What is the Indian Academy of Pediatrics (IAP) recommended immunization schedule?

Indian Academy of Pediatrics (IAP) Immunization Schedule

The Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices (ACVIP) provides a comprehensive immunization schedule for children aged 0-18 years, with specific timing for each vaccine dose based on age-appropriate administration. 1

Birth to 6 Weeks

• Hepatitis B vaccine should be administered within 24 hours of birth as the first dose to prevent vertical transmission, which is critical for effectiveness. 2
• BCG vaccine is given at birth or as early as possible. 1
• Oral Polio Vaccine (OPV) is administered at birth in the national program, though IAP emphasizes the importance of Injectable Polio Vaccine (IPV) in the primary schedule. 1

Primary Vaccination Series (6 weeks to 6 months)

• At 6 weeks: DTP (whole-cell pertussis preferred for primary series), IPV (first dose), Hib, Hepatitis B (second dose), Rotavirus, and Pneumococcal conjugate vaccine (PCV). 1, 3
• At 10 weeks: DTP, IPV (second dose), Hib, Rotavirus, and PCV (second dose). 1
• At 14 weeks: DTP, IPV (third dose), Hib, Rotavirus, and PCV (third dose). 1
• Hepatitis B third dose is given at 6 months of age. 2

Important Primary Series Considerations

• Whole-cell pertussis vaccines are now recommended for the primary infant vaccination series due to superior priming and slower waning compared to acellular vaccines. 3
• IPV is strongly emphasized in the primary immunization schedule by IAP, with all three primary doses being IPV rather than OPV. 1

9-12 Months

• Measles-containing vaccine (first dose) is given at 9 months. 1
• Typhoid conjugate vaccine can be administered at 9 months. 1

12-18 Months

• MMR (first dose) is given at 12 months if not already received as measles vaccine. 1
• Varicella vaccine (first dose) at 12-15 months. 1
• Hepatitis A vaccine (first dose) at 12 months. 1
• PCV booster dose at 12-15 months. 1

15-18 Months

• DTP booster (first booster) at 15-18 months. 1
• IPV booster at 15-18 months. 1
• Hib booster at 15-18 months. 1

16-24 Months

• Second dose of Measles vaccine or MMR should be administered at 16-24 months, with the preferred timing for the second varicella dose being 3-6 months after the first dose. 2, 1
• Hepatitis A vaccine (second dose) 6 months after the first dose. 1

4-6 Years

• DTP booster (second booster) at 4-6 years. 1
• IPV booster is now recommended at 4-6 years for children who received initial IPV doses as per the IAP schedule—this is a major recent update. 1
• Second dose of varicella vaccine if not given earlier. 1
• Typhoid conjugate vaccine booster. 1

10 Years

• Td (Tetanus and reduced diphtheria) vaccine is administered at 10 years of age. 2

10-12 Years (Adolescent Vaccination)

• HPV vaccine is recommended for adolescent girls, with two doses administered if started before 15 years of age (at least 5 months apart). 2

16 Years

• Td booster at 16 years of age. 2

Annual Vaccination

• Inactivated influenza vaccine is recommended annually for all children ≥6 months of age, with uniform dosing of 0.5 mL (15 µg HA) for all age groups. 1
• Children 6 months through 8 years receiving influenza vaccine for the first time require 2 doses administered 4 weeks apart. 4

Special Populations

Children with Cancer on Chemotherapy

• Live vaccines are contraindicated during chemotherapy and up to 6 months after completion of treatment. 5
• Annual inactivated influenza vaccine is the only vaccine recommended during active chemotherapy for all children with cancer. 5
• Non-live vaccines are best administered 6 months after completion of chemotherapy for durable immunity. 5
• Hepatitis B vaccine is recommended during treatment only for previously unimmunized children at risk of transfusion-associated transmission. 5

Immunocompromised Children

• Severely immunocompromised children require special consideration for vaccination schedules, with live vaccines generally contraindicated. 2

Critical Pitfalls to Avoid

• Delaying the birth dose of Hepatitis B vaccine beyond 24 hours significantly reduces effectiveness in preventing vertical transmission. 2
• Not following minimum intervals between doses can result in suboptimal immune response. 2
• Failure to complete multi-dose vaccine series compromises protective efficacy. 2
• Misunderstanding contraindications may lead to inappropriate deferral of needed vaccines, particularly in special populations. 2
• For siblings of immunocompromised children, oral polio vaccine must be substituted with injectable vaccine to prevent vaccine-associated transmission. 5