National Immunization Schedule

At Birth

• BCG: Dose: <1 month: 0.05 mL and  1 month: 0.1 mL
  • OPV-0 Dose
  • Hepatitis B - 0 Dose

At 6 Weeks

• Pentavalent - 1st Dose: Diphtheria, Pertussis, Tetanus, Hepatitis B, Haemophilus influenzae type B
• OPV - 1st Dose
• fIPV - 1st Dose: 0.5 mL
• Rotavirus - 1st Dose
• PCV-13 - 1st Dose: Pneumococcal Conjugate Vaccine

At 10 Weeks

• Pentavalent - 2nd Dose
• OPV - 2nd Dose
• Rotavirus - 2nd Dose

At 14 Weeks

• Pentavalent - 3rd Dose
• OPV - 3rd Dose
• Rotavirus - 3rd Dose
• fIPV - 2nd Dose
• PCV - 2nd Dose

At 9 Months

• MR - 1st Dose
• PCV - Booster/PCV-3
• Oral Vitamin A - 1st Dose: 1 mL (1 lakh IU)
• JE-1: In certain regions where Japanese Encephalitis is endemic

At 16-24 Months

• MR - 2nd Dose
• DPT - Booster 1
• OPV - Booster 1
• Vitamin A - 2nd Dose: 2 mL (2 lakh IU)
• JE-2

At 5-6 Years

• DPT - Booster 2

At 10 Years

• Td: Tetanus toxoid + low dose diphtheria toxoid

At 16 Years

• Td

In Pregnancy

• 1st Dose Td: Early Pregnancy (1st trimester)
• 2nd Dose Td: 4 weeks after 1st dose
• 2nd Pregnancy: Single Td dose if within 3 years of the 1st pregnancy where both Td doses were administered

Vitamin A

• 1st Dose: 1 mL at 9 months
• 2nd Dose: 2 mL at 16-24 months, then 2 mL every 6 months until 5 years

Key Points

• Vaccines not given after 1 year: Pentavalent, BCG, Rotavirus
• Type of OPV: Bivalent (P1 and P3 strains)
• BCG Vaccine Doses:
  • <1 month: 0.05 mL
  • ≥1 month: 0.1 mL
• BCG Protection: Efficacy 0-80%, protects against CNS TB, disseminated TB, but not pulmonary TB
• PCV in NIS: PCV13, given at 6 weeks, 14 weeks, and booster at 9 months

Routes Of Vaccines

• Oral: Rotavirus, OPV, Vitamin A
• Intradermal: BCG, fIPV
• Subcutaneous: MR, Japanese Encephalitis
• Intramuscular: Pentavalent, DPT, Hepatitis B, PCV13

Doses Of Vaccines

• Injectable Vaccines: Generally 0.5 mL, except BCG and fIPV (0.1 mL)
• Oral Vaccines:
  • OPV: 2 drops
  • Rotavirus: 5 drops
  • Vitamin A: 1 mL (1st dose), 2 mL (subsequent doses)

BCG Vaccine

• BCG Vaccine Administration: Left upper arm
• Less BCG Dose in Neonates: Thin skin, risk of abscess and lymphadenopathy
• BCG Only Till 1 Year: Exposure to TB by then, partial immunity achieved
• No Scar with BCG: Do not repeat dose
• Breastfeeding After OPV: Immediately permissible
• OPV with Rotavirus/Vitamin A: Yes, can be given simultaneously
• Purpose of Hep B-0 Dose: Reduces perinatal transmission

Open Vial Policy

• Applicable Vaccines: DPT, TT, OPV, HepB, Pentavalent with HiB, IPV
• Not Applicable To: Measles, BCG, Rotavirus, JE
• Conditions: Proper storage, no contamination, expiry not passed, intact vaccine vial monitor

Needle Position and Sensitivity

• Vaccine Sensitivity:
  • Heat Sensitive: OPV, Measles/MR, BCG (after reconstitution), RVV, JE
  • Freeze Sensitive: Hep B, Penta, PCV, IPV, DPT, TT

Also Read: Image Based Questions On Immune System

IAP Recommended Vaccines For High-risk Children

List of Vaccines Used Only for High-Risk Children

1. Meningococcal Vaccine
2. Japanese Encephalitis (JE) Vaccine
3. Oral Cholera Vaccine
4. Rabies Vaccine
5. Yellow Fever Vaccine
6. Pneumococcal Polysaccharide Vaccine (PPSV 23)

High-Risk Children Include

• Congenital or Acquired Immunodeficiency: Includes HIV infection, immunosuppressive therapy, radiation.
• Chronic Cardiac Conditions
• Chronic Pulmonary Conditions: Including asthma if treated with prolonged high-dose oral corticosteroids.
• Chronic Systemic Diseases: Renal (including nephrotic syndrome), hematological, hepatic diseases, diabetes mellitus.
• Functional/Anatomic Asplenia/Hyposplenism
• Cerebrospinal Fluid Leaks, Cochlear Implants: For pneumococcal infection.

Specific High-Risk Groups and Corresponding Vaccines

• Children Having Pets at Home: Rabies vaccine
• JE Endemic Areas: Japanese encephalitis vaccine
• During Outbreaks: Oral cholera vaccine
• For Travelers: Rabies vaccine, meningococcal vaccine, yellow fever vaccine
• CSF Leaks, Cochlear Implant, Nephrotic Syndrome: Pneumococcal vaccine

Key IAP ACVIP Recommendations 2020-21

1. Booster Dose of IPV:
   • Needed at 4-6 years of age.
2. Pentavalent and bOPV:
   • No child should be administered only pentavalent vaccine and bOPV in infancy without IPV. If unable to afford hexavalent forms of IPV, refer the child to the nearest government health center to complete the primary series, including f IPV.
3. IPV Post-Switch:
   • Infants and young children born after the switch (April 25, 2016), who have not received IPV in any schedule, should receive at least one dose of an IPV/IPV combination vaccine, intramuscularly, at the earliest opportunity.
4. Inactivated Influenza Vaccines:
   • ACVIP endorses a uniform dosing schedule of inactivated influenza vaccines (15 ug/0.5 mL) for all children older than 6 months.
5. Varicella Vaccine:
   • The second varicella vaccine dose should preferably be administered 3-6 months after the first dose.
6. Rabies Post-Exposure Management:
   • Recommends using rabies monoclonal antibodies (mAbs) over rabies immunoglobulins (RIGS) in managing category 3 bites. Human monoclonal rabies antibodies (Rabishield) and murine cocktail monoclonal rabies antibodies (Twinrab) are available in India and approved for post-exposure management of suspected rabies exposure.

New Vaccines Approved by IAP ACIP 2020-21

1. Tetraxim:
   • DPT + IPV: Approved for use as a booster at 4-6 years of age.
2. Pneumosil:
   • A new 10-valent pneumococcal vaccine, for use at 6, 10, 14 weeks and a booster at 15 months, the so-called 3+1 regimen. Not approved above 2 years of age for catch-up vaccination.
3. Typhidev:
   • A typhoid conjugate vaccine: Single dose, approved for use between 6 months and 45 years of age.
4. Menveo:
   • The quadrivalent conjugate meningococcal vaccine covering serogroups A, C, Y, and W-135, approved for use in the age group 2-55 years, only in the high-risk group.

MISSION INDRADHANUSH

Launched in December 2014:

• Objective: To fully immunize >90% of infants by 2020.
• Coverage: 528 districts in 35 states and union territories.
• Focus: 201 districts in 28 states with a high proportion of unimmunized or partially immunized children.
• Achievements: By 2017, the annual increase in immunization coverage rose from 1% in 2014 to 6.7% in 2015.

Illnesses Covered

• Diphtheria
• Whooping cough
• Tetanus
• Poliomyelitis
• Tuberculosis
• Measles
• Hepatitis B
• JE and HiB additionally covered in selected areas.

Intensified Mission INDRADHANUSH

Launched in October 2017:

• Objective: To fully immunize >90% full immunization by December 2018.
• Implemented: Week-long immunization drives from 7th each month.
• Coverage: Left out and dropout sites in selected 173 districts and urban areas in 17 cities.

Intensified Mission INDRADHANUSH 2.0

Launched on December 2, 2019:

• Objective: To reach all children aged below two years and pregnant women, who were left uncovered routine immunization programs.
• Target: 272 districts in 27 states and at block level (652 blocks) in Uttar Pradesh and Bihar due to their hard-to-reach and tribal population.

Intensified Mission INDRADHANUSH 3.0

Launched in 2021:

• Aim: To cover children and pregnant women who missed routine immunization during the COVID-19 pandemic.
• Implementation: Two rounds conducted in 250 pre-identified districts/urban areas across 29 States/UTs.
• Risk Classification: 313 low-risk, 152 medium-risk, and 250 high-risk districts.

Also Read: Key Points And Recommendations In Pediatric Advanced Life Support

Hope you found this blog helpful for your NEET SS Pediatrics Immunology and Vaccines preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.