Immunization Schedule

Monica Madvariya
Immunization Schedule - Patient Education
What schedule should be followed for vaccinating my child?
Schedules for immunization varies in different countries based on the prevalence of various infections in their area. The ACIP/CDC for USA is depicted in table 1.

Table 1: 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              
Rota oral RV1 or Rv5   Rv1 or Rv5 Rv1 or RV5                
DTaP   1st 2nd 3rd       4th   5th Tdap Q 10 yrs.
Hib   1st 2nd     3rd 4th        
Pneumo   1st 2nd 3rd     4th        
Polio: IPV <18y   1st 2nd     3rd       4th  
Influenza (IIV)       yearly              
MMR           1st       2nd  
Varicella           1st       2nd  
HepA                 2 dose series    
HepA                     2 dose
HPV                     3 dose series

The Government of India has recommended the National immunization schedule, which is followed in all government hospitals and clinics. It provides vaccination against 8 diseases free of cost to all children who visit government facilities.

Age Vaccines recommended
Birth BCG, OPV, Hep B
6 weeks DPT, HiB, HepB, OPV
10 weeks DPT, HiB, HepB, OPV
14 weeks DPT, HiB, HepB, OPV
9- 12 months Measles 1st
16-24 months Measles 2nd, OPV , DPT booster
5-6 years DPT booster
10 years TT
16 years TT

BCG- against tuberculosis
OPV- Oral Polio Vaccine
Hep B- Hepatitis B
HiB- H. influenze B
DPT- Diphtheria, Pertussis, Tetanus
TT- Tetanus Toxoid

However, there are additional vaccines in the market, which prevent against important disease, including viral diarrhea and pneumonia, which ideally should be given to children. These are included in the Indian Academy of Pediatrics (IAP) schedule:

Age Vaccines recommended
Birth BCG, OPV, Hep B
6 weeks DPT, HiB, HepB, IPV
Rotavirus, PCV
10 weeks DPT, HiB, IPV
Rotavirus, PCV
14 weeks DPT, HiB, IPV
Rotavirus, PCV
6 months OPV, Hep B
9 months OPV, MMR
9-12 months Typhoid conjugate vaccine
12 months Hepatitis A
15 months MMR, Chicken pox, PCV booster
16-18 months DPT, IPV, HiB
18 months Hep A
2 years Typhoid booster
4-6 years DPT booster, Chicken pox, OPV , Typhoid booster
10-12 years Td/ Tdap

IPV- Injectable (killed) Polio Vaccine
PCV- Pneumococcal conjugate vaccine
MMR- Measles, Mumps, Rubella
Hep A- Hepatitis A
Td- Typhoid, diphtheria
Tdap- Typhoid, diphtheria, acellular pertussis

Are there additional vaccines needed in special situations apart from the routine vaccines?
There are certain situations called High-risk situations which place a child or a person at greater risk for contracting serious infections than the general population. Hence, these children need additional vaccinations to protect them from these diseases.
These conditions include:
1. Congenital or acquired defects in immune system (including HIV infection, cancers)
2. Chronic heart, lung (including asthma if treated with prolonged high-dose oral corticosteroids), blood, kidney(including nephrotic syndrome) and liver disease;
3. Children on long term steroids, salicylates, immunosuppressive or radiation therapy;
4. Diabetes, Cochlear implant,
5. During disease outbreaks
6. Laboratory personnel and healthcare workers
7. Travelers
8. Children having pets in home;
9. Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor.

The vaccines include:
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)

How should vaccination be given in preterm babies?
Since vaccines given at birth are BCG, OPV and Hepatitis B. Studies show that response to Hepatitis B Vaccine may be diminished in infants with birthweight less than 2000 grams after administration of Hepatitis B Vaccine at birth. However, by 1 month of chronologic age, all preterm infants, regardless of initial birthweight or gestational age, are as likely to respond as adequately as do older and larger infants. Thus BCG, OPV and Hepatitis B should be given in preterm infants weighing < 2000 grams and born to HBsAg-negative mothers at 1 month of postnatal age if medically stable or at hospital discharge.

Immunization Schedule Immunization Schedule 02/19/2016
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