This is Iap vaccination schedule give me dosage of each in tabular col

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This is Iap vaccination schedule give me dosage of each in tabular coloumn i. Same order

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IAP immunization schedule 2023 2024 vaccine dosage ml standard doses

Here is the IAP vaccination schedule from your notes with standard dosages, in the exact same order:

IAP Vaccination Schedule - with Dosages

Age	Vaccine	Dose	Route
Birth	BCG	0.1 ml	Intradermal
	OPV-0	2 drops	Oral
	Hep B-1	0.5 ml	IM
6 Weeks	DTwP / DTaP-1	0.5 ml	IM
	IPV-1	0.5 ml	IM
	Hib-1	0.5 ml	IM
	Hep B-2	0.5 ml	IM
	Rotavirus-1	1.5 ml (RV1) / 2 ml (RV5)	Oral
	PCV-1	0.5 ml	IM
10 Weeks	DTwP / DTaP-2	0.5 ml	IM
	IPV-2	0.5 ml	IM
	Hib-2	0.5 ml	IM
	Hepatitis B-3	0.5 ml	IM
	Rotavirus-2	1.5 ml (RV1) / 2 ml (RV5)	Oral
	PCV-2	0.5 ml	IM
14 Weeks	DTwP / DTaP-3	0.5 ml	IM
	IPV-3	0.5 ml	IM
	Hib-3	0.5 ml	IM
	Hep B-4	0.5 ml	IM
	RVV-3	1.5 ml (RV1) / 2 ml (RV5)	Oral
	PCV-3	0.5 ml	IM
6 Months	Influenza (IIV)-1	0.25 ml (<3 yrs) / 0.5 ml (>3 yrs)	IM
7 Months	Influenza (IIV)-2	0.25 ml (<3 yrs) / 0.5 ml (>3 yrs)	IM
6-9 Months	Typhoid Conjugate Vaccine (TCV)	0.5 ml	IM
9 Months	MMR-1	0.5 ml	Subcutaneous

Notes:

BCG dose: 0.1 ml is the correct standard IAP dose (your notes show a correction - 0.1 ml is right, not 0.5 ml)
DTwP/DTaP, IPV, Hib, HepB at 6/10/14 weeks are often given as a combined hexavalent vaccine (0.5 ml IM)
Rotavirus dose varies by brand: Rotarix (RV1) = 1.5 ml oral; RotaTeq (RV5) = 2 ml oral
IIV (Influenza): 0.25 ml for children under 3 years; 0.5 ml for 3 years and above
MMR is given subcutaneous (SC), not IM

Same way give nis based on reced schedule dose and route in tabular form

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NIS National Immunization Schedule India 2023 2024 revised vaccine dose route site complete

Here is the complete NIS (National Immunization Schedule / Universal Immunization Programme - UIP) India, in order with dose, route, and site:

NIS - National Immunization Schedule, India (Revised/Current UIP)

For Pregnant Women

Vaccine	When to Give	Dose	Route	Site
Td-1	Early in pregnancy (1st ANC visit)	0.5 ml	IM	Deltoid (upper arm)
Td-2	4 weeks after Td-1	0.5 ml	IM	Deltoid (upper arm)
Td Booster	If 2 Td doses given in last 3 years	0.5 ml	IM	Deltoid (upper arm)

For Infants (Birth - 12 Months)

Age	Vaccine	Disease Prevented	Dose	Route	Site
Birth	BCG	Tuberculosis	0.1 ml (0.05 ml if <1 month)	Intradermal (ID)	Left upper arm
	Hepatitis B (birth dose)	Hepatitis B	0.5 ml	IM	Anterolateral mid-thigh (Left)
	bOPV-0	Poliomyelitis	2 drops	Oral	Mouth
6 Weeks	bOPV-1	Poliomyelitis	2 drops	Oral	Mouth
	Pentavalent-1 (DPT+HepB+Hib)	Diphtheria, Pertussis, Tetanus, Hep B, Hib	0.5 ml	IM	Anterolateral mid-thigh (Left)
	fIPV-1 (fractional IPV)	Poliomyelitis	0.1 ml	Intradermal (ID)	Right upper arm
	RVV-1 (Rotavirus)	Rotavirus diarrhoea	5 drops	Oral	Mouth
	PCV-1	Pneumococcal disease	0.5 ml	IM	Anterolateral mid-thigh (Right)
10 Weeks	bOPV-2	Poliomyelitis	2 drops	Oral	Mouth
	Pentavalent-2	Diphtheria, Pertussis, Tetanus, Hep B, Hib	0.5 ml	IM	Anterolateral mid-thigh (Left)
	RVV-2 (Rotavirus)	Rotavirus diarrhoea	5 drops	Oral	Mouth
14 Weeks	bOPV-3	Poliomyelitis	2 drops	Oral	Mouth
	Pentavalent-3	Diphtheria, Pertussis, Tetanus, Hep B, Hib	0.5 ml	IM	Anterolateral mid-thigh (Left)
	fIPV-2 (fractional IPV)	Poliomyelitis	0.1 ml	Intradermal (ID)	Right upper arm
	RVV-3 (Rotavirus)	Rotavirus diarrhoea	5 drops	Oral	Mouth
	PCV-2	Pneumococcal disease	0.5 ml	IM	Anterolateral mid-thigh (Right)
9-12 Months	MR-1 (Measles-Rubella)	Measles & Rubella	0.5 ml	Subcutaneous (SC)	Right upper arm
	JE-1*	Japanese Encephalitis	0.5 ml	SC	Left upper arm
	PCV Booster	Pneumococcal disease	0.5 ml	IM	Anterolateral mid-thigh (Right)
	fIPV-3	Poliomyelitis	0.1 ml	Intradermal (ID)	Right upper arm
	Vitamin A (1st dose)	Vitamin A deficiency	1 ml (1 lakh IU)	Oral	Mouth

For Children (1 Year and Above)

Age	Vaccine	Disease Prevented	Dose	Route	Site
16-24 Months	DPT Booster-1	Diphtheria, Pertussis, Tetanus	0.5 ml	IM	Anterolateral mid-thigh (Left)
	bOPV Booster	Poliomyelitis	2 drops	Oral	Mouth
	MR-2	Measles & Rubella	0.5 ml	SC	Right upper arm
	JE-2*	Japanese Encephalitis	0.5 ml	SC	Left upper arm
	Vitamin A (2nd-9th dose)	Vitamin A deficiency	2 ml (2 lakh IU)	Oral	Mouth
5-6 Years	DPT Booster-2	Diphtheria, Pertussis, Tetanus	0.5 ml	IM	Deltoid (left upper arm)
10 Years	Td	Tetanus & Diphtheria	0.5 ml	IM	Deltoid (upper arm)
16 Years	Td	Tetanus & Diphtheria	0.5 ml	IM	Deltoid (upper arm)

Key Notes:

fIPV (fractional IPV) = 0.1 ml intradermal, NOT 0.5 ml IM (unlike IAP's full IPV)
Pentavalent = DPT + Hep B + Hib combined in one injection (replaces separate Hib and HepB of IAP schedule)
JE vaccine* = given only in JE-endemic districts
Vitamin A = 9 doses total (1 lakh IU at 9 months, then 2 lakh IU every 6 months till 5 years)
bOPV = Bivalent Oral Polio Vaccine (types 1 & 3)
NIS does not include Typhoid conjugate, Varicella, or Influenza as routine (these are IAP additions)

Remove the disease prevented and site

NIS - National Immunization Schedule, India

For Pregnant Women

Vaccine	When to Give	Dose	Route
Td-1	Early in pregnancy (1st ANC visit)	0.5 ml	IM
Td-2	4 weeks after Td-1	0.5 ml	IM
Td Booster	If 2 Td doses given in last 3 years	0.5 ml	IM

For Infants (Birth - 12 Months)

Age	Vaccine	Dose	Route
Birth	BCG	0.1 ml (0.05 ml if <1 month)	ID
	Hepatitis B (birth dose)	0.5 ml	IM
	bOPV-0	2 drops	Oral
6 Weeks	bOPV-1	2 drops	Oral
	Pentavalent-1	0.5 ml	IM
	fIPV-1	0.1 ml	ID
	RVV-1	5 drops	Oral
	PCV-1	0.5 ml	IM
10 Weeks	bOPV-2	2 drops	Oral
	Pentavalent-2	0.5 ml	IM
	RVV-2	5 drops	Oral
14 Weeks	bOPV-3	2 drops	Oral
	Pentavalent-3	0.5 ml	IM
	fIPV-2	0.1 ml	ID
	RVV-3	5 drops	Oral
	PCV-2	0.5 ml	IM
9-12 Months	MR-1	0.5 ml	SC
	JE-1*	0.5 ml	SC
	PCV Booster	0.5 ml	IM
	fIPV-3	0.1 ml	ID
	Vitamin A (1st dose)	1 ml (1 lakh IU)	Oral

For Children (1 Year and Above)

Age	Vaccine	Dose	Route
16-24 Months	DPT Booster-1	0.5 ml	IM
	bOPV Booster	2 drops	Oral
	MR-2	0.5 ml	SC
	JE-2*	0.5 ml	SC
	Vitamin A (2nd-9th dose)	2 ml (2 lakh IU)	Oral
5-6 Years	DPT Booster-2	0.5 ml	IM
10 Years	Td	0.5 ml	IM
16 Years	Td	0.5 ml	IM

*JE = given only in endemic districts

Contraindications to vaccins in accordance with paediatrics

Based on standard pediatric immunization guidelines, here is a comprehensive coverage of vaccine contraindications:

Contraindications to Vaccines in Paediatrics

1. TRUE (Absolute) Contraindications - Valid for ALL Vaccines

Contraindication	Details
Severe allergic reaction (anaphylaxis)	Previous anaphylaxis to a prior dose of the same vaccine or to any vaccine component
Severe combined immunodeficiency (SCID)	Absolute contraindication to all live vaccines
Encephalopathy within 7 days of DPT	Not attributable to any other cause - contraindication to further pertussis-containing vaccines

2. Contraindications to LIVE Vaccines

(BCG, OPV, MMR, Varicella, Rotavirus, Yellow Fever)

Condition	Reason
Primary immunodeficiency (SCID, DiGeorge, CGD)	Risk of vaccine-strain disseminated disease
HIV with severe immunosuppression (CD4 <15%)	Cannot mount safe response; risk of dissemination
On high-dose steroids (>2 mg/kg/day prednisolone >14 days)	Immunosuppression - wait 4 weeks after stopping
On immunosuppressive therapy (chemotherapy, biologics)	Risk of disseminated vaccine-strain infection
Malignancy (leukaemia, lymphoma)	Contraindicated during active disease/treatment
Pregnancy	Theoretical teratogenic risk (especially MMR, Varicella)
Recent blood/immunoglobulin transfusion	Passive antibodies may neutralize live vaccine
Symptomatic HIV	Only BCG; give MMR if CD4 >15%

3. Vaccine-Specific Contraindications

Vaccine	Specific Contraindication
BCG	Known HIV positive (symptomatic), SCID, other severe immunodeficiency, birth weight <2 kg (delay)
OPV	Immunodeficient child OR household contact of immunodeficient person (use IPV instead)
DPT / DTwP	Encephalopathy within 7 days of previous DPT dose; progressive neurological disorder (e.g., uncontrolled epilepsy, infantile spasms)
MMR	Anaphylaxis to neomycin or gelatin; severe immunodeficiency; pregnancy; recent Ig/blood product (defer 3-11 months depending on product)
Varicella	Severe immunodeficiency; pregnancy; anaphylaxis to neomycin/gelatin; high-dose steroids
Rotavirus	History of intussusception; SCID; known latex allergy (Rotarix applicator); uncorrected congenital GI malformation
PCV / Hep B / IPV / Hib	Anaphylaxis to previous dose or vaccine component only
Influenza (IIV)	Anaphylaxis to egg (relative - can give under observation); anaphylaxis to previous flu vaccine dose
Yellow Fever	Age <6 months (absolute); age 6-8 months (relative); immunocompromised; thymus disorder; anaphylaxis to egg
Typhoid (injectable Vi)	Age <2 years
HPV	Pregnancy (defer until postpartum); anaphylaxis to yeast (Gardasil)

4. FALSE Contraindications (Vaccines Should Still Be Given)

These are common misconceptions - vaccines are NOT contraindicated in these situations:

Misconception	Correct Action
Mild fever / URTI / mild illness	Vaccinate - minor illness is NOT a contraindication
Diarrhoea / vomiting (mild)	Vaccinate (repeat oral vaccines if vomiting within 10 min)
Low-grade fever after previous dose	Vaccinate
Stable neurological condition (e.g., controlled epilepsy, Down syndrome, CP)	Vaccinate
Prematurity / low birth weight (at discharge or 6 weeks)	Vaccinate as per chronological age
Breastfeeding	Vaccinate - not a contraindication for any vaccine
Family history of seizures	Vaccinate (counsel regarding fever management)
Family history of adverse vaccine reaction	Vaccinate - family history alone is not a contraindication
Malnutrition	Vaccinate - malnourished children need vaccines more
Child on antibiotics	Vaccinate - antibiotics do not affect most vaccines
Allergy to penicillin	Vaccinate - penicillin allergy is irrelevant
Recent surgery / hospitalization	Vaccinate when stable

5. Precautions (Defer, Not Absolute Contraindication)

Condition	Vaccine	Action
Moderate-severe acute illness with/without fever	Any	Defer until recovery
Thrombocytopenia or bleeding disorder	MMR, Varicella	Use SC route carefully; avoid IM
Guillain-Barre Syndrome within 6 weeks of flu vaccine	Influenza	Precaution - weigh risk/benefit
Progressive neurological disorder	DPT	Defer until stabilized; use DT instead
Immunosuppressive therapy ending	Live vaccines	Wait 3 months after stopping immunosuppressives
Blood products / Ig received	MMR, Varicella	Defer 3-11 months (depends on product/dose)

6. HIV and Vaccines - Special Paediatric Guidance

Vaccine	HIV Asymptomatic (CD4 normal)	HIV Symptomatic / Low CD4
BCG	Give at birth (if not known HIV+)	Contraindicated
OPV	Give (use IPV preferred)	Use IPV only
MMR	Give (2 doses)	Contraindicated if CD4 <15%
Varicella	Give if CD4 >15%	Contraindicated
DPT / IPV / Hep B / Hib / PCV	Give all	Give all (inactivated - safe)

Key Rule to Remember:

Inactivated vaccines - contraindicated only in anaphylaxis to prior dose/component
Live vaccines - contraindicated in immunocompromise, pregnancy, and recent Ig
Never withhold vaccines for false contraindications - missed opportunities increase vaccine-preventable disease

What is vvm

VVM - Vaccine Vial Monitor

What is it?

A VVM (Vaccine Vial Monitor) is a small heat-sensitive chemical indicator label attached to or printed directly on a vaccine vial. It gives a visual indication of whether a vaccine has been damaged by heat exposure (cumulative heat damage) over time.

How it Works

The VVM contains a thermochromic (heat-sensitive) material that undergoes an irreversible chemical reaction when exposed to heat. The reaction is cumulative - it records total heat exposure over the entire life of the vial, not just a single episode.

The center square darkens progressively with heat exposure
It is compared against the surrounding reference circle
Once the square becomes darker than or equal to the reference circle - the vaccine should NOT be used

Reading the VVM - The 4 Stages

Stage	Appearance	Meaning	Action
Stage 1	Inner square lighter than outer circle	Full potency - not heat damaged	✅ Use the vaccine
Stage 2	Inner square still lighter but has darkened slightly	Some heat exposure but still usable	✅ Use the vaccine (use first/prioritize)
Stage 3	Inner square color matches outer circle	Discard point reached	❌ Do NOT use
Stage 4	Inner square darker than outer circle	Well past discard point	❌ Do NOT use

Rule: If square = circle or darker → DISCARD

Key Features

Feature	Detail
Full form	Vaccine Vial Monitor
Principle	Cumulative heat exposure (thermochromic)
What it detects	Heat damage (not freeze damage)
What it does NOT detect	Freezing damage (separate shake test needed)
Attached to	Vaccine vial label or cap
Response	Irreversible - once dark, cannot reverse
Introduced by	WHO / PATH - widely adopted in UIP/NIS

Which Vaccines Have VVM in India (UIP)?

Vaccine	VVM Present
OPV	✅ Yes
BCG	✅ Yes
Hepatitis B	✅ Yes
Pentavalent	✅ Yes
Measles / MR	✅ Yes
DPT	✅ Yes
TT / Td	✅ Yes

Clinical Importance

Shake test checks for freeze damage (separate from VVM)
VVM only monitors heat - a vial can have a good VVM but still be damaged by freezing
Freeze-sensitive vaccines (Hep B, DPT, Pentavalent, TT) can be damaged by cold even if VVM looks fine
"Open vial policy" - multi-dose vials can be reused in subsequent sessions only if VVM is still in Stage 1 or 2, cap is intact, and no contamination

Why it Matters in Paediatrics / Immunization

Ensures cold chain integrity at the point of use
Prevents administration of heat-damaged, ineffective vaccines
Empowers even field-level health workers to make a quick go/no-go decision
Reduces vaccine wastage by avoiding unnecessary discarding of viable vials
Key component of WHO's cold chain monitoring system

Give it for a 5 mark question

Vaccine Vial Monitor (VVM)

Definition

A VVM is a small heat-sensitive chemical indicator label affixed to a vaccine vial that gives a continuous, cumulative record of heat exposure to detect whether a vaccine has been damaged by heat and is no longer fit for use.

Principle

Contains a thermochromic material that undergoes an irreversible chemical reaction proportional to cumulative heat exposure over time
The inner square darkens progressively and is compared to the surrounding reference circle
Records total heat exposure throughout the vaccine's life - not just a single episode

Reading the VVM - 4 Stages

Stage	Appearance	Action
1	Square much lighter than circle	✅ Use
2	Square slightly darker, still lighter than circle	✅ Use (prioritize)
3	Square color equals circle	❌ Discard
4	Square darker than circle	❌ Discard

Simple rule: Square ≥ Circle = Do NOT use

Important Points

Detects heat damage only - does NOT detect freeze damage
For freeze-sensitive vaccines (Hep B, DPT, TT), a separate shake test is required to detect freeze damage
Response is irreversible - once darkened, cannot return to original color
Present on all UIP vaccines in India - OPV, BCG, MR, Pentavalent, DPT, Hep B, Td

Significance

Maintains cold chain integrity at point of use
Enables even field-level workers to assess vaccine potency without equipment
Prevents administration of ineffective heat-damaged vaccines
Reduces unnecessary wastage of viable vaccines
Essential component of WHO cold chain monitoring

What is aefi

AEFI - Adverse Events Following Immunization

Definition

Any untoward medical occurrence that follows immunization and does not necessarily have a causal relationship with the vaccine. It may be any unfavorable or unintended sign, abnormal laboratory finding, symptom, or disease occurring after vaccination. (WHO Definition)

Classification of AEFI (WHO 2013)

Type	Definition	Examples
1. Vaccine product-related reaction	Caused by inherent properties of the vaccine	BCG lymphadenitis, MMR-related rash, fever after DPT
2. Vaccine quality defect-related reaction	Due to manufacturing defect or substandard quality	Sterile abscess due to adjuvant clumping
3. Immunization error-related reaction	Due to error in vaccine preparation, handling, or administration	Abscess from non-sterile injection, wrong dose/route/site
4. Immunization anxiety-related reaction	Arising from anxiety about immunization	Vasovagal syncope, hyperventilation, psychogenic reactions
5. Coincidental event	Occurs after vaccination but caused by something else - no causal link	Fever due to concurrent infection unrelated to vaccine

Common AEFI by Vaccine

Vaccine	Common AEFI
BCG	Local ulcer, regional lymphadenitis, BCG-itis, disseminated BCG (rare - in immunocompromised)
DPT / Pentavalent	Local pain, swelling, redness; fever; persistent inconsolable crying (>3 hrs); hypotonic-hyporesponsive episode (HHE)
OPV	Vaccine-associated paralytic poliomyelitis (VAPP) - 1 in 2.7 million doses
MMR	Fever (7-12 days), mild rash, febrile seizure, thrombocytopenia (rare), parotitis
Hepatitis B	Local soreness, mild fever; anaphylaxis (very rare)
PCV	Local reactions, fever
Varicella	Mild varicelliform rash, fever
Influenza	Injection site pain, mild fever, Guillain-Barre (rare)
Any vaccine	Anaphylaxis (within 30 min)

Serious AEFI - Must Report Immediately

AEFI	Definition / Features
Anaphylaxis	Acute hypersensitivity - within 30 min; urticaria, bronchospasm, hypotension
HHE (Hypotonic-Hyporesponsive Episode)	Sudden hypotonia, unresponsiveness, pallor/cyanosis within 48 hrs of DPT
Persistent inconsolable crying	Crying >3 hours after DPT
Encephalopathy	Altered consciousness, seizures within 72 hrs of DPT
VAPP	Flaccid paralysis after OPV - onset 4-30 days (recipient), up to 60 days (contact)
Seizures / febrile seizure	Within 3 days of DPT; 5-12 days of MMR
Toxic shock syndrome	Multi-dose vial contamination - rapid onset fever, vomiting, shock
BCG dissemination	Rare - in immunocompromised children

Time Window for Reporting AEFI

AEFI	Time of Onset After Vaccination
Anaphylaxis	Within 30 minutes
HHE	Within 48 hours
Persistent crying	Within 24 hours
Seizures (DPT)	Within 3 days
Fever (DPT)	Within 3 days
Seizures / fever (MMR)	5-12 days
VAPP	4-30 days (recipient); up to 60 days (contact)
BCG lymphadenitis	2-6 weeks
Abscess at injection site	1-6 weeks

Management of AEFI

Step	Action
1. Immediate	Keep child under observation for 30 minutes post-vaccination for all children
2. Anaphylaxis	Adrenaline (epinephrine) 0.01 mg/kg IM (1:1000); airway, oxygen, fluids
3. Febrile seizure	Paracetamol, diazepam if prolonged; reassure parents
4. HHE	Observation - usually self-limiting; hospitalize if needed
5. Local abscess	Refer; do NOT incise BCG abscess; antibiotics if bacterial
6. Report	Fill AEFI reporting form and report to district immunization officer

AEFI Reporting in India

All serious AEFI must be reported within 24-48 hours to the District Immunization Officer
India has a national AEFI surveillance system under the Ministry of Health
Reported via AEFI reporting form at all levels - PHC → District → State → National
National AEFI committee reviews serious/cluster cases
Part of pharmacovigilance and vaccine safety monitoring

Key Points to Remember

AEFI ≠ always caused by vaccine - may be coincidental
Most AEFI are mild and self-limiting
Observe every child for 30 minutes after vaccination
Serious AEFI requires immediate treatment + mandatory reporting
VAPP is the most feared AEFI of OPV - reason for shift to IPV
HHE after DPT - not a contraindication to future vaccines (use DTaP instead of DTwP)

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