This document provides information on Dr. Kamlesh Lala's credentials and contact information. It then summarizes India's vaccination schedule and the evolution of the country's universal immunization program over time to include additional vaccines. Key details are provided on individual vaccines such as BCG, polio, measles, and others. The document concludes with brief descriptions of vaccination recommendations and schedules for specific diseases.

1. DR. KAMLESH LALA
M.B.B.S.; D.PED, FCGP
FAMILY PHYSICIAN
NARANPURA
KAMLESHLALA@ HOTMAIL.COM

2.  Immunisation is one of the most cost
effective of all the health care interventions
practiced worldwide.
 Vaccination provides the opportunity to
eradicate, eliminate or significantly reduce
common infectious diseases to save lives and
to reduce human suffering.

3.  A vaccination schedule is a series of vaccinations,
including the timing of all doses, which may be either
recommended or compulsory depending on the
country of residence, needs of the community, disease
burden, feasibility of implementation, availability of
vaccines and cost effectiveness.
 Based on above issues, every country decides its own
immunisation schedule as per the local
epidemiological situation and programmatic needs.

4. Guidelines for evidence-based review on
vaccine-related recommendations are available
from Advisory Committee on Immunization
Practice (ACIP), Strategic Group of Advisory
Experts on immunization (SAGE), European
Center for Disease Control (ECDC) and WHO.
ACIP review the evidence for best practices and
release updated guidance every 3 – 5 years.

5. Indian Academy of Pediatrics (IAP) Advisory Committee
on Vaccines & Immunization Practices (ACVIP), set up
as a special subcommittee of the academy, has been
entrusted with the responsibility to frame the
recommendations.

6. The WHO launched global immunisation program
in 1974, known as Expanded Program on
Immunisation (EPI) to protect all children of the
world against six killer diseases.
And the journey continues with newer and newer
vaccines.

7. Age
Vaccine
Birth 6 weeks 10 weeks` 14 weeks 9 months
BCG BCG
OPV OPV 1 OPV 2 OPV 3
DPT DPT 1 DPT 2 DPT 3
Measles Measles

8.  1978 - The Govt of India launched its EPI to cover BCG,
DTP, OPV and Typhoid.
 1981 - Typhoid-paratyphoid vaccine was dropped from EPI
due to higher reactogenicity and low efficacy of the
vaccines
 1983 - tetanus toxoid vaccine for pregnant woman added in
EPI.
 1985 - EPI was modified as Universal Immunisation
Programme (UIP).
 1985 - First dose of measles was added .
 1992 - UIP become a part of child survival and safe
motherhood (CSSM).

9.  2002 - Hepatitis B was piloted and scaled up in entire
country .
 2006 - Japanese encephalitis in endemic areas.
 2010 -Phase wise introduction of Second dose of
measles .
 2011 December - Pentavalent vaccine introduced in
phase wise.
 2014 December - Mission Indradhanush was launched
to cover children up to two years and pregnant
women.

10.  2016 - New vaccines are added namely Rubella, IPV
and Rotavirus.
 Also tOPV was replaced by bOPV.
 Adult JE vaccination was started
 2017 - Pneumococcal conjugate vaccine PCV was
added in UIP in certain states (HP, UP, Bihar).
 2017 October - Intensified Mission Indradhanush IMI
was launched with a target to achieve 90%
coverage by 2018 instead of 2020.
 2017 February - Measles-Rubella MR campaign started.

11.  Thus under UIP, government is providing vaccination to
prevent 11 vaccine preventable diseases (VPD) to infants.
 DTP
 HepB Pentavalent
 Hib
 Polio
 MR
 Childhood TB
 Rotavirus diarrhoea
 JE

13. INDIVIDUAL VACCINES

14.  At birth or as early as possible preferably
within 24 hours.
 If missed by any reason, it should be given
till one year of age.

15.  Universal hepatitis B vaccination within 24 hours
of birth for medically stable infants weighing more
than 2 Kg.
 Three doses are given at 6-10-14 weeks as a
pentavalent vaccine. Here 4 doses are permissible
including zero dose.
 For catch up, at 0 – 1 – 6 months.
 No booster is required.

16.  If mother is HBsAg positive, give 0.5 ml
HBIG along with HepB vaccine.
 For orphan infant, post vaccination
serologic testing is must.
 Single dose revaccination for infants born to
HBsAg positive mothers not responding to
initial vaccine series tested at 9-12 months
age.

17.  Zero dose within 15 days of birth
 Three doses at 6, 10,and 14 weeks
 OPV booster with DTP/Quadrivalent at 18
months.
 Additional doses of OPV on all pulse polio days till
5 years of age.
 It will be discontinued once IPV is freely available.

18. On 25 Feb 2012 INDIA is removed from the list of
“POLIO ENDEMIC COUNTRIES”

19.  As a part of polio end game strategy, IPV has been
introduced.
 If available or as a combination (Hexavalent) vaccine:
three doses at 6-10-14 weeks
 If not possible, give at least one dose at 14 weeks along
with OPV (either standalone or combination vaccine)
 Two fractional intradermal doses of IPV (fIPV- 0.1 ml)
at 6 and 14 weeks are either equally or more effective.
Given in govt. facilities.
 Again if available, booster at 12-18 months.

20.  DTwP is superior to DTaP.
 3 primary doses at 6-10-14 weeks either as
DTP or pentavalent or hexavalent
 First booster at 16-24 months either as DTP
or Quadrivalent
 Second booster at 4-6 years

22.  Immunity wanes more rapidly after first year with aP
vaccine. So WHO advised to consider additional
boosters and immunisation of mothers during
pregnancy. So Tdap vaccine is for countries using
DTaP
 Single dose to all adolescents and adults who have not
received the same.
 Women are recommended to receive a dose of Tdap
during each pregnancy between 27 to 36 weeks
regardless of previous receipt of it.

23.  Three doses at 6-10-14 weeks as a pentavalent
 Booster at 16-24 months as Quadrivalent
 Catch up schedule:
 For age 6 -12 months, two doses plus one booster
 For age 12-15 months, one dose plus one booster (can be
given after 4 weeks of last dose)
 For age 15 months to 5 years, only one dose.
 No catch up above 5 years.

25.  Remember, this is an ORAL vaccine.
 First dose should be started as early as 6 weeks.
 For Rotarix®
 Two doses at 4 weeks interval: 6 and 10 weeks
 For other brands
 Three doses at 6-10-14 weeks age.
 For both the vaccines:
 First dose not later than 16 weeks.
 Last dose not later than 32 weeks

27.  If given for the first time, two doses are to be given
at one month interval for children aged 6 months
to 9 years
 Only half the dose is required for children from 6
months to 3 years.

28. Age Group Dose No of doses
in the first
year of
vaccination
If
previously
received
one or
more doses
6 months to 3 years 0.25 ml 2 doses at 4
weeks apart
1
3 years to 9 years 0.5 ml 2 doses at 4
weeks apart
1
9 years and older 0.5 ml 1 1

29.  It may not be practical to recommend routine
influenza vaccine to everyone in India.
 It is recommended for high risk groups of children
below five, medical practitioners, pregnant women
and elderly.
 The dose is to be repeated every year around July-
August.
 Adult (0.5 ml) dose cannot be halved to make a
pediatric dose.

31.  Two brands are available: Synflorix® and Prevenar ®
 Three doses at 6-10-14 weeks.
 One booster at 15 months
 Catch up schedule
Age
No of doses
Booster
At 15
months
6-12 months 2 1 4 weeks apart
12-23 months 1 1 8 weeks apart
2-5 years 1 No Booster

32.  Total three doses are given
 9-12 months (270 days completed)
Monovalent measles is replaced by MMR
 15-18 months
 4-6 years
 Additional dose of MR vaccine during MR
campaign for children 9 months to 15 years
irrespective of previous immunisation.

33. • Compared to earlier ViPS and oral typhoid
vaccines,
• TCV provides longer-lasting protection,
• Requires fewer doses and
• Is suitable for children under two years
of age.

34. Developed for the first time by an Indian Company.
Two brands are available in India. (2013)
Typbar TCV® (25mcg/dose) which is also WHO
prequalified vaccine.
Other one is Tyvax CV® (5mcg/dose)
IAP advocates former one Typbar TCV®

35.  First dose starting at 6 months of age
 Natural boosting may occur in endemic
areas.
 There is a lack of evidence concerning
the need for booster vaccination.
 So at present no booster recommended

37.  Only one dose of HepA live attenuated vaccine
starting at age 12 months onward. No booster.
(Biovac A ®)
 Two doses of Hep A killed vaccine. (Havrix®)
 First dose at 12-23 months
 Second dose after six months
 Havrix® 720 can be given till 18 years.
 Havrix® 1440 for adults after 18 years.

38.  Hepatitis A and B combination vaccine
 Available as junior and adult
 Used for catch up immunisation only – not for routine

39.  First dose at 12-15 months.
 Second dose any time after 3 months of first
dose.
 Catch up
 For children aged 7-12 years:
 2 doses with a gap of 3 months
 For persons aged 13 years and older:
 2 doses with a gap of 4 weeks.

40.  For children age 2 months to 5 years DTaP or DTwP
 For child between 5 to 7 years of age, DT is given.
 Later on if patient needs tetanus prophylaxis, ACIP
recommends Td or if appropriate Tdap, but not single
antigen tetanus.
 Booster dose with Td is to be given every ten years
throughout life time.
 Pregnancy
 2 doses : 1st as early as possible and second after 4 weeks of
first dose and before 36 weeks.
 Booster dose: Only one dose in last trimester if previously two
doses are taken.

41. RABIES

42.  One dose is reduced both in PrEP and PEP
by ACIP way back in 2010. (But by IAP
recommended only this year).
 No need for RIG, if previously vaccinated
either PrEP or PEP.
 hRIG and eRIG are equally effective.
 No need for skin testing before eRIG.

43.  If anatomically feasible, the full dose of RIG
should be thoroughly infiltrated in the area
around and into the wounds along with first
dose of ARV or within 7 days of the same in
category III bites.
 The remaining dose if any not to be injected IM
at a distance from wound. It can be spared for
another patient after due aseptic precautions.

44. Scrupulous wound cleaning and deep irrigation with
soap and water (at least for 15 minutes), application
of a potent antiseptic agent, and timely
administration of first anti rabies vaccine followed
by complete course of rabies vaccine are key factors
in increasing survival when RIG is unavailable.
Wound toilet is must even if patient reports late
(should be advised if wound is still not healed)

45.  Pre Exposure Prophylaxis:
Two doses on day 0 and 7.
 Post Exposure Prophylaxis: Four dose schedule
 Essen Regimen: 0 , 3, 7 and between 14-28 days.
 Zagreb Regimen: Two doses on day 0, and one dose on days 7
and 21.
 IPC Regimen: 2 site ID on days 0, 3 and 7.
 Re-exposure if within 3 months: No need for vaccine.
 Re-exposure at any time after three months:
 Two dose on days 0 and 3.
 4 site ID on day 0
 I site ID on days 0 and 3

46.  No suturing or bandage
 No contraindication for use of PrEP or PEP
including pregnancy, immunocomprised, person
taking chloroquine or HCQS.
 It should never be given in gluteal region. And if it
is given, then this dose should not be counted.
 Change in brand and the route of administration
are acceptable.

47.  Should a vaccine dose is delayed, resume the
schedule from where left. No need to
restart.
 No need for ARV after a bite by rodent (rat),
squirrel, hare and rabbit. Bat rabies is not
conclusively proved in India and so exposure
to bat also does not warrant PEP.

48.  History of rabies vaccination in dog is not always a
guarantee that the biting animal is not rabid. There are
several factors for failure of vaccination to dog. So
better to give PEP.
 PEP should be started immediately after the bite. The
observation period of 10 days is valid for dogs and cats
only. If biting animal is healthy throughout
observation period, PEP can be converted to PrEP by
skipping the fourth dose.

49. Introduced in 2017.

50.  In view of the irregular availability and high cost of
RIGs, human monoclonal Ab is an alternative to RIGs,
in category III bites.
 Available in India as Rabishield®.
Agent Dose in IU per Kg
body weight
Concentration
IU Per ml
hRIG 20 150
eRIG 40 200
RHMAB 3.33 40 and 100

52.  Gardasil® is 9 valent while Cervarix® is bivalent.
 Gardasil® is indicated for both male and female.
 Cervarix® is indicated for females only.
 Cervarix® is not available in USA.
Vaccine Age in years Dose Interval
Both 9 – 14 2 0 - 6
Gardasil® 15 - 45 3 0 – 2 - 6
Cervarix® 15 - 25 3 0 – 1 - 6

53.  Meningococcal Conjugate Vaccine MCV4 or
MenACWY single dose for microbiologists,
military recruits, students living in dormitories
and travellers to endemic regions for adults less
than 55 years.
 Revaccination recommended every 5 years
 Polysaccharide vaccine is for adults more than 55
years
 Vaccination must for travellers to Hajj

54. Age wise schedule of vaccines

56. BCG
OPV Zero
HepB

57.  OPV
 IPV
 DTP As pentavalent or hexavalent
 HepB
 Hib
 Rotavirus
 PCV 10 (Synflorix®) or PCV 13 (Prevenar®)

58.  Typhoid TCV
 (Can be given at nine months to reduce
the visit)
 Influenza

59.  MMR - 1
 Typhoid TCV, if not given at 6 months

60. Hepatitis A
Depending upon brand,
either single or two doses

61.  MMR - 2
 PCV Booster
 Chicken Pox – 1
Second dose can be given any time after 3
months

62.  DTP Booster
 Hib Booster can be given as Quadravalent
 OPV - 5
 IPV (If available in the market)

63.  DTP Booster – 2
 OPV - 6
 MMR - 3

64.  Td or Tdap
 HPV
 Finish the schedule as per brand.

65.  Adults need vaccines based on their age, health
conditions, job, lifestyle, or travel habits.
 Vaccines are given according to catch up schedule.
 Routine vaccinations are:
 Flu vaccine
 Pneumococcal Vaccine
 Tdap vaccine
 Zoster vaccine

66.  Flu shot is given every year.
 Tdap and/or Td is given as discussed earlier
 Zoster vaccine advised depending on vaccine.
 RZV after 50 years and ZVL after 60 years.
 MMR, Chicken Pox, HepA, HepB, Hib, HPV.
(If not given earlier during childhood)

67.  It is recommended for
 All children younger than 2 years old
 All adults 65 years or older
 People from 2 to 64 years old with
certain medical conditions.

68.  cerebrospinal fluid (CSF) leaks
 cochlear implants
 sickle cell disease or other hemoglobinopathies
 congenital or acquired asplenia ‚
 congenital or acquired immunodeficiencies ‚
 HIV infection ‚
 chronic renal failure, ‚nephrotic syndrome ‚
 leukemia ‚lymphoma ‚Hodgkin disease ‚generalized
malignancy, ‚iatrogenic immunosuppression, ‚solid
organ transplant,‚multiple myeloma

69. PPSV23 OR Pneumovax®
It is recommended for
All adults 65 years or older
People from 2 to 64 years old with
certain medical conditions.

70.  Chronic heart or lung disease
 Diabetes mellitus,
 Alcoholism ‚
 Chronic liver disease
 Adults who smoke cigarettes

71.  PCV13 Prevenar® and PPSV23 Pneumovax® should not
be administered simultaneously.
 Better immune response if PCV13 is administered first.
 PPSV23 after one year of PCV13.
 Booster of PPSV23 is given after 5 years, if first dose
given before 65 years.
 If PPSV 23 is administered first
 PCV 13 after8 weeks in children 6-18 years.
 PCV 13 after one year in adults 19 years and older.

73.  References:
 Weekly Epidemiological Record WER 48(92):
2017; 729-748.
 WER, Typhoid Vaccines, March 2018
 http://www.who.int/wer
 WHO position paper April 2018
 IAP ACVIP recommendations December 2018.

74. The brand names and pictures
mentioned are for information
only.
I do not advertise any brand.