Immunization Schedule

Sayenna Uduman
Sayenna A Uduman MD, FAAP
Visiting Professor, Infection Control Committee & ID Division of the KIMS
Thiruvananthapuram, Kerala, India

First Created: 01/09/2001  Last Updated: 02/15/2016

Combination Vaccines

Combination vaccines are necessary and important for the continuing success of our immunization program, especially when more vaccines are added to the already crowded immunization schedule. However, the multiplicity of competing vaccine products, with various overlapping antigen menu and subtle immunologic differences, may be confusing to the busy practitioner. Combining vaccines that target children immunization may expand immunization opportunities and effectiveness. However, offering new choices may not necessarily translate into simpler solutions at the practical level. The combo’s aspects of immunization schedules are not included in this review.

Immunization Schedule - Introduction

The purpose of this review is to revise and update the evolving immunization schedule at the national and global levels. Good vaccination practices begin shortly after birth. The WHO estimated that immunization currently averts an estimated 2 to 3 million deaths every year apart from societal burden & medical costs. For each birth cohort vaccinated in the United States, approximately 20 million illnesses are prevented, along with 40,000 deaths.

The Advisory Committee on Vaccines and Immunization Practices (ACVIP) of the Indian Academy of Pediatrics (IAP) has recently (2014) updated the immunization schedule for children aged 0 through 18 years. This was based on recent evidence for licensed vaccines that are incorporated into our clinical practices in India (Table 1).

Table 1: Recommendation for IAP Immunization - updated 2014 Schedule

Age Vaccines Comments
Birth dose BCG, OPV-zero, HepB1 these vaccines given to all newborns before hospital discharge
6 weeks DTwP1, IPV1, Hib1, PCV1, HepB2 DTaP combinations should preferably be avoided for the primary series.
10 DTwP2, IPV2, Hib2, PCV2, Rota1 If RV1 is chosen, the first dose should be given at 10 weeks. Only 2 doses of RV1 are recommended at present
14 DTwP3, IPV3, Hib3, PCV3, Rota2 (2nd dose Rotarix –final)
6 months OPV1, HepB3  
9 months OPV2, MMR1 Measles-containing vaccine ideally should not be administered before completing 270 days or 9 months of life. The 2nd dose must follow in 2nd year of life.
9-12 months Conjugated Typhoid vaccine Currently, two typhoid conjugate vaccines, Typbar-TCV and PedaTyph available in Indian market. Should follow a booster at 2 years of age
12 months HepA1 One of the 2 doses of inactivated now or a-single dose for live attenuated H2-strain HepA vaccine now recommended
15 month MMR2, varicella1, PCVb The risk of breakthrough varicella is lower if given 15 months onwards
16 to 18 months DTwP b1 or DTaP b1
IPV b1, Hib b1
DTwP or DTaP booster (4th dose) may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose. Considering a higher reactogenicity of DTwP, consider DTaP for the boosters.
18 months to 2 yrs HepA2, Typhoidb Also suggesting only single dose for live attenuated H2- strain HepA vaccine
4 -6 yrs DTwP b2 or DTaP b2 ; OPV3 Varicella2 and Typhoid b 2nd dose varicella can be given at any time 3 months after the 1st dose
10 -12 years Tdap or Td,
HPV series to begin
Tdap is preferred to Td, followed by every 10 years
HPV: 2 or 3 doses > 9 yrs. & older

One should follow and adhere to the regional health authority & Institutional immunization policy that are principally derived from the Centers for Disease Control and Prevention (CDC &P) and the WHO. The immunization schedules are intermittently revised and updated; these programs are supported by the Global Alliance for Vaccines and Immunization (GAVI) at the global level.

The Advisory Committee on Immunization Practices (ACIP) of the CDC & P, has now updated to reflect the 2016 immunization schedules for the use of vaccines for children and adolescents. The schedules are approved by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AFP), and the American College of Obstetricians and Gynecologists (ACOG). (Table 2)

Table 2: General Recommendation from ACIP/CDC from Newborn to 18 yrs. of age

Vaccines Birth 2 mons 4 mons 6 mons 9 mons 12 mons 15 mons 18 mons 2-3 yrs. 4-6 Yrs. 11-12 Yrs.
HepB 1st 2nd   3rd 3rd 3rd 3rd 3rd      
Rota oral RV1 or Rv5   Rv1 or Rv5 Rv1 or RV5                
DTaP   1st 2nd 3rd     4th 4th   5th Tdap Q 10 yrs.
Hib   1st 2nd     3rd or 4th 3rd or 4th        
Pneumo   1st 2nd 3rd   4th 4th        
Polio: IPV <18 y   1st 2nd   3rd 3rd       4th  
Influenza (IIV)       yearly              
MMR           1st 1st     2nd  
Varicella           1st 1st     2nd  
HepA                 2 dose series    
Meningo(MCV4)                     2 dose
HPV                     3 dose series

Readers are referred to the AAP Web site ( or the CDC & P Web site ( for the most recent version of the immunization schedule, the full set of footnotes, and the catch-up schedule. This method will ensure that readers have the most current recommendations on the clinical and immunogenicity effects of individual vaccines. Further, the WHO and GAVI support the Combination Vaccines (Combo’s), which are now an integral part of vaccination programs.

Acip 2016 Immunization Schedules And Iap Immunization Schedule 2014

The ACIP 2016 immunization schedules for children and adolescents from birth through 18 years of age include several changes from last year, including updated recommendations for the human papillomavirus (HPV) and meningococcal B vaccines. Both the updated schedules (IAP 2014) and the immunization schedules for 2016 (IAP, ACIP) is summarized in the following two tables:

Table 3: Background summary of Licensed HPV vaccines

Recombinant vaccines Bivalent- HPV 2 (Cervarix) GSK Quadrivalent HPV-4 (Gardasil 4) Merck Quadrivalent (HPV-9) Gardasil 9; Merck
Valent types 16 & 18 6, 11, 16 & 18 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Adjuvant ASO4 AAHS  
Licensed Females aged 9-25 years Females & Males aged 9-26 years Females aged 9-26 & Males aged 9-21
Schedules 3 doses: 0-1-6 months 3 doses: 0-2-6 months Can start at age nine. Also for females aged 13 to 26 & for males aged 13 to 21 who have not been vaccinated previously or have not completed the 3-dose series.
Immunogenicity-based neutralizing Ab Minimal protective Ab threshold May lose detectable Ab but no loss of protection Licensed for both males & females; expanded HPV9 age indication of 16-26 years for males.

Other IAP Recommended Vaccines For High-risk* Children (vaccines Under Special Circumstances)

1-Influenza Vaccine, 2-Meningococcal Vaccine. 3-Japanese Encephalitis Vaccine. 4-Cholera Vaccine. 5-Rabies Vaccine. 6-Yellow Fever Vaccine. 7-Pneumococcal Polysaccharide vaccine (PPSV 23)

Highlights from the IAP updated schedule are shown below:

  • Now whole-cell pertussis (wP) vaccines are scheduled for the primary series of infant vaccination.
  • Rotavirus vaccine has been revised to 10 & 14 weeks from existing 6 & 10 weeks of age. Only 2 doses of RV1 (Roderick) are recommended at present. If chosen, 3-dose Rota-teq (RV5) should be completed before 32 weeks of age.
  • New typhoid conjugated vaccine (tetanus toxoid conjugated Vi TT) and new meningococcal conjugate vaccines have been introduced (TT conjugated VI-TT).
  • To use Tdap vaccine during 2nd or 3rd trimester of each pregnancy to protect neonatal tetanus and pertussis during infancy.

1. Jamison DT, Saxenian H. Investing in immunization: conclusions from the 1993 World DevelopmentReport. In: Cutts FT, Smith PG. (eds) Vaccination and World Health. Chichester, UK: Wiley, 1995; 145-60.
2. Global Programme for Vaccines and Immunization ,Expanded Programme on Immunization.Immunization Policy.WHO/EPI/GEN/95.03.REV.1. 1996; Unpublished.
3. Cutts FT. Advances and challenges for the expanded programme on immunization. British Medical Bulletin 1998;54 (No. 2): 445-461.
4. WHO recommendations for routine immunization. Available on URL: Accessed on 27th July 2011.

Immunization Schedule Immunization Schedule 2016-02-15
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