IMMUNIZATION

National Immunization Schedule

Vaccine When to give Dose Route Site
TT-1 Early in pregnancy 0.5 ml IM Upper
arm
TT-2 After minimum 4 weeks of TT-1
but before 36 weeks
TT- If received 2 TT doses in last 3
Booster years, then only a booster dose
is required
Dose When to give Dose Route Site

BCG At birth- within 0.05 ml till 1 Intra- Left

1 year month of age dermal upper
0.1 ml thereafter arm
Hepatitis B At birth- within 0.5 ml Intra- Right
24 hours muscular thigh

OPV-0 At birth- within 2 drops Oral Oral

15 days
OPV – 1,2,3 6,10,14 2 drops Oral Oral
Pentavalent weeks 0.5 ml IM Left thigh
1,2,3
Rotavirus-1,2,3 5 drops Oral Oral

fIPV-1, 2 6, 14 0.1 ml ID Right

weeks arm
Pneumoco 6, 14 weeks 0.5 ml IM Right
ccal Thigh
Conjugate
Vaccine -
1,2
Measles- 9-12 months 0.5 ml SC Rt upper
Rubella arm

JE-1 9-12 months 0.5 ml Lt Upper

arm

PCV- 9-12 months 0.5 ml IM Right

Booster Thigh
MMR 16-24 months 0.5 ml SC Rt upper
arm

DPT 0.5 ml IM Lt Thigh

Booster-1

OPV 2 drops Oral Oral

Booster
JE-2 0.5 ml SC Lt Upper
arm

DPT 5-7 years 0.5 ml IM Upper

Booster-2 arm
Vaccines
 BCG
• Freeze dried BCG vaccine is reconstituted with 1 ml of normal
saline.
• A single vial contains 20 doses (10 doses if 0.1 ml is used)
• Reconstituted BCG vaccine can be used for 4 hours
• BCG vaccine protects against childhood TB and severe forms
of TB like meningeal TB and military TB
• If BCG is accidentally given subcutaneously, then a local
abscess may form. Such a child should not be revaccinated.
 BCG
• BCG vaccination should be done before 1 year of age.
After 1 year, there is no need of giving BCG vaccination
• BCG is given on the left upper arm to maintain
uniformity
• If no scar appears after administering BCG, there is no
need to revaccinate the child.
• Contraindicated in Immunodeficiency
 OPV
• OPV 0 dose can be given till 15 days after birth.
• OPV dose is given till 5 years of age.
• A single vial contains 20 doses of OPV.
• Dose of OPV is 2 drops.
• Bivalent – OPV1 and 3
 Pentavalent
• DPT + Hep B + HIB
• At 6,10, 14 weeks
• Instramuscularly in thigh
• It can be given up to 1 year
• Open Vial policy
 Hepatitis B
• The birth dose of Hepatitis B vaccine is effective in
preventing peri-natal transmission of Hepatitis B if given
within the first 24 hours.
• Recombinant DNA
• Included in Pentavalent
• Up to 1 year of age
• Open Vial Policy
 Rotavirus Vaccine
• Rotavac- Bharat Biotech
• Each vaccine vial contains 10 doses in liquid form
• It doesn’t require reconstitution
• Color of the vaccine is generally pink
• The dose is 5 drops given orally.
• Three doses at 6, 10 and 14 weeks
• A vial has to be used within 4 hours of opening
 IPV
• Inactivated (killed) poliovirus vaccine (IPV) with types 1,
2 and 3 antigens
• IPV is a liquid vaccine; No reconstitution is required
• Available as 50-dose vial
• At 6 and 14 weeks, to maximum up to 1 year of age
• 0.1 ml , intradermally in right deltoid region
• Open Vial Policy
 MR/MMR
• It is reconstituted using double distilled pyrogen-free water.
• The reconstituted vaccine should be used within 4 hours
• It is given subcutaneously on the right upper arm to maintain
uniformity
• It can be administered until 5 years of age.
 DPT
• The DPT vaccine can be given until 7 years of age
• There should be a minimum gap of 28 days between
DPT 1,2 and 3
• There should be a minimum gap of 6 months between
DPT 3 and DPT booster 1 and 3 years between DPT
booster 1 and booster 2
• A child who is allergic to DPT or develops
encephalopathy after DPT should be given the DTaP /
DT vaccine
 Japanese Encephalitis
• Vero cell-derived, inactivated and alum-adjuvanted
• SA-14-14-2
• First dose is given at 9 months and second dose at 16
months.
• It is administered to children below 15 years of age.
• 0.5 ml of vaccine should be given subcutaneously
• The left upper arm is the site of the injection
• After reconstitution, the vaccine should be used within 4
hours
 Pneumococcal vaccine
• 2 primary doses at 6 weeks and 14 weeks, followed by a
booster dose at 9 months
• The dose of the vaccine is 0.5 ml - intramuscular injection in the
anterolateral aspect of the right mid-thigh of infants.
• PCV should be given under 1 year of age.
• In delayed cases, due doses above 1 year of age can be given
to a child only if a child has received at least one dose of PCV
in infancy.
 Pneumococcal vaccine
• Stored at temperatures ranging between +2°C and +8°C
• The Shake Test is applicable
• It is available in a 4-doses vial
• If the doses are delayed within the first year of life, doses (both
primary and booster) must be separated by a minimum interval
of at least 2 months
Ages by which vaccines should be administered
Vaccine Age
BCG 1 year
Hepatitis B 1 year
Pentavalent 1 year
OPV 5 years
MR / MMR 5 years
DPT 7 years
Japanese Encephalitis 15 years
IPV 1 year
PCV 1 year
Rotavac 1 year
VVM
 Adverse event following immunization
Any untoward medical occurrence which follows
immunization and which does not necessarily have a
causal relationship with the use of the vaccine. The
adverse event may be any unfavourable or unintended
sign, an abnormal laboratory finding, a symptom or a
disease.
 Cause-specific definitions
Vaccine product-related reaction:
An AEFI that is caused or precipitated by a vaccine due to one or
more of the inherent properties of the vaccine product.

Vaccine quality defect-related reaction:

An AEFI that is caused or precipitated by a vaccine due to one or
more quality defects of the vaccine product, including the
administration device, as provided by the manufacturer.
Immunization error-related reaction:
An AEFI that is caused by inappropriate vaccine handling,
prescribing or administration and that thus, by its nature, is
preventable.

Immunization anxiety-related reaction:

An AEFI arising from anxiety about the immunization

Coincidental event:
An AEFI that is caused by something other than the vaccine
product, immunization error or immunization anxiety
Which of the following statements is not true about BCG
vaccination? (AIIMS-2011)
a) Normal saline is used as diluent for BCG vaccine
b) The site for injection should be cleaned thoroughly
with spirit
c) Tuberculin test is positive after 6 weeks of vaccination
d) WHO recommends Danish 1331 strain for vaccine
production
Vaccine that is contraindicated in pregnancy is – (AIIMS
2009)
a) MMR
b) Diphtheria
c) Hepatitis B
d) Rabies vaccine
A 37 weeks pregnant woman attends an antenatal clinic at
primary health center. She has not had any antenatal care till
now. The best approach regarding tetanus immunization in this
case would be to- (AIPGME 2004)
a) Give a dose of TT and explain to her that it will not protect the
newborn and she should take the second dose after four
weeks even if she delivers in the meantime
b) Do not waste the TT vaccine as it would anyhow be of no use
in this pregnancy
c) Give one dose of TT and explain that it will not be useful for
this pregnancy
d) Give her anti-tetanus immunoglobulin along with the TT
vaccine
Eight months old child had history of unusual crying and
convulsions following previous vaccination after BCG,
Penta1, fIPV1 & OPV1. Now parents have brought child
for next doses of vaccination. Which vaccine is
contraindicated in this situation?
a) Measles
b) Pentavalent
c) OPV
d) IPV
A 9-month-old infant is brought to you for immunization.
The infant has previously received the first dose of OPV
and Penta. What will you do?
a) Repeat the first dose counting afresh
b) Skip Penta/ OPV
c) Give the infant second dose of Penta/OPV
d) Give the infant a booster dose of DPT/Polio
The minimum accepted interval between the two doses
of Pentavalent is
a) 4 weeks
b) 6 weeks
c) 8 weeks
d) 10 weeks
Strain used for BCG vaccine is (AIPGME 2007)
a) Edmonston Zagreb
b) Oka
c) Danish 1331
d) RA 27/3
A 3-year-old completely unimmunized child comes to an
immunization clinic at PHC for the first time. He should
be given
a) BCG, MMR, Vitamin A
b) DT-1, OPV-1, MMR, Vitamin A
c) BCG, Penta-1, OPV-1, MMR, Vitamin A
d) DPT-1, OPV-1, MR, Vitamin A
The risk of cold chain failure is greatest at – (AIPGME
2000)
a) Regional level
b) District level
c) PHC level
d) Subcentre and village level
The strain used in Mumps vaccine is
a) Jeryll Lynn
b) Edmonston Zagreb
c) RA 27/3
d) Oka
Hepatitis B vaccine, dose schedule in adults, in months
a) 0, 1 and 2
b) 2, 4 and 6
c) 0, 6 and 12
d) 0, 1 and 6
Which of the following vaccines can result in
Thrombocytopenia? (AIIMS 2014)
a) MMR
b) Typhoid
c) Influenza
d) HiB
A 10-month-old child was given measles and Pentavalent
vaccine at a PHC. After 24 hours he got seizures. The
correct statement regarding this is-
a) It is most likely due to Pertussis component
b) It is most likely due to Measles vaccine
c) It is most likely due to simultaneous administration of
multiple vaccines
d) None of the above
A child accidentally receives BCG subcutaneously
a) He should be revaccinated with Intradermal BCG
immediately
b) Nothing needs to be done
c) Mantoux should be done after 1 month
d) Both b and c
In the identification of the cause of AEFIs, it was found
that the cases were from different facilities that received
the same vaccine from same batch. However, similar
illness was reported in others who didn’t get the vaccine.
The most likely cause is-
a) Programmatic error
b) Coincidental error
c) Vaccine reaction
d) Batch problem
конец