✔️What is Immunisation and how does it work ?

Immunisation is a method of providing artificial immunity against antigens by the means of vaccines. Vaccines stimulate an immune response in the body which results in the formation of antibodies that would fight against diseases if our body encounters the same antigens in the future. A person has some innate immunity at birth and gets some natural immunity from the mother and through breastfeeding. However, this is not enough to tackle infectious and potentially fatal diseases. Artificial vaccines help in the prevention of various serious illnesses which could deter a child's development or even result in death.

✔️What are the side effects of vaccinations?

At rare occasions, vaccination might have some side effects such as pain at the site of injection or a mild fever. The DPT (Diptheria, Pertussis & Tetanus) vaccine shows such side effects while measles-like rashes may develop after the administration of a measles vaccine. Some vaccines might also result in allergic reactions in babies. If a baby develops a high fever or a loss of consciousness upon being vaccinated, a doctor should be immediately consulted. A timely treatment will result in the complete recovery of the child.

✔️Are there any reasons why a child should not be immunized?

Common illnesses like colds and diarrhoea are not impediments to getting a child vaccinated. However, there are some conditions where a doctor should be consulted before administering a vaccine. They are enlisted below: The child has a high fever S/He has had a bad reaction to another immunization S/He has had a severe reaction after eating eggs The child had a convulsion (fits) in the past. (With the right advice, children who have had fits in the past can be immunized) S/He has had, or is having, treatment for cancer An illness which affects the immune system, for example, HIV or AIDS The child is taking a medicine which affects the immune system, for example, immunosuppressants or high-dose steroids.

✔️How do we know that vaccines are safe?

Vaccines undergo extensive trials and tests to ensure safety. They are made available to the public only after these tests have been successfully conducted and the vaccines are found to be safe. Even after the launch of a vaccine, it is periodically assessed and actions are taken if needed.

✔️Which vaccines can be given to a child between 1-2 years of age, who has never been vaccinated?

DPT1, OPV-1, Measles and 2ml of Vitamin A solution should be given to the child. The 2nd and 3rd doses of the DPT and OPV vaccine should then be administered at one-month intervals till the child is 2 years of age. Booster doses of the vaccines can be given at a minimum age of 6 months after the OPV3/DPT3 vaccines have been administered.

National Immunization Schedule

Immunisation is one of the primary interventions for protecting children from preventable, life-threatening conditions. Upon seeing its importance, the immunisation programme was started in India in 1978 as the Expanded Programme of Immunisation (EPI). Under UIP, free vaccines are provided against 11 life-threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae Type B, Measles, Rubella, Japanese Encephalitis (JE), Rotavirus diarrhoea, etc. Any delay in the vaccinations can put your children at needless risk of serious diseases.

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What is the National Immunisation Schedule 2023?

The Immunisation programme in India was introduced in the year 1978 as the Expanded Programme of Immunisation (EPI). The same was further expanded as the Universal Immunisation Programme seven years later in 1985. Under UIP, free vaccines are provided against 11 life-threatening diseases that are as follows- Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea (Rubella, JE and Rotavirus vaccine in select states and districts).

The State Government gives a vaccination schedule to enable a timely national immunisation programme. You should note that a significant delay in vaccination can put children at risk of serious diseases that can easily be prevented. The following National Immunisation Schedule recommended by the Ministry of Health, Government of India is most widely followed by child healthcare providers across the country:

National Immunisation Schedule Chart

Vaccine	When to give	Maximum age	Dose	Route	Site
For Pregnant Women
Td -1	early pregnancy	--	0.5ml	Intra- muscular	Upper arm
Td -2	4 weeks after 1st dose of Td*	--	0.5ml	Intra- muscular	Upper arm
Td booster	If received 2 Td doses in a pregnancy within the last 3yrs	--	0.5ml	Intra- muscular	Upper arm
National Immunisation Schedule For Infants
BCG	At birth or as early as possible till 1 year of age	At birth till one year	0.1ml (0.05ml until 1month age)	Intradermal	Left Upper Arm
Hepatitis B - Birth dose	At birth or as early as possible within 24 hours	At birth within 24 hours	0.5 ml	Intra- muscular	Antero-lateral side of mid-thigh
OPV -0	At birth or as early as possible within first 15 days	Within the first 15 days	2 drops	Oral	Oral
OPV -1,2,3,	6 weeks, 10 weeks & 14 weeks	Till 5 years of age	2 drops	Oral	Oral
fIPV 1 &2	6 weeks & 14 weeks	1 year of age	0.1 ml	Intradermal	Upper arm
Pentavalent vaccine - 1, 2 & 3**	6 weeks, 10 weeks & 14 weeks	1 year of age	0.5 ml	Intra- muscular	Antero-lateral side of mid-thigh
RVV 1, 2 & 3	At 6 weeks, 10 weeks & 14 weeks	1 year of age	5 drops	Oral	Oral
PCV 1, 2 & Booster	At 6 weeks, 14 weeks & 9 months	1 year of age	0.5 ml	Intra- muscular	Antero-lateral side of mid-thigh
MCV 1/ MR 1	9 completed months - to 12 months. Give up to 5yrs if not received at 9 - 12 months age	5 years of age	0.5 ml	Sub- cutaneous	Right upper arm
Vitamin A (1st dose)	At 9 completed months	5 years of age	1ml (1lakh IU)	Oral	Oral
Japanese Encephalitis (1st Dose)***	At 9 completed months - 12 months	15 years of age	0.5 ml	Sub- cutaneous	Left Upper Arm
For Children and Adolescents
DPT booster 1	16- 24 months	7 years of age	0. 5 ml	Intra- muscular	Antero-lateral side of mid-thigh
MCV 2/ MR 2	16-24 months	5 years of age	0.5 ml	Subcutaneous	Right Upper arm
OPV Booster	16-24 months	5 years of age	2 drops	Oral	Oral
Japanese Encephalitis(if applicable)*	16-24 months	15 years of age	0.5 ml	Sub- cutaneous	Left Upper Arm
Vitamin A(2nd to 9th dose)	18 months (2nd dose). Then, one dose every 6 months upto the age of 5 years.	5 years of age	2 ml (2 lakh IU)	Oral	Oral
DPT booster	5- 6 years	7 years of age	0.5 ml	Intra- muscular	Upper arm
Td	10 years &16 years	16 years of age	0.5 ml	Intra- muscular	Up

* Give Td-2 or Booster doses before 36 weeks of pregnancy. However, give these even if more than 36 weeks have passed. Give Td to a woman in labour if, she has not previously received Td Pentavalent vaccine** (containing Diphtheria+Pertussis+Tetanus+Hepatitis B+Hib).

*** JE vaccine at selected endemic districts.

Rotavirus vaccine (RVV)

The Under-5 Mortality Rate (U-5MR) in India is 37 for every 1000 births. One of the major causes of this are diarrhoeal deaths, a disease primarily caused by the rotavirus.

Pentavalent Vaccines

Pentavalent vaccines are a combination of DPT (diphtheria, Pertussis/whooping cough and tetanus), Hepatitis B and Hib vaccines. DPT and Hepatitis B vaccines which are already a part of the immunisation programme are being replaced by the pentavalent vaccines in a phased manner. The pentavalent vaccines are administered intramuscularly in doses of 0.5 ml in the mid-thigh region.

The revised immunisation schedule, when pentavalent vaccines are introduced, is as follows:

Vaccine	Schedule
BCG, Hep B birth dose, OPV-O	At Birth
Pentavalent (DPT + Hep B + Hib), OPV	6 weeks, 10 weeks and 14 weeks
Measles and Vitamin A	9-12 months
DPT booster, OPV booster, Measles2*	16-24 months
DPT booster	5-6 years

IAP (Indian Academy of Pediatrics) Recommendations

The Indian Academy of Pediatrics which is the largest organisation of paediatricians in India endorses the National Immunisation Schedule. The committee has further supplemented the schedule with the Hepatitis B and the MMR vaccines (Measles, Mumps, & Rubella). Even though Rubella might appear to be a mild illness, it can cause congenital defects in babies if the mother is not protected against Rubella and catches the infection during pregnancy. The schedule is as follows:

Age	Vaccines
Birth	BCG, OPV 0, Hepatitis B -1
6 weeks	IPV-1, DTwP-1, Hepatitis B -2, Hib -1, Rotavirus 1, PCV 1
10 weeks	DTwP-2, IPV 2, Hib -2, Rotavirus 2, PCV 2
14 weeks	DTwP-3 , IPV-3 , Hib -3, Rotavirus 3, PCV 3
6 months	OPV 1, Hep B 3
9 months	OPV 2, MMR-1
9-12 months	Typhoid Conjugate Vaccine
12 months	Hep-A 1
15 months	MMR 2, Varicella 1, PCV Booster
16-18 months	DTwP B 1 / DTaP booster -1, IPV B 1, Hib booster 1
18 months	Hep-A 2
2 years	Booster of Typhoid Conjugate Vaccine
4 - 6 years	DTwP B 2 / DTaP booster -2, OPV 3, MMR 3, Varicella 2,
10 - 12 years	Tdap / Td, HPV (Only for females, three doses at 0, 1-2 and 6 months

Abbreviations

BCG: Bacillus Calmette Guerin
OPV: Oral poliovirus vaccine
DTwP: Diphtheria, tetanus, whole-cell Pertussis
DT: Diphtheria and tetanus toxoids
TT: Tetanus toxoid
Hep B: Hepatitis B vaccine
MMR: Measles, Mumps and Rubella Vaccine
Hib: Haemophilus influenzae Type ‘b’ Vaccine
IPV: Inactivated Poliovirus Vaccine
Td: Tetanus, reduced dose diphtheria toxoid
HPV: Human Papillomavirus Vaccine
PCV: Pneumococcal Conjugate Vaccine
TdaP: Tetanus and Diphtheria Toxoids and a Cellular Pertussis Vaccine

WHO-India Recommendation

The immunisation schedule recommended by the WHO is as follows:

The cross below the age (in weeks) table indicates when the vaccine should be given.

Vaccine	Schedule when the vaccine is to be given
	Birth	6 weeks	10 weeks		14 weeks		9-12 months
Primary vaccination
BCG Vaccine	X
Polio Vaccine	X	X		X	X
DTP		X		X	X
Hepatitis B*		X		X	X
Rotavirus Vaccine		X		X	X
Haemophilus influenzae type b		X		X	X
Pneumococcal (Conjugate)		X		X	X
Measles						X
Rubella						X

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FAQs on National Immunization Schedule

✔️What is Immunisation and how does it work ?

Immunisation is a method of providing artificial immunity against antigens by the means of vaccines. Vaccines stimulate an immune response in the body which results in the formation of antibodies that would fight against diseases if our body encounters the same antigens in the future.

A person has some innate immunity at birth and gets some natural immunity from the mother and through breastfeeding. However, this is not enough to tackle infectious and potentially fatal diseases. Artificial vaccines help in the prevention of various serious illnesses which could deter a child's development or even result in death.
✔️What are the side effects of vaccinations?

At rare occasions, vaccination might have some side effects such as pain at the site of injection or a mild fever. The DPT (Diptheria, Pertussis & Tetanus) vaccine shows such side effects while measles-like rashes may develop after the administration of a measles vaccine. Some vaccines might also result in allergic reactions in babies. If a baby develops a high fever or a loss of consciousness upon being vaccinated, a doctor should be immediately consulted. A timely treatment will result in the complete recovery of the child.
✔️Are there any reasons why a child should not be immunized?
Common illnesses like colds and diarrhoea are not impediments to getting a child vaccinated. However, there are some conditions where a doctor should be consulted before administering a vaccine. They are enlisted below:
1. The child has a high fever
2. S/He has had a bad reaction to another immunization
3. S/He has had a severe reaction after eating eggs
4. The child had a convulsion (fits) in the past. (With the right advice, children who have had fits in the past can be immunized)
5. S/He has had, or is having, treatment for cancer
6. An illness which affects the immune system, for example, HIV or AIDS
7. The child is taking a medicine which affects the immune system, for example, immunosuppressants or high-dose steroids.
✔️How do we know that vaccines are safe?

Vaccines undergo extensive trials and tests to ensure safety. They are made available to the public only after these tests have been successfully conducted and the vaccines are found to be safe. Even after the launch of a vaccine, it is periodically assessed and actions are taken if needed.
✔️Which vaccines can be given to a child between 1-2 years of age, who has never been vaccinated?

DPT1, OPV-1, Measles and 2ml of Vitamin A solution should be given to the child. The 2nd and 3rd doses of the DPT and OPV vaccine should then be administered at one-month intervals till the child is 2 years of age. Booster doses of the vaccines can be given at a minimum age of 6 months after the OPV3/DPT3 vaccines have been administered.