IAP immunization guidelines 2025 rotavirus pneumococcal vaccine schedule India

IAP immunization schedule 2025 rotavirus pneumococcal vaccine India guidelines

https://drbaweja.com/wp-content/uploads/2026/05/acviprecomme…

Medical flowchart for Rotavirus Vaccine (exam-ready, 5-mark format). Clean professional style, white background, blue and green color scheme. Include the following sections as a structured flowchart with boxes and arrows: ROTAVIRUS VACCINE | [PATHOGEN BOX]: Rotavirus - dsRNA virus, Group A most common, causes severe diarrheal disease in infants | [AVAILABLE VACCINES BOX]: - RV1 (Rotarix): Monovalent, live oral, human rotavirus strain - RV5 (RotaTeq): Pentavalent, live oral, bovine-human reassortant - ROTAVAC (India): Monovalent, 116E strain, indigenous - ROTAVAC 5D: Liquid formulation by Bharat Biotech | [DOSE & SCHEDULE TABLE]: Rotarix: 2 doses - 6w & 10w (IAP) | RotaTeq/ROTAVAC: 3 doses - 6w, 10w, 14w | [ROUTE & DOSE BOX]: Oral | 1.5 mL (Rotarix) | 2 mL (RotaTeq) | 0.5 mL (ROTAVAC) | [IAP 2025 SCHEDULE]: 6 weeks, 10 weeks, 14 weeks (3-dose for ROTAVAC/RotaTeq); 6w & 10w for Rotarix | [COLD CHAIN]: 2-8°C | Do NOT freeze | [CONTRAINDICATIONS]: SCID, History of intussusception, Hypersensitivity to components, Age >8 months for last dose | [KEY POINTS]: First dose max by 14 weeks 6 days | Last dose by 8 months | Min interval: 4 weeks | Can give with other vaccines

Medical flowchart for Pneumococcal Vaccine (PCV) - exam-ready, 5-mark format. Clean professional style, white background, purple and orange color scheme. Structured flowchart with boxes and arrows: PNEUMOCOCCAL VACCINE | [PATHOGEN BOX]: Streptococcus pneumoniae - Gram positive diplococcus, >90 serotypes, causes pneumonia, meningitis, bacteremia, otitis media | [TYPES OF VACCINES]: PPV23 (Polysaccharide) --- PCV10 --- PCV13 --- PCV14 (Abbott) --- PCV20 (adults) | [PCV vs PPV23 COMPARISON BOX]: PCV: Conjugate, T-cell dependent, used <2 yrs | PPV23: Polysaccharide, T-cell independent, used >2 yrs | [IAP 2025 SCHEDULE BOX]: Primary: 3 doses at 6w, 10w, 14w (3p+0) OR: 2 doses + 1 booster (2p+1): 6w & 14w + booster at 9-15m Booster: PCV booster at 15 months (IAP recommended) UIP India: PCV1 at 6w, PCV2 at 10w, PCV3 at 14w, Booster at 9m | [DOSE & ROUTE]: 0.5 mL IM | Anterolateral thigh in infants | Deltoid in older children | [COLD CHAIN]: 2-8°C | Do NOT freeze | Discard if frozen | [CONTRAINDICATIONS]: Anaphylaxis to previous dose | Revaccination not recommended after anaphylaxis | [NEWER PCVs 2025]: PCV14-TT (Apexxnar, Abbott) 6-10-14w schedule | Vaximune-13 / Pneumoguard-13 (TT-conjugate) | PCV20 for adults >18 yrs only

mkdir -p /home/daytona/workspace/vaccine-notes && ls /home/daytona/workspace/vac…

~/vaccine-notes/create_vaccine_notes.py

import requests
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Image, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import PageBreak
from io import BytesIO
import os

# ---- Download images ----
rota_url = "https://cdn.orris.care/image-gen/38c82e5c5aba49fdb61f18e014c5654f.png"
pcv_url  = "https://cdn.orris.care/image-gen/6f296adcf4c5476f9491f8185b8e5327.png"

def download_img(url, path):
    r = requests.get(url, timeout=30)
    with open(path, "wb") as f:
        f.write(r.content)
    print(f"Downloaded: {path}")

download_img(rota_url, "/home/daytona/workspace/vaccine-notes/rota_flowchart.png")
download_img(pcv_url,  "/home/daytona/workspace/vaccine-notes/pcv_flowchart.png")

# ---- Styles ----
W, H = A4
doc = SimpleDocTemplate(
    "/home/daytona/workspace/vaccine-notes/Vaccine_Notes_5Mark.pdf",
    pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=1.2*cm, bottomMargin=1.2*cm
)

styles = getSampleStyleSheet()

title_style = ParagraphStyle(
    "VacTitle",
    parent=styles["Heading1"],
    fontSize=16,
    textColor=colors.HexColor("#1a3c6e"),
    spaceAfter=4,
    spaceBefore=2,
    fontName="Helvetica-Bold",
    alignment=TA_CENTER
)

subtitle_style = ParagraphStyle(
    "SubTitle",
    parent=styles["Normal"],
    fontSize=8,
    textColor=colors.HexColor("#555555"),
    spaceAfter=6,
    alignment=TA_CENTER,
    fontName="Helvetica-Oblique"
)

section_style = ParagraphStyle(
    "Section",
    parent=styles["Heading2"],
    fontSize=10,
    textColor=colors.white,
    fontName="Helvetica-Bold",
    spaceBefore=6,
    spaceAfter=2,
    leftIndent=0,
    backColor=colors.HexColor("#1a3c6e"),
    borderPad=3
)

section_style_green = ParagraphStyle(
    "SectionGreen",
    parent=section_style,
    backColor=colors.HexColor("#1e6e3c"),
)

body_style = ParagraphStyle(
    "Body",
    parent=styles["Normal"],
    fontSize=8.5,
    leading=12,
    spaceAfter=3,
    fontName="Helvetica",
    textColor=colors.HexColor("#222222")
)

bullet_style = ParagraphStyle(
    "Bullet",
    parent=body_style,
    leftIndent=12,
    bulletIndent=4,
    spaceAfter=2,
    fontSize=8.5
)

key_style = ParagraphStyle(
    "Key",
    parent=body_style,
    fontSize=8.5,
    fontName="Helvetica-Bold",
    textColor=colors.HexColor("#b30000")
)

footer_style = ParagraphStyle(
    "Footer",
    parent=styles["Normal"],
    fontSize=7,
    textColor=colors.HexColor("#888888"),
    alignment=TA_CENTER
)

def make_section_header(text, color_hex="#1a3c6e"):
    return Table(
        [[Paragraph(f"<b>{text}</b>", ParagraphStyle(
            "SH", parent=styles["Normal"],
            fontSize=9.5, textColor=colors.white,
            fontName="Helvetica-Bold"
        ))]],
        colWidths=[W - 3*cm],
        style=TableStyle([
            ("BACKGROUND", (0,0), (-1,-1), colors.HexColor(color_hex)),
            ("TOPPADDING", (0,0), (-1,-1), 3),
            ("BOTTOMPADDING", (0,0), (-1,-1), 3),
            ("LEFTPADDING", (0,0), (-1,-1), 6),
        ])
    )

def make_table(data, col_widths=None, header_color="#1a3c6e"):
    if col_widths is None:
        col_widths = [(W - 3*cm) / len(data[0])] * len(data[0])
    
    table_data = []
    for i, row in enumerate(data):
        table_data.append([
            Paragraph(str(cell), ParagraphStyle(
                "TC",
                parent=styles["Normal"],
                fontSize=8,
                fontName="Helvetica-Bold" if i == 0 else "Helvetica",
                textColor=colors.white if i == 0 else colors.HexColor("#222222"),
                alignment=TA_CENTER
            )) for cell in row
        ])
    
    ts = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), colors.HexColor(header_color)),
        ("BACKGROUND", (0,1), (-1,-1), colors.HexColor("#f5f8ff")),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f5f8ff"), colors.HexColor("#eaf0ff")]),
        ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#cccccc")),
        ("TOPPADDING", (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
    ])
    return Table(table_data, colWidths=col_widths, style=ts)

# ===== PAGE 1: ROTAVIRUS VACCINE =====
page1 = []

page1.append(Paragraph("ROTAVIRUS VACCINE", title_style))
page1.append(Paragraph("Sources: Park's Preventive Medicine | Red Book 2021 | IAP-ACVIP 2025 Guidelines", subtitle_style))
page1.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#1a3c6e"), spaceAfter=4))

# Key points banner
kp_table = Table([[
    Paragraph("Oral Live Attenuated Vaccine", ParagraphStyle("kp", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#1a3c6e"), alignment=TA_CENTER)),
    Paragraph("Prevents Rotavirus Gastroenteritis", ParagraphStyle("kp2", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#1e6e3c"), alignment=TA_CENTER)),
    Paragraph("Start at 6 Weeks | Complete by 8 Months", ParagraphStyle("kp3", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#8B4513"), alignment=TA_CENTER)),
]], colWidths=[(W-3*cm)/3]*3,
style=TableStyle([
    ("BOX", (0,0), (-1,-1), 1, colors.HexColor("#1a3c6e")),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#cccccc")),
    ("BACKGROUND", (0,0), (0,0), colors.HexColor("#e8f0fe")),
    ("BACKGROUND", (1,0), (1,0), colors.HexColor("#e8f5ec")),
    ("BACKGROUND", (2,0), (2,0), colors.HexColor("#fff3e0")),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
]))
page1.append(kp_table)
page1.append(Spacer(1, 4))

# Two column layout: Left = notes, Right = flowchart
left_content = []

left_content.append(make_section_header("PATHOGEN", "#1a3c6e"))
left_content.append(Paragraph("• Rotavirus: double-stranded RNA (dsRNA) virus, family Reoviridae", bullet_style))
left_content.append(Paragraph("• Group A most important cause of severe diarrhea in infants <5 years", bullet_style))
left_content.append(Paragraph("• Leading cause of vaccine-preventable diarrheal deaths in children", bullet_style))
left_content.append(Spacer(1, 3))

left_content.append(make_section_header("AVAILABLE VACCINES (India)", "#1e6e3c"))
vax_data = [
    ["Vaccine", "Type", "Doses", "Strain"],
    ["Rotarix (RV1)", "Monovalent", "2", "Human (89-12)"],
    ["RotaTeq (RV5)", "Pentavalent", "3", "Bovine-human"],
    ["ROTAVAC", "Monovalent", "3", "116E (India)"],
    ["ROTAVAC 5D", "Monovalent", "3", "116E liquid"],
]
left_content.append(make_table(vax_data, header_color="#1e6e3c"))
left_content.append(Spacer(1, 3))

left_content.append(make_section_header("IAP 2025 SCHEDULE", "#6a1a6e"))
sched_data = [
    ["Vaccine", "Dose 1", "Dose 2", "Dose 3", "Last Dose"],
    ["Rotarix", "6 weeks", "10 weeks", "-", "By 8 months"],
    ["RotaTeq", "6 weeks", "10 weeks", "14 weeks", "By 8 months"],
    ["ROTAVAC/5D", "6 weeks", "10 weeks", "14 weeks", "By 8 months"],
]
left_content.append(make_table(sched_data, header_color="#6a1a6e"))
left_content.append(Spacer(1, 3))

left_content.append(make_section_header("DOSE, ROUTE & COLD CHAIN", "#8B4513"))
left_content.append(Paragraph("• <b>Route:</b> Oral (NOT injectable)", bullet_style))
left_content.append(Paragraph("• <b>Dose:</b> 1.5 mL (Rotarix) | 2 mL (RotaTeq) | 0.5 mL (ROTAVAC)", bullet_style))
left_content.append(Paragraph("• <b>Storage:</b> 2–8°C | Do NOT freeze | Protected from light", bullet_style))
left_content.append(Paragraph("• <b>First dose:</b> Not before 6 weeks, not after 14 weeks 6 days", bullet_style))
left_content.append(Paragraph("• <b>Min interval:</b> 4 weeks between doses", bullet_style))
left_content.append(Spacer(1, 3))

left_content.append(make_section_header("CONTRAINDICATIONS", "#b30000"))
left_content.append(Paragraph("• Severe Combined Immunodeficiency (SCID) - absolute CI", bullet_style))
left_content.append(Paragraph("• History of intussusception - absolute CI", bullet_style))
left_content.append(Paragraph("• Hypersensitivity/anaphylaxis to any vaccine component", bullet_style))
left_content.append(Paragraph("• Age >8 months for last dose", bullet_style))
left_content.append(Spacer(1, 3))

left_content.append(make_section_header("SPECIAL SITUATIONS", "#2c5f8a"))
left_content.append(Paragraph("• <b>Preterm infants:</b> Vaccinate at chronological age ≥6 weeks if clinically stable", bullet_style))
left_content.append(Paragraph("• <b>Immunocompromised household:</b> Can vaccinate; avoid diaper handling for 4 weeks", bullet_style))
left_content.append(Paragraph("• <b>NICU infants:</b> Vaccinate at discharge or at recommended chronologic age", bullet_style))
left_content.append(Paragraph("• <b>Mild illness:</b> Not a contraindication; can vaccinate", bullet_style))
left_content.append(Paragraph("• <b>Mixed series:</b> If any dose was RV5 or unknown → give total 3 doses", bullet_style))

# Build left column as table
left_table_content = [[item] for item in left_content]
# Actually, render as a flat list in left column, flowchart in right column
left_col = left_content  # list of flowables

# Right column: flowchart image
right_col_content = [
    Spacer(1, 10),
    Image("/home/daytona/workspace/vaccine-notes/rota_flowchart.png",
          width=8.5*cm, height=14*cm, kind='proportional'),
]

# Two column table
two_col = Table(
    [[left_col, right_col_content]],
    colWidths=[(W-3*cm)*0.62, (W-3*cm)*0.38]
)
two_col.setStyle(TableStyle([
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("LEFTPADDING", (0,0), (0,0), 0),
    ("RIGHTPADDING", (0,0), (0,0), 6),
    ("LEFTPADDING", (1,0), (1,0), 4),
    ("RIGHTPADDING", (1,0), (1,0), 0),
]))
page1.append(two_col)
page1.append(Spacer(1, 4))

page1.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#1a3c6e"), spaceAfter=2))
page1.append(Paragraph(
    "Sources: Park's Textbook of Preventive & Social Medicine | Red Book 2021 (AAP) | IAP-ACVIP Recommended Immunization Schedule 2025 | IAP Guidebook on Immunization 2025",
    footer_style
))

page1.append(PageBreak())

# ===== PAGE 2: PNEUMOCOCCAL VACCINE =====
page2 = []

page2.append(Paragraph("PNEUMOCOCCAL VACCINE (PCV / PPV)", title_style))
page2.append(Paragraph("Sources: Park's Preventive Medicine | IAP-ACVIP 2025 Guidelines | IAP Guidebook on Immunization 2025", subtitle_style))
page2.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#6a1a6e"), spaceAfter=4))

# Key banner
kp2_table = Table([[
    Paragraph("IM Conjugate Vaccine (PCV)", ParagraphStyle("kp", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#6a1a6e"), alignment=TA_CENTER)),
    Paragraph("Prevents Pneumonia, Meningitis, Septicemia", ParagraphStyle("kp2", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#1e6e3c"), alignment=TA_CENTER)),
    Paragraph("Schedule: 6w-10w-14w + Booster 15m", ParagraphStyle("kp3", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold", textColor=colors.HexColor("#8B4513"), alignment=TA_CENTER)),
]], colWidths=[(W-3*cm)/3]*3,
style=TableStyle([
    ("BOX", (0,0), (-1,-1), 1, colors.HexColor("#6a1a6e")),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#cccccc")),
    ("BACKGROUND", (0,0), (0,0), colors.HexColor("#f5e8ff")),
    ("BACKGROUND", (1,0), (1,0), colors.HexColor("#e8f5ec")),
    ("BACKGROUND", (2,0), (2,0), colors.HexColor("#fff3e0")),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
]))
page2.append(kp2_table)
page2.append(Spacer(1, 4))

left2 = []

left2.append(make_section_header("PATHOGEN", "#6a1a6e"))
left2.append(Paragraph("• Streptococcus pneumoniae: Gram-positive diplococcus, lancet-shaped", bullet_style))
left2.append(Paragraph("• >90 serotypes; capsular polysaccharide is main virulence factor", bullet_style))
left2.append(Paragraph("• Diseases: Pneumonia, Meningitis, Bacteremia, Otitis media, Sinusitis", bullet_style))
left2.append(Spacer(1, 3))

left2.append(make_section_header("TYPES OF VACCINES", "#1a3c6e"))
pcv_types = [
    ["Vaccine", "Serotypes", "Age Group", "T-cell Response"],
    ["PPV23", "23", ">2 years", "Independent (weak in <2yr)"],
    ["PCV10", "10", "Infants/Children", "Dependent (strong)"],
    ["PCV13", "13", "Infants/Children", "Dependent (strong)"],
    ["PCV14-TT", "14", "6-10-14 weeks", "Dependent (strong)"],
    ["PCV20", "20", ">18 years", "Dependent (adults only)"],
]
left2.append(make_table(pcv_types, header_color="#1a3c6e"))
left2.append(Spacer(1, 3))

left2.append(make_section_header("IAP 2025 SCHEDULE", "#1e6e3c"))
left2.append(Paragraph("<b>Standard 3p+0 schedule (IAP/UIP):</b>", body_style))
left2.append(Paragraph("• PCV1 at 6 weeks | PCV2 at 10 weeks | PCV3 at 14 weeks", bullet_style))
left2.append(Paragraph("• Booster: 15 months of age (IAP recommended)", bullet_style))
left2.append(Paragraph("<b>Alternate 2p+1 schedule (WHO):</b>", body_style))
left2.append(Paragraph("• 2 primary doses in infancy (≥4–8 weeks apart) + 1 booster at 9–15 months", bullet_style))
left2.append(Paragraph("• PCV14-TT (Abbott/Apexxnar): 6-10-14w schedule, no booster currently recommended", bullet_style))
left2.append(Spacer(1, 3))

left2.append(make_section_header("DOSE, ROUTE & COLD CHAIN", "#8B4513"))
left2.append(Paragraph("• <b>Dose:</b> 0.5 mL IM", bullet_style))
left2.append(Paragraph("• <b>Site:</b> Anterolateral thigh (infants) | Deltoid (older children)", bullet_style))
left2.append(Paragraph("• <b>Storage:</b> 2–8°C | NEVER freeze | Discard if frozen", bullet_style))
left2.append(Paragraph("• <b>PPV23:</b> 0.5 mL IM or SC (25 µg per serotype) | Single dose | Adults/splenectomy", bullet_style))
left2.append(Spacer(1, 3))

left2.append(make_section_header("CONTRAINDICATIONS & ADVERSE EFFECTS", "#b30000"))
left2.append(Paragraph("• Anaphylaxis to previous dose or vaccine component - <b>absolute CI</b>", bullet_style))
left2.append(Paragraph("• Revaccination NOT recommended after anaphylaxis", bullet_style))
left2.append(Paragraph("• <b>AEFI:</b> Local pain, redness, swelling in 30–50% | Systemic reactions uncommon", bullet_style))
left2.append(Spacer(1, 3))

left2.append(make_section_header("SPECIAL NOTES (IAP 2025)", "#2c5f8a"))
left2.append(Paragraph("• <b>HIV positive / Preterm:</b> If 3 primary doses before 12m → booster in 2nd year of life", bullet_style))
left2.append(Paragraph("• <b>PPV23 indications:</b> Splenectomy, sickle cell disease, chronic cardiac/pulmonary/renal/hepatic disease, diabetes, malignancy, organ transplant, age >65 yrs", bullet_style))
left2.append(Paragraph("• <b>PCV + PPV23 combo:</b> PCV first, then PPV23 ≥8 weeks later for high-risk adults", bullet_style))
left2.append(Paragraph("• <b>Newer PCVs 2025:</b> Vaximune-13 / Pneumoguard-13 (TT-conjugate, 6-10-14w) | PCV20 for adults >18 yrs only", bullet_style))

# Right column: flowchart
right2 = [
    Spacer(1, 10),
    Image("/home/daytona/workspace/vaccine-notes/pcv_flowchart.png",
          width=8.5*cm, height=14*cm, kind='proportional'),
]

two_col2 = Table(
    [[left2, right2]],
    colWidths=[(W-3*cm)*0.62, (W-3*cm)*0.38]
)
two_col2.setStyle(TableStyle([
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("LEFTPADDING", (0,0), (0,0), 0),
    ("RIGHTPADDING", (0,0), (0,0), 6),
    ("LEFTPADDING", (1,0), (1,0), 4),
    ("RIGHTPADDING", (1,0), (1,0), 0),
]))
page2.append(two_col2)
page2.append(Spacer(1, 4))

page2.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#6a1a6e"), spaceAfter=2))
page2.append(Paragraph(
    "Sources: Park's Textbook of Preventive & Social Medicine | IAP-ACVIP Recommended Immunization Schedule 2025 | IAP Guidebook on Immunization 2025 (5th ed.)",
    footer_style
))

# Build PDF
all_content = page1 + page2
doc.build(all_content)
print("PDF created successfully!")

cd /home/daytona/workspace/vaccine-notes && python create_vaccine_notes.py 2>&1

ls -lh /home/daytona/workspace/vaccine-notes/

rotavirus vaccine strains efficacy ROTAVAC 116E catch-up schedule intussusception IAP 2025

PCV pneumococcal vaccine catch-up schedule special situations HIV preterm IAP 2025 efficacy serotype coverage

~/vaccine-notes/create_vaccine_notes_v2.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT

W, H = A4
doc = SimpleDocTemplate(
    "/home/daytona/workspace/vaccine-notes/Vaccine_Notes_5Mark_v2.pdf",
    pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=1.2*cm, bottomMargin=1.2*cm
)

styles = getSampleStyleSheet()

# ---- Style definitions ----
def S(name, **kw):
    base = kw.pop("parent", styles["Normal"])
    return ParagraphStyle(name, parent=base, **kw)

title_s   = S("T", fontSize=17, textColor=colors.HexColor("#1a3c6e"),
              fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=2, spaceBefore=0)
src_s     = S("Src", fontSize=7.5, textColor=colors.HexColor("#666666"),
              fontName="Helvetica-Oblique", alignment=TA_CENTER, spaceAfter=5)
body_s    = S("B", fontSize=8.5, leading=12.5, spaceAfter=2, fontName="Helvetica")
bull_s    = S("Bl", fontSize=8.5, leading=12, leftIndent=12, spaceAfter=2, fontName="Helvetica")
bold_s    = S("Bo", fontSize=8.5, leading=12, fontName="Helvetica-Bold", spaceAfter=1)
foot_s    = S("F", fontSize=7, textColor=colors.HexColor("#888888"), alignment=TA_CENTER)
key_s     = S("K", fontSize=8.5, fontName="Helvetica-Bold",
              textColor=colors.HexColor("#b30000"), leading=12, spaceAfter=2)

def hdr(text, bg="#1a3c6e", fg="white"):
    return Table(
        [[Paragraph(f"<b>{text}</b>",
                    S("H", fontSize=9, textColor=colors.HexColor(fg),
                      fontName="Helvetica-Bold"))]],
        colWidths=[W - 3*cm],
        style=TableStyle([
            ("BACKGROUND", (0,0),(-1,-1), colors.HexColor(bg)),
            ("TOPPADDING",(0,0),(-1,-1),3), ("BOTTOMPADDING",(0,0),(-1,-1),3),
            ("LEFTPADDING",(0,0),(-1,-1),6),
        ])
    )

def banner(cells, bgs):
    """Top 3-cell banner"""
    col_w = (W-3*cm)/len(cells)
    data = [[Paragraph(f"<b>{c}</b>",
                       S(f"bn{i}", fontSize=8, fontName="Helvetica-Bold",
                         textColor=colors.HexColor("#222222"), alignment=TA_CENTER))
             for i, c in enumerate(cells)]]
    ts = TableStyle([
        ("TOPPADDING",(0,0),(-1,-1),5),("BOTTOMPADDING",(0,0),(-1,-1),5),
        ("GRID",(0,0),(-1,-1),0.5,colors.HexColor("#cccccc")),
        ("BOX",(0,0),(-1,-1),1,colors.HexColor("#555555")),
    ] + [("BACKGROUND",(i,0),(i,0),colors.HexColor(bgs[i])) for i in range(len(cells))])
    return Table(data, colWidths=[col_w]*len(cells), style=ts)

def make_tbl(data, col_widths=None, hdr_bg="#1a3c6e"):
    if col_widths is None:
        col_widths = [(W-3*cm)/len(data[0])]*len(data[0])
    rows = []
    for i, row in enumerate(data):
        rows.append([Paragraph(str(c),
            S(f"tc{i}", fontSize=7.8,
              fontName="Helvetica-Bold" if i==0 else "Helvetica",
              textColor=colors.white if i==0 else colors.HexColor("#222222"),
              alignment=TA_CENTER, leading=11)) for c in row])
    ts = TableStyle([
        ("BACKGROUND",(0,0),(-1,0), colors.HexColor(hdr_bg)),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[colors.HexColor("#f5f8ff"),colors.HexColor("#eaf0ff")]),
        ("GRID",(0,0),(-1,-1),0.4,colors.HexColor("#bbbbbb")),
        ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),3),
        ("LEFTPADDING",(0,0),(-1,-1),4),("RIGHTPADDING",(0,0),(-1,-1),4),
    ])
    return Table(rows, colWidths=col_widths, style=ts)

def sp(n=4): return Spacer(1, n)

# =====================================================================
# PAGE 1 — ROTAVIRUS VACCINE
# =====================================================================
p1 = []

p1.append(Paragraph("ROTAVIRUS VACCINE", title_s))
p1.append(Paragraph("Sources: Park's Preventive & Social Medicine | Red Book 2021 (AAP) | IAP-ACVIP 2025 | Bharat Biotech (ROTAVAC PI)", src_s))
p1.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#1a3c6e"), spaceAfter=5))

p1.append(banner(
    ["🦠 Oral Live Attenuated Vaccine", "🎯 Target: Rotavirus Gastroenteritis", "🇮🇳 Indigenous: ROTAVAC 116E (India)"],
    ["#e3eeff", "#e3ffe8", "#fff7e0"]
))
p1.append(sp(5))

# --- PATHOGEN ---
p1.append(hdr("1. PATHOGEN & EPIDEMIOLOGY", "#1a3c6e"))
p1.append(sp(2))
p1.append(Paragraph("• <b>Virus:</b> Rotavirus — double-stranded RNA (dsRNA) virus, family Reoviridae, non-enveloped, 11 segments", bull_s))
p1.append(Paragraph("• <b>Groups:</b> A, B, C; Group A is responsible for >90% of human disease", bull_s))
p1.append(Paragraph("• <b>Genotypes:</b> Named by G (VP7) and P (VP4) antigens. Common: G1P[8], G2P[4], G3P[8], G4P[8], G9P[8]", bull_s))
p1.append(Paragraph("• <b>Disease:</b> Severe watery diarrhoea + vomiting in infants 6–24 months; leading cause of severe diarrheal deaths <5 yrs globally", bull_s))
p1.append(Paragraph("• <b>Immunity:</b> Natural infection confers partial protection; repeated infections occur but are less severe", bull_s))
p1.append(sp(4))

# --- AVAILABLE VACCINES & STRAINS ---
p1.append(hdr("2. AVAILABLE VACCINES — STRAINS & COMPOSITION", "#1e6e3c"))
p1.append(sp(2))
tbl1 = make_tbl([
    ["Vaccine", "Type", "Strain / Composition", "Origin", "Doses", "Volume", "WHO Prequalified"],
    ["Rotarix (RV1)", "Live oral monovalent", "Human G1P[8] (89-12 strain)", "GSK", "2", "1.5 mL", "2008"],
    ["RotaTeq (RV5)", "Live oral pentavalent", "5 bovine-human reassortants\n(G1,G2,G3,G4 + P[8])", "Merck", "3", "2 mL", "2009"],
    ["ROTAVAC", "Live oral monovalent", "Human 116E strain (G9P[11])\nNeonatal strain, India", "Bharat Biotech", "3", "0.5 mL", "2018"],
    ["ROTAVAC 5D", "Live oral monovalent", "116E strain — liquid formulation", "Bharat Biotech", "3", "0.5 mL", "2021"],
], col_widths=[2.8*cm, 3.2*cm, 4.0*cm, 2.8*cm, 1.0*cm, 1.2*cm, 1.8*cm], hdr_bg="#1e6e3c")
p1.append(tbl1)
p1.append(sp(4))

# --- EFFICACY ---
p1.append(hdr("3. EFFICACY", "#6a3e00"))
p1.append(sp(2))
eff_tbl = make_tbl([
    ["Vaccine", "High-income countries", "Low/middle-income countries", "India-specific"],
    ["Rotarix (RV1)", "85–96% vs severe RVGE", "49–77%", "—"],
    ["RotaTeq (RV5)", "98–100% vs severe RVGE (G1–G4)", "43–64%", "—"],
    ["ROTAVAC (116E)", "No data (LMIC-designed)", "56.4% vs severe RVGE", "56.4% (1st yr); 49% (2nd yr)"],
    ["ROTAVAC 5D", "—", "Non-inferior to ROTAVAC", "Non-inferior (Zambia study)"],
], col_widths=[2.8*cm, 3.8*cm, 4.0*cm, 3.2*cm], hdr_bg="#6a3e00")
p1.append(eff_tbl)
p1.append(Paragraph("  ★ Efficacy against any severity RVGE: 74–87% (RV1/RV5) | Protection persists into 2nd year of life", bull_s))
p1.append(sp(4))

# --- IAP 2025 SCHEDULE ---
p1.append(hdr("4. IAP-ACVIP 2025 SCHEDULE", "#6a1a6e"))
p1.append(sp(2))
sched = make_tbl([
    ["Vaccine", "Dose 1", "Dose 2", "Dose 3", "Min 1st dose age", "Max 1st dose", "Min interval", "Max last dose"],
    ["Rotarix (RV1)", "6 weeks", "10 weeks", "—", "6 weeks", "14w 6d", "4 weeks", "8 months"],
    ["RotaTeq (RV5)", "6 weeks", "10 weeks", "14 weeks", "6 weeks", "14w 6d", "4 weeks", "8 months"],
    ["ROTAVAC / 5D", "6 weeks", "10 weeks", "14 weeks", "6 weeks", "14w 6d", "4 weeks", "8 months"],
], col_widths=[2.6*cm, 1.4*cm, 1.4*cm, 1.4*cm, 2.2*cm, 1.8*cm, 1.8*cm, 1.8*cm], hdr_bg="#6a1a6e")
p1.append(sched)
p1.append(Paragraph("  ★ UIP India provides ROTAVAC free at 6, 10, 14 weeks. ROTAVAC 5D booster trial data submitted to DCGI (Oct 2025) — booster NOT yet recommended", bull_s))
p1.append(sp(4))

# --- CATCH-UP ---
p1.append(hdr("5. CATCH-UP VACCINATION", "#8B4513"))
p1.append(sp(2))
p1.append(Paragraph("• Rotavirus vaccine is <b>NOT recommended for catch-up</b> if the child is beyond 8 months of age — risk of intussusception rises significantly after 12 weeks with first dose", bull_s))
p1.append(Paragraph("• <b>Maximum age for first dose:</b> 14 weeks 6 days; <b>Maximum age for any dose:</b> 8 months 0 days", bull_s))
p1.append(Paragraph("• If an infant had rotavirus gastroenteritis before completing the series → <b>continue</b> the remaining doses as per standard schedule", bull_s))
p1.append(Paragraph("• If product used for prior dose is unavailable/unknown → continue with available product; if any RV5 dose was given → complete with 3 doses total", bull_s))
p1.append(sp(4))

# --- CONTRAINDICATIONS + SPECIAL ---
# Two sub-columns for CI and Special Situations
ci_content = [
    hdr("6. CONTRAINDICATIONS", "#b30000"),
    sp(2),
    Paragraph("<b>Absolute:</b>", bold_s),
    Paragraph("• SCID (Severe Combined Immunodeficiency) — live virus can cause severe prolonged gastroenteritis", bull_s),
    Paragraph("• History of intussusception", bull_s),
    Paragraph("• Hypersensitivity/anaphylaxis to any vaccine component", bull_s),
    Paragraph("• Age >8 months (last dose)", bull_s),
    Paragraph("• Latex allergy (anaphylactic) → avoid RV1 (tip cap has latex) — use RV5 instead", bull_s),
    sp(2),
    Paragraph("<b>Precautions:</b>", bold_s),
    Paragraph("• Altered immunocompetence other than SCID — consult expert", bull_s),
    Paragraph("• Acute severe gastroenteritis — defer", bull_s),
    Paragraph("• Maternal biologic response modifiers (BRMs) in utero — avoid RV vaccine for first 12 months (exceptions: certolizumab, possibly infliximab)", bull_s),
]

sp_content = [
    hdr("7. SPECIAL SITUATIONS", "#2c5f8a"),
    sp(2),
    Paragraph("<b>Preterm infants:</b>", bold_s),
    Paragraph("• Vaccinate at chronological age ≥6 weeks if clinically stable", bull_s),
    Paragraph("• Same schedule as term infants; first dose at NICU discharge if eligible", bull_s),
    sp(2),
    Paragraph("<b>HIV-exposed / HIV-infected infants:</b>", bold_s),
    Paragraph("• Administer RV vaccine irrespective of CD4 count/% — same schedule as uninfected", bull_s),
    sp(2),
    Paragraph("<b>Immunocompromised household contacts:</b>", bold_s),
    Paragraph("• Can vaccinate the infant; immunocompromised persons should avoid diaper handling for 4 weeks post-vaccination", bull_s),
    sp(2),
    Paragraph("<b>Breastfed infants:</b>", bold_s),
    Paragraph("• Vaccinate on same schedule — breastfeeding does NOT reduce vaccine efficacy", bull_s),
    sp(2),
    Paragraph("<b>Spitting/regurgitation during dose:</b>", bold_s),
    Paragraph("• Do NOT repeat the dose", bull_s),
    sp(2),
    Paragraph("<b>Blood products / antibodies:</b>", bold_s),
    Paragraph("• Can give before, during, or after blood products — no interaction", bull_s),
]

two_col = Table(
    [[ci_content, sp_content]],
    colWidths=[(W-3*cm)*0.5, (W-3*cm)*0.5]
)
two_col.setStyle(TableStyle([
    ("VALIGN",(0,0),(-1,-1),"TOP"),
    ("LEFTPADDING",(0,0),(0,0),0), ("RIGHTPADDING",(0,0),(0,0),5),
    ("LEFTPADDING",(1,0),(1,0),5), ("RIGHTPADDING",(1,0),(1,0),0),
]))
p1.append(two_col)
p1.append(sp(4))

# --- COLD CHAIN + AEFI ---
p1.append(hdr("8. COLD CHAIN, AEFI & KEY EXAM POINTS", "#444444"))
p1.append(sp(2))
aefi_tbl = make_tbl([
    ["Parameter", "Detail"],
    ["Storage temperature", "2–8°C | Do NOT freeze | Discard if frozen"],
    ["Route", "Oral (NOT injectable)"],
    ["Co-administration", "Can give with all other childhood vaccines simultaneously"],
    ["AEFI", "Generally mild — low-grade fever, mild diarrhoea, vomiting; intussusception risk very small (~1–2 per 100,000 first doses) — benefit far outweighs risk"],
    ["Serotype breadth", "All 4 WHO-prequalified vaccines provide broad cross-protection beyond their included genotypes"],
    ["Shedding", "Vaccine virus shed in stool for several weeks post-vaccination; transmission risk in household is very low"],
], col_widths=[3.5*cm, (W-3*cm)-3.5*cm], hdr_bg="#444444")
p1.append(aefi_tbl)
p1.append(sp(5))

p1.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#1a3c6e"), spaceAfter=2))
p1.append(Paragraph(
    "Sources: Park's Preventive & Social Medicine (23rd ed.) | Red Book 2021 (AAP) | IAP-ACVIP Recommended Immunization Schedule 2025 | ROTAVAC Prescribing Information (Bharat Biotech) | WHO Rotavirus Vaccine Position Paper 2013",
    foot_s
))

p1.append(PageBreak())

# =====================================================================
# PAGE 2 — PNEUMOCOCCAL VACCINE
# =====================================================================
p2 = []

p2.append(Paragraph("PNEUMOCOCCAL VACCINE (PCV / PPV23)", title_s))
p2.append(Paragraph("Sources: Park's Preventive & Social Medicine | IAP-ACVIP 2025 | IAP Guidebook on Immunization 2025 (5th ed.) | Red Book 2021", src_s))
p2.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#6a1a6e"), spaceAfter=5))

p2.append(banner(
    ["💉 Conjugate Vaccine (PCV) — IM injection", "🦠 Target: Streptococcus pneumoniae", "📋 IAP 2025: 6w-10w-14w + Booster 15m"],
    ["#f5e8ff", "#e3ffe8", "#fff7e0"]
))
p2.append(sp(5))

# --- PATHOGEN ---
p2.append(hdr("1. PATHOGEN & EPIDEMIOLOGY", "#6a1a6e"))
p2.append(sp(2))
p2.append(Paragraph("• <b>Organism:</b> Streptococcus pneumoniae — Gram-positive, alpha-haemolytic, lancet-shaped diplococcus; bile-soluble, optochin-sensitive", bull_s))
p2.append(Paragraph("• <b>Serotypes:</b> >90 capsular serotypes; ~23 cause >85% of invasive disease; serotypes differ by geography and age group", bull_s))
p2.append(Paragraph("• <b>Virulence:</b> Polysaccharide capsule — anti-phagocytic; main target of vaccine immunity", bull_s))
p2.append(Paragraph("• <b>Diseases caused:</b> Pneumonia (most common), Bacteraemia, Meningitis, Otitis media, Sinusitis, Peritonitis", bull_s))
p2.append(Paragraph("• <b>At-risk:</b> Infants <2 yrs, elderly >65 yrs, asplenic, HIV+, immunocompromised, chronic disease patients", bull_s))
p2.append(sp(4))

# --- TYPES ---
p2.append(hdr("2. TYPES OF VACCINES — STRAINS & COMPOSITION", "#1a3c6e"))
p2.append(sp(2))
pcv_types = make_tbl([
    ["Vaccine", "Serotypes Covered", "Conjugated to", "Age Group", "T-cell Response", "India Availability"],
    ["PPV23\n(Pneumovax 23)", "1,2,3,4,5,6B,7F,8,9N,9V,10A,\n11A,12F,14,15B,17F,18C,\n19A,19F,20,22F,23F,33F",
     "None (polysaccharide only)", ">2 years", "T-independent\n(poor <2yrs)", "Yes"],
    ["PCV10\n(Synflorix)", "1,4,5,6B,7F,9V,14,18C,19F,23F", "Protein D, TT, DT", "Infants/Children", "T-dependent", "Limited"],
    ["PCV13\n(Prevenar 13)", "PCV10 + 3,6A,19A", "CRM197", "Infants/Children", "T-dependent", "Yes"],
    ["PCV14-TT\n(Apexxnar/Abbott)", "1,3,4,5,6B,7F,9V,14,18C,19A,\n19F,22F,23F,33F", "Tetanus Toxoid", "6-10-14 weeks\n(primary only)", "T-dependent", "Yes (2025)"],
    ["Vaximune-13 /\nPneumoguard-13", "1,3,4,6A,6B,7F,9V,18C,19A,19F,23F\n(13-valent TT)", "Tetanus Toxoid", "6-10-14 weeks\n(primary only)", "T-dependent", "Yes (2025)"],
    ["PCV20\n(Prevnar 20)", "PCV13 + 8,10A,11A,12F,15B", "CRM197", ">18 years only\n(India 2025)", "T-dependent", "Yes (adults)"],
], col_widths=[2.4*cm, 4.5*cm, 2.2*cm, 2.0*cm, 1.8*cm, 2.0*cm], hdr_bg="#1a3c6e")
p2.append(pcv_types)
p2.append(sp(4))

# --- EFFICACY ---
p2.append(hdr("3. EFFICACY", "#1e6e3c"))
p2.append(sp(2))
eff2 = make_tbl([
    ["Vaccine", "Efficacy Against Invasive Pneumococcal Disease (IPD)", "Otitis Media", "Nasopharyngeal Carriage"],
    ["PCV13", ">90% against vaccine-serotype IPD in children", "Moderate reduction", "Significant reduction — herd immunity"],
    ["PCV10", ">80% against vaccine-serotype IPD", "Moderate reduction", "Some reduction"],
    ["PPV23", "60–70% against IPD in adults; INEFFECTIVE <2 yrs", "Not effective", "No significant effect"],
    ["Newer PCVs (14-TT)", "Non-inferior to PCV13 for shared serotypes (IAP 2025)", "—", "—"],
], col_widths=[2.8*cm, 5.5*cm, 2.2*cm, 3.3*cm], hdr_bg="#1e6e3c")
p2.append(eff2)
p2.append(Paragraph("  ★ Herd immunity effect of PCV reduces carriage in unvaccinated household contacts — indirect protection to elders", bull_s))
p2.append(sp(4))

# --- IAP 2025 SCHEDULE ---
p2.append(hdr("4. IAP-ACVIP 2025 SCHEDULE (India)", "#6a1a6e"))
p2.append(sp(2))
sched2 = make_tbl([
    ["Schedule Type", "Primary Doses", "Booster", "Notes"],
    ["3p+0 (IAP / UIP Standard)", "6w, 10w, 14w", "15 months (IAP recommended)", "Preferred by IAP for India; UIP provides PCV free at govt centres"],
    ["2p+1 (WHO alternate)", "6w + 14w (≥8 weeks apart)", "Booster at 9–15 months", "Min interval 4-8 weeks primary; booster at 9-15m"],
    ["PCV14-TT / Vaximune-13", "6w, 10w, 14w", "NOT recommended (2025)", "Booster trials pending DCGI approval as of 2025"],
    ["PCV20", "Single dose (adults)", "Not applicable", "Only for >18 yrs in India 2025"],
], col_widths=[3.5*cm, 3.5*cm, 3.0*cm, (W-3*cm)-10.0*cm], hdr_bg="#6a1a6e")
p2.append(sched2)
p2.append(sp(4))

# --- CATCH-UP + SPECIAL ---
catch_content = [
    hdr("5. CATCH-UP VACCINATION", "#8B4513"),
    sp(2),
    Paragraph("<b>Age <12 months unvaccinated:</b>", bold_s),
    Paragraph("• 3 doses with ≥4 week intervals; booster at 12–15m", bull_s),
    sp(1),
    Paragraph("<b>Age 12–24 months unvaccinated:</b>", bold_s),
    Paragraph("• 2 doses ≥8 weeks apart", bull_s),
    sp(1),
    Paragraph("<b>Age 2–5 years unvaccinated (healthy):</b>", bold_s),
    Paragraph("• 1 dose PCV13 only", bull_s),
    sp(1),
    Paragraph("<b>Age 2–5 years with risk factors:</b>", bold_s),
    Paragraph("• 2 doses PCV13 ≥8 weeks apart, then PPV23 ≥8 weeks later", bull_s),
    sp(1),
    Paragraph("<b>Interrupted schedule:</b>", bold_s),
    Paragraph("• Resume without repeating; do NOT restart series", bull_s),
    sp(1),
    Paragraph("<b>Interchangeability:</b>", bold_s),
    Paragraph("• PCV10 ↔ PCV13: not documented; complete with same product when possible", bull_s),
    Paragraph("• PCV13 → PCV14-TT: newer TT-conjugate PCVs may complete series", bull_s),
]

sp2_content = [
    hdr("6. SPECIAL SITUATIONS", "#2c5f8a"),
    sp(2),
    Paragraph("<b>HIV-positive children:</b>", bold_s),
    Paragraph("• Give extra booster in 2nd year of life if 3 primary doses completed before 12 months", bull_s),
    Paragraph("• PPV23 at 2 yrs + repeat 5 yrs later", bull_s),
    sp(1),
    Paragraph("<b>Preterm infants:</b>", bold_s),
    Paragraph("• 3 primary doses before 12m → booster in 2nd year", bull_s),
    sp(1),
    Paragraph("<b>Asplenia / sickle cell disease:</b>", bold_s),
    Paragraph("• PCV13 + PPV23 (≥8 wks after PCV); revaccinate with PPV23 every 5 years", bull_s),
    sp(1),
    Paragraph("<b>Cochlear implant / CSF leak:</b>", bold_s),
    Paragraph("• Same as asplenia regimen — both PCV + PPV23", bull_s),
    sp(1),
    Paragraph("<b>Chronic illness</b> (cardiac, pulmonary, renal, hepatic, DM, alcoholism, malignancy, transplant):", bold_s),
    Paragraph("• PPV23 single dose; repeat once after 5 years if <65 yrs at first dose", bull_s),
    sp(1),
    Paragraph("<b>Elderly >65 years:</b>", bold_s),
    Paragraph("• PPV23 single dose routinely; PCV13 then PPV23 in high-risk individuals", bull_s),
    sp(1),
    Paragraph("<b>DMARD / immunosuppressants:</b>", bold_s),
    Paragraph("• Give PCV before starting immunosuppressants if possible; reduced immunogenicity on therapy", bull_s),
]

two_col2 = Table(
    [[catch_content, sp2_content]],
    colWidths=[(W-3*cm)*0.50, (W-3*cm)*0.50]
)
two_col2.setStyle(TableStyle([
    ("VALIGN",(0,0),(-1,-1),"TOP"),
    ("LEFTPADDING",(0,0),(0,0),0),("RIGHTPADDING",(0,0),(0,0),5),
    ("LEFTPADDING",(1,0),(1,0),5),("RIGHTPADDING",(1,0),(1,0),0),
]))
p2.append(two_col2)
p2.append(sp(4))

# --- COLD CHAIN + CI + AEFI ---
p2.append(hdr("7. DOSE / ROUTE / COLD CHAIN / CI / AEFI", "#444444"))
p2.append(sp(2))
final_tbl = make_tbl([
    ["Parameter", "Detail"],
    ["Dose", "0.5 mL (all PCVs and PPV23)"],
    ["Route", "IM (PCV) | IM or SC (PPV23)"],
    ["Site", "Anterolateral thigh (infants) | Deltoid (older children/adults)"],
    ["Storage", "2–8°C | DO NOT freeze | Discard if frozen — preservative-free"],
    ["Absolute CI", "Anaphylaxis to previous dose or any vaccine component; revaccination NOT recommended after anaphylaxis"],
    ["AEFI", "Local: Erythema, tenderness, swelling (30–50%); more common with 2nd dose of PPV23 and with SC route | Systemic: Rare"],
    ["Co-administration", "Can give simultaneously with other vaccines at different sites"],
    ["PPV23 note", "Do NOT mix in same syringe with influenza vaccine; give separately in opposite arm"],
], col_widths=[3.5*cm, (W-3*cm)-3.5*cm], hdr_bg="#444444")
p2.append(final_tbl)
p2.append(sp(4))

p2.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#6a1a6e"), spaceAfter=2))
p2.append(Paragraph(
    "Sources: Park's Preventive & Social Medicine (23rd ed.) | IAP-ACVIP Recommended Immunization Schedule 2025 | IAP Guidebook on Immunization 2025 (5th ed., Jaypee) | Red Book 2021 (AAP)",
    foot_s
))

# =====================================================================
# BUILD PDF
# =====================================================================
doc.build(p1 + p2)
print("PDF v2 created successfully!")

cd /home/daytona/workspace/vaccine-notes && python create_vaccine_notes_v2.py 2>…

~/vaccine-notes/create_vaccine_notes_v2.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/vaccine-notes/create_vaccine_notes_v2.py'

cd /home/daytona/workspace/vaccine-notes && python create_vaccine_notes_v2.py 2>…

ls -lh /home/daytona/workspace/vaccine-notes/Vaccine_Notes_5Mark_v2.pdf

India UIP national immunization schedule 2025 rotavirus PCV doses ages free government

~/vaccine-notes/create_v3.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT

W, H = A4
CONTENT_W = W - 2.8*cm

doc = SimpleDocTemplate(
    "/home/daytona/workspace/vaccine-notes/Vaccine_Notes_5Mark_v3.pdf",
    pagesize=A4,
    leftMargin=1.4*cm, rightMargin=1.4*cm,
    topMargin=1.0*cm, bottomMargin=1.0*cm
)

styles = getSampleStyleSheet()

def S(name, **kw):
    base = kw.pop("parent", styles["Normal"])
    return ParagraphStyle(name, parent=base, **kw)

title_s = S("T",  fontSize=16, textColor=colors.HexColor("#0d2b6b"),
             fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=1, spaceBefore=0)
src_s   = S("Src", fontSize=7, textColor=colors.HexColor("#666666"),
             fontName="Helvetica-Oblique", alignment=TA_CENTER, spaceAfter=4)
foot_s  = S("F",  fontSize=6.8, textColor=colors.HexColor("#888888"), alignment=TA_CENTER)
sp2     = lambda n=4: Spacer(1, n)

# ── cell text helpers ──────────────────────────────────────────────
def C(txt, bold=False, size=7.8, color="#111111", align=TA_LEFT, wrap=True):
    fn = "Helvetica-Bold" if bold else "Helvetica"
    return Paragraph(str(txt),
        S(f"c{txt[:6]}", fontSize=size, fontName=fn,
          textColor=colors.HexColor(color),
          leading=11, alignment=align))

def CH(txt, size=8, color="#ffffff"):          # header cell
    return C(txt, bold=True, size=size, color=color, align=TA_CENTER)

# ── section title bar ──────────────────────────────────────────────
def sec(text, bg="#0d2b6b"):
    return Table([[Paragraph(f"<b>  {text}</b>",
                  S("sh", fontSize=9, textColor=colors.white,
                    fontName="Helvetica-Bold", leading=12))]],
                 colWidths=[CONTENT_W],
                 style=TableStyle([
                     ("BACKGROUND",(0,0),(-1,-1), colors.HexColor(bg)),
                     ("TOPPADDING",(0,0),(-1,-1),3),
                     ("BOTTOMPADDING",(0,0),(-1,-1),3),
                 ]))

# ── generic master table builder ──────────────────────────────────
def master_table(rows, col_widths, hdr_bg="#0d2b6b",
                 alt1="#f0f4ff", alt2="#e4eeff",
                 span_col0=True):
    """
    rows: list of lists; first row = header.
    If a cell is a tuple (text, span_end), spans columns [col, span_end].
    """
    tbl_data = []
    for ri, row in enumerate(rows):
        tbl_row = []
        for ci, cell in enumerate(row):
            if ri == 0:
                tbl_row.append(CH(cell))
            else:
                # left col (parameter name) bold
                if ci == 0:
                    tbl_row.append(C(cell, bold=True, size=7.8))
                else:
                    tbl_row.append(C(cell, size=7.8))
        tbl_data.append(tbl_row)

    style_cmds = [
        ("BACKGROUND",  (0,0), (-1,0),  colors.HexColor(hdr_bg)),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[colors.HexColor(alt1), colors.HexColor(alt2)]),
        ("GRID",        (0,0), (-1,-1), 0.35, colors.HexColor("#bbbbbb")),
        ("TOPPADDING",  (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0),(-1,-1), 3),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
        ("RIGHTPADDING",(0,0), (-1,-1), 4),
        ("VALIGN",      (0,0), (-1,-1), "TOP"),
    ]
    return Table(tbl_data, colWidths=col_widths,
                 style=TableStyle(style_cmds), repeatRows=1)


# ── top banner strip ───────────────────────────────────────────────
def top_banner(items, bgs):
    n = len(items)
    cw = CONTENT_W / n
    data = [[Paragraph(f"<b>{t}</b>",
                       S(f"bn{i}", fontSize=7.8, fontName="Helvetica-Bold",
                         textColor=colors.HexColor("#111111"),
                         alignment=TA_CENTER)) for i, t in enumerate(items)]]
    ts = TableStyle(
        [("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
         ("GRID",(0,0),(-1,-1),0.5,colors.HexColor("#aaaaaa")),
         ("BOX",(0,0),(-1,-1),1,colors.HexColor("#555555"))] +
        [("BACKGROUND",(i,0),(i,0),colors.HexColor(bgs[i])) for i in range(n)]
    )
    return Table(data, colWidths=[cw]*n, style=ts)


# ═══════════════════════════════════════════════════════════════════
#  PAGE 1 — ROTAVIRUS VACCINE
# ═══════════════════════════════════════════════════════════════════
P1 = []

P1.append(Paragraph("ROTAVIRUS VACCINE", title_s))
P1.append(Paragraph(
    "Park's Preventive Medicine  |  Red Book 2021 (AAP)  |  IAP-ACVIP 2025  |  NIS India  |  ROTAVAC Prescribing Info",
    src_s))
P1.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#0d2b6b"), spaceAfter=4))
P1.append(top_banner(
    ["Oral Live Attenuated Vaccine", "dsRNA Virus — Group A commonest", "No Catch-up after 8 months"],
    ["#dce8ff","#d9f5e5","#fff4dc"]
))
P1.append(sp2(5))

# ── MASTER TABLE ───────────────────────────────────────────────────
P1.append(sec("MASTER REFERENCE TABLE — ROTAVIRUS VACCINE", "#0d2b6b"))
P1.append(sp2(2))

L = CONTENT_W
c0 = 3.4*cm          # parameter
c1 = 3.2*cm          # RV1 Rotarix
c2 = 3.2*cm          # RV5 RotaTeq
c3 = 3.0*cm          # ROTAVAC / 5D
c4 = L-c0-c1-c2-c3   # NIS / UIP India

master_rota = master_table([
    # HEADER
    ["Parameter", "RV1 — Rotarix (GSK)", "RV5 — RotaTeq (Merck)", "ROTAVAC / ROTAVAC 5D\n(Bharat Biotech)", "NIS India (UIP / Govt)"],

    # PATHOGEN block
    ["PATHOGEN",
     "Rotavirus: dsRNA, Reoviridae, non-enveloped, 11 gene segments; Group A → >90% human disease; genotypes G/P",
     "← Same pathogen →",
     "← Same pathogen →",
     "Target disease: Rotavirus gastroenteritis — #1 cause of severe diarrheal deaths in <5 yr globally"],

    ["Strain / Composition",
     "Monovalent — human G1P[8] attenuated (89-12 strain)",
     "Pentavalent — 5 bovine-human reassortants: G1, G2, G3, G4 + P[8]",
     "Monovalent — human neonatal 116E strain (G9P[11]); indigenously developed in India;\n5D = liquid formulation",
     "ROTAVAC (116E) used in UIP;\nROTAVAC 5D (liquid) — same strain, easier logistics"],

    ["Vaccine type", "Live attenuated oral vaccine", "Live attenuated oral vaccine",
     "Live attenuated oral vaccine", "Live attenuated oral vaccine"],

    ["Dose (volume)", "1.5 mL", "2 mL", "0.5 mL", "5 drops (ROTAVAC in UIP)"],

    ["Route", "Oral", "Oral", "Oral", "Oral"],

    # SCHEDULE block
    ["Number of doses", "2 doses", "3 doses", "3 doses",
     "3 doses (ROTAVAC)\nNIS: 6w, 10w, 14w"],

    ["IAP 2025 schedule",
     "Dose 1: 6 weeks\nDose 2: 10 weeks",
     "Dose 1: 6 weeks\nDose 2: 10 weeks\nDose 3: 14 weeks",
     "Dose 1: 6 weeks\nDose 2: 10 weeks\nDose 3: 14 weeks",
     "NIS (UIP India):\nRVV-1: 6 weeks\nRVV-2: 10 weeks\nRVV-3: 14 weeks\n(all free at govt centres)"],

    ["Min age — 1st dose", "6 completed weeks", "6 completed weeks",
     "6 completed weeks", "6 completed weeks"],

    ["Max age — 1st dose", "14 weeks 6 days\n(do NOT start after this)", "14 weeks 6 days",
     "14 weeks 6 days", "14 weeks 6 days"],

    ["Min interval between doses", "4 weeks", "4 weeks",
     "4 weeks", "4 weeks"],

    ["Max age — last dose", "8 months 0 days", "8 months 0 days",
     "8 months 0 days", "8 months 0 days"],

    ["Booster / Catch-up",
     "NO booster recommended;\nCatch-up NOT allowed after 8 months",
     "NO booster recommended;\nCatch-up NOT allowed after 8 months",
     "Booster trial data submitted to DCGI (Oct 2025);\nbooster NOT yet approved/recommended",
     "No booster in NIS;\nCatch-up not given in UIP beyond 8 months"],

    # EFFICACY block
    ["Efficacy — high income",
     "85–96% vs severe RVGE;\n74–87% vs any RVGE",
     "98–100% vs severe G1–G4 RVGE;\n~74% vs any RVGE",
     "No data (designed for LMIC)", "—"],

    ["Efficacy — LMIC / India",
     "49–77% vs severe RVGE",
     "43–64% vs severe RVGE",
     "56.4% vs severe RVGE (Year 1, India RCT);\n49% (Year 2) — protection persists",
     "Programme effectiveness data ongoing;\nproxy: ROTAVAC efficacy data"],

    ["Cross-protection",
     "Broad — protects G1-G4, G9, G12 beyond vaccine strain",
     "Broad — G1-G4+P[8]; cross-protection vs G9, G12",
     "Broad — 116E (G9P[11]) induces heterotypic immunity",
     "Cross-protective — covers diverse circulating strains in India"],

    # CONTRAINDICATIONS block
    ["Absolute contraindications",
     "SCID; History of intussusception; Anaphylaxis to vaccine component;\nLatex allergy (tip cap has latex) → use RV5 instead",
     "SCID; History of intussusception;\nAnaphylaxis to vaccine component",
     "SCID; History of intussusception;\nAnaphylaxis to vaccine component",
     "SCID; History of intussusception;\nStrict max age 8 months for last dose"],

    ["Precautions",
     "Altered immunocompetence (non-SCID) — consult expert;\nSevere acute gastroenteritis — defer;\nIn utero BRM exposure — avoid for first 12 months (exceptions: certolizumab, infliximab)",
     "← Same precautions →",
     "No safety/efficacy data in immunocompromised; consult expert",
     "Defer in acute severe illness"],

    # SPECIAL SITUATIONS block
    ["Preterm infants",
     "Vaccinate at chronological age ≥6 weeks if clinically stable; first dose at NICU discharge",
     "← Same →",
     "← Same →",
     "Vaccinate at ≥6 weeks chronological age — same NIS schedule"],

    ["HIV-exposed / infected",
     "Administer irrespective of CD4 count — same schedule as uninfected (Red Book / IAP 2025)",
     "← Same →",
     "No specific data; IAP 2025 recommends following standard schedule",
     "HIV-exposed infants receive RVV on standard NIS schedule"],

    ["Immunocompromised household",
     "Vaccinate infant;\nImmunocompromised person avoids diaper for 4 weeks post-vaccination",
     "← Same →", "← Same →",
     "Vaccinate the infant as per schedule"],

    ["If dose spat/regurgitated", "Do NOT repeat dose", "Do NOT repeat dose", "Do NOT repeat dose", "Do NOT repeat dose"],

    ["Blood products / Ig",
     "Can give before, during, or after blood products — no interaction",
     "← Same →", "← Same →", "← Same →"],

    ["Breastfeeding",
     "Vaccinate on same schedule — breastfeeding does NOT reduce efficacy",
     "← Same →", "← Same →", "← Same →"],

    ["Mixed/unknown series",
     "If any dose was RV5 or unknown → complete with 3 doses total",
     "If any dose was RV5 → use 3 doses total",
     "Complete with same product where possible",
     "Complete with available ROTAVAC doses"],

    # COLD CHAIN / AEFI
    ["Storage / Cold chain",
     "2–8°C | Do NOT freeze | Protect from light",
     "2–8°C | Do NOT freeze | Protect from light",
     "2–8°C | Do NOT freeze | Lyophilised (ROTAVAC); Liquid (5D)",
     "Maintained via UIP cold chain; discard if frozen"],

    ["AEFI",
     "Mild: low-grade fever, loose stools, vomiting (transient);\nIntussusception risk: ~1–2/100,000 first doses (post-marketing, not seen in trials); benefit >> risk",
     "← Same → | No increase in intussusception in pre-licensure trials",
     "No significant increase in intussusception in India trials",
     "AEFI reporting via AEFI surveillance under UIP"],

    ["Co-administration",
     "With all routine vaccines simultaneously (OPV, DPT, IPV, Hib, PCV)",
     "← Same →", "← Same →", "Given alongside Pentavalent, fIPV, PCV at same visit"],

    ["WHO prequalification", "Yes — 2008", "Yes — 2009", "Yes — 2018 (ROTAVAC); 2021 (5D)", "UIP uses WHO PQ vaccines"],

], col_widths=[c0, c1, c2, c3, c4], hdr_bg="#0d2b6b")

P1.append(master_rota)
P1.append(sp2(4))
P1.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#0d2b6b"), spaceAfter=2))
P1.append(Paragraph(
    "Sources: Park's Preventive & Social Medicine (23rd ed.)  |  Red Book 2021 (AAP)  |  IAP-ACVIP Recommended Immunization Schedule 2025  |  "
    "NIS India (MoHFW / Co-WIN)  |  ROTAVAC PI (Bharat Biotech)  |  WHO Rotavirus Vaccine Position Paper",
    foot_s))
P1.append(PageBreak())


# ═══════════════════════════════════════════════════════════════════
#  PAGE 2 — PNEUMOCOCCAL VACCINE
# ═══════════════════════════════════════════════════════════════════
P2 = []

P2.append(Paragraph("PNEUMOCOCCAL VACCINE (PCV / PPV23)", title_s))
P2.append(Paragraph(
    "Park's Preventive Medicine  |  IAP-ACVIP 2025  |  IAP Guidebook on Immunization 2025 (5th ed.)  |  Red Book 2021  |  NIS India",
    src_s))
P2.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#5a0070"), spaceAfter=4))
P2.append(top_banner(
    ["Conjugate (PCV) — IM injection", "Target: S. pneumoniae >90 serotypes", "NIS India: 6w–14w + Booster 9-12m"],
    ["#f3e5ff","#d9f5e5","#fff4dc"]
))
P2.append(sp2(5))

P2.append(sec("MASTER REFERENCE TABLE — PNEUMOCOCCAL VACCINE", "#5a0070"))
P2.append(sp2(2))

c0p = 3.4*cm
c1p = 3.0*cm   # PCV13
c2p = 3.0*cm   # PPV23
c3p = 3.0*cm   # Newer PCVs 2025
c4p = CONTENT_W - c0p - c1p - c2p - c3p  # NIS / UIP

master_pcv = master_table([
    # HEADER
    ["Parameter", "PCV13 — Prevenar 13\n(Pfizer/Wyeth)", "PPV23 — Pneumovax 23\n(Polysaccharide)", "Newer PCVs 2025\n(PCV14-TT / Vaximune-13 / PCV20)", "NIS India (UIP / Govt)"],

    # PATHOGEN
    ["PATHOGEN",
     "S. pneumoniae — Gram+ve lancet-shaped diplococcus; >90 capsular serotypes; alpha-haemolytic, bile-soluble, optochin-sensitive",
     "← Same pathogen →",
     "← Same pathogen →",
     "Target: IPD (pneumonia, meningitis, bacteraemia) + otitis media"],

    ["Diseases prevented",
     "Invasive pneumococcal disease (IPD): Pneumonia, Meningitis, Bacteraemia; Otitis media; Sinusitis",
     "IPD in adults/asplenic patients; does NOT prevent otitis media",
     "IPD — broader serotype coverage than PCV13",
     "Pneumococcal pneumonia + meningitis in infants"],

    ["Virulence / immunity basis",
     "Polysaccharide capsule = anti-phagocytic virulence factor;\nConjugation to CRM197 → T-cell dependent immunity → immunogenic in <2 yrs",
     "Polysaccharide only → T-cell independent → poor response in <2 yrs;\nNo booster response",
     "Conjugated to Tetanus Toxoid (TT) → T-dependent;\nBetter immunogenicity in infants",
     "PCV13 (Prevenar) used in UIP India"],

    # COMPOSITION
    ["Serotypes covered",
     "1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F\n(13 serotypes conjugated to CRM197)",
     "23 serotypes:\n1,2,3,4,5,6B,7F,8,9N,9V,10A,11A,12F,14,15B,17F,18C,19A,19F,20,22F,23F,33F\n(25 µg each/0.5 mL)",
     "PCV14-TT (Abbott/Apexxnar): 1,3,4,5,6B,7F,9V,14,18C,19A,19F,22F,23F,33F;\nVaximune-13/Pneumoguard-13: 13-valent TT-conjugate;\nPCV20: PCV13 + 8,10A,11A,12F,15B",
     "PCV13 (Prevenar 13) used;\ncoverage: 13 key serotypes"],

    ["% disease burden covered",
     "~70–80% of paediatric IPD serotypes covered in India",
     ">85% of adult IPD serotypes covered",
     "PCV14 adds 22F, 33F — ~5% additional serotype coverage over PCV13",
     "~70–80% IPD in Indian infants"],

    # SCHEDULE
    ["IAP 2025 schedule",
     "3p+0: 6w, 10w, 14w + Booster at 15 months (IAP preferred)\nOR 2p+1: 6w + 14w + booster at 9–15m",
     "Single dose IM or SC;\nFor adults >2 yrs, splenectomy, elderly >65 yrs",
     "PCV14-TT/Vaximune-13: 6w-10w-14w primary;\nBooster NOT yet recommended (pending DCGI 2025);\nPCV20: Single dose — adults >18 yrs only (India)",
     "NIS (UIP):\nPCV-1: 6 weeks\nPCV-2: 14 weeks\nPCV Booster: 9–12 months\n(3-dose 2p+1 schedule in UIP)"],

    ["Dose (volume)",
     "0.5 mL", "0.5 mL", "0.5 mL (all newer PCVs)", "0.5 mL"],

    ["Route",
     "IM only", "IM preferred; SC acceptable (↑local reactions)",
     "IM (all newer PCVs)", "IM"],

    ["Site",
     "Anterolateral thigh (infants);\nDeltoid (older children)",
     "Deltoid (adults);\nAnterolateral thigh (young children)",
     "Anterolateral thigh / Deltoid as per age",
     "Anterolateral thigh (right) in infants"],

    # EFFICACY
    ["Efficacy vs IPD",
     ">90% vs vaccine-serotype IPD in children\n(immunogenic + highly effective)",
     "60–70% vs IPD in adults;\nINEFFECTIVE in children <2 years (T-independent, no memory)",
     "PCV14-TT: non-inferior to PCV13 for shared serotypes (IAP 2025 data);\nPCV20: non-inferior to PCV13 + PPSV23 combined",
     "PCV13 highly effective vs vaccine-type IPD in infants"],

    ["Efficacy vs otitis media",
     "Moderate reduction (~7% overall; 57% vs vaccine-type OM)",
     "NOT effective vs otitis media",
     "Similar to PCV13 for shared serotypes",
     "Indirect benefit through herd immunity"],

    ["Herd immunity / carriage",
     "Significant reduction in nasopharyngeal carriage → indirect protection of unvaccinated (elders, siblings)",
     "No effect on carriage",
     "Expected herd effect similar to PCV13",
     "Herd immunity benefit documented post-UIP introduction"],

    # NIS-specific
    ["NIS — Availability / Cost",
     "Free under UIP at all govt health centres;\nAlso available private (paid)",
     "Not in NIS; available in private sector for high-risk adults",
     "Not yet in NIS; available in private clinics (paid);\nPCV20 for adults only",
     "PCV13 free in UIP;\nIntroduced nationally — rolled out to all states"],

    ["NIS — Programme notes",
     "UIP uses 2p+1 schedule:\nPCV1 at 6w, PCV2 at 14w, Booster at 9-12 months\n(differs from IAP 3p+0)",
     "Not in NIS", "Not in NIS (2025)", "PCV Booster at 9 months in NIS differs from IAP 15 months"],

    # CATCH-UP
    ["Catch-up: <12 months",
     "3 doses with ≥4 week intervals; booster at 12–15m",
     "Not applicable",
     "PCV14-TT: not established", "Resume as per NIS — no restart"],

    ["Catch-up: 12–24 months",
     "2 doses ≥8 weeks apart", "Not applicable", "2 doses ≥8 weeks apart", "2 doses per IAP"],

    ["Catch-up: 2–5 yrs (healthy)",
     "1 dose PCV13 only", "Not applicable",
     "1 dose PCV14-TT (if available)", "Not routinely under NIS after 2 yrs"],

    ["Catch-up: 2–5 yrs (high risk)",
     "2 doses PCV13 (≥8 wks apart) + PPV23 ≥8 wks after last PCV",
     "1 dose PPV23 after PCV series",
     "Follow PCV13 guidance for shared serotypes",
     "IAP catch-up applies; NIS does not cover catch-up"],

    ["Interrupted schedule",
     "Resume WITHOUT repeating; do not restart series",
     "Single dose — no series to interrupt",
     "Resume without repeating",
     "Resume without repeating"],

    ["Interchangeability",
     "PCV10 ↔ PCV13: not documented; complete with same product;\nPCV13 → PCV14-TT possible per IAP 2025",
     "N/A", "TT-conjugate PCVs may complete PCV13 series", "Complete with PCV13 in NIS"],

    # SPECIAL SITUATIONS
    ["HIV+ children",
     "If 3 primary doses given before 12m → extra booster in 2nd year of life;\nPPV23 at 2 yrs + repeat every 5 yrs",
     "PPV23 at 2 yrs; revaccinate every 5 yrs",
     "Follow PCV13 regimen then PPV23", "Standard NIS + extra booster (IAP recommendation)"],

    ["Preterm infants",
     "3 primary doses before 12m → booster in 2nd year",
     "Not recommended <2 yrs",
     "Follow PCV13 guidance", "Standard NIS schedule at chronological age"],

    ["Asplenia / sickle cell",
     "PCV13 complete series + PPV23 ≥8 weeks after PCV",
     "PPV23 + revaccinate every 5 yrs (or once if <65 yrs at first dose)",
     "PCV14 then PPV23 as per IAP",
     "IAP special situation guideline applies; not routinely in NIS"],

    ["Cochlear implant / CSF leak",
     "PCV13 + PPV23 — same as asplenia",
     "PPV23 after PCV series",
     "PCV14-TT then PPV23",
     "IAP high-risk schedule applies"],

    ["Chronic disease (cardiac, pulmonary,\nrenal, hepatic, DM, malignancy, transplant)",
     "PCV13 (if <5 yrs); then PPV23",
     "PPV23 single dose; repeat once if <65 yrs at first dose",
     "As per individual product guidance",
     "Not in NIS; IAP/clinician-driven for high-risk"],

    ["Elderly >65 yrs",
     "PCV13 (1 dose) then PPV23 (≥1 yr later); or shared decision-making",
     "PPV23 routinely recommended",
     "PCV20 single dose (India 2025) as alternative to PCV13+PPV23",
     "Not in NIS (adults not covered by NIS)"],

    ["DMARDs / Immunosuppressants",
     "Vaccinate BEFORE starting therapy if possible; reduced immunogenicity on DMARDs",
     "Same — vaccinate before therapy",
     "Same principle", "N/A (adults, not NIS)"],

    # COLD CHAIN / CI / AEFI
    ["Storage / Cold chain",
     "2–8°C | Do NOT freeze | Discard if frozen | Preservative-free",
     "2–8°C | Do NOT freeze | Discard if frozen",
     "2–8°C | Do NOT freeze | Discard if frozen",
     "UIP cold chain; discard if frozen"],

    ["Absolute contraindications",
     "Anaphylaxis to previous dose or any component;\nRevaccination NOT recommended after anaphylaxis",
     "Same; also avoid <2 yrs (ineffective)",
     "Anaphylaxis to any component including TT carrier",
     "Anaphylaxis CI; no age restriction issue in NIS (started at 6 weeks)"],

    ["AEFI",
     "Local: Pain, redness, swelling (up to 50%); more with 2nd dose & SC route;\nSystemic: Fever (uncommon); severe reactions rare",
     "More local reactions with SC route & 2nd dose;\n30–50% mild local reactions",
     "Similar to PCV13; TT-conjugate may have more local reactions",
     "AEFI reported via UIP surveillance system"],

    ["Co-administration",
     "With all routine vaccines at different sites simultaneously",
     "With influenza vaccine ONLY in separate syringe/site; not same syringe",
     "With routine vaccines at different sites",
     "Given with OPV, Pentavalent, fIPV at same visit in UIP"],

    ["WHO PQ status",
     "Yes — PCV13 (Prevenar 13)", "Yes — PPV23",
     "PCV14-TT: under review; PCV20: licensed not yet PQ",
     "UIP uses WHO-PQ vaccines only"],

], col_widths=[c0p, c1p, c2p, c3p, c4p], hdr_bg="#5a0070")

P2.append(master_pcv)
P2.append(sp2(4))
P2.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#5a0070"), spaceAfter=2))
P2.append(Paragraph(
    "Sources: Park's Preventive & Social Medicine (23rd ed.)  |  IAP-ACVIP Recommended Immunization Schedule 2025  |  "
    "IAP Guidebook on Immunization 2025 (5th ed., Jaypee)  |  Red Book 2021 (AAP)  |  NIS India (MoHFW)  |  vaccinesafety.edu",
    foot_s))

# ═══ BUILD ═══════════════════════════════════════════════════════
doc.build(P1 + P2)
print("v3 PDF created successfully!")

cd /home/daytona/workspace/vaccine-notes && python create_v3.py 2>&1

ls -lh /home/daytona/workspace/vaccine-notes/Vaccine_Notes_5Mark_v3.pdf

cd /home/daytona/workspace/attachments/09dffecf-3ea8-4ab9-9494-e8574bb6a3df && p…

cd /home/daytona/workspace/attachments/09dffecf-3ea8-4ab9-9494-e8574bb6a3df && p…

cd /home/daytona/workspace/attachments/09dffecf-3ea8-4ab9-9494-e8574bb6a3df && p…

cd /home/daytona/workspace/attachments/09dffecf-3ea8-4ab9-9494-e8574bb6a3df && p…

ls /home/daytona/workspace/vaccine-notes/ && python3 -c " import pickle with ope…