Know All About your Childhood Vaccination Schedules, Newer Guidelines in 2021

Notes: 1) BCG(Bacillus Calmette Guerin) is given intradermally in the deltoid region,.05 ml given as a single dose. It is given to prevent Tuberculosis. It prevents pulmonary tuberculosis not extrapulmonary. To date, it is the only vaccine for tuberculosis.

It is available as lyophilized form(freeze-dried), vacuum shield,amber-colored ample with two ml normal saline as a diluent. After reconstitution, it should be used within four hours as light destroys it.

After given there is no immediate reaction but after 1 to 2 weeks in 95 percent of cases if given accurately a papule appears then ulcerates and heals within 12 weeks leaving a scar.No treatment is required for ulcer. one single dose contains 0.1 to 0.4 million of live bacillus.

2) OPV( oral polio vaccine):

 First used in 1961, invented by Dr. Albert Sabin, it is a very effective live vaccine to prevent poliomyelitis. It contains a mixture of all three strains of live virus.

3) Hepatitis -B:

 Hepatitis – B vaccine which is currently available has been used since 1963. The dose is 05. ml intramuscular in the deltoid or anterolateral aspect of the thigh. It is a surface antigen of hepatitis -B made by recombinant technology in yeast and adjuvanted with aluminum salt and preserved with a thermistor. It is available in a single and multidose vial. It is stored at 2 -8 degrees centigrade

AT 6 WEEKS: IPV1(Or bOPV1),DTwP1/DTaP1/Hib1/pCV1/Rota1/Hepatis B2

Here usually we give pentavalent or Hexavalent vaccine with PCV in the childhood vaccination schedule

Notes: 1) IPV: It is an injectable polio vaccine. It is also very effective against eradicating poliomyelitis.IVP first developed and licensed in 1955, is given by injection and is available in a trivalent form containing the three virus serotypes PV1, PV2 and PV3

2) DTwP/ : (Diptheria,Tetetus and Pertusis)

Popularly known as Triple antigen it is composed of tetanus and Diptheria toxoid and whole-cell pertussis bacilli( killed). Aluminum salt is used as an adsorbent and adjuvant.

 It should be stored in 2- 8 degrees centigrade. This vaccine never is frozen( if accidentally frozen then discard immediately).

 The dose is 0.5 ml intramuscular and the preferred site is the anterolateral aspect of the thigh

DWP is the preferred choice than DTaP during childhood vaccination schedule

The mortality rate due to Diphtheria, Tetanus, and Pertussis(whooping cough) reduced significantly after the introduction of triple antigen in India.

 Due to the Pertussis component receiver experience pain, fever, and a little swelling in the area which may last for 2 to 3 days. Paracetamol is given to reduce pain and fever.

3)Hib1: Haemophilus influenza type B is an important pathogen that causes meningitis, Bacteremia, cellulitis, epiglottitis, osteomyelitis, septic arthritis, pneumonia, etc in children below 2 years. Hib vaccine is a conjugate vaccine where capsular polysaccharide (PRP) is conjugated with a protein carrier. Currently, available in India are HBOC and PRP-T.Dose .5 ml intramuscular.It should be stored at 2 to 8 degrees Centigrade. Side effects are mild and usually local.

4)PCV1: Streptococcus pneumonia is a major cause of morbidity and mortality worldwide. As per WHO pneumococcal disease is the number 1 vaccine-preventable cause of death among infants and children younger than 5 years of age.

 Pneumococcal conjugate vaccine (PCV) has been very effective in preventing Invasive pneumococcal disease, pneumonia, Otitis media, etc. Depending on the serotypes covered currently PCV-10 and PCV -13 are used. Dose: 0.5 ml intramuscularly. Preferred site anterolateral aspect of the thigh. side effects mild and local. The only problem is it is costly.

4) Rota: Rota is a monovalent, human, live attenuated rotavirus vaccine containing one rotavirus strain of G1P[8] specificity.

 Rotarix is indicated for the prevention of rotavirus gastroenteritis caused by G1 and non-G1 types (G3, G4, and G9) when administered as a 2-dose series in infants and children It was approved in Europe in 2006 and by the U.S. FDA in April 2008.

 It is administered by mouth.

 In India, Rotarix and Rotavac are the common brands. This oral vaccine is very effective in preventing rotaviral diarrhea and has become an essential part while we talk about all about childhood vaccination schedules and newer guidelines in 2021

 AT 10 WEEKS: DTwP 2,IPV2(or bOPV2),Rotavirus2,PCV2,Hib2

Notes: 1) Only two doses of RV1 are recommended

2} If RV1 is chosen, the 2nd dose should be given at 10 weeks

 AT 14 WEEKS : DTwP3,,IPV3(or bOPV3),Hib3/Rota3/PCV3

Notes: If any dose of RV5 or RV116E is chosen then three doses of RV should be given

 AT 6 MONTHS: Influenza vaccine, OPV, Hepatitis3

Notes : Children between 6 to 59 months are high risk 

.So routine immunization for influenza is recommended to these high-risk groups.

 Both IIV3 and IIV4 are licensed For first-time vaccination two doses are required between 6 months to 9 years of age in 1 month apart.

 After 9 years single dose needed.Then annual revaccination with single dose.

 9 MONTHS TO 12 MONTHS: MMR1, OPV, TCV

Notes: 1) MMR(Measles, Mumps, Rubella): It is given as subcutaneous.MMR should be given after completed 9 months, not before 9 months. Three doses are recommended now a day.2nd dose is at 15 to 18 months and 3rd one is at 5 years of age.

2) TCV: Typhoid conjugate vaccine: Single-dose intramuscular.0.5 ML, preferable site anterolateral aspect of the thigh. It can be administered along with measles. 

Mild pain and fever can come.

 AT 12 MONTHS OF AGE: Hepatitis A, Japanese encephalitis vaccine:

Notes:1) Hepatitis A: Two types: live and killed.

 Live vaccine needed single dose while inactivated or killed needs two doses at 6 months apart. Both are highly immunogenic and effective vaccines and are given intramuscularly.

 Mild pain, redness in the local area may be noted. Both are very safe.

2) Japanese encephalitis ( J.E ): Japanese encephalitis, mosquito-borne viral encephalitis is one of the most common viral encephalitis below 15 years of age in Asia. In India, it is a major burden and endemic in almost 268 districts (2018 data).

 The worst affected states are Assam,west Bengal,Bihar ,UP. The vaccine for J.E is given intramuscularly. The following brands are available in India:

1. JEEV: Inactivated, ready to use liquid form .5. ml,dose 1
2. JENVAC: Inactivated, ready to use liquid form .5. ml,dose 1
3. JE Live attenuated: Public sector only, lyophilized active component to be reconstituted with diluent, dose 1

At 15 months: Varicella(chickenpox),MMR2,PCV booster

Notes: 1) Varicella: Varicella-zoster is a highly contagious disease caused by the Herpes virus. It causes Chickenpox in early life but in adults, it can cause Herpes-zoster.

 The vaccine should be given in two doses, the first dose at 15 months of age and the second dose at 4-6 years of age.

 The route of administration is subcutaneous .5ml OKA strain live vaccine(India only OKA strain available at present). Pregnancy is a contraindication to use this vaccine.

 AT 16 TO 18 MONTHS:OPV booster 1/IPVa ,DTPwB1/DTPaB1/Hib B1

 AT 18 MONTHS: Hepatitis A, Influenza Booster

Notes: Hepatitis A should be given if the first dose was given inactive or killed

11} AT 2 YEARS ; meningococcal/pneumococcal /typhoid polysaccharide

Notes: 1)Meningococcal vaccine: It is not a routine vaccine.IAP recommends its use only in the conditions like a disease outbreak, persons with high-risk conditions, or situations.

 AT 5 YEARS: OPV booster2,TCV2,VARICELLA2,MMR3,DTwP booster2/DTaPbooster2

AT 10 to 12 Years: TT,Td/Tdap,HPV

NOTES: HPV: Human Papilloma vaccine, an effective vaccine against cervical cancer in females.

 One of the most common viruses associated with cervical cancer is the Human papillomavirus. 

Human papillomavirus infections are transmitted primarily by sexual contact and are highly transmissible. 

Two types of vaccines are available globally, one is quadrivalent and the other one is bivalent. Dose is .5 ml intramuscular {0,2 and 6 for Quadrivalent and 0,1 and 6 months for Bivalent).The vaccine should not be frozen but should be kept in between 2-8 degrees centigrade.

One common question asked by parents is that they are taking polio vaccine according to their pediatrician then why should take OPV during polio programs organized by Govt of Indiabevery year? 

The answer is that yes you should give your baby the extra dose given by the Govt. The more the OPV dose the better the outcome.