IMMUNIZATION SCHEDULE
Last Updated : 1/9/2014
Ira Shah
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Immunization
Immunization is the process of artificially inducing immunity or providing protection from disease. Active immunization is the process of stimulating the body to produce antibody and other immune responses through administration of a vaccine or toxoid. Passive immunization is provision of temporary immunity by administration of preformed antibodies derived from humans or animals.

Vaccine
It is defined as a suspension of live attenuated or inactivated micro-organisms, or fractions of microorganisms which on administration induce immunity and prevent disease.

History of vaccination
With introduction of vaccines, over 3 million deaths from measles, neonatal tetanus and pertussis are prevented by vaccination each year. In the Americas, poliomyelitis has been eliminated, and measles is close to elimination. Globally, reported poliomyelitis incidence has declined by over 80% since 1988. Subsequently vaccines are now available for various diseases including Hepatitis A, Hepatitis B, H. influenza B, pneumococcal disease, mumps, rubella, typhoid, chickenpox, rotavirus, human papillomavirus, meningococcal disease, and influenza virus.

Expanded Programme of Immunization (EPI)
The World Health Organization (WHO) initiated the Expanded Program on Immunization (EPI) in May 1974 with the objective to vaccinate children throughout the world. Ten years later, in 1984, the WHO established a standardized vaccination schedule for the original EPI vaccines: Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DPT), oral polio and measles. Increased knowledge of the immunologic factors of disease led to new vaccines being developed and added to the EPI's list of recommended vaccines: Hepatitis B (HepB), yellow fever in countries endemic for the disease, and Haemophilus influenzae meningitis (Hib) conjugate vaccine in countries with high burden of disease. For over 30 years, the EPI programme has helped to create a global consensus on disease prevention and immunization.


Table 1: EPI schedules as recommended by Govt. of India

Birth -15 days - BCG + OPV (ZERO DOSE)
6 weeks- OPV1 + DPwT1 + Hep B1 + Hib 1*
10 weeks- OPV2 + DPwT2 + Hep B2+ Hib 2*
14 weeks- OPV3 + DPwT3 + Hep B3+ Hib 2*
9 months- Measles Vaccine
15 months-18 months- 1st booster of OPV/ DPwT + MMR*
5 years -6 years- 2nd booster of DPwT
10 years- Tetanus Toxoid
16 years- Tetanus Toxoid

* These vaccines have been introduced in few states currently, Hep B = Hepatitis B vaccine

WHO recommendations for routine immunization
In order to assist programme managers develop optimal immunization schedules WHO has compiled key information on its current routine immunization recommendations into two summary tables. The table given below provides detailed information for routine immunizations for children including age at first dose and intervals.

Table 2: Recommended Routine Immunization - Summary of WHO Position Papers

AntigenChildren
(see Table 2 
for details)
AdolescentsAdults Considerations
Recommendations for all
BCG1 dose  Exceptions HIV
Hepatitis B 3-4 doses
3 doses (for high-risk groups if not previously immunized) (see footnote)Birth dose, Premature and low birth weight, Co-administration and combination vaccine, Definition high-risk
Polio3 doses, with DTP  OPV birth dose, Transmission and importation risk criteria, Type of vaccine
DTP
3 dosesBooster (DTP) 1-6 years of age
Booster (Td)
Booster (Td) in early adulthood or pregnancy
Delayed/interrupted schedule, Combination vaccine
Hemophilus Influenza type b3 doses, with DTP  Single dose if 12-24 months of age Delayed/interrupted schedule, Co-administration and combination vaccine
Pneumococcal (Conjugate)3 doses, with DTP  Single dose if >12 months of age Delayed/interrupted schedule, Co-administration
Rotavirus
Rotarix: 2 doses with DTP
RotaTeq: 3 doses with DTP
  Maximum age limits for starting/completing vaccination; Rotarix with DTP1 and DTP2.
Measles2 doses  Combination vaccine; HIV early vaccination
HPV 3 doses (girls) Vaccination of males for prevention of cervical cancer 
Recommendations for certain regions
Japanese EncephalitisLive attenuated vaccine: 1 dose Booster after 1 year Mouse brain-derived vaccine: 2 doses Booster after 1 year, then every 3 yearsMouse brain-derived vaccine: booster every 3 years up to 10-15 years of age Vaccine options
Yellow Fever1 dose, with measles  Co-administration
Recommendations for some high-risk populations
Typhoid
Vi polysaccharide vaccine: 1 dose; Ty21a live oral vaccine: 3-4 doses. Booster dose 3-7 years after primary seriesDefinition of high-risk, Vaccine options
Cholera
Dukoral (WC-rBS): 3 doses > 2-5 yrs, booster every 6 months; 2 doses adults/children > 6 yrs, booster dose every 2nd year Shanchol & mORCVAX: 2 doses >1 yrs, booster dose after 2 yearsMinimum age Definition of high-risk
Meningococcal (polysaccharide)1 doseDefinition of high-risk, Conjugate vaccine
Hepatitis A
2 dosesDefinition of high-risk
Rabies
3 dosesDefinition of high-risk, booster
Recommendations for immunization programmes with certain characteristics
Mumps
2 doses, with measles  Coverage criteria > 80%, Combination vaccine
Rubella
1 dose
1 dose (alternative strategy adolescent girls & child bearing age women) (see footnote)Coverage criteria > 80% Combination vaccine
Influenza (inactivated)First vaccine use: 2 doses. Revaccinate annually: 1 dose only
1 dose from 9 years of age. Revaccinate annually
Priority targets, Definition of high-risk, Lower dosage for children


Vaccination schedule recommended by Indian Academy of Pediatrics (IAP) 2013
Since EPI schedule contains only few vaccines, IAP schedule also includes vaccines which can be given to prevent various other infections. These are depicted in table 3.

Table 3- IAP Time Schedule of routine vaccination

Birth - 15 days

BCG + OPV (zero dose) +HepB1

6 weeks - 8 weeks

OPV1 +IPV1 + DPT1* + HepB2 + Hib1 + Rotavirus1 + PCV1

10 weeks- 12 weeks

OPV2 + IPV2 + DPT2* + Hib2 + Rotavirus2 + PCV2

14 weeks - 16 weeks

OPV3 + IPV3 + DPT3* + Hib3 + Rotavirus3# + PCV3

6 months

HepB3 + OPV1

9 months (completed)

Measles vaccine + OPV2

12 months

Hepatitis A1

15 months

MMR1 + Varicella + PCV booster

18 months

OPV4 + IPV booster1 + DPT*booster1 + Hib booster1 + Hepatitis A2

2 years

Typhoid1 (give repeat shots every 3 years)

5 years

OPV5 + DPT* booster2 +MMR2^ + Varicella2$$

10 - 12 years

Tdap/Td (Every 10 years then give Td)+ HPV**


*DPT: It is given either as DPaT or DPwT
**HPV is given only in females (3 doses at 0,1-2 months and 6 months interval)
#Rotavirus 3rd dose may be required only with one brand)
^ MMR 2nd dose can be given at any time 4-8 weeks after the first dose
$$ Varicella 2nd dose can be given anytime 3 months from the first dose
PCV= Pneumococcal conjugated vaccine, IPV= Injectable polio vaccine, Td = Tetanus toxoid + adult dose of pertussis toxoid, HPV= Human papillomavirus


References

Contributor Information and Disclosures

Ira Shah
Consultant Pediatrician, B J Wadia Hospital for Children, Mumbai, India


First Created : 1/9/2001

References

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