Childhood Immunisation
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Direct answer
At birth an Indian newborn receives BCG, the zero dose of oral polio vaccine and the birth dose of hepatitis B; at 6, 10 and 14 weeks the pentavalent vaccine (DPT, hepatitis B, Hib) with polio vaccines; at 9 to 12 months the first measles-rubella dose with the pneumococcal booster; DPT and MR boosters follow at 16–24 months and 5–6 years, with tetanus-diphtheria at 10 years. Rotavirus and pneumococcal vaccines have joined the Universal Immunisation Programme, and the Indian Academy of Pediatrics adds hepatitis A, varicella, typhoid conjugate, influenza, HPV and MMR to its schedule. Missed doses are caught up — a dropped-out child is never restarted from zero.
What you must remember
- The UIP core: birth — BCG, OPV-0, hepatitis B within 24 hours; 6, 10, 14 weeks — pentavalent and OPV, with IPV at 6 and 14 weeks; 9–12 months — MR-1 and PCV booster; 16–24 months — DTP booster-1, OPV booster, MR-2; 5–6 years — DTP booster-2; 10 years — Td.
- BCG: 0.05 mL intradermally over the left deltoid in neonates (0.1 mL after one month), with a tuberculin syringe; the scar forms in 6–8 weeks, BCG lymphadenitis is the commonest complication, and the vaccine protects mainly against miliary and meningeal tuberculosis.
- Newer UIP additions: rotavirus (oral, 6, 10, 14 weeks in phases), pneumococcal conjugate vaccine, IPV, measles-rubella replacing standalone measles vaccine, and Japanese encephalitis vaccine in endemic districts.
- IAP augments the national schedule: hepatitis A from 9–12 months, varicella, typhoid conjugate, annual influenza from 6 months, MMR-3 at 4–6 years, Tdap at 10 years, and HPV at 9–14 years as a two-dose series.
- Live vaccines (BCG, OPV, MR, varicella, rotavirus) are contraindicated in pregnancy and significant immunocompromise — an immunodeficient child receives IPV instead of OPV; mild illness, low-grade fever, antibiotics and malnutrition are not contraindications.
- Anaphylaxis to a previous dose or component is the only absolute contraindication to that vaccine; adrenaline must be ready at every session.
- Minimum interval between doses of the same vaccine is four weeks; a delayed series is resumed, not restarted, and dropped-out children are the specific target of Mission Indradhanush catch-up rounds.
- Cold chain at 2–8°C and the vial monitor decide vaccine viability — discarding a vaccine whose monitor has reached its endpoint is correct practice, and adverse events are reported through AEFI surveillance.
Working through a dropped-out child
A nine-month-old arrives with only a birth BCG. Catch-up logic: pentavalent dose 1, IPV dose 1, hepatitis B as due, OPV dose 1, PCV dose 1 and — because he has crossed nine completed months — MR dose 1, all in one session at separate sites; rotavirus is past its age window and is abandoned rather than chased. He returns at four-week intervals for doses 2 and 3, then boosters per age eligibility. Nothing restarts; intervals are honoured. The examinable spine is this reconstruction: which vaccines, which sites, what co-administration allows, which vaccines have age ceilings, and what "minimum four weeks" means. The counselling layer: fever and local pain after DTP are expected and paracetamol is acceptable, and the MR fever-rash at day 6–10 is mild and mostly non-contagious.
How the exam frames the confusion
The favourite distractors live in the overlap between the national and IAP schedules — MR versus MMR, IPV-OPV timing, when HPV starts — and the safest answer structure is "per the Universal Immunisation Programme..., while IAP additionally recommends...". The second battery is technique: BCG is intradermal at the left deltoid, OPV and rotavirus are oral, and any vaccine can share a session with BCG. Third, contraindications are over-invoked — refusing vaccination for a mild cold or finished antibiotics is wrong; genuine deferrals are few and usually name anaphylaxis or immunosuppression.
Frequently asked questions
When is the first dose of measles-rubella vaccine given?
At nine completed months (up to twelve in UIP), with the second at 16–24 months; earlier dosing is blunted by maternal antibody.
What is the dose and site of BCG in a neonate?
0.05 mL intradermally over the left deltoid with a tuberculin syringe; a proper intradermal bleb leaves a scar in 6–8 weeks.
Which vaccines are contraindicated in an immunocompromised child?
The live ones — BCG, OPV (replaced by IPV), measles-rubella, varicella and rotavirus — in significant immunodeficiency; killed vaccines may be given, though the response may be weaker.
What happens if a child misses scheduled doses?
The series resumes without restarting, respecting a minimum four-week interval, with dropouts specifically targeted by Mission Indradhanush catch-up rounds.
Which newer vaccines have joined India's UIP?
Rotavirus, pneumococcal conjugate, inactivated polio, measles-rubella, and Japanese encephalitis vaccine in endemic districts.
Can vaccines be given during a mild illness?
Yes — mild fever, upper respiratory infection, antibiotic use or malnutrition does not contraindicate immunisation; anaphylaxis to a prior dose is the true contraindication.