The WHO launched global immunization program in 1974, known as Expanded Program on Immunization (EPI) to protect all children of the world against six killer disease. In India, Expanded Program on Immunization (EPI) was launched in january 1978. Universal Immunization Program launched in 1985. Before coming to the topic national immunization schedule one should understand about immunization.
Immunization Defination
Immunization is a process of protecting an individual from a disease through introduction of live, killed or attenuated organisms in the individual body. Artificial acquired immunity is developed by immunization.
Immunity is the security against a particular disease and nonsusceptibility to the invasive or pathogenic effects of foreign microorganism . Acquired immunity can be Active immunity or passive immunity.
Differentiate between Active and Passive Immunity
| Active Immunity | Passive Immunity |
| Active immunity is produced by stimulating immunological defense system through administration of antigen usually prior to natural exposure to infection. | Passive immunity is produced temporarily by supplying preformed exogenous animal or human antibody to suppress disease. It is given soon after exposure. |
| Active immunizing agent are called vaccines | It is ready made antibodies. Antisera and immunoglobulin are passive immunity agents. |
| Example of active immunity : BCG , Oral Polio, Measles etc vaccination. | Example of passive immunity : Human Immunoglobulin like Hepatitis A , Measles , rabies,tetanus and mumps etc. |
There are different types of immunizing agents like Vaccines, Immunoglobulins and antisera.
Vaccines
Vaccines are immuno-biological substances which produce specific protection against a given disease. It stimulates active production of protective antibody and other immune mechanism.
Types of immunizing agent / vaccine:
Live Attenuated Vaccines
- Bacterial : BCG, Typhoid (Oral) , Plague
- Viral : Oral polio , Measles, Mumps, Rubella , Yellow fever, Influenza.
- Rickettisial : Epi. typhus
Killed or Inactivated Vaccines :
- Bacterial : Pertussis, Typhoid , Cholera , CS meningitis.
- Viral : Rabies, Hepatitis B , Influenza , salk polio, japanese encephalitis.
- Toxoids : Diphtheria and tetanus.
- Cellular fractions : Meningococcal and pneumococcal vaccines.
- Combinations : DPT( Diphtheria, Tetanus, Pertussis), MMR (Measles ,mumps,Rubella) DT( Diphtheria Teanus), Hib – hep. B.
Immunoglobulins
Immunoglobulins are ready-made antibodies which are generally introduced in body after exposure.
Types of immunoglobulins
There are two types of immunoglobulin preprations available for Passive Immunization . These are :
- Human Immnunoglobulin (Ig) : It is composed of major classsed IgG, IgM, IgA, IgDand IgE.
- Specific Immunoglobulin
Normal Human Ig : Hepatiti A, Measles, Rabies, Tetanus and Mumps.
Specific Human Ig : Hepatitis B, Varicella and diphtheria.
Antisera or Antitoxins
Antisera is applied to the materials prepared in animals. passive immunity is achieved by administration of antisera or antitoxin prepared from non human like horses. Two types of antisera are:
- Bacterial : Diphtheria, Tetanus , Gas gangrene, Botulism
- Viral : Rabies
National Immunuzation Schedule
| Age | Vaccine to be Given |
| At Birth | Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV)-0 dose, Hepatitis B birth dose |
| At 6 Weeks | OPV-1, Pentavalent-1, Rotavirus Vaccine (RVV)-1, Fractional dose of Inactivated Polio Vaccine (fIPV)-1, Pneumococcal Conjugate Vaccine (PCV) -1 |
| At 10 weeks | OPV-2, Pentavalent-2, RVV-2 |
| At 14 weeks | Measles & Rubella (MR)-1, , PCV-Booster* |
| At 16-24 months | MR-2, Diphtheria, Pertussis & Tetanus (DPT)-Booster-1, OPV – Booster |
| At 5-6 years | DPT-Booster-2 |
| At 10 years | Tetanus & adult Diphtheria (Td) |
| 16 years | Td |
| Pregnant Mother | Td-1, Td-2 |
National Immunization Schedule (NIS) for Infants, Children and Pregnant women
For Pregnant Women
| Name of vaccine | Time of vaccine | Dose | Route | Site |
| Tetanus & adult Diphtheria (Td)- 1 | Early in pregnancy | 0.5 ml | Intra-muscular (IM) | Upper Arm |
| Td-2 | 4 weeks after Td1 | 0.5 ml | Intra-muscular (IM) | Upper Arm |
| Td- Booster | If received 2 TT/Td doses in a pregnancy within the last 3 years | 0.5 ml | Intra-muscular (IM) | Upper Arm |
For Infants
| Name of vaccine | Time of vaccine | Dose | Route | Site |
| Bacillus Calmette Guerin (BCG) | At birth or as early as possible till one year of age | 0.1ml (0.05ml until 1 month age) | Intra-dermal | Left Upper Arm |
| Hepatitis B – Birth dose | At birth or as early as possible within 24 hours | 0.5 ml | Intra-muscular | Antero-lateral side of mid thigh |
| Oral Polio Vaccine (OPV)-0 | At birth or as early as possible within the first 15 days | 2 drops | Oral | Oral |
| OPV 1, 2 & 3 | At 6 weeks, 10 weeks & 14 weeks (OPV can be given till 5 years of age) | 2 drops | Oral | Oral |
| Pentavalent (Diphteria, Pertussis, Tetanus, Hepatitis B, Hib) 1, 2 & 3 | At 6 weeks, 10 weeks & 14 weeks (can be given till one year of age) | 0.5 ml | Intra-muscular | Antero-lateral side of mid thigh |
| Pneumococcal Conjugate Vaccine(PCV) | Two primary doses at 6 and 14 weeks followed by Booster dose at 9-12 months | 0.5 ml | Intra-muscular | Antero-lateral side of mid thigh |
| Rotavirus (RVV) | At 6 weeks, 10 weeks & 14 weeks (can be given till one year of age) | 5 drops (liquid vaccine) 2.5 ml (lyophilized vaccine) | Oral | Oral |
| Inactivated Polio Vaccine (IPV) | Two fractional dose at 6 and 14 weeks of age | 0.1 ml | Intra dermal two fractional dose | Intra-dermal: Right upper arm |
| Measles Rubella (MR) 1st dose | 9 completed months-12 months. (Measles can be given till 5 years of age) | 0.5 ml | Sub-cutaneous | Right upper Arm |
| Japanese Encephalitis (JE) | 9 completed months-12 months. | 0.5 ml | Sub-cutaneous (Live attenuated vaccine) Intramuscular(Killed vaccine | Left upper Arm (Live attenuated vaccine) Anterolateral aspect of mid thigh (Killed vaccine) |
| Vitamin A (1st dose) | At 9 completed months with measles-Rubella | 1 ml ( 1 lakh IU) | Oral | Oral |
For Children
| Name of vaccine | Time of vaccine | Dose | Route | Site |
| Diphtheria, Pertussis & Tetanus (DPT) booster-1 | 16-24 months | 0.5 ml | Intra-muscular | Antero-lateral side of mid-thigh |
| MR 2nd dose | 16-24 months | 0.5 ml | Sub-cutaneous | Right upper Arm |
| OPV Booster | 16-24 months | 2 drops | Oral | Oral |
| JE-2 | 16-24 months | 0.5 ml | Sub-cutaneous (Live attenuated vaccine) Intramuscular(Killed vaccine) | Left upper Arm (Live attenuated vaccine) Anterolateral aspect of mid thigh (Killed vaccine) |
| Vitamin A (2nd to 9th dose) | 16-18 months. Then one dose every 6 months up to the age of 5 years | 2 ml (2 lakh IU) | Oral | Oral |
| DPT Booster-2 | 5-6 years | 0.5 ml | Intra-muscular | Upper Arm |
| Td | 10 years & 16 years | 0.5 ml | Intra-muscular | Upper Arm |
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