All about National Immunization & Schedule Delayed Immunization

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

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

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

Routes of vaccines 

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 

PSM Related Articles:

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

Note

• 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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