What is the immunization schedule in India?

India's National Immunization Schedule

The current immunization schedule in India includes vaccines against major preventable diseases administered from birth through adolescence, with specific timing for each dose to ensure optimal protection against mortality and morbidity.

Birth to 6 Months

• First dose of Hepatitis B vaccine should be administered within 24 hours of birth to prevent vertical transmission, followed by second dose at 1-2 months and third dose at 6-18 months 1, 2
• BCG (Bacillus Calmette-Guérin) vaccine is given at birth to protect against severe forms of tuberculosis 2
• Oral Polio Vaccine (OPV) is administered at birth (zero dose), followed by Inactivated Polio Vaccine (IPV) at 6,10, and 14 weeks 2
• DPT (Diphtheria, Pertussis, Tetanus) vaccine is administered at 6,10, and 14 weeks of age 2
• Rotavirus vaccine is given at 6,10, and 14 weeks to prevent severe diarrheal disease 2, 1
• Pneumococcal conjugate vaccine (PCV) is administered at 6,10, and 14 weeks to prevent pneumococcal diseases 2
• Haemophilus influenzae type b (Hib) vaccine (often as part of pentavalent vaccine with DPT and Hepatitis B) is given at 6,10, and 14 weeks 2

9 Months to 18 Months

• First dose of Measles vaccine or MMR (Measles, Mumps, Rubella) is administered at 9 months 2
• Second dose of Measles vaccine or MMR is given at 16-24 months 2, 1
• First dose of Japanese Encephalitis vaccine is administered at 9 months in endemic areas 2
• DPT booster is given at 16-24 months 2
• OPV booster is administered at 16-24 months 2

5-6 Years

• DPT second booster is administered at 5-6 years of age 2
• OPV booster is given at 5 years 2

10-16 Years

• Td (Tetanus and reduced diphtheria) vaccine is administered at 10 and 16 years of age 2, 1
• HPV (Human Papillomavirus) vaccine is recommended for adolescent girls, with two doses if started before 15 years of age 1

Special Considerations

• For infants born to HBsAg-positive mothers, Hepatitis B vaccine should be administered within 12 hours of birth along with Hepatitis B immune globulin (HBIG) 3
• Children who are behind on vaccinations should follow catch-up schedules to ensure complete protection 4, 2
• Immunocompromised children, including HIV-infected patients, require special consideration for vaccination schedules 1
• Live vaccines (such as MMR, varicella) are contraindicated in severely immunocompromised patients 1

Implementation Challenges

• Despite progress, immunization coverage varies significantly across different states in India, with rural areas generally having lower coverage than urban areas 5, 6
• The Universal Immunisation Programme (UIP) in India has been gradually expanding to include newer vaccines based on disease burden and epidemiological relevance 7, 5
• Adult immunization remains largely neglected in India despite its importance in preventing infectious diseases and their sequelae 8

Common Pitfalls to Avoid

• Delaying the birth dose of Hepatitis B vaccine beyond 24 hours significantly reduces its effectiveness in preventing vertical transmission 1
• Misunderstanding contraindications may lead to inappropriate deferral of needed vaccines, particularly in special populations 4
• Failure to complete multi-dose vaccine series compromises the protective efficacy of immunization 4, 5
• Not following minimum intervals between doses can result in suboptimal immune response 4, 2

The immunization schedule in India continues to evolve with the introduction of newer vaccines and updated recommendations based on disease epidemiology and vaccine effectiveness data 5.