Vaccine Schedule (IAP 2024 & UIP)

IAP ACVIP 2023/2024 Key Updates:
• Typhoid Conjugate Vaccine (TCV): Recommended at 6 to 9 months (single dose 0.5 mL IM). Complete replacement of older Vi-polysaccharide. Booster at 2 years if 1st dose given <9m.
• HPV Vaccine: 2-Dose Schedule (0, 6 months) for both Girls & Boys aged 9–14 years. Recognized WHO SAGE single-dose alternative for public health drives. 3-dose schedule (0, 1–2, 6m) for ≥15 years or immunocompromised.
• MMR at 9 Months: IAP mandates MMR at 9 months over standalone MR.
• Full IM-IPV: 3 primary doses (6w, 10w, 14w) + booster at 16–18 months.

Age	Vaccines & Brands	Dose, Route & Site	Diluent & Expiry	Max Cutoff	Type & Strain	Clinical Guidelines & Precautions
At Birth ≤24 hours	BCG Hepatitis B (Birth Dose) bOPV (Zero Dose)	• BCG: 0.05 mL (<1m) / 0.1 mL (≥1m) ID, Left deltoid • HepB: 0.5 mL (10 µg) IM, Anterolateral thigh • bOPV: 2 drops Oral	• BCG: Normal Saline (0.9% NaCl) Discard in 4h • HepB: Liquid (Never freeze!) • OPV: Liquid (Store at -20°C)	• BCG: 5 Years • HepB Birth: 24 Hours • OPV-0: 15 Days	• BCG: Live attenuated (Danish 1331) • HepB: Recombinant HBsAg subunit • bOPV: Live Sabin Type 1 & 3	• BCG scar develops at 6–12 weeks; contraindicated in SCID & symptomatic HIV. • If mother HBsAg +ve: Administer HBIG (0.5 mL IM) + HepB within 12h at separate anatomic sites. • OPV zero dose does not count towards 3-dose primary series.
6 Weeks	DTwP 1 / DTaP 1 (or Hexavalent 1: DTaP/DTwP + HepB + IPV + Hib) IPV 1 (Full IM Dose) Hepatitis B 1/2 & Hib 1 Rotavirus 1 (RV1 / RV5 / 116E) PCV 1 (PCV13 / PCV14 / PCV15)	• DTP/Hexa/Hib/HepB: 0.5 mL IM, Thigh • IPV: 0.5 mL IM, Thigh • PCV: 0.5 mL IM, Thigh • Rotavirus: Oral (Rotavac 5 drops, Rotasiil 2.5 mL, Rotarix 1.5 mL)	None (Pre-filled liquid / supplied diluents)	• DTP: 7 Years • RV1 1st Dose: Strictly ≤ 14w 6d • PCV: 5 Years	• DTP: Toxoids + Pertussis • IPV: Inactivated Mahoney, MEF-1, Saukett • PCV: CRM197 conjugate • RV: Live attenuated 116E / RV1 / RV5	• IAP recommends full-dose IM-IPV at 6w, 10w, 14w + booster at 16–18m. • DTaP causes fewer febrile seizures / local reactions than DTwP. • Strict Rotavirus Rule: Do not start 1st dose after 14w 6d.
10 Weeks	DTwP 2 / DTaP 2 (or Hexavalent 2) IPV 2 (Full IM) Hib 2 & Hep B Rotavirus 2 PCV 2	• DTP/Hexa/PCV: 0.5 mL IM • Rotavirus: Oral	None	Rotavirus schedule rules apply	Inactivated / Toxoid / Live Oral	• Rotarix (RV1) series is complete after 2 doses (6w & 10w). • Rotavac/Rotasiil/RotaTeq require 3rd dose at 14w.
14 Weeks	DTwP 3 / DTaP 3 (or Hexavalent 3) IPV 3 (Full IM) Hib 3 & Hep B Rotavirus 3 (if 3-dose vaccine) PCV 3	• DTP/Hexa/PCV: 0.5 mL IM • Rotavirus: Oral	None	• RV Final Cutoff: Strictly ≤ 8m 0d	Inactivated / Toxoid / Live Oral	• Absolute Rotavirus Cutoff: Never give rotavirus vaccine beyond 8 months 0 days. • Completes primary 3-dose infant series for DTP, IPV, Hib, HepB, and PCV.
6 Months	Influenza (IIV) Dose 1 Typhoid Conjugate Vaccine (TCV) (Typbar-TCV / Zyvac TCV)	• Flu: 0.5 mL IM, Anterolateral thigh • TCV: 0.5 mL IM, Anterolateral thigh	None (Liquid)	• Flu: Annual • TCV: 18 Years	• Flu: Inactivated Quadrivalent (2A + 2B strains) • TCV: Vi polysaccharide conjugated to Tetanus Toxoid (Vi-TT)	• TCV at 6–9 Months: Single dose provides long-lasting T-cell dependent mucosal & systemic immunity. • If TCV is administered between 6–9 months, IAP recommends a booster at 2 years of age. • Influenza requires 2 doses 4 weeks apart in first year of vaccination (<9y).
7 Months	Influenza (IIV) Dose 2	0.5 mL IM, Anterolateral thigh	None	Annual after 1st year series	Inactivated Quadrivalent	Administered exactly 4 weeks after 1st dose of Influenza. Single annual booster thereafter.
9 Months	MMR 1 (Measles, Mumps, Rubella) TCV (if not given at 6m) Japanese Encephalitis 1 (Live SA 14-14-2) (In endemic regions / travel)	• MMR: 0.5 mL SC, Right deltoid / thigh • TCV: 0.5 mL IM • JE: 0.5 mL SC, Left deltoid	• MMR: Sterile Water Discard in 4h • JE: Supplied diluent Discard in 1h	18 Years	• MMR: Live Attenuated (Edmonston-Zagreb / L-Zagreb / RA 27/3) • JE: Live Attenuated SA 14-14-2	• IAP recommends MMR at 9 months (rather than standalone MR) to ensure early mumps protection. • If MMR is given <9 months during measles outbreak, repeat 2 routine doses at ≥12m.
12 Months	Hepatitis A (Dose 1) Choice of Live vs Inactivated: • Option A (Live H2 strain): Single dose only • Option B (Inactivated): 2-dose series (12m & 18m) JE Dose 2 (if using inactivated JE)	• Live HepA: 0.5 mL SC • Inactivated HepA: 0.5 mL IM • Inactivated JE: 0.5 mL IM	None	18 Years	• Live HepA: H2 strain • Inactivated HepA: HM175 / CR326F antigen	• Live Attenuated Hep A (Biovac-A): Requires only 1 single lifetime dose. • Inactivated Hep A (Havrix / Avaxim): Requires 2nd dose 6 months after 1st dose.
15 Months	MMR 2 Varicella 1 (Chickenpox) PCV Booster (Pneumococcal Booster)	• MMR: 0.5 mL SC, Upper arm • Varicella: 0.5 mL SC, Upper arm • PCV Booster: 0.5 mL IM, Thigh/Arm	• Varicella: Supplied diluent 🚨 CRITICAL: Use within 30 minutes of reconstitution!	18 Years	• Varicella: Live Attenuated (Oka / Varilrix / Variped strain) • MMR: Live Attenuated • PCV: Conjugate	• Varicella 30-Minute Shelf-Life: Extremely heat labile; reconstitute only when patient is ready. • Avoid salicylates (aspirin) for 6 weeks after varicella vaccination (Reye's syndrome risk).
16–18 Months	DTwP Booster 1 / DTaP Booster 1 IPV Booster 1 Hib Booster Hepatitis A Dose 2 (if Inactivated HepA used)	• DTP/IPV/Hib: 0.5 mL IM, Anterolateral thigh / deltoid • HepA: 0.5 mL IM	None	7 Years for DPT	Toxoids + Inactivated	• First major toddler booster. • Can be given as standalone vaccines or combined Pentavalent/Hexavalent booster formulation.
18–24 Months	Varicella Dose 2 (Can be given at 18–24m or by 4–6y; min interval 3 months) Typhoid Booster (if indicated)	• Varicella: 0.5 mL SC • TCV: 0.5 mL IM	Supplied diluent (30 min)	18 Years	Live Attenuated Oka	2 doses of Varicella provide >98% protection against chickenpox and prevent breakthrough varicella.
2–3 Years	Annual Influenza Vaccine PPSV23 (High Risk Only) Cholera Vaccine (Endemic / Outbreak)	• Flu: 0.5 mL IM • PPSV23: 0.5 mL IM/SC • Cholera: 1.5 mL Oral (2 doses 2w apart)	None	High-risk indications	Inactivated / Polysaccharide	• PPSV23 (Pneumovax 23): Indicated at ≥2y for asplenia, sickle cell disease, nephrotic syndrome, CSF leaks, cochlear implants (≥8w after last PCV).
4–6 Years	DTwP Booster 2 / DTaP Booster 2 MMR 3 Varicella 2 (if not given at 18–24m) bOPV / IPV Standby Annual Influenza	• DTP: 0.5 mL IM, Deltoid • MMR: 0.5 mL SC • Varicella: 0.5 mL SC	Supplied diluents	Strictly < 7 Years for DPT	Toxoids + Live Attenuated	• Pre-school booster visit. • Final dose of pediatric DTwP/DTaP. Any booster given at ≥7 years must use adult-type Tdap or Td.
9–14 Years	HPV Vaccine (Human Papillomavirus) (Cervavac 4v / Gardasil 4 / Gardasil 9) Tdap / Td Booster (10–12 Years) Annual Influenza	• HPV: 0.5 mL IM, Deltoid • Tdap: 0.5 mL IM, Deltoid	None	26y (Girls/Boys) / 45y (Females)	• HPV: Recombinant VLP (Types 6, 11, 16, 18, 31, 33, 45, 52, 58) • Tdap: Toxoid + Acellular Pertussis	• HPV 2-Dose Schedule: 0 and 6 months (6–12m interval) for girls AND boys aged 9–14y. • Single-Dose Alternative: WHO SAGE endorses 1-dose schedule as an alternative for national public health coverage. • IAP recommends Tdap at 10–12y to sustain pertussis immunity. • Keep patient seated for 15 min after HPV to prevent vasovagal syncope.
15–18 Years	HPV (3-Dose Schedule if starting ≥15y) Td Booster (every 10 years)	0.5 mL IM, Deltoid	None	Adult routine	Recombinant / Toxoid	• If HPV is initiated at ≥15 years or in immunocompromised: 3-dose schedule (0, 1–2, 6 months) is mandatory. • Td booster repeated every 10 years throughout adulthood.

Recent Universal Immunization Programme (UIP) Expansions:
• Typhoid Conjugate Vaccine (TCV) in UIP: Recommended by NTAGI for phased national inclusion at 9–12 months (single dose 0.5 mL IM). Already successfully piloted in municipal corporation areas (Navi Mumbai, etc.).
• National HPV Immunization Campaign: Government of India nationwide rollout targeting adolescent girls aged 9 to 14 years (starting with 14-year-old cohort) using quadrivalent HPV vaccine.
• fIPV 3rd Dose: Intradermal fractional IPV-3 (0.1 mL ID) universalized at 9 months alongside MR-1.
• PCV 2+1 Schedule: Universalized nationwide at 6 weeks, 14 weeks, and 9 months booster.

Age Timing	Vaccines (UIP)	Dose	Route & Site	Max Upper Age Limit	Operational Notes & Updates
At Birth	BCG Hepatitis B (Birth dose) bOPV (Zero dose)	0.05 mL (<1m) / 0.1 mL 0.5 mL 2 drops	Intradermal, Left upper arm Intramuscular, Anterolateral mid-thigh Oral	1 Year (BCG) 24 Hours (HepB) 15 Days (bOPV)	HepB birth dose prevents perinatal vertical transmission. BCG scar is mandatory check at 6–12w.
6 Weeks	Pentavalent 1 (DTwP+HepB+Hib) bOPV 1 Rotavirus 1 (RVV) fIPV 1 (fractional IPV) PCV 1	0.5 mL 2 drops 5 drops (Rotavac) / 2.5 mL 0.1 mL 0.5 mL	IM, Anterolateral mid-thigh (Left) Oral Oral Intradermal (ID), Right upper arm IM, Anterolateral mid-thigh (Right)	1 Year (Penta) 1 Year (Rotavirus) 1 Year (fIPV/PCV)	Separate injection sites by ≥2.5 cm. fIPV is given intradermally (0.1 mL) on right upper deltoid.
10 Weeks	Pentavalent 2 bOPV 2 Rotavirus 2	0.5 mL 2 drops 5 drops / 2.5 mL	IM, Anterolateral mid-thigh (Left) Oral Oral	1 Year	fIPV and PCV are NOT scheduled at 10 weeks under UIP.
14 Weeks	Pentavalent 3 bOPV 3 Rotavirus 3 fIPV 2 PCV 2	0.5 mL 2 drops 5 drops / 2.5 mL 0.1 mL 0.5 mL	IM, Anterolateral mid-thigh (Left) Oral Oral Intradermal (ID), Right upper arm IM, Anterolateral mid-thigh (Right)	1 Year	Completes primary infant pentavalent and rotavirus series.
9–12 Months	MR 1 (Measles-Rubella) fIPV 3 (3rd fractional dose) PCV Booster JE 1 (in 231 endemic districts) Typhoid (TCV) NTAGI Phased Rollout Vitamin A (1st Dose)	0.5 mL 0.1 mL 0.5 mL 0.5 mL 0.5 mL 1 mL (100,000 IU)	Subcutaneous (SC), Right upper arm Intradermal (ID), Right upper arm IM, Anterolateral mid-thigh (Right) SC, Left upper arm IM, Anterolateral mid-thigh Oral	5 Years (MR/fIPV/PCV/TCV)	• TCV in UIP: NTAGI approved for phased introduction at 9–12m co-administered with MR-1. • fIPV-3 was added at 9m to close immunity gaps against Type 2 poliovirus.
16–24 Months	DPT Booster 1 MR 2 bOPV Booster JE 2 (in endemic districts) Vitamin A (2nd Dose)	0.5 mL 0.5 mL 2 drops 0.5 mL 2 mL (200,000 IU)	IM, Anterolateral mid-thigh SC, Right upper arm Oral SC, Left upper arm Oral	7 Years (DPT)	Subsequent Vitamin A doses (200,000 IU) administered every 6 months up to 5 years of age (total 9 doses).
5–6 Years	DPT Booster 2	0.5 mL	IM, Left upper arm	Strictly < 7 Years	Do not give pediatric DPT at ≥7 years; switch to Td.
9–14 Years	HPV Vaccine (National Campaign)	0.5 mL	IM, Deltoid	14 Years (Target cohort)	National campaign for adolescent girls to prevent cervical cancer (quadrivalent vaccine).
10 Years	Td (Tetanus & adult Diphtheria)	0.5 mL	IM, Upper arm	Adolescents	Replaced TT in national schedule to prevent adult diphtheria outbreaks.
16 Years	Td	0.5 mL	IM, Upper arm	Adolescents	Routine school-leaving tetanus-diphtheria booster.
Pregnant Women	Td 1 & Td 2 (or Td Booster)	0.5 mL	IM, Upper arm	Pregnancy	Td-1 early in pregnancy, Td-2 4 weeks later. If received 2 Td doses in last 3y pregnancy, only 1 Td booster needed.

Feature / Vaccine	Universal Immunization Programme (UIP)	IAP ACVIP Recommendations (2024)	Clinical Rationale & Recent Updates
Typhoid (TCV)	NTAGI approved for phased introduction at 9–12 months (piloted in municipal areas)	TCV at 6 to 9 months (Single dose 0.5 mL IM; booster at 2y if given <9m)	TCV triggers T-dependent memory, mucosal immunity, and prevents multi-drug resistant (MDR) Salmonella Typhi.
HPV (Cervical Cancer)	National Campaign Rollout for 9–14y Girls (using quadrivalent HPV vaccine)	2 Doses (0, 6m) for 9–14y Girls & Boys (WHO SAGE 1-dose alternative recognized)	Prevents high-risk oncogenic HPV 16/18 (responsible for >70% of cervical cancers) and low-risk HPV 6/11 (genital warts).
Polio Schedule	bOPV (0, 6w, 10w, 14w, 16–24m) + fractional IPV (fIPV 0.1 mL ID at 6w, 14w, 9m)	Full-dose IM-IPV (0.5 mL IM at 6w, 10w, 14w + booster at 16–18m)	IM-IPV eliminates risk of Vaccine-Associated Paralytic Poliomyelitis (VAPP) and Vaccine-Derived Polioviruses (VDPV).
Pertussis Antigen	DTwP (Whole-cell pertussis in Pentavalent & DPT boosters)	DTwP or DTaP (Acellular pertussis in Hexavalent/standalone)	DTaP provides significantly fewer febrile reactions and local arm swelling. DTwP confers longer immunological memory.
Measles / Mumps / Rubella	MR vaccine at 9 months and 16–24 months (No Mumps component)	MMR vaccine at 9 months, 15 months, and 4–6 years	Mumps outbreaks frequently occur in school children; IAP mandates 3 doses of MMR for comprehensive parotitis/orchitis prevention.
Pneumococcal (PCV)	PCV (2+1 schedule: 6w, 14w, and 9m booster)	PCV13 / PCV14 / PCV15 (3+1 schedule: 6w, 10w, 14w, and 12–15m booster)	3-dose primary provides earlier antibody protection in young infants against invasive pneumococcal disease (IPD).
Hepatitis A	Not included in routine UIP	Live HepA (1 dose at 12m) OR Inactivated HepA (2 doses at 12m & 18m)	Prevents acute viral hepatitis and fulminant hepatic failure in children.
Varicella (Chickenpox)	Not included in UIP	2 Doses: Dose 1 at 15 months, Dose 2 at 18–24 months (or 4–6y)	2 doses provide >98% protection against varicella and prevent secondary bacterial skin infections / necrotizing fasciitis.
Influenza (Flu)	Not included in UIP	Annual Quadrivalent Influenza (IIV): 2 doses 4w apart at 6m & 7m, then annually	Reduces severe viral pneumonia, croup, and hospitalizations during peak influenza seasons.

🐕 Rabies Prophylaxis (PEP & PrEP) 100% Fatal

• Pre-Exposure (PrEP): 2 doses on Day 0 and Day 7 (0.5 mL IM or 0.1 mL ID).
• Post-Exposure (PEP - Unvaccinated):
  1. Intramuscular (Essen 4-Dose / 5-Dose): Day 0, 3, 7, 14 (and 28).
  2. Intradermal (Updated Thai Red Cross 2-site): 0.1 mL at 2 sites (deltoids) on Day 0, 3, 7, 28.
• Rabies Immunoglobulin (RIG) in Category III bites:
  - Human RIG (HRIG): 20 IU/kg infiltrated into wound.
  - Equine RIG (eRIG): 40 IU/kg infiltrated into wound.

🧠 Meningococcal (MenACWY / MenB) High-Risk / Travel

• Indications: Anatomical/functional asplenia, persistent complement deficiencies (C3, C5-C9), eculizumab therapy, travelers to Hajj/Meningitis belt.
• Quadrivalent Conjugate (MenACWY - Menactra / MenQuadfi / Nimenrix):
- Infants 9–23m: 2 doses 3 months apart.
- Age ≥2y: Single dose; booster every 5 years if ongoing risk.

🫁 PPSV23 (Pneumovax 23) High-Risk ≥2 Years

• Indications: Sickle cell disease, asplenia, HIV, chronic renal failure, nephrotic syndrome, immunosuppression, cochlear implants, CSF leak.
• Dosing: 0.5 mL IM/SC at ≥ 2 years of age, administered ≥ 8 weeks after the last dose of PCV13/15.
• Booster: Single booster dose 5 years later for asplenic/immunocompromised children.

💧 Oral Cholera Vaccine (OCV) Endemic / Outbreaks

• Vaccines: Shanchol / Euvichol-Plus (Killed whole-cell V. cholerae O1 & O139).
• Dose: 1.5 mL oral suspension for individuals ≥ 1 year of age.
• Schedule: 2 doses spaced 2 weeks apart.
• Conveys protective immunity for up to 3–5 years.

🦟 Japanese Encephalitis (JE) Live / Inactivated

• Live Attenuated (SA 14-14-2): 0.5 mL SC; Dose 1 at 9 months, Dose 2 at 16–24 months.
• Inactivated Vero Cell (JENVAC / JEEV):
- JENVAC (1–3y: 0.25 mL IM, >3y: 0.5 mL IM): 2 doses 4 weeks apart + booster at 1 year.
- Highly recommended for endemic regions (UP, Bihar, Assam, WB, Karnataka, Tamil Nadu).

🌍 Yellow Fever Vaccine (17D Strain) Travel Requirement

• Indication: Travel to endemic yellow fever zones (Sub-Saharan Africa, South America).
• Dose: 0.5 mL SC at ≥ 9 months of age, at least 10 days prior to travel.
• Validity: Single lifetime dose provides lifelong immunity (International Certificate of Vaccination).

Core IAP Catch-Up Principles:

Never restart a delayed vaccine series regardless of the elapsed interval; simply resume and give remaining doses.
Simultaneous Live Vaccines: Live parenteral vaccines (MMR, Varicella, Yellow Fever) must be given on the same day at separate anatomical sites OR separated by at least 4 weeks (28 days).
Multiple Injections: Multiple IM injections should be spaced ≥1 inch (2.5 cm) apart.

Vaccine	Minimum Age for Dose 1	Minimum Interval (Dose 1 to 2)	Minimum Interval (Dose 2 to 3)	Booster Catch-Up Rules	Upper Cutoff Age
BCG	Birth	—	—	No booster needed	5 Years (IAP) / 1y (UIP)
Hepatitis B	Birth	4 Weeks	8 Weeks (and ≥16w after Dose 1, ≥24w age)	Total 3 doses complete series	18 Years / Adulthood
DTwP / DTaP	6 Weeks	4 Weeks	4 Weeks	Booster 1: 6 months after Dose 3. Booster 2: 3 years after Booster 1 (4–6y).	Strictly < 7 Years (Use Tdap/Td if ≥7y)
IPV (Polio)	6 Weeks	4 Weeks	4 Weeks	Booster: 6 months after Dose 3 (16–18m).	18 Years
Hib	6 Weeks	4 Weeks	4 Weeks (if started <12m)	If started at 12–14m: 1 dose + booster 8w later. If started ≥15m: 1 single dose.	5 Years (Healthy children)
Rotavirus	6 Weeks	4 Weeks	4 Weeks	Do NOT start if >14w 6d. Do NOT give any dose if >8m 0d.	Strictly 8 Months 0 Days
PCV Conjugate	6 Weeks	4 Weeks	4 Weeks (if <12m)	If started 7–11m: 2 doses 4w apart + booster at 12–15m. If started 12–23m: 2 doses 8w apart. If ≥24m: 1 single dose.	5 Years (Healthy children)
MMR	9 Months (IAP)	4 Weeks	4 Weeks (or at 4–6 Years)	Total 2–3 doses; catch-up children require 2 doses spaced 4 weeks apart.	18 Years / Adulthood
Varicella	12 Months	3 Months (if <13y) / 4 Weeks (if ≥13y)	—	Total 2 doses complete series.	18 Years / Adulthood
Hepatitis A	12 Months	6 Months (Inactivated HepA)	—	Live HepA: 1 single dose. Inactivated HepA: 2 doses 6m apart.	18 Years / Adulthood
Typhoid (TCV)	6 Months	—	—	Single dose provides long-term immunity; booster at 2y if 1st dose given <9m.	18 Years / Adulthood
HPV	9 Years	6 Months (if 9–14y) / 1–2 Months (if ≥15y)	6 Months after Dose 1 (if ≥15y)	Age 9–14y: 2 doses (0, 6m) OR WHO 1-dose schedule. Age ≥15y: 3 doses (0, 1–2m, 6m).	26 Years (Girls/Boys)
Tdap / Td	7 Years	4 Weeks (Td-2)	6 Months (Td-3)	Give Tdap for 1st catch-up dose at ≥7y, followed by Td-2 at 4w and Td-3 at 6m. Repeat Td q10y.	Lifelong

Pediatric Vaccine Schedule (IAP 2024 & UIP)