Current UIP (Universal

Immunization Programme)
Schedule in our state

DR P. RAVI KUMAR. M.D, D.C.H

Professor and HOD,
Department of Pediatrics,
Sri Venkateswara Medical College &
S.V.R.R.G.G.H, Tirupati.
Overview
 Concept of immunization and vaccination
 Current schedule under UIP
 Doses, routes and sequence of administration
 Brief note on individual vaccines
 Conclusion and take home message
Immunization - definition
It is the process whereby a person is made immune or
resistant to an infectious disease, by the administration
of
 Live attenuated or killed organisms or specific
antigens usually prior to natural exposure to
infectious agent. (Active immunization)
Example: Vaccination
 Preformed antibodies, soon after or prior to
exposure to neutralize infectious agent. (Passive
Immunization)
Vaccine
 A VACCINE is composed of one or more
antigens of a pathogenic agent which, when
administered to a previously unexposed
individual, will elicit an immune response
but not cause the disease.
 The secondary immune response, elicited
when the vaccinated host encounters the
pathogen itself, is rapid and accentuated so
that it protects from disease.
Types of Vaccines
Description Example
Bacterial BCG, Oral Typhoid ([Link] Ty21a)
Live attenuated
organism OPV, Measles, MMR, Varicella, Rota Virus,
Viral
Yellow fever
Bacterial DTwP, Whole cell killed Typhoid
Killed or inactivated
organism IPV, Rabies, Hepatitis-A
Viral
Influenza (Whole Virion)
Diphtheria Toxoid, Tetanus Toxoid,
Modified toxins or Bacterial [Link] (Vi), Hib, Pneumococcal,
surface components Meninigococcal, Acellular Pertussis
or subunits
Viral Recombinant Hepatitis B, Influenza Subunit
National Programs

Expanded Program on Immunization (EPI) started in

India
1978
Started with BCG, DPT and Typhoid Vaccines.
OPV added in 1979, later Measles.

Universal Immunization Program (UIP)

Nov 19,1985 BCG, DPT, OPV & Measles for children
TT for pregnant women

1995 Pulse Polio Immunization Program started

 IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN

Vaccine When to give Dose Route Site

TT-1 Early in pregnancy 0.5 ml Intra muscular Upper arm

TT-2 4 wk after TT-1 0.5 ml Intra muscular Upper arm

If received 2 TT
doses in a
TT - Booster 0.5 ml Intra muscular Upper arm
pregnancy within
the last 3 yrs

For prevention of neonatal tetanus

 IMMUNIZATION SCHEDULE FOR NEW BORN

Vaccine When to give Dose Route Site

At birth or as early
HBV Anterolateral side
as possible with in 0.5 ml Intra muscular
Birth dose of mid thigh
24 hrs

At birth or as early
OPV - 0 as possible with in 2 drops Oral
first 15 days

0.05 ml till 1
At birth or as early month
BCG as possible till 1 Intra dermal Left upper arm
year of age 0.1 ml after 1
month

BCG is not given beyond one year of age and there is no need to re-vaccinate the child
even if no scar is formed.
 IMMUNIZATION SCHEDULE FOR INFANT
Vaccine When to give Dose Route Site

OPV At 6 wk, 10 wk & 14 wk

2 drops Oral
1,2 & 3 Can give upto 5 Y age.

Penta valent At 6 wk, 10 wk & 14 wk Anterolateral side of

0.5 ml Intra muscular
1,2 & 3 Can give upto 1 Y age. mid thigh

Rotavirus Vaccine At 6 wk, 10 wk & 14 wk

5 drops Oral
(RVV) 1,2 & 3 Can give upto 1 Y age.

IPV 1 & 2 At 6 wk & 14 wk 0.1 ml Intradermal Right upper arm

9 completed months
Measles to 12 months
0.5 ml Sub-cutaneous Right upper arm
1st dose
Can give up to 5 Y of age

9 completed months
JE 1 0.5 ml Sub-cutaneous Left upper arm
to 12 months

Vitamin A 1 ml
9 months Oral
(1st dose) (1 lakh I.U)
 IMMUNIZATION SCHEDULE FOR CHILD
Vaccine When to give Dose Route Site

DPT 16-24 months Anterolateral side

0.5 ml Intra muscular
booster - 1 Can be give upto 7 Y age of mid thigh

Measles
16-24 months 0.5 ml Sub cutaneous Right upper arm
2nd dose

OPV booster 16-24 months 2 drops Oral

JE booster 16-24 months 0.5 ml Sub cutaneous Left upper arm

At 16 months
with DPT/OPV/JE/
Vitamin A Measles 2 ml
Oral
(2nd to 9th dose) (2 lakh I.U)
And then, one dose every
6 months upto 5 Y age

DPT booster - 2 5-6 Y 0.5 ml Intra muscular Upper arm

TT 10 Y & 16 Y 0.5 ml Intra muscular Upper arm

Sites and route of administration

IPV Intradermal
(right upper arm)
Sequence of vaccination at 6 & 14 weeks

OPV Vaccine Rota Vaccine IPV Vaccine Pentavalent

1 2 3 4

4
3
BCG Vaccine
 Bacillus Calmette Guerin
 Live attenuated vaccine
 Copenhagen (Danish 1331) strain is
used to produce vaccine
 Lyophilized (freeze-dried) preparation.
 Contains 0.1-0.4 million live viable
bacilli per dose.
 Extremely heat and light sensitive.
BCG Vaccine
 Diluent is sterile normal saline.
 Reconstituted vaccine should be stored at
2 to 8°C, protected from light and discarded within
4 to 6 hours of reconstitution.
 As the vaccine contains no preservative, bacterial
contamination and consequent toxic shock syndrome
may occur if kept for long after reconstitution.
 Efficacy: 50-80% for prevention of miliary and
meningeal TB. 50% for pulmonary tuberculosis.
 Contraindications: Cellular immunodeficiency,
symptomatic HIV
BCG Vaccine
 Dose: 0.05 ml to < 1month. 0.1 ml for older
children.
 Route: Intradermal with 26G needle
 Site: The convex aspect of the left shoulder at
level of deltoid insertion
 Method: The selected site may be swabbed
clean using sterile saline and local antiseptics
should be avoided. A wheal of 5 mm at the
injection site indicates successful intradermal
administration
BCG Vaccine
2-3 weeks: Papule develops
5-6 weeks: Papule increases in size to 4-8 mm
6-12 weeks: Heals with ulceration and scar

 Recommended Age: The recommended age of

administration is at birth. If missed at birth, can be given
up to 1 year of age (as early as possible).
 Adverse reactions: Secondary bacterial infection at the
site, local discharging sinus, axillary lymphadenitis,
disseminated infection (in immunocompromised children)
Oral Polio Vaccine
 Developed by Sabin.
 Live attenuated bi-valent vaccine.
 Stabilizing agent: Magnesium Chloride
 Each dose (2 drops) contains:
o 3,00,000 TCID50 (Tissue Culture infective Dose – 50) of
each Type 1 and Type 3 viruses.
 “Take” of the vaccine: When administered orally, the
vaccine viruses infect the intestinal mucosa and multiply
in the mucosal cells.
National switch – done on 25th
April 2016
Oral Polio Vaccine
 Infection by vaccine virus interrupts infection and
transmission of Wild type Polio virus and thus prevents
paralytic polio.
 Multiple doses required to ensure adequate take and
immunity.
 Recommended Schedule: OPV zero dose at birth, 3
doses at 6, 10 & 14 weeks along with Pentavalent &
RVV. Booster doses given along with DTP boosters at
16-24 months and 5 years of age.
In addition, all children below 5 years should receive
additional doses of OPV during Pulse Polio Immunization
campaigns.
Oral Polio Vaccine
 Storage: Stable at 2-8o C for 3-4 months and at -20o C
for a year. Highly sensitive to temperature fluctuations.
 Vaccine Vial Monitor (VVM) is used to indicate the
potency of OPV.

 The vaccine should be

discarded if the colour of
inner square is as dark as  
OR darker than the outer
circle.

 
Oral Polio Vaccine
 Contraindications: Immunodeficienct children, house
hold contacts of immunodeficient patients. Leukemia &
other malignancies. Severe diarrhea and dysentery.

 Adverse Reactions:
o VAPP (Vaccine Associated Paralytic Polio) – due to
Serotype 2.
o cVDPV (Circulating Vaccine Derived Poliovirus) –
Paralytic Polio cause by virulent strain formed due to
mutation of OPV.
Inactivated Polio Vaccine
 Formaldehyde killed vaccine.
 Induces humoral immune response.
 Doesn’t not induce mucosal immunity & doesn’t have
herd effect.
 Potency is measured by D antigen content.
 Each dose is 0.1 ml.
 Storage: At 2-8O C
 Route: Intradermal
 Has the advantage of not causing VAPP (Vaccine
Associated Paralytic Polio)
Inactivated Polio Vaccine
 Fractional immunization:
o IPV 1st and 2nd doses are given at 6 wk & 14 wk
respectively under UIP.
o Intradermal in Right upper arm.
Measles Vaccine
 Live attenuated vaccine
 Edmonston Zagreb strain
 Freeze dried form, no preservative.

 Storage: stored frozen or at 2-8°C (shelf life 2 years)

Reconstituted vaccine should be protected from light, kept

at 2-8°C and used within 4-6 hours of reconstitution.
 Diluent: Distilled water

 Dose: 0.5 ml
 Route: Subcutaneous
 Site: Right upper arm (at insertion of deltoid) or
Anterolateral thigh.
Measles Vaccine
 Schedule: At 9 months. 2nd dose at 16-24 months.
 Contraindications: Immunodeficiency, On
immunosuppressive therapy, Malignancy
 Adverse reactions: Fever, transient macular rash
(Measles like Illness) 5-10 days later.
Hepatitis-B Vaccine
 Viral subunit vaccine (Surface antigen)
 Adjuvant Aluminum Salts, Preservative Thiomersal.
 Dose: 0.5 ml (1 ml contains 20 µg of antigenic
component)
 Route: Intramuscular
 Site: Deltoid or Anterolateral thigh. Avoid Gluteal.
 Schedule: At birth. At 6 weeks, 10 weeks & 14 weeks as
a part of Pentavalent vaccine.
 95% seroconversion (Antibody titer >10 mIU/ml) after 3
doses.
 Adverse reactions: Mild erythema, induration at
injection site, fever.
Pentavalent Vaccine
 Protection to a child from 5 life-threatening
diseases – Diphtheria, Pertussis, Tetanus,
Hepatitis B and Haemophilus influenza
Type B.
 Dose: 0.5 ml (Each vial 10 doses)
 Route: Intramuscular
 Site: Deltoid or Anterolateral side of mid-
thigh.
 Schedule: At 6 wk, 10 wk & 14 wk

Contains VVM (Vaccine

Vial Monitor) like OPV
Rotaviral Vaccine (RVV)
 Rotavac is being used currently.
 Dose: 5 drops (Each vial 10 doses)
 Route: Oral
 Schedule: At 6 wk, 10 wk & 14 wk
 No booster
 Also has VVM (Vaccine Vial Monitor)
 OPV vs RVV

OPV Rotavirus vaccine

> Two drops Five drops

> Transparent dropper Pink dropper
> Bland / bitter to taste Sweet to taste
> Can be used up to 28 days Can be used only up to 4 hours
after opening vial after opening vial
Japanese Encephalitis vaccine
 Jenvac is being used currently.
 Inactivated Vero cell- derived vaccine
prepared from an Indian strain of the
Japanese encephalitis virus
 Dose: 0.5 ml

 Route: Subcutaneous left upper arm

 Schedule:

JE-1 at 9 months to 12 months

JE-booster at 16-24 months
Points to remember

 Wait at least 4 weeks (one month) after previous

dose of Penta-OPV before giving next dose.
 If child comes after gap of more than 4 weeks for
its next dose of Penta-OPV, give next dose of
series. Do NOT repeat previous dose, as there
is no maximum interval between doses.
Points to remember

 Two live injectable vaccines can be administered

simultaneously at different sites, otherwise at a
minimum interval of 28 days.
 If more than 2 injections are to be given in the
same thigh then the distance between the two
injections should be at least 2.5 cm (1 inch).
Conclusion
 Government of India under UIP is providing free of cost
protection to all children from following entities:
1. Neonatal & childhood tetanus
2. Hepatitis B
3. Tuberculosis
4. Poliomyelitis
5. Diphtheria
6. Pertussis
7. Haemophilus influenza type B
8. Rota viral gastroenteritis
9. Measles
10. Japanese encephalitis &
11. Vitamin A deficiency
Conclusion

 One of the objectives of Routine Immunization is to

increase immunization coverage to >90% by 2020.

 Hence let us all utilize this golden opportunity to reduce

childhood mortality and morbidity.

THANK YOU