if given 15 months onwards |
|
|
|
|
• The first booster (4th dose) may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose. |
|
DTP: |
||
|
• First and second boosters should preferably be of DTwP |
||
|
• Considering a higher reactogenicity of DTwP, DTaP can be considered for the boosters |
||
|
18 months |
Hep-A 2 |
• 2nd dose for killed vaccines; only single dose for live attenuated H2- strain vaccine |
|
2 years |
Typhoid booster |
• Either Typbar-TCV® or Vi-polysaccharide (Vi-PS) can be employed as booster; |
|
• Typhoid revaccination every 3 years, if Vi-polysaccharide vaccine is used |
||
|
• Need of revaccination following a booster of Typbar-TCV® not yet determined |
||
|
4 to 6 years |
DTwP B2/DTaP B2 |
Varicella: |
|
OPV 3 Varicella 2 |
• 2nd dose can be given at anytime 3 months after the 1st dose |
|
|
Typhoid booster |
|
|
|
10 to 12 years |
Tdap/Td |
Tdap: |
|
HPV |
• Tdap is preferred to Td followed by Td every 10 years |
|
|
HPV: |
||
|
• Only 2 doses of either of the two HPV vaccines for adolescent/pre-adolescent girls aged 9-14 years |
||
|
• For girls 15 years and older, and immunocompromised individuals 3 doses are recommended |
||
|
• For two-dose schedule, the minimum interval between doses should be 6 months. |
||
|
• For 3 dose schedule, the doses can be administered at 0, 1-2 (depending on brands) and 6 months |
|
II. 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) |
|
* High-risk category of children: Congenital or acquired immunodeficiency (including HIV infection); Chronic cardiac, pulmonary (including asthma if treated with prolonged high-dose oral corticosteroids), hematologic, renal (including nephrotic syndrome) and liver disease; Children on long term steroids, salicylates, immunosuppressive or radiation therapy; Diabetes mellitus, Cerebrospinal fluid leak, Cochlear implant, Malignancies; Children with functional/ anatomic asplenia/ hyposplenia; During disease outbreaks; Laboratory personnel and healthcare workers; Travelers; Children having pets in home; Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor. |
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