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IMMUNIZATION SCHEDULE
Expanded Program of Immunization (EPI) and Universal Immunization Program (UIP) Following the WHO recommendation, India introduced six vaccines under the Expanded Program of Immunization (EPI) in 1978 to reduce child mortality. (Bacillus Calmette-Guerin (BCG), TT, DPT, DT, polio, and typhoid) in its EPI. Subsequently, in 1985 the Indian government included Measles vaccination and launched the Universal Immunization Programme (UIP) and a mission to achieve immunization coverage of all infants and pregnant women by the1990s. National Immunization Schedule The national immunization schedule comprises of those vaccines that are given free of cost to all children of the country under EPI. Table 1: National Immunization Schedule
Age Birth 6 weeks 10 weeks 14 weeks 9-12 months 16-24 months 5-6 years 10 years 16 years Pregnant women Vaccines BCG, OPV0 (for institutional deliveries) DTwP1, OPV1, HepB1, Hib1$$ (BCG if not given at birth) DTwP2, OPV2, HepB2, Hib2 DTwP3, POV3, HepB3, Hib3 Measles DTwP B1, OPV4, MMR$ DTwP TT** TT TT1 (early in pregnancy) TT2 (1 month later) TT booster (if vaccinated in past 3 years) 9,18, 24, 30 and 36 months

Vitamin A

$ MMR is available in some states only $$ Hib is being introduced in two states to begin with. * A second dose of DTwP vaccine should be given at an interval of one month if there is no clear history or documented evidence of previous immunization with DTwP

** A second dose of TT vaccine should be given at an interval of one month if there is no clear history or documented evidence of previous immunization with DTwP, DT or TT vaccines

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IAP Immunization Schedule The IAP Committee on Immunization submits its position on vaccines not included in the national schedule on a periodic basis as and when they are licensed and made available in the country. The process of issuing recommendations involves an exhaustive review of published literature including standard text books, vaccine trials, recommendations of various countries, World Health Organization (WHO) position papers, literature from the vaccine industry, post-marketing surveillance reports, costeffective analysis, epidemiology of disease in India and if available Indian studies on vaccine efficacy, immunogenicity and safety. If knowledge gaps are present then expert opinion is sought to fill the gaps. The existing national immunization schedule and government policies are also considered. These recommendations of IAPCOI are meant primarily for pediatricians in office practice as best individual practice guidelines. In addition, IAPCOI also submits its recommendations on incorporation of various new vaccines in the national immunization schedule. The IAPCOI has categorized the available licenced vaccines in two broad groups 1. Vaccines recommended by IAP for routine use. 2. Vaccines to be used in special circumstances only. Recommendations on new vaccines licensed and available are based on the likely epidemiology and disease burden, vaccine efficacy, safety and cost in the Indian context. It is important to note that these recommendations are based on the available data and consensus opinion, this being a dynamic process and the guidelines may change from time to time as new information is available. A complete information on the disease and its likely outcome along with the benefits of the vaccine must be given to the parents while prescribing and using the vaccine in a given child. Table 2: IAP recommended vaccines (2011)
IAP recommended vaccines for routine use Vaccines under special circumstances BCG OPV IPV DTwP/DTaP DT Td Tdap Measles Typhoid Hib Hep B MMR HPV PCV Hepatitis A Chicken Pox Rotavirus vaccine Rabies Influenza PPSV23 Japanese Encephalitis Meningococcal Cholera Yellow Fever

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BCG: Bacillus Calmette Guerin; OPV: Oral poliovirus vaccine; DTwP: Diphtheria, tetanus, whole cell pertussis; DT: Diphtheria and tetanus toxoid; TT: Tetanus toxoid; Hep B: Hepatitis B vaccine; MMR: Measles, mumps, rubella vaccine; Hib: Hemophilus influenzae type b vaccine; IPV: Inactivated poliovirus vaccine; Td: Tetanus, reduced dose diphtheria toxoid; Tdap: Tetanus, reduced dose diphtheria & acellular pertussis vaccine; HPV: Human papilloma virus vaccine; PCV pneumococcal conjugate vaccine; DTaP: Diphtheria, Tetanus, acellular pertussis vaccine; PPV 23: 23 valent pneumococcal polysaccharide vaccine. Details of individual vaccines, basis for their recommendation and position in the immunization schedule is detailed in chapter on individual vaccines.

Table 3: IAP Immunization Time Table 2011; IAP recommended vaccines for routine use
Age (completed weeks/ months/years) Birth BCG OPV0 HepB 1 DTwP1/DTaP1 OPV1*/ OPV1 + IPV1 Hib1 HepB2 Rotavirus 1 *# PCV 1 DTwP2/ DTaP2 OPV2*/ OPV2 + IPV2 Hib 2 Rotavirus 2 PCV 2 DTwP3/ DTaP3 OPV3*/ OPV3 + IPV3 Hib3 Rotavirus 3 HepB3** PCV 3 Measles Hepatitis A 1 MMR1 Varicella PCV booster DTwP B1/ DTaP B1 OPV4*/ OPV4 + IPVB1 Hib B1
IAP Guide Book on Immunization

Vaccines

6 weeks

10 weeks

14 weeks

9 months 12 months 15 months

16 to 18 months

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Age (completed weeks/ months/years) 18 months 2 years 5 years Hepatitis A 2 Typhoid 1#

Vaccines

DTwP B2 / DTaP B2 OPV5 MMR2$ Typhoid 2 Varicella 2 $$ Tdap/Td& HPV^

10 to 12 years

OPV alone if IPV cannot be given

*# Rotavirus vaccine (2/3 doses depending on the brand at 4-8 weeks interval) ** The third dose of Hepatitis B can be given at 6 months $ The second dose of MMR vaccine can be given at any time 4-8 weeks after the first dose $ $ Varicella (2nd dose may be given any time 3 months after the 1st dose) # Typhoid revaccination every 3 years & Tdap preferred to Td, followed by repeat Td every 10 years ^ Only females, three doses at 0, 1-2 (depending on brands) and 6 months

For details regarding recommendations please refer to individual vaccines

IAP Guide Book on Immunization