◆ Evidence-Based Pearls
National Immunization Schedule (NIS) at a Glance
💡 Key Fact: Under UIP, immunization is provided free of cost against 12 vaccine-preventable diseases nationally (11 diseases) and sub-nationally (Japanese Encephalitis in endemic districts).
| Age |
Vaccines |
Route & Site |
| Birth |
BCG, OPV-0, Hepatitis B Birth Dose |
ID Left Upper Arm; Oral; IM Mid-Thigh |
| 6 Weeks |
OPV-1, Pentavalent-1, RVV-1, fIPV-1, PCV-1 |
Oral; IM; Oral; ID Right Arm; IM |
| 10 Weeks |
OPV-2, Pentavalent-2, RVV-2 |
Oral; IM Mid-Thigh; Oral |
| 14 Weeks |
OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2 |
Oral; IM; ID Right Arm; Oral; IM |
| 9-12 Months |
MR-1, JE-1*, PCV Booster, Vitamin A (1st) |
SC Right Arm; SC/IM Left; IM; Oral |
| 16-24 Months |
MR-2, JE-2*, DPT Booster-1, OPV Booster |
SC Right Arm; SC/IM Left; IM; Oral |
| 5-6 Years |
DPT Booster-2 |
IM Upper Arm |
| 10 Years |
Td |
IM Upper Arm |
| 16 Years |
Td |
IM Upper Arm |
| Pregnant Women |
Td-1, Td-2, or Td Booster |
IM Upper Arm |
⚠ Note: *JE vaccine is provided only in endemic districts. Vitamin A supplementation continues every 6 months from 16 months to 5 years.
NIS vs IAP Schedule: Key Differences
💡 Context: The NIS is the government schedule under UIP (free, public sector). The IAP schedule (2022) is recommended by the Indian Academy of Pediatrics for private practitioners and includes additional vaccines.
| Feature |
NIS (Government) |
IAP (Private) |
| Polio |
OPV + 2 fractional IPV doses (6 & 14 wk) |
Full-dose IPV at 6, 10, 14 wk + boosters; OPV only as per NIS |
| DPT type |
Whole-cell pertussis (DTwP) in Pentavalent |
DTwP or DTaP; DTaP preferred for boosters |
| Hepatitis A |
Not in NIS |
2 doses: 12 months + booster |
| Varicella |
Not in NIS |
2 doses: 15 months + 4-6 years |
| Typhoid |
Not in NIS |
TCV from 6-9 months (catch-up to 15 yr) |
| MMR |
MR only (no Mumps component) |
MMR at 9 months, 15 months, 4-6 years |
| Influenza |
Not in NIS |
Annual from 6 months onwards |
| HPV |
Not yet in NIS (NTAGI recommended) |
9-14 years: 2 doses; 15+ years: 3 doses |
| PCV schedule |
2 primary + 1 booster (6, 14 wk, 9-12 m) |
3 primary + 1 booster (6, 10, 14 wk, 15 m) |
Understanding the Pentavalent Vaccine
The Pentavalent vaccine used under NIS is a combination of DPT + Hepatitis B + Hib (Haemophilus influenzae type b). It replaced the earlier practice of giving these as separate injections, significantly reducing the injection burden per visit.
| Component |
Protects Against |
Disease Burden (India) |
| Diphtheria |
Pharyngeal membrane, myocarditis, neuropathy |
968 cases reported (HMIS 2021-22) |
| Pertussis |
Whooping cough, apnoea in infants |
295 cases reported |
| Tetanus |
Neonatal & generalised tetanus |
409 neonatal cases |
| Hepatitis B |
Chronic hepatitis, cirrhosis, hepatocellular carcinoma |
3-4% carrier rate in India |
| Hib |
Meningitis, pneumonia, epiglottitis |
Leading cause of bacterial meningitis in under-5s |
The Critical Birth Dose Window
⚠ Clinical Pearl: The Hepatitis B birth dose must be administered within 24 hours of birth. Delayed administration significantly reduces its efficacy in preventing perinatal (vertical) transmission.
- BCG: Administer at birth or as early as possible (up to 1 year). Dose is 0.05 ml until 1 month of age, then 0.1 ml thereafter. Route: Intradermal, left upper arm.
- OPV-0 (Zero Dose): Administer at birth or within the first 15 days. This is an extra dose and is not counted in the primary series.
- Hepatitis B Birth Dose: Administer within 24 hours of birth. Dose: 0.5 ml IM, anterolateral mid-thigh. Particularly critical for infants born to HBsAg-positive mothers.
Route & Site Quick Reference
| Route |
Vaccines |
Preferred Site |
| Intradermal (ID) |
BCG, fIPV |
BCG: Left upper arm; fIPV: Right upper arm |
| Intramuscular (IM) |
Pentavalent, PCV, HepB, DPT Boosters, Td |
Anterolateral mid-thigh (infants); Upper arm (older children, adults) |
| Subcutaneous (SC) |
MR/MMR, JE (live attenuated) |
Right upper arm (MR); Left upper arm (JE) |
| Oral |
OPV, Rotavirus, Vitamin A |
Oral |
Catch-Up Vaccination: The Golden Rules
✓ Principle: There is no need to restart a vaccine series if a dose is missed. Continue from where the schedule was interrupted, maintaining the minimum intervals between doses.
- 💡 Minimum interval between Pentavalent / OPV / RVV doses: 4 weeks.
- 💡 BCG: Can be given up to 1 year. After 1 year, it is not routinely recommended.
- 💡 Hepatitis B: Catch-up schedule: 0, 1, 6 months. No need to restart if delayed.
- 💡 MR Vaccine: Can be given up to 5 years of age. Two doses are critical for measles elimination.
- 💡 OPV: Can be given up to 5 years of age.
- 💡 Pentavalent: Should be completed by 1 year of age.
- 💡 Rotavirus: Must be completed by 1 year. Do not initiate after 1 year of age.
Td Vaccination in Pregnancy
💡 Key Change: Td (Tetanus and adult Diphtheria) vaccine has replaced TT (Tetanus Toxoid) in the NIS since February 2019, following NTAGI recommendations, to address waning diphtheria immunity in adults.
| History |
Doses Required |
Timing |
| No previous Td/TT |
Td-1 + Td-2 |
Td-1: Early in pregnancy; Td-2: 4 weeks after Td-1 |
| Td-1 received previously |
Td-2 only |
At least 4 weeks after Td-1 |
| 2 doses within last 3 years |
Td Booster only |
Single booster dose during current pregnancy |
Cold Chain: What Every Clinician Must Know
⚠ FREEZE-SENSITIVE vaccines: Pentavalent, Hepatitis B, Td, DPT, PCV, and IPV must NEVER be frozen. Freezing destroys antigen potency irreversibly.
| Storage Zone |
Vaccines |
Temperature |
| Freezer (-15 to -25 °C) |
OPV |
Can be frozen; thaw before use |
| Refrigerator (+2 to +8 °C) |
All other vaccines (BCG, Pentavalent, HepB, Td, DPT, PCV, RVV, fIPV, MR, JE) |
Store between +2 to +8 °C. Do NOT freeze. |
- Shake Test: If freezing is suspected for DPT/Pentavalent/Td/HepB, perform the shake test. If the vaccine sediments faster than a known frozen control, it has been damaged and must be discarded.
- Open Vial Policy: Opened multi-dose vials of liquid vaccines (OPV, HepB, DPT, Td, Pentavalent, PCV, fIPV) can be used for up to 28 days if stored correctly with VVM intact. Reconstituted vaccines (BCG, MR, JE) must be discarded at the end of the session or within 4 hours, whichever is earlier.
India's Immunization Milestones
| Year |
Milestone |
| 1977 |
✓ Smallpox eradicated (last case: 1975, West Bengal) |
| 1978 |
Expanded Programme on Immunization (EPI) launched |
| 1985 |
Renamed as Universal Immunization Programme (UIP) |
| 2014 |
✓ India certified Polio-free (last WPV case: 2011) |
| 2016 |
✓ Maternal & Neonatal Tetanus eliminated |
| 2016 |
Rotavirus vaccine (RVV) introduced under UIP |
| 2017 |
MR vaccine & PCV introduced under UIP |
| 2019 |
Td replaced TT; Introduced for pregnant women & adolescents |
Full Immunization Coverage: Tracking Progress
| Survey |
Year |
FIC (%) |
| NFHS-3 |
2005-06 |
43.5% |
| CES |
2009 |
61.0% |
| NFHS-4 |
2015-16 |
62.0% |
| NFHS-5 |
2019-21 |
76.4% |
| HMIS |
2019-20 |
92.8% (administrative data) |
✓ Progress: Full immunization coverage improved by 14.4 percentage points from NFHS-4 (62.0%) to NFHS-5 (76.4%), driven by Mission Indradhanush and systematic intensification drives.
