National Immunization Schedule (NIS), 2023

Age Vaccine
Birth BCG, OPV-0, Hepatitis B birth dose

1.5 Months (or 6 weeks) bOPV-1, Rota-1, fIPV-1, Pentavalent-1, & PCV-1

2.5 Months (or 10 weeks) bOPV-2, Rota-2, Pentavalent-2

3.5 Months (or 14 weeks) bOPV-3, Rota-3, fIPV-2, Pentavalent-3 & PCV-2

9 Months MR-1, JE1, PCV booster, fIPV-3, Vit A oil 1 mL

16–24 months MR-2, JE-2, DPT booster 1, bOPV booster, Vit A oil
2 mL

2 Yr, 2.5 Yr, 3Yr, Vitamin A oil 2 mL

3.5 Yr, 4 Yr, 4.5 Yr, 5 Yr
5–6 years DPT booster 2

HPV Vaccine:
9-14 Year Girls
Cervavac or Gardasil-4 for Types 6,11,16,18 or
[June 2023 Onwards] Gardasil-9 for Types 6, 11, 16, 18, 31, 33, 45, 52,
58
10 years Td

16 years Td

Pregnant mother Td 1, 2 or Td-booster**

**One dose if previously vaccinated within 3 years

Few desirable vaccines not currently available through the national schedule include:

1. Hepatitis A vaccine - high-risk selected infants, 18 months, and 6 months later

2. Influenza vaccine - 6 months of age to high risk selected infants annually
3. Varicella vaccine (Chicken Pox or VZV) - 15 months (or after 1 year)
4. Meningococcal conjugate vaccine (MenACWY) – 2 doses b/w 9-23 months

Vaccine Dose Route Diluent Site

0.1 mL (0.05
BCG mL if <1 ID Normal Saline Left Upper Arm
month)
Upper Arm or
DPT 0.5 mL IM No Antero-lateral side of
mid-thigh
 Antero-lateral side of
Hep B 0.5 mL IM No
mid-thigh
fIPV 0.1 mL ID No Right Upper Arm
Phosphate Buffer
JE 0.5 mL SC Left Upper Arm
Solution
MR 0.5 mL SC Sterile Water Right Upper Arm
OPV 2 drops Oral No Oral
Antero-lateral side of
PCV-13 0.5 mL IM No
mid-thigh
(DPT-HepB liquid) is
Antero-lateral side of
Pentavalent 0.5 mL IM diluent for the freeze-
mid-thigh
dried Hib
RotaVV 5 drops Oral Citrate Bicarbonate Buffer Oral
Vitamin A 1 mL or 2 mL Oral No Oral

BCG: Bacillus Calmette-Guerin; DPT: Diphtheria-Pertussis-Tetanus; Hep B: Hepatitis B;

Pentavalent vaccine: DPT+ HepB + Hib (Haemophilus influenza type b); JE: Japanese
encephalitis: MR: Measles–Rubella; OPV: Oral Polio Vaccine; TT: Tetanus Toxoid; IPV:
Inactivated Poliovirus Vaccine; fIPV: Fractional Inactivated Polio Vaccine; RVV:
Rotavirus Vaccine, Td: tetanus, reduced dose diphtheria
VACCINE MAX ALLOWED AGE
BCG 1 Year
OPV-0 15 days
Hep B Birth dose 24 hours
OPV 1/2/3 5 years
Rota 1 year
Pentavalent 1 year
Hep B 1 year
Hib 1 year
IPV 1 year
PCV 1 year
Vitamin A 5 years
MR/ Measles 5 years
DPT Booster 7 years
JE 15 years
TT 16 years
BCG (Bacille Calmette Guerin)
Type: Live attenuated
Freeze dried (lyophilized) type [more stable]
Liquid (fresh) type [less stable]
Diluent: Normal saline, use within 1 hr of reconstitution
Strain: DANISH 1331 strain of M. bovis
Phenomena after vaccination:
After 2-3 wks Papule formation
5 wks 4-8 mm diameter of Papule
6-8 wks Shallow ulcer
6-12 wks Permanent tiny round scar
8-14 wks Mantoux test becomes positive
Protective efficacy: 0% for pulmonary TB,
0-80% (~50%) for severe forms of TB,
20-40% for leprosy
Protective duration: 20 Years
Complications: Prolonged severe ulceration at site of vaccination, Suppurative
lymphadenitis, osteomyelitis, Disseminated BCG infection, Death.

OPV (Oral Polio Vaccine/ Sabin) & IPV (Inactivated Polio Vaccine/ Salk)

OPV IPV
 OPV IPV
Type Live attenuated Killed formolised
Route Oral IM/SC
Type of Humoral (Serum IgM, IgG, IgA) Humoral (Serum IgM, IgG, IgA)
immunity +
Intestinal (Local) (Nasal &
Duodenal IgA)
Prevention of Paralysis Paralysis
+
Intestinal re-infection
Control of Effective Not useful
epidemics
Manufacture Easy Difficult
Cost Cheaper Expensive
Storage & Sub-zero temperatures Less stringent conditions
Transport
Shelf life Short Longer
VAPP 1/1 million Zero incidence
Composition For tOPV → Poliovirus type 1 (20 D antigen
Poliovirus type 1 (3 lac TCID units)
50) +
+ Poliovirus type 2 (2 D antigen
Poliovirus type 2 (1 lac TCID units)
50) +
+ Poliovirus type 3 (4 D antigen
Poliovirus type 3 (3 lac TCID units)
50)
For Improved IPV →
For bOPV → Poliovirus type 1 (40 D antigen
Poliovirus type 1 (3 lac TCID units)
50) +
+ Poliovirus type 2 (8 D antigen
Poliovirus type 3 (3 lac TCID units)
50) +
Poliovirus type 3 (32 D antigen
units)
Advantages Produce herd immunity Safe in immunodeficient

IPV f-IPV (Fractional Dose IPV)

Dose 0.5 ml 0.1 ml x 3 = 0.3 mL (40% Savings)
Route IM ID (Less Painful)
Site Thigh Upper arm
Immunogenicity ++ [Only 1 Inj.] ++++ [3 Inj. at Intervals]
HepB
(HEPATITIS B
VACCINE)
Type: Genetically
engineered
recombinant subunit
vaccine based on
HBsAg
Protective efficacy: 95%

PENTAVALENT VACCINE
GOI has introduced pentavalent vaccine in NIS as liquid
formulation, provides protection to a child from 5 life-
threatening diseases: Diphtheria, Pertussis, Tetanus,
Hepatitis B, Hemophilus influenza B.

ROTAVIRUS VACCINE
Rotavax Monovalent vaccine, given under NIS
Rotarix Monovalent, Live attenuated oral vaccine
RotaTeq Pentavalent bovine-human reassortant strain,
Live attenuated oral vaccine,

Potential Complication: Intussusception

(when first dose given after 12 weeks age).

Rotavirus vaccine diluent

(Citrate Bicarbonate Buffer)
PNEUMOCOCCAL CONJUGATE VACCINE
PPSV 23 PCV 13
Name 23 valent Pneumococcal
pneumococcal conjugate vaccine
polysaccharide
vaccine
Serotypes 23 13
Coverage 70-80% invasive 30-40% invasive strains
strains in adult in adult, most infective
strains in children
Immunogenic Less, not effective More, effective for
in children <2 yrs children <2 yrs
Duration 3-5 years Longer duration
Herd Promote Don’t promote
immunity
Effect on No effect as no Effective in
carriers mucosal immunity nasopharyngeal carrier
as provide mucosal
immunity
Indication Adult >65 years Same as PPSV
Adult 19-64 yrs with Also, in children
underlying risk
factor
Brand name Pneumovax 23 Prevnar 13
MEASLES RUBELLA (MR) VACCINE
Measles vaccine:
Type: Live attenuated, lyophilized (freeze dried)
Strains used: Edmonston Zagreb stain (Most common),
Schwartz stain, Moraten stain
Diluent: Distilled/ Sterile water (use within 4 hours)
C/I: Pregnancy
Efficacy: >85% (with one dose)
Duration of protection: Life long
IP of vaccine induced measles: 7 days
Ideal gap between 2 successive doses: 6 months
MR Vaccination campaign: Dose administered to all the
children 9 months- 15 years of age, irrespective of any
past history of disease/ vaccination (both sexes).
In epidemic situation, MR vaccine can be given in minimum age of 6 months.
Before this, child is believed to be protected from measles due to maternal antibodies.
VITAMIN A

VITAMIN A Spoon

Classification of Xerophthalmia:
Primary sign Secondary sign
X1A Conjunctival xerosis [First clinical sign: XN Night blindness [First clinical
like sand banks at receding tide] symptom]
X1B Bitot spot XF Xerophthalmic fundus
X2 Corneal xerosis XS Xerophthalmic scarring
X3A Corneal ulceration
X3B Keratomalacia

Extraocular manifestations of Vitamin A deficiency: Follicular hyperkeratosis, anorexia,

growth retardation

Prevention:
Individual Dose (IU) Timing
Child <12 months age 1 lac Once every 4-6 months
Child >12 months age 2 lac Once every 4-6 months
Newborn 50k At birth
Women 15-49 years 3 lac Within 1 month of delivery
Pregnancy & lactation 5000 Every day
Or
20k Once every week
DPT VACCINE
Type: Combined triple vaccination
Composition: Diphtheria toxoid, Tetanus toxoid, Pertussis killed
acellular bacilli, Aluminium phosphate, Thiomersal
Absolute C/I: Severe hypersensitivity reaction to previous dose
Progressive neurological disease (e.g., Active epilepsy)
If frozen, discard the vaccine.
Adult type diphtheria- tetanus vaccine (dT): 2 Lf diphtheroid toxoid,
given 2 doses 4-6 weeks apart, followed by a booster after 6-12 months,
is useful in >12 years of age & adults.

JE VACCINE

Diluent: Phosphate buffer solution (use within 2 hours)

Vaccine Strain
Mouse brain derived, purified & Nakayama + Beijing
inactivated
Cell culture derived, inactivated Beijing P3
Cell culture derived, Live attenuated SA 14-14-2
(used under NIS)
FEW EXTRA-VACCINES
HEP A
Type: Inactivated
hepatitis A virus
Composition: HAV
Antigen (HM 175 strain)
Route: IM, typically into
the upper arm
Schedule: 2 doses, 6 months apart
Dose: 0.5 mL
Effectiveness:
• Over 95% of people developing protective Abs after 2 doses
• Protection lasts for at least 20 years, and possibly lifelong

HPV
Type: Inactivated HPV particles.
Composition:
Gardasil 9: Protects against 9 HPV
types (6, 11, 16, 18, 31, 33, 45, 52, 58).
Cervavac / Gardasil 4: Protects
against 4 HPV types (16, 18, 6, 11).
Cervarix: Protects against 2 HPV
types (16, 18).
Route: IM, into the upper arm.
Schedule:
• Ages 9-14 years: 2 doses, 6-
12 months apart.
• Ages 15-26 years: 3 doses, at 0, 1-2, and 6 months.
• Catch-up vaccination available up to age 45.
• Boosters not routinely recommended.
Dose: 0.5 mL
Effectiveness: Highly effective, preventing cancer:
• 93% ↓ in cervical cancer.
• 88% ↓ in vaginal and vulvar cancers.
• 90% ↓ in anal cancer.
• 78% ↓ in H&N cancers.
Protection: Long-lasting, potentially
lifelong for cervical cancer prevention.
CHICKENPOX [1° infection with VZV]
Type: Live, attenuated varicella-zoster virus (VZV) vaccine.
Composition:
• Oka/Merck strain of VZV.
Route: SC injection, typically into the upper arm.
Schedule:
• Children: 2 doses
First dose at 12-15 months old
Second dose at 4-6 years old.
• Adults without immunity:
2 doses, 4-8 weeks apart.
Dose: 0.5 mL.
Effectiveness:
Highly effective:
• 98% prevention of any varicella (chickenpox), 100% prevention of severe varicella.
Protection against shingles (herpes zoster) is moderate:
• 51% ↓ in shingles incidence, 67% ↓ in postherpetic neuralgia (PHN).
Protection:
• Long-lasting, possibly lifelong for chickenpox prevention.
• Shingles protection may wane over time, booster recommended for adults 60+.

HERPES ZOSTER (SHINGLES) [2° re-activation of VZV]

Types:
• Shingrix (RZV): Non-live,
subunit vaccine with gE
antigen of varicella-
zoster virus (VZV).
• Zostavax: Live vaccine,
now discontinued
Composition:
• Shingrix: gE antigen, adjuvants, other excipients.
Route: IM Injection, typically in the upper arm.
Schedule: 2 doses, 2-6 months apart, recommended for adults 50 years and older,
regardless of prior shingles/chickenpox history.
Dose: 0.5 mL
Effectiveness (Shingrix):
• 90% reduction in shingles incidence.
• 97% reduction in postherpetic neuralgia (PHN).
Protection (Shingrix):
Long-lasting, may need booster in the future.
INFLUENZA
Type:

• Inactivated influenza virus vaccine (IIV): Contains killed influenza viruses.

• Recombinant influenza virus vaccine (RIV): Uses recombinant technology to
produce viral proteins, without using the whole virus.
• Live attenuated influenza virus vaccine (LAIV): Contains weakened live influenza
viruses sprayed into the nose. (Not available in all countries due to safety
concerns.)
Composition:
• Varies depending on the specific flu season and vaccine type. Generally includes:
o Surface proteins (hemagglutinin and neuraminidase) from 3 or 4 influenza
virus strains predicted to be circulating.
o Adjuvants to boost immune response (IIV and RIV only).
o Other excipients.
Route:
• IIV and RIV: Intramuscular injection (IM), typically in the upper arm.
• LAIV: Intranasal spray, administered into each nostril.
Schedule:
• Adults and children 6 months and older: One dose per flu season.
• Children 6 months to 8 years old may require 2 doses 4-6 weeks apart in their first
flu season.
Dose:
• IIV and RIV: Typically 0.5 mL for adults, 0.25 mL for children.
• LAIV: 0.1 mL per nostril.
Effectiveness:
 • Varies depending on the match between vaccine strains and circulating
viruses, but can be:
o Upto 60% effective in preventing illness if the strains closely match
circulating viruses.
o Reduce the severity of illness even if the match is not perfect.
Protection:
• Develop about 2 weeks after vaccination and lasts for several months, but wanes
over time.
• Annual vaccination is recommended for optimal protection throughout
Contraindications:
• Severe allergic reaction to a previous dose or vaccine component.
• Fever or acute illness.

RABIES PROPHYLAXIS
Types:
eRIG / hRIG (Rabies Immunoglobulin): Antibodies from horse /
human blood plasma.
Rabies Vaccines: Inactivated rabies virus vaccines.
Composition:
RIG: Antibodies against rabies virus.
Rabies Vaccines:
HDCV (Human Diploid Cell Vaccine), PCECV (Purified Chick
Embryo Cell Vaccine)
Route:
RIG: IM injection at site of bite / tear.
Rabies Vaccines: ID or IM Injection, typically in the arm.
Schedule:
Pre-exposure Prophylaxis:
Vaccine: 2 doses, 7 days apart
Post-exposure Prophylaxis:
RIG: Single dose immediately after exposure, followed by rabies vaccine regimen.
Rabies Vaccines:
Updated Thai Red Cross Regimen (UTRCID):
2 doses ID (0.1 mL each) on days 0, 3, 7, and 28
Dose:
RIG: Human - 20 mL/kg x W (in kg),
Equine - 40 mL/kg x W (in kg)
Rabies Vaccines: 0.1 mL (ID), 0.5 mL (IM)
Effectiveness:
Nearly 100% effective in preventing rabies if
completed as scheduled.
TYPHOID
Types:
• Conjugate Vaccines: Vi polysaccharide conjugated to a protein
carrier (Typhim Vi).
• Polysaccharide Vaccines: Purified Vi capsular polysaccharide
(Vi Typhi).
• Live Attenuated Vaccines: Ty21a – Limited availability due to
potential side effects.
Route:
• Conjugate and Polysaccharide Vaccines: IM inj., typically in the
upper arm.
• Live Attenuated Vaccines: Oral capsules.
Schedule:
• Adults and children 2 years and older:
• Conjugate and Polysaccharide Vaccines: Single dose.
• Live Attenuated Vaccines: 4 capsules every other day, starting at least 1 week
before travel.
Booster Doses:
• Conjugate Vaccines:
Every 3 years
• Polysaccharide Vaccines:
Every 2 years
• Live Attenuated
Vaccines: Not routinely
recommended.
Dose:
• Conjugate and
Polysaccharide Vaccines: 0.5 mL
• Live Attenuated Vaccines: 4 capsules (total)
Effectiveness:
• Conjugate Vaccines: 50-80% effective in preventing typhoid fever for 3 years.
• Polysaccharide Vaccines: 50-70% effective in preventing typhoid fever for 2 years.
• Live Attenuated Vaccines: 30-80% effective in preventing typhoid fever for 5 years.
Protection:
• Short-term to longer-term depending on vaccine type and booster schedule.
• Vaccination complements but does not replace safe food and water practices in
high-risk areas.
Contraindications:
• Severe allergic reaction to a previous dose or vaccine component.
• Immunodeficiency, pregnancy, breastfeeding.
MENINIGITIS [ACYW-135 ± B ± X]
Type:
• MenACWY vaccines
• MenB vaccines
• MenABCWY vaccines: Covers both
Composition:
o Conjugated Polysaccharide antigens
of the targeted serogroups
o Adjuvants [AlPO4 or Al(OH)3]
o Other excipients
Route:
• IM injection, typically in the upper arm
Schedule:
• MenACWY and MenABCWY vaccines:
o Children and teens: 2 doses, 6 months apart, at
ages 11-12 and 16 years old.
o Catch-up vaccination: Recommended for high-risk individuals and travelers.
• MenB vaccines:
o Adolescents and young adults
(16-23 years old): 2 doses, at least
2 months apart.
o High-risk individuals: 3
doses, 0, 2, and 6 months apart.
Dose:
• Usually 0.5 mL for all types.
Effectiveness:
• Highly effective, preventing over
90% of meningitis cases
• Protection lasts for several years
Protection:
• Does not cover all strains of
meningitis-causing bacteria.
• Vaccination alongside good
hygiene practices offers
effective protection.
Contraindications:
• Severe allergic reaction to a
previous dose or vaccine
component
• Fever or acute illness
CHIKUNGUNYA
The first Chikungunya Vaccine
Type: Live vaccine, lyophilized,
reconstituted with distilled water
Dose: 0.5mL
Route: IM injection only
• Approved ONLY for age> 18 years
Contraindications: Immunosuppression,
Allergic reactions.
• No data for use in pregnancy, lactation or paediatric age group ☹
Composition: weakened live chikungunya virus (CHIKV), recombinant human albumin,
sucrose, D sorbitol, L-methionine and salts.
IXCHIQ may contain trace amounts of bovine serum albumin, Vero cell protein, Vero cell
DNA and protamine sulphate

MALARIA
Type: 2 main types are currently available:
• RTS, S/AS01 (Mosquirix): A protein-based
vaccine targeting the Plasmodium
falciparum parasite, responsible for most
malaria deaths in Africa.
• R21/Matrix-M: Another protein-based
vaccine also targeting
P. falciparum, recently WHO-
recommended as an addition to RTS, S.
Composition:
• RTS, S/AS01: Recombinant surface
protein (RTS) of P. falciparum + adjuvants
• R21/Matrix-M: Modified surface protein + adjuvants
Dose: 0.5 mL for both vaccines
Route: Intramuscular injection (IM), typically in the upper
arm
Schedule:
• RTS, S/AS01: 4 doses for children aged 5-17 months.
• R21/Matrix-M: Currently recommended for 3 doses
in children aged 6-12 months,
Effectiveness:
• RTS, S/AS01: ↓ severe malaria by 30-40%, overall
malaria by 15-25% in children.
• R21/Matrix-M: Comparable or slightly higher
effectiveness than RTS, S/AS01
Protection:
• Moderate and short-lived, requiring complementary malaria prevention measures.
• Both vaccines are not yet widely available due to limited supply
Contraindications:
• Severe allergic reaction to previous dose or vaccine component
• Certain immunocompromised conditions

DENGUE
Type: Live, attenuated tetravalent vaccine
(CYD-TDV, Dengvaxia)
Composition: Weakened live viruses for all 4
dengue serotypes (1, 2, 3, and 4)
Route: SC injection, under the upper arm
Schedule: 3 doses, 6 months apart,
in individuals 9-16 years old with lab-
confirmed previous dengue infection living in
endemic areas.
Dose: 0.5 mL
Effectiveness:
o Overall prevention of symptomatic
dengue: 59.2% after one year
o Prevention of severe dengue: 79.1% after one year
o Effectiveness higher against serotypes 3
and 4 than 1 and 2
o May increase the risk of severe dengue in
individuals without prior dengue infection
Protection:
• Long-term duration is still under
investigation
Contraindications:
• No prior confirmed dengue infection
• Severe allergies (e.g., egg)
• Pregnant or breastfeeding women
• Underlying immunosuppression
Safety Considerations:
• Increased risk of severe dengue in
individuals without prior dengue
infection (vaccine-associated enhanced
disease)
• Monitoring and assessment of prior
dengue infection crucial before
vaccination.
 COLD CHAIN

Cold chain temperature of vaccines available in India:

For all vaccines: +2 to +8 degree C, except 
 For Yellow fever vaccine: -30 to +5 degree C
 For Long term storage of OPV: -15 to -25 degree C
 Diluents: can be stored in +2 to +8 degree C or at room temperature
 Vitamin A: at room temperature
Shake test:
Cold chain levels in India:

Level Component Temp Storage duration

State/ regional Walk-in-cold rooms +2 to +8 degree C 3 months
level Walk-in-freezers -15 to -25 degree C
District level Large ILRs +2 to +8 degree C 1 month
Large deep freezers -15 to -25 degree C
PHC level Small ILR +2 to +8 degree C 1 month
Small deep freezer -15 to -25 degree C
Sub-centre level Vaccine carriers +2 to +8 degree C 48-72 hours
Day carriers
Session level Fully frozen ice +2 to +8 degree C 1-3 hours
packs
 Ice Lined Refrigerator

Dial thermometer

ICE PACK:
Use: Temp maintenance during vaccine transportation in a
vaccine carrier, during an immunization session.
Capacity: 320-340 mL
Has a horizontal mark- water fill level
Has 2 holes- meant for keeping vaccines.
In the hole 
OPV, MR, JE, BCG
On the Ice pack,
Outside the
Hole Rota
Outside the ice
pack  DPT, TT,
Hep B, Penta, IPV

Picture
showing BCG
vaccine place
in the hole on
the Ice Pack

Vaccine
carrier
(should
have a
minimum
of 2 Ice
Packs)
Adverse Effects Following Immunization (AEFI)