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

At birth	BCG, 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 months	MR2, JE2, OPV booster, DPT 1st booster
5-6 years	DPT 2nd booster
10 years	Td1
16 years	Td2

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? 9  What is the total dose of Vit A given? 17 L IU

Routes of vaccines 

ORAL	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

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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