Immunisation Schedule
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Direct answer
At birth, every newborn delivered in an Indian facility receives BCG, the zero dose of OPV and the monovalent hepatitis B birth dose, and the National Immunisation Schedule then runs through 6, 10 and 14 weeks (pentavalent, OPV, IPV, rotavirus and pneumococcal vaccines), 9 to 12 completed months (MR-1 with the first vitamin A dose and Japanese encephalitis vaccine in endemic districts) and 16 to 24 months (MR-2 and the DPT booster), with boosters at 5 to 6 years, 10 years and 16 years. Tetanus-diphtheria toxoid for pregnant women completes the picture. FMGE asks the schedule as list questions and as "which vaccine is due now" scenarios.
What you must remember
- Birth dose trio: BCG 0.05 mL intradermally at the left upper arm, OPV-0 and hepatitis B within 24 hours of birth — the hepatitis B birth dose is critical because perinatal transmission causes most chronic infection in babies of e-antigen-positive mothers.
- 6, 10 and 14 weeks: pentavalent (DPT, hepatitis B, Hib), OPV and rotavirus drops; IPV at 6 weeks with a second dose at 14 weeks; pneumococcal conjugate vaccine at 6 and 14 weeks with a booster at 9 months.
- 9 to 12 completed months: MR-1, the first vitamin A dose (100,000 IU), and JE vaccine (live attenuated SA-14-14-2) only in endemic districts.
- 16 to 24 months: MR-2, DPT booster-1 and OPV booster; 5 to 6 years DPT booster-2; then Td at 10 and 16 years.
- Pregnancy: Td-1 early in the second trimester and Td-2 at least 4 weeks later; a previously immunised woman needs only one booster.
- Measles-containing vaccine waits until 9 completed months because passively transferred maternal antibody neutralises the vaccine earlier; vitamin A then continues 200,000 IU every 6 months up to 5 years.
- BCG protects best against childhood disseminated disease — miliary tuberculosis and tuberculous meningitis — not adult pulmonary disease.
- Missed doses are caught up respecting minimum intervals, never restarted; mild fever or antibiotic use is no contraindication.
Reading the immunisation card of a nine-month-old
A mother brings a card showing a BCG scar, birth doses, and three pentavalent, OPV and rotavirus visits completed, the last at 14 weeks. The baby is now 9 months and 5 days old. What is due today? Exactly four things: MR-1, the first vitamin A dose, the pneumococcal booster where PCV is in the state schedule, and JE-1 if the district is JE-endemic. The DPT booster waits until 16 to 24 months. If instead the child arrives at 11 months with only birth doses done, you do not restart: give the due antigens with minimum 4-week intervals, and MR can be given at the visit itself because 9 completed months have passed. This card-reading exercise is the most examined skill in the chapter, and it punishes rote learning — the examiner deliberately makes the child older or the record incomplete.
High-yield viva angles
Examiners ask why India gives both OPV and IPV: OPV induces gut and humoral immunity cheaply but carries a tiny risk of vaccine-associated paralytic poliomyelitis; IPV safely generates antibody with less gut immunity, and the combined schedule is the endgame strategy — India's last wild poliovirus case was 13 January 2011 and certification came on 27 March 2014. A second favourite is the MR switch: since 2017 measles-rubella vaccine replaced standalone measles at 9 months, with a second dose at 16 to 24 months, because congenital rubella syndrome is a significant cause of deafness and cataract in India. Expect one question on BCG technique — 0.05 mL intradermally at the left deltoid insertion, a site and depth that guarantee a proper take and a visible scar that doubles as documentation.
Frequently asked questions
Which vaccines are given at birth under the National Immunisation Schedule?
BCG intradermally at the left deltoid insertion, OPV zero dose and the monovalent hepatitis B birth dose, all within 24 hours of birth for institutional deliveries.
Why is the measles-containing vaccine delayed until 9 completed months?
Transplacentally acquired maternal IgG neutralises the live attenuated vaccine virus in younger infants, so seroconversion is poor before 9 months, when antibody has fallen sufficiently.
What is the vitamin A prophylaxis schedule?
The first dose of 100,000 IU comes with MR-1 at 9 months, followed by 200,000 IU every 6 months up to 5 years; the first 200,000 IU dose comes with MR-2 at 16 to 24 months.
What tetanus toxoid schedule is recommended for a pregnant woman?
Td-1 early in the second trimester and Td-2 four weeks later for an unimmunised woman, with a booster if a third dose fits before delivery; an adequately immunised woman needs a single booster each pregnancy.
What is the dose, route and site of BCG?
0.05 mL (0.1 mL above 1 month of age) intradermally at the upper left arm over the deltoid insertion, producing a pustule and scar within 6 to 8 weeks.
Which vaccine in the Indian schedule is given only in selected districts?
Japanese encephalitis vaccine (SA-14-14-2), given with MR-1 and MR-2 in JE-endemic districts of states such as Uttar Pradesh, Bihar and Assam.