Immunisation Schedule (UIP/IAP)

Immunisation is among the most reliably tested topics in NEET PG Paediatrics and PSM, examined as direct factual recall (dose, route, age), as applied "which vaccine next" questions, and increasingly via cold-chain and AEFI vignettes. Master the Government of India Universal Immunisation Programme (UIP) schedule cold, then layer the IAP (Indian Academy of Paediatrics) additions on top.

Key definitions & vaccine classification

Vaccine = a biological preparation that induces active, acquired immunity against a specific pathogen. Two broad operational distinctions dominate the exam: live attenuated vs killed/inactivated, and UIP (free, public) vs IAP-recommended (often optional/private).

Live attenuated	Killed / Inactivated / Subunit
BCG	DPT (whole-cell pertussis)
OPV (Oral Polio)	IPV (inactivated polio – Salk)
Measles, MMR, MR	Hepatitis B (recombinant subunit)
Rotavirus (oral)	Hib (conjugate)
Varicella	Pneumococcal conjugate (PCV)
Oral typhoid (Ty21a)	Typhoid conjugate / Vi polysaccharide
Yellow fever	Rabies, Hepatitis A (killed), Cholera
JE (live SA 14-14-2)	Influenza (IIV), HPV, Meningococcal conjugate

High-yield: Live vaccines are generally contraindicated in pregnancy and in immunocompromised hosts (the classic exceptions: yellow fever may be given in pregnancy if travel to an endemic area is unavoidable). Killed vaccines are safe in both.

Mnemonic for live vaccines — "Bring Out My Rotten Yellow Vaccine, Junior Tom": BCG, OPV, MMR/Measles, Rotavirus, Yellow fever, Varicella, JE-live, Typhoid-oral.

National Immunisation Schedule (UIP) — the core table

The UIP currently protects against 12 diseases nationally: tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzae type b, measles, rubella, severe diarrhoea (rotavirus), pneumonia (pneumococcus), and Japanese encephalitis (in endemic districts).

Age	Vaccines (UIP)
Birth	BCG, OPV-0 (zero dose), Hepatitis B birth dose
6 weeks	OPV-1, Pentavalent-1, RVV-1, fIPV-1, PCV-1
10 weeks	OPV-2, Pentavalent-2, RVV-2
14 weeks	OPV-3, Pentavalent-3, RVV-3, fIPV-2, PCV-2
9–12 months	MR-1, JE-1 (endemic), PCV-booster, Vitamin A (1st dose)
16–24 months	MR-2, JE-2, DPT-booster-1, OPV-booster
5–6 years	DPT-booster-2
10 years	Td (tetanus + reduced diphtheria)
16 years	Td
Pregnancy	Td-1, Td-2 (or 1 booster if previously vaccinated)

High-yield: Pentavalent vaccine = DPT + Hep B + Hib. It replaced standalone DPT and Hep B at 6/10/14 weeks in the UIP. Note Hep B is still given separately at birth (within 24 hours).

High-yield: India switched from oral TT to Td (lower-dose diphtheria toxoid added) to maintain diphtheria immunity in adolescents and pregnant women. TT alone is no longer used in UIP.

fIPV = fractional IPV, given intradermally (0.1 mL, two doses at 6 and 14 weeks) as part of the polio endgame to conserve IPV supply while OPV use winds down.

Routes, sites & doses (frequently asked)

Vaccine	Route	Site	Dose
BCG	Intradermal	Left upper arm (deltoid insertion)	0.1 mL (0.05 mL neonate)
OPV	Oral	—	2 drops
Hep B / Pentavalent	Intramuscular	Anterolateral thigh	0.5 mL
fIPV	Intradermal	Right upper arm	0.1 mL
IPV (full)	Intramuscular/SC	Anterolateral thigh	0.5 mL
PCV	Intramuscular	Anterolateral thigh	0.5 mL
Rotavirus	Oral	—	5 drops (varies by brand)
MR / MMR / Measles	Subcutaneous	Right upper arm	0.5 mL
JE	Subcutaneous	—	0.5 mL
Td / Vitamin A	IM / Oral	Thigh / —	0.5 mL / 1–2 mL

High-yield: BCG is the only intradermal UIP vaccine routinely (fIPV is also ID). A correct BCG injection produces a wheal of 5 mm. The expected sequence: papule at 2–3 weeks → ulcer → heals with a scar by 6–12 weeks. Absence of scar does not mandate revaccination if given correctly, but UIP allows BCG up to 1 year of age.

Cold chain — temperature & storage logic

The cold chain is the system of storing and transporting vaccines within a safe temperature range from manufacturer to beneficiary.

Flow: Manufacturer → Walk-in cooler (WIC)/Walk-in freezer (WIF) at state → Ice-Lined Refrigerator (ILR) + Deep Freezer (DF) at district/PHC → vaccine carrier/cold box to session site.

Equipment	Temperature	Stores
Walk-in freezer (WIF)	−15 to −25 °C	OPV, measles bulk stock
Walk-in cooler / ILR	+2 to +8 °C	All vaccines for issue
Deep freezer	−18 to −20 °C	OPV; makes ice packs
ILR	+2 to +8 °C	DPT, Td, Hep B, BCG diluent, PCV, RVV
Vaccine carrier	+2 to +8 °C (with ice packs)	Transport to outreach

High-yield: Most heat-sensitive vaccine = OPV (store frozen). Most heat-stable of the routine vaccines = BCG (lyophilised) but its reconstituted form must be discarded within 4 hours; measles/MR reconstituted vaccine within 4 hours too.

High-yield: Vaccines damaged by freezing (must NOT be frozen): DPT, Td, Hep B, IPV, PCV — i.e. the adsorbed/aluminium-containing and liquid vaccines. The Shake test detects freeze damage in adsorbed vaccines (a frozen-then-thawed vial shows rapid sedimentation/flocculation).

High-yield: VVM (Vaccine Vial Monitor) is a heat-sensitive label on OPV vials. Inner square lighter than outer ring = usable; inner square as dark as or darker than outer ring = discard. Open Vial Policy permits reuse of opened multidose vials of OPV, Hep B, Pentavalent (liquid), Td, fIPV for up to 28 days if VVM acceptable, expiry not passed, stored at 2–8 °C, no contamination — but does NOT apply to reconstituted BCG, measles/MR, JE (discard in 4 hours).

AEFI — Adverse Events Following Immunisation

AEFI = any untoward medical occurrence following immunisation that does not necessarily have a causal relationship. WHO classifies AEFIs into five categories:

1. Vaccine product–related (e.g. fever after DPT).
2. Vaccine quality defect–related (manufacturing fault).
3. Immunisation error–related (formerly "programme error") — e.g. wrong diluent, contamination, reuse of syringe. Most preventable and cause of clustering of cases.
4. Immunisation anxiety–related (vasovagal/fainting, hyperventilation).
5. Coincidental (unrelated illness happening by chance).

Serious AEFI = death, hospitalisation, disability, or a cluster of cases — must be reported and investigated.

High-yield: Anaphylaxis is the most feared immediate AEFI → treat with intramuscular adrenaline (1:1000), 0.01 mL/kg, anterolateral thigh, repeat every 5–15 min. Every immunisation site must keep an adrenaline kit.

High-yield: Hypotonic-Hyporesponsive Episode (HHE) classically follows whole-cell pertussis (DPT) — sudden onset of limpness, pallor, reduced responsiveness within 48 hours; self-limiting. Persistent inconsolable crying >3 hours and high-grade fever are also DPT-associated.

Contraindications & true precautions

• True general contraindication: severe allergic (anaphylactic) reaction to a previous dose or vaccine component.
• Live vaccines: pregnancy, primary/secondary immunodeficiency, high-dose steroids, active malignancy on chemo, symptomatic HIV (asymptomatic HIV may still receive most vaccines per WHO).
• DPT (whole-cell) absolute contraindication: encephalopathy within 7 days of a previous dose not attributable to another cause. → switch to DPaT/DT or omit pertussis.

High-yield: NOT contraindications (common exam trap): mild illness with low-grade fever, current antibiotic therapy, prematurity, breastfeeding, malnutrition, family history of seizures/SIDS, mild local reaction to a previous dose, and stable neurological conditions. Immunise the malnourished and the mildly ill child.

Interval rules & catch-up logic

• Two live parenteral vaccines (e.g. MMR and varicella) must be given either on the same day or ≥4 weeks apart; oral/intranasal live vaccines and any inactivated vaccine have no interval restriction.
• Minimum interval between doses of the same vaccine in the primary series = 4 weeks.
• "The road to immunity is never lost" — if a schedule is interrupted, resume from where it stopped; do not restart the series.
• Immunoglobulin/blood products blunt live parenteral vaccines (measles/MMR, varicella): defer the vaccine for 3–11 months depending on the Ig dose; conversely defer Ig for 2 weeks after such a vaccine.

High-yield: Maximum age caps in UIP: BCG up to 1 year, OPV/Pentavalent primary up to 1 year (catch-up to 5 yrs as needed), MR up to 5 years. Rotavirus has strict age limits — first dose by ~6 weeks, complete by ~8 months (older limits to reduce theoretical intussusception risk).

IAP 2024 additions (beyond UIP)

IAP recommends several vaccines not (yet) universal in UIP — frequent in private-practice and "recommended schedule" questions:

Vaccine	IAP timing	Note
Typhoid conjugate (TCV)	9–12 months, booster at 2 yrs	Replaces older Vi-PS
Hepatitis A	12 months onward, 2 doses (killed)	Single dose if live
Varicella	15 months + 4–6 yrs (2 doses)	Live
MMR	9, 15 months + 4–6 yrs	UIP uses MR
Influenza (IIV)	6 months annually	2 doses first year
HPV	9–14 yrs (2 doses), ≥15 yrs (3 doses)	Cervical cancer prevention
Meningococcal / Cholera	risk groups / outbreaks	—

High-yield: HPV two-dose schedule (0, 6–12 months) is valid only when started before the 15th birthday; three doses (0, 1–2, 6 months) if started at ≥15 years or in immunocompromised. India has introduced an indigenous quadrivalent HPV vaccine (Cervavac) with plans for national roll-out in adolescent girls.

Special situations

• Pregnancy: only Td and influenza are routinely recommended; Tdap in third trimester (IAP) for neonatal pertussis protection. Live vaccines avoided.
• HIV-exposed/infected: give inactivated vaccines normally; avoid OPV (give IPV instead); BCG is given at birth in asymptomatic infants per Indian policy but avoided if symptomatic AIDS; MMR/varicella only if CD4 adequate.
• Preterm/low birth weight: vaccinate by chronological age, full dose, no correction for prematurity. Hep B birth dose: if <2 kg, the birth dose may not count toward the series (give 3 further doses).
• Asplenia/sickle cell: prioritise PCV, Hib, meningococcal (encapsulated organisms).

Recently asked / exam angle

• Pentavalent composition and which vaccines it replaced (DPT + Hep B + Hib) — repeatedly asked.
• Most heat-sensitive vaccine (OPV) and vaccines damaged by freezing (DPT/Td/Hep B/IPV/PCV) — classic cold-chain MCQ.
• VVM interpretation and Open Vial Policy (28-day rule and its exclusions) — increasingly common applied questions.
• AEFI classification (immunisation-error vs product-related) and HHE association with whole-cell pertussis.
• "Schedule interrupted — what next?" vignettes testing the resume-don't-restart and 4-week minimum-interval rules.
• BCG technique/site (intradermal, left arm) and expected scar timeline.
• fIPV route (intradermal) and rationale (polio endgame).
• HPV dose schedule by age (2 vs 3 doses around the 15-year cut-off) — newer, high-yield.
• Reconstituted BCG/measles discard time = 4 hours.
• Td replacing TT in adolescents and pregnancy.

Rapid revision

1. Pentavalent = DPT + HepB + Hib, given at 6/10/14 weeks; Hep B birth dose is separate.
2. OPV is the most heat-sensitive vaccine; DPT/Td/HepB/IPV/PCV must never be frozen (use the shake test).
3. BCG = intradermal, left arm, 0.1 mL, scar by 6–12 weeks; reconstituted BCG/measles discard in 4 hours.
4. VVM: inner square lighter than outer ring = use; equal/darker = discard.
5. Open Vial Policy = 28 days for liquid multidose vials (OPV, HepB, Pentavalent, Td, fIPV); excludes reconstituted vaccines.
6. fIPV is intradermal (0.1 mL × 2 at 6 and 14 weeks) — polio endgame strategy.
7. Td replaced TT at 10 yrs, 16 yrs and in pregnancy.
8. Resume, never restart an interrupted schedule; minimum same-vaccine interval = 4 weeks; two live parenteral vaccines same day or ≥4 weeks apart.
9. HHE follows whole-cell DPT; DPT encephalopathy within 7 days = stop pertussis component.
10. Anaphylaxis → IM adrenaline 1:1000, 0.01 mL/kg, anterolateral thigh.
11. Mild illness, malnutrition, prematurity, antibiotics, breastfeeding are NOT contraindications to vaccination.
12. HPV: 2 doses if started <15 years, 3 doses if ≥15 years; live vaccines contraindicated in pregnancy and immunocompromise.