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All about National Immunization & Schedule Delayed Immunization

Mar 31, 2023

As a doctor it is critical that you are well versed in immunization knowledge. Information regarding Immunization techniques, shots, schedules and others should be on the tip of your tongue. 

In this blog post we are going to learn about National Immunization and Schedule Delayed Immunization, which is an important topic for PSM.  

NIS- National Immunization Schedule

Beneficiaries of NIS: Birth to 16 years

At birthBCG, OPV0, HepB
6 weeks OPV1, RV1, Penta1, fIPV1, PCV1
10 weeks OPV2, RV2, Penta2, - , -
14 weeks OPV3, RV3, Penta3, fIPV2, PCV2
9 completed months (Vit A drops also given)MR1, JE1, PCV booster, fIPV3 
16-24 monthsMR2, JE2, OPV booster, DPT 1st booster
5-6 years DPT 2nd booster 
10 yearsTd1
16 yearsTd2

Highlighting point

  • OPV0 → 0 means birth dose
  • Order of giving vaccine at birth - BCG, OPV , Hepatitis B
  • fIPV → 1/5th of IPV full dose
  • PCV - Pneumococcal conjugate vaccine 
  • JE - Japanese encephalitis

Important information

  • Introduction of third dose of FIPV from 1st january,2023
  • What will be the number of doses of fIPV to be given from 1st January ,2023?
    • 3 doses at 6 weeks, 14 weeks and 9 completed months 
    • At 6 weeks,14 weeks - 0.1 ml ID right upper arm 
    • At 9 months - 0.1 ml ID left upper arm 
    • (as MR vaccine is given at right upper arm)

VIT A drops

  • 9 completed months- 1 ml or 1 L IU 
  • Thereafter every 6 months till 5 years of age - 2 ml or 2L IU

Important information

  • What is the total number of doses of Vit A?
  • What is the total dose of Vit A given?
    • 17 L IU

Routes of vaccines 


ID - O.1 ml

Angle- 10-15 degree

S/C - 0.5 ml 

45 degree

IM - 0.5ml

90 degree

OPV - 2 drops 

BCG - 0.05 ml upto 1 month

After 1 month till 1 year - 0.01 ml 

Site - left upper arm 

9 completed months -

MR - right upper arm

‘t’ series vaccine 

Letter t in it

  • Hepatitis B 
  • Pentavalent
  • DPT (upto 1st booster) 

Anterolateral aspect of left thigh 

Rotavirus Vaccine - 5 drops

fIPV- ⅕ of full dose - 0.1ml

Site- right upper arm 

fIPV3- left upper arm

JE - left upper arm

JE only in endemic areas

PCV - right thigh 

To remember

2 drops of polio can save life 
Rotavirus - associated with diarrhea - 5 drops 
After 5 years absorption from leg decreases so DPT2nd booster given in either of upper arm

BCG (golden points)

  • BCG scar takes 8-12 weeks to form
  • It can also be given on right upper arm 
  • Left upper arm has been taken for uniformity in the country for proper identification
  • BCG vaccine offers no protection from pulmonary TB , it protects against extrapulmonary TB
  • BCG scar not present not necessarily means that the child is not vaccinated so you need not revaccinate

Direct BCG v/s indirect BCG

  • BCG vaccine till 1 year can be given directly
    • No need to perform tuberculin test
  • BCG vaccine after 1 year will be given only after performing tuberculin test called indirect BCG 

Beneficiaries of NIS: Pregnant women     

  • Primi- pregnant for first time Or
  • Multi with last childbirth more than 3 years ago
    • 2 doses of Td vaccine
    • First dose - as soon as possible
    • Second dose - 4 weeks or 28 days later 
  • Multi with last childbirth less than 3 years ago
    • Booster dose of td vaccine around 7th month of pregnancy 

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Q. A 26-year-old primigravida in her second trimester presented to the hospital to take her Td dose. Which of the following is true regarding Td dose in pregnancy?

  1. 1 dose in 2nd trimester
  2. 2 doses (1 month apart) in second trimester
  3. 1 dose anytime as soon as possible in pregnancy 
  4. 2 doses (1 month apart) as soon as possible in pregnancy 

Q. Zero dose of polio vaccine is given 

  1. Within 24 hrs of birth
  2. At birth 
  3. At  6 weeks 
  4. When child suffers from polio

Q. Dose of vitamin A administered at 16 months

  1. 5000 IU
  2. 1 lac IU
  3. 2 lac IU
  4. 1.5 lac IU 

Q. You are posted at a PHC and you have to ensure that the routine vaccination process is carried out smoothly. All o the vaccines are given at 16-24 months except:

  1. DPT booster
  2. OPV booster
  3. Japanese encephalitis 2nd dose 
  4. PCV booster 

Delayed Immunization     

  • OPV birth dose can be given till 15 days
  • Hepatitis B- birth dose given till 24 hours

Vaccines that can be given upto 1 year - 

  • BCG
  • Rotavirus Vaccine
  • Pentavalent 
  • fIPV
  • PCV
  • Hepatitis B vaccine alone can also be given till 1-year

Vaccines that can be given upto 5 years

  • OPV
  • Measles vaccine
  • MR vaccine
  • Vit A drops

Vaccines that can be given upto 7 years

  • DPT

Vaccines that can be given upto 15 years

  • JE


  • Td can be given lifelong 

Q. An 18 months old unvaccinated child comes to the PHC for the first time. Vaccines to be given include:

  1. OPV, DPT
  2. Pentavalent vaccine
  3. BCG, OPV
  4. BCG,OPV, MMR, Pentavalent

Tuberculin vs Insulin Syringe

  • Tuberculin syringe has (0.1ml to 1 ml) markings
  • Insulin syringe has units 10 to 100 units 
  • There is no interchangeability between the syringes 

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