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UNIVERSAL IMMUNIZATION PROGRAMME (UIP) - INDIA

A Comprehensive Assignment

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1. Introduction

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2. Historical Background and Milestones

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3. Objectives of UIP

1. To reduce morbidity, mortality, and disability from vaccine-preventable diseases (VPDs)
2. To achieve and sustain universal immunization coverage across all children under 2 years and pregnant women
3. To interrupt disease transmission in the community (herd immunity)
4. To eliminate/eradicate specific diseases (e.g., polio - achieved 2014; neonatal tetanus - near elimination)
5. To ensure equitable access to vaccines across rural, urban, and tribal populations
6. To introduce new vaccines as evidence and funding allows

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4. Diseases Covered Under UIP (12 VPDs)

1. Tuberculosis (BCG)
2. Diphtheria
3. Pertussis (Whooping Cough)
4. Tetanus
5. Poliomyelitis
6. Measles
7. Rubella
8. Hepatitis B
9. Haemophilus influenzae type B (Hib) - meningitis/pneumonia
10. Rotavirus diarrhoea
11. Pneumococcal disease (pneumonia/meningitis)
12. Japanese Encephalitis (in endemic districts only)

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5. National Immunization Schedule (NIS) / UIP 2025

For Infants and Children

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For Pregnant Women

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6. IAP (Indian Academy of Pediatrics) Schedule - Additional Vaccines

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7. Key Vaccines - Individual Details

BCG (Bacillus Calmette-Guerin)

• Type: Live attenuated (Mycobacterium bovis)
• Dose: 0.1 mL (0.05 mL for neonates <1 month)
• Route/Site: Intradermal, left upper arm
• Age: At birth (up to 1 year if missed)
• Contraindication: Immunodeficiency, symptomatic HIV
• Storage: 2-8°C, sensitive to light and heat
• Expected response: Koch's phenomenon (induration >5 mm at 4-6 weeks) confirms "take"

OPV (Oral Polio Vaccine)

• Type: Live attenuated (Sabin), trivalent
• Dose: 2 drops oral
• Schedule: Birth, 6, 10, 14 weeks; booster at 16-24 months
• Advantage: Produces intestinal immunity (IgA), induces herd protection
• Contraindication: Immunodeficiency (use IPV instead)
• Key note: Not given to symptomatic HIV-positive children

IPV/fIPV (Inactivated/Fractional IPV)

• Type: Killed (Salk), fractional dose (1/5th of full dose) intradermal
• Advantage: Safe in immunocompromised; produces systemic immunity
• Given at: 6 and 14 weeks under UIP (fractional intradermal dose)

Pentavalent Vaccine (DPT + HepB + Hib)

• Combines 5 antigens in a single injection
• Reduces the number of injections from 5 to 1
• Given at 6, 10, 14 weeks
• Antero-lateral aspect of the thigh (left side)

Measles-Rubella (MR) Vaccine

• Type: Live attenuated
• Route: Subcutaneous, right upper arm
• Schedule: 9-12 months (MR-1) and 16-24 months (MR-2)
• Note: Replaced standalone measles vaccine; part of global measles-rubella elimination drive

Rotavirus Vaccine (RVV)

• Type: Live attenuated oral (ROTAVAC - indigenous Indian vaccine by Bharat Biotech)
• Schedule: 6, 10, 14 weeks (3-dose series)
• Maximum age for first dose: 15 weeks
• Maximum age for last dose: 8 months

PCV (Pneumococcal Conjugate Vaccine)

• Type: Conjugate vaccine (PCV-13 or PCV-10)
• Schedule: 6 weeks, 14 weeks, booster at 9-12 months
• Prevents: Streptococcus pneumoniae invasive disease, pneumonia, meningitis

HPV Vaccine

• Indigenous vaccine: CERVAVAC (quadrivalent, by Serum Institute of India)
• Target: Girls 9-14 years (2-dose schedule, 6 months apart)
• Prevents: Cervical cancer, genital warts (HPV types 6, 11, 16, 18)
• Introduced into UIP (phased rollout from 2023 onwards)

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8. Cold Chain and Vaccine Storage

• Freeze-sensitive vaccines (DPT, TT, Hep B, Pentavalent, PCV, fIPV): Must NOT be frozen - stored at +2 to +8°C
• Freeze-tolerant vaccines (OPV): Can be stored frozen (-15 to -25°C) at higher levels to extend shelf life
• BCG and MR: Sensitive to heat and light; store at 2-8°C, protect from light
• VVM (Vaccine Vial Monitor): Heat-sensitive label on each vial; inner square turning as dark or darker than outer ring indicates the vaccine should NOT be used
• Open Vial Policy: Multi-dose vials of OPV, liquid pentavalent, liquid DPT, TT, Hep B, and MR can be used in subsequent sessions if VVM is intact and stored appropriately

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9. Immunization Delivery Strategies

Fixed Sites

• Sub-centre, PHC, CHC, district hospitals
• AWC (Anganwadi Centres) - monthly immunization days

Outreach Sessions

• ANM visits villages/habitations on fixed days
• Village Health Sanitation and Nutrition Days (VHSND)
• Outreach sessions reach underserved populations

Special Campaigns

• Pulse Polio Immunization (National Immunization Days/NIDs): Annual OPV campaigns for all children <5 years (Dec-Jan); resulted in India being declared polio-free in 2014
• Mission Indradhanush: Launched in 2014 to reach unvaccinated/partially vaccinated children; intensified version (IIM) since 2017
• Intensified Mission Indradhanush (IMI): Targets districts with low coverage, pregnant women and children aged 0-2 years

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10. Herd Immunity and Community Protection

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11. Contraindications to Vaccination

Absolute Contraindications

• Anaphylaxis to a previous dose or to a vaccine component
• Severe immunodeficiency for live vaccines (BCG, OPV, MR)

Precautions (Not Contraindications)

• Mild illness with low-grade fever: vaccinate (DO NOT postpone)
• Diarrhoea in progress: OPV can be given but dose may not count; give IPV instead if available
• Malnourished children: Vaccinate - they need protection most
• Prematurity: Full doses as per chronological age
• Breastfeeding: All vaccines can be given

False Contraindications (Common Myths - Must be Corrected)

• Mild cold/URTI - NOT a contraindication
• Low-grade fever - NOT a contraindication
• Antibiotic use - NOT a contraindication
• Malnutrition - NOT a contraindication
• Previous febrile reaction to DPT (minor) - NOT a contraindication (give antifebrile, vaccinate)

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12. Adverse Events Following Immunization (AEFI)

Classification (WHO 2013)

1. Vaccine product-related reaction - caused by intrinsic properties of the vaccine
2. Vaccine quality defect-related reaction - due to manufacturing defect
3. Immunization error-related reaction - due to improper preparation/administration
4. Immunization anxiety-related reaction - stress response, not vaccine-specific
5. Coincidental event - temporal association only, not causal

Common AEFIs

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13. WHO EPI - Global Perspective

• IA2030 goal: Reduce deaths from VPDs; achieve 90% national coverage with 3 primary doses of DTP-containing vaccine; reduce zero-dose children by 50% by 2030
• GAVI (Global Alliance for Vaccines and Immunization): Finances vaccine procurement for lower-income countries
• WHO EPI core vaccines: BCG, OPV/IPV, DTP, Hepatitis B, Hib, MCV (measles), Rubella

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14. Achievements and Challenges

Achievements

• Full immunization coverage: rose from 62% (2015) to 98.4% (January 2026)
• India declared polio-free in 2014 (WHO certified)
• Neonatal tetanus near-elimination
• Dramatic decline in VPDs:
  • Polio cases: 28,257 (1987) → 0 (2018 onwards)
  • Neonatal tetanus: 11,849 (1987) → 181 (2018)
  • Pertussis: 163,786 (1987) → 18,006 (2018)
  • Measles: 247,519 (1987) → 20,815 (2018)

Remaining Challenges

1. Zero-dose children: Still 0.06% of total population (2024), concentrated in urban slums, conflict-affected zones, tribal areas
2. Cold chain gaps in remote/hilly regions
3. Vaccine hesitancy - misinformation spread through social media
4. Urban migration disrupts immunization schedules
5. AEFI surveillance needs strengthening
6. Gender gap in vaccination access in some regions
7. Reaching scheduled castes/tribes and hard-to-reach populations

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15. Mission Indradhanush

• Named after the 7 colours of the rainbow representing the 7 vaccines initially targeted
• Intensified Mission Indradhanush (IMI) launched in 2017 with 4 rounds of immunization activities
• Focus on 190 high-priority districts with low immunization coverage
• Result: Significant improvement in full immunization coverage in targeted districts

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16. Summary

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References

1. Park, K. Park's Textbook of Preventive and Social Medicine, 27th ed. Jabalpur: Banarsidas Bhanot Publishers. (Immunization chapters, pp. 3497-3600)
2. Ministry of Health and Family Welfare, Government of India. National Immunization Schedule 2025. New Delhi: MoHFW.
3. Press Information Bureau, Government of India. UIP achievements and schedule 2025-26.
4. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP). IAP Immunization Schedule 2025.
5. World Health Organization. Immunization Agenda 2030 (IA2030). Geneva: WHO.
6. Wikipedia. Universal Immunisation Programme - India.

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Note: This assignment covers the UIP/NIS 2025 schedule. The schedule is periodically updated by the National Technical Advisory Group on Immunization (NTAGI). Always verify with the latest MoHFW circular for the most current recommendations.

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UNIVERSAL IMMUNIZATION PROGRAMME (UIP)

Assignment for Community Health Nursing

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1. INTRODUCTION

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2. DEFINITION AND BACKGROUND

• Child Survival and Safe Motherhood Programme (1992)
• National Reproductive and Child Health (RCH) Programme (1997)
• National Rural Health Mission (NRHM) / National Health Mission (NHM) - 2005 onwards

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3. OBJECTIVES OF UIP

1. To reduce morbidity, disability, and mortality from vaccine-preventable diseases (VPDs)
2. To achieve and sustain universal immunization coverage for all eligible children and pregnant women
3. To interrupt the chain of disease transmission in the community through herd immunity
4. To eliminate/eradicate specific VPDs (polio - achieved 2014; neonatal tetanus - near elimination)
5. To ensure free, equitable vaccine access across rural, urban, tribal, and slum populations
6. To introduce new, evidence-based vaccines progressively into the national schedule

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4. DISEASES COVERED UNDER UIP

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5. NATIONAL IMMUNIZATION SCHEDULE (NIS) 2025

5a. For Pregnant Women

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5b. For Infants and Children

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6. NURSING RESPONSIBILITIES IN UIP

6a. Pre-Session Responsibilities (Preparation)

1. Planning the session:
   • Prepare a list of beneficiaries (pregnant women, infants 0-2 years) from the sub-centre register
   • Fix a convenient day, time, and place for immunization sessions
   • Coordinate with AWW (Anganwadi Worker) and ASHA for mobilization
   • Plan session to minimize waiting time for mothers
2. Vaccine and logistics indent:
   • Calculate vaccine requirements based on beneficiary count
   • Collect vaccines from PHC/CHC cold chain point
   • Verify expiry dates and VVM status before collecting vaccines
3. Cold chain maintenance before session:
   • Place 4 conditioned ice packs in the vaccine carrier
   • Place vaccines in a plastic/zipper bag in the centre of the carrier - NOT directly on the ice
   • Freeze-sensitive vaccines (DPT, TT, Hep B, Pentavalent, PCV, fIPV) must NOT be placed directly on the ice pack
   • Reconstituted BCG and Measles/MR vaccines should be kept only on top of the ice pack during session
   • Diluents should be chilled at +2 to +8°C before reconstitution

6b. During the Session - Technical Nursing Skills

• Welcome beneficiaries warmly
• Wash hands thoroughly before the session
• Verify the immunization card and the age of the child
• Screen for contraindications
• Check the vaccine label and expiry date
• Check the VVM (Vaccine Vial Monitor): DO NOT use the vaccine if the inner square is as dark as or darker than the outer circle
• Lightly shake the T-series vaccine vial before drawing the dose
• Use a new Auto-Disable (AD) syringe for each injection

• Do NOT clean the injection site with a spirit swab before vaccination - spirit can kill live vaccine components
• Use the correct site for each vaccine (antero-lateral mid-thigh for IM injections, NOT the gluteal region - to prevent sciatic nerve injury and ensure adequate immune response)
• For BCG: intradermal in the left upper arm - a pale, raised bleb of 5-7 mm indicates correct placement
• For MR/Measles: subcutaneous, right upper arm only
• Give all due vaccines on the same visit - do NOT miss an opportunity

• Fill in the immunization card and sub-centre register
• Advise the mother to wait 30 minutes at the session site for observation for immediate reactions
• Counsel on common expected reactions and what to do

6c. Post-Session Responsibilities

1. Cold chain:
   • Return leftover vaccines to the cold chain immediately after the session
   • Multi-dose vials that were opened may be used in subsequent sessions within the same day (Open Vial Policy applies to OPV, liquid pentavalent, liquid DPT, TT, HepB, and MR)
   • Reconstituted BCG and MR vaccines must be discarded within 4 hours or at end of session (whichever is earlier)
2. Record keeping:
   • Update the immunization register
   • Mark defaulters (children who did not turn up)
   • Plan for follow-up of defaulters
3. AEFI surveillance:
   • Monitor for and record any adverse events
   • Report serious AEFIs to the MO and District Immunization Officer (DIO) using the prescribed AEFI reporting form

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7. KEY VACCINES - NURSING NOTES

BCG Vaccine

• Type: Live attenuated (Mycobacterium bovis)
• Age: At birth, up to 1 year (never give above 1 year of age)
• Dose: 0.1 mL (0.05 mL for neonates under 1 month)
• Route/Site: Intradermal, left upper arm
• Expected reaction: A small papule appears at 2 weeks, ulcerates, and heals to form the characteristic BCG scar by 6-12 weeks. This confirms a successful "take"
• Koch's phenomenon: Induration >5 mm at 4-6 weeks post-vaccination (positive reaction in tuberculin-sensitive individuals)
• Storage: 2-8°C, protected from light and heat
• Contraindication: Immunodeficiency, symptomatic HIV infection

OPV (Oral Polio Vaccine)

• Type: Live attenuated (Sabin vaccine), bivalent (types 1 and 3)
• Dose: 2 drops oral
• Advantage: Produces intestinal IgA (mucosal immunity), induces herd protection by eliminating virus from gut
• Schedule in UIP: Birth dose (OPV-0), then 6, 10, 14 weeks; booster at 16-24 months
• Nursing note: Do NOT give OPV to immunocompromised children - use IPV instead
• VAPP risk: Vaccine-associated paralytic polio - extremely rare (1 in 2.7 million doses)

fIPV (Fractional Inactivated Polio Vaccine)

• Given at 6 and 14 weeks under UIP (0.1 mL intradermal, right upper arm)
• Fractional dose = 1/5th of the full IPV dose; given ID rather than IM
• Safe for immunocompromised children
• Produces strong systemic (blood) immunity

Pentavalent Vaccine (DPT + Hepatitis B + Hib)

• Combines 5 antigens in one injection - reduces pain and visit burden
• Given at 6, 10, and 14 weeks
• Site: Antero-lateral aspect of mid-thigh (left)
• Why NOT gluteal? Risk of sciatic nerve injury; fat in gluteal region reduces immune response
• Minimum gap: 4 weeks between doses; decreasing the interval reduces optimal antibody production

Measles-Rubella (MR) Vaccine

• Type: Live attenuated
• Route: Subcutaneous, right upper arm only
• Why right arm? Standardized so BCG scar on left arm can be distinguished from MR reaction
• Schedule: MR-1 at 9-12 months; MR-2 at 16-24 months
• Must be reconstituted with the supplied diluent; used within 4 hours of reconstitution
• Key: If a child received only measles vaccine earlier, still give MR vaccine as per schedule

Rotavirus Vaccine (RVV - ROTAVAC)

• Indigenous vaccine developed in India (Bharat Biotech) using neonatal strain 116E
• 3-dose oral series: 6, 10, 14 weeks
• First dose must be given before 15 weeks of age; last dose before 8 months
• Reduces severe rotavirus diarrhoea hospitalizations by ~55-60%

Hepatitis B Birth Dose

• Must be given within 24 hours of birth - this is critical for preventing perinatal (mother-to-child) transmission
• If given after 24 hours, protective efficacy against perinatal transmission is significantly reduced
• Given intramuscularly in the antero-lateral mid-thigh

DPT Catch-up Guidance

• DPT can be given up to 7 years of age; OPV up to 5 years
• If a child is brought late: do NOT restart the schedule - pick up from where it was left off
  • Example: Child had BCG, HepB-1, DPT-1, OPV-1 at 5 months and comes at 11 months → give DPT-2, HepB-2, OPV-2, and Measles; do NOT restart from DPT-1

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8. COLD CHAIN MANAGEMENT - NURSING RESPONSIBILITIES

Temperature Requirements

Cold Chain Equipment

Vaccine Vial Monitor (VVM)

• A heat-sensitive sticker on each vaccine vial
• The inner square changes from light to dark when the vaccine has been exposed to excessive heat
• Rule: If inner square is as dark as or darker than the outer ring → DO NOT USE the vaccine
• VVM helps identify heat-damaged vaccines even if expiry date has not passed

DO's and DON'Ts in Cold Chain (Park's Preventive Medicine)

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9. CONTRAINDICATIONS TO VACCINATION

True (Absolute) Contraindications

• Anaphylaxis to a prior dose or known vaccine component
• Symptomatic HIV / severe immunodeficiency: do NOT give live vaccines (BCG, OPV, MR)

False Contraindications - Conditions that are NOT Contraindications

Park's Textbook states: "Immunization is frequently postponed if children are ill or malnourished. This is not acceptable in the light of present knowledge. In fact, it is particularly important to immunize children with malnutrition. Low grade fever, mild respiratory infections or diarrhoea and other minor illnesses should NOT be considered as contraindications to immunization. These are the very children who are most in need of immunization."

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10. ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI)

WHO 2013 Classification of AEFI

Common AEFIs - Nursing Management

AEFI Reporting (Nursing Duty)

• All serious AEFIs must be reported within 24 hours to the Medical Officer and District Immunization Officer
• Use the prescribed AEFI reporting form (MoHFW format)
• India has a national AEFI surveillance system under MoHFW/NHM
• Child with DPT allergy/encephalopathy: give DTaP instead for remaining doses (P = whole-cell pertussis component is usually responsible)

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11. IMMUNIZATION DELIVERY STRATEGIES

11a. Fixed Strategy

• Sub-centres, PHCs, CHCs, district hospitals, AWCs (Anganwadi Centres)
• Monthly immunization days (Village Health, Sanitation and Nutrition Day - VHSND)
• Convenient for urban and peri-urban populations

11b. Outreach Strategy

• ANM/CHN travels to villages, hamlets, and remote habitations
• Fixed days and times announced in advance
• Reaches populations without easy access to fixed facilities

11c. Mobile Strategy

• Mobile immunization vans/teams for very remote/hilly areas
• Used in tribal districts, islands, border areas

11d. Special Campaigns

• Pulse Polio Immunization / National Immunization Days (NIDs): Annual OPV campaigns for all children under 5 years, irrespective of prior vaccination status. Conducted every December-January. Led to India being declared polio-free on March 27, 2014
• Mission Indradhanush (MI): Launched December 2014 to immunize all unvaccinated/partially vaccinated children up to 2 years and pregnant women. Named for 7 colours of the rainbow = 7 vaccines
• Intensified Mission Indradhanush (IMI): From 2017; 4 rounds per year in 190 high-priority low-coverage districts

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12. HEALTH EDUCATION - NURSING ROLE

What to Tell Mothers/Caregivers

1. Why vaccinate? Vaccines prevent serious diseases that can kill or permanently disable your child
2. When to vaccinate? Bring the child as per the schedule on the immunization card; do not miss any dose
3. If a dose is missed: Come as soon as possible - you do NOT have to restart from the beginning
4. What to expect after vaccination:
   • Mild fever, pain, swelling at injection site = normal, last 1-3 days
   • Give paracetamol if fever is high
   • BCG scar formation in 6-12 weeks is normal and expected
5. When to come back urgently: High fever, convulsions, child becomes very unwell, excessive crying, difficulty breathing
6. Dispelling myths:
   • Vaccines do NOT cause autism (scientifically disproven)
   • Mild illness or fever is NOT a reason to delay vaccination
   • Breastfeeding does NOT reduce vaccine effectiveness
   • Multiple vaccines on the same day are safe
7. Keep the immunization card safe - bring it every time

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13. HERD IMMUNITY

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14. PROGRAMME ACHIEVEMENTS AND CHALLENGES

Achievements

• Full immunization coverage: 62% (2015) → 98.4% (January 2026) (PIB, MoHFW 2026)
• India declared polio-free on March 27, 2014 (WHO certified)
• Zero-dose children declined from 0.11% (2023) to 0.06% (2024)
• Dramatic decline in VPDs:

Challenges

1. Zero-dose children - concentrated in urban slums, conflict zones, tribal areas
2. Cold chain gaps in remote/hilly/island regions
3. Vaccine hesitancy - driven by misinformation and social media
4. Urban migration disrupts immunization schedules
5. Gender inequality - girls vaccinated less in some regions
6. Weak AEFI surveillance at peripheral levels
7. High dropout rates - children who receive first dose but not complete the series

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15. NURSING PROCESS IN IMMUNIZATION (Applying the Nursing Process)

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16. SUMMARY

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REFERENCES

1. Park, K. Park's Textbook of Preventive and Social Medicine, 27th ed. Jabalpur: Banarsidas Bhanot Publishers - Chapter on Immunization, Tables 43, 8, and 9
2. Ministry of Health and Family Welfare, Government of India. National Immunization Schedule 2025. New Delhi: MoHFW
3. Press Information Bureau, Government of India. UIP achievements 2025-26 - Full immunization coverage 98.4% as of Jan 2026
4. National Health Mission. Immunization - NHM India
5. Indian Academy of Pediatrics (IAP). IAP Immunization Schedule 2025 - ACVIP Recommendations
6. World Health Organization. Immunization Agenda 2030 (IA2030). Geneva: WHO

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Examiner's Note: For community health nursing examinations, pay special attention to: (1) the complete NIS table with routes and sites, (2) nursing responsibilities at each phase of the immunization session, (3) cold chain do's and don'ts, (4) false contraindications, and (5) AEFI classification and reporting. These are the most frequently tested areas.

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UNIVERSAL IMMUNIZATION PROGRAMME (UIP)

Assignment for Pediatric Nursing

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1. INTRODUCTION

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2. DEFINITION OF KEY TERMS

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3. TYPES OF VACCINES

3a. By Composition

3b. By Route of Administration

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4. NATIONAL IMMUNIZATION SCHEDULE (NIS) 2025 - INDIA

4a. Complete NIS - Age-wise Schedule

FOR PREGNANT WOMEN

FOR INFANTS - BIRTH

6 WEEKS

10 WEEKS

14 WEEKS

9-12 MONTHS

16-24 MONTHS

5-6 YEARS

10 YEARS AND 16 YEARS

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5. DISEASES COVERED AND VACCINE-SPECIFIC NURSING NOTES

5a. BCG Vaccine - Tuberculosis Prevention

• Type: Live attenuated (Mycobacterium bovis - Calmette-Guerin strain)
• Age: At birth; can be given up to 1 year of age. NEVER give BCG above 1 year of age
• Dose: 0.1 mL (0.05 mL in neonates under 1 month)
• Route/site: Intradermal, left upper arm

• Use a 26G, 3/8 inch needle; 1 mL syringe
• Stretch the skin taut over the outer aspect of the left upper arm
• Insert needle at 10-15° angle (almost horizontal, bevel upward)
• Inject to raise a pale, discrete bleb of 5-7 mm = confirms correct intradermal placement
• If no bleb or bleb disappears immediately = subcutaneous injection (incorrect) → repeat at different site

• 2-3 weeks: small red papule at injection site
• 4-6 weeks: papule ulcerates
• 6-12 weeks: heals with a characteristic round scar (4-8 mm) = "BCG scar" = sign of successful vaccination
• Absence of scar does NOT always mean vaccine failed - check tuberculin test (Mantoux) if in doubt

• Local - abscess, keloid scar, regional lymphadenitis (BCG-itis)
• Serious/rare - disseminated BCG disease (only in severe immunodeficiency)

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5b. OPV - Oral Polio Vaccine

• OPV can be given up to 5 years of age

• 2 drops directly into the mouth; hold child horizontally, tilt head slightly back
• If child vomits within 10 minutes - repeat the dose
• Do NOT give OPV to immunocompromised children (use IPV instead) - risk of VAPP
• Can be given concurrently with pentavalent vaccine (different sites)

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5c. fIPV - Fractional Inactivated Polio Vaccine

• Lower cost (less antigen per dose)
• Produces strong serum immunity (IgG)
• Safe for immunocompromised children
• Combined with OPV (complementary immunity - gut + systemic)

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5d. Pentavalent Vaccine (DPT + Hepatitis B + Hib)

1. Diphtheria toxoid - prevents diphtheria (pseudomembranous pharyngitis, "bull neck," airway obstruction)
2. Pertussis (whole cell) - prevents whooping cough (paroxysmal cough + inspiratory "whoop" + post-tussive vomiting)
3. Tetanus toxoid - prevents tetanus (lockjaw, risus sardonicus, opisthotonus)
4. Hepatitis B antigen - prevents HBV infection (cirrhosis, hepatocellular carcinoma)
5. Hib conjugate - prevents Haemophilus influenzae type B meningitis and pneumonia

• Site: Antero-lateral mid-thigh (left); NEVER the gluteal region
  • Why not gluteal? Risk of sciatic nerve injury; fat tissue in gluteal area reduces immune response
• Minimum interval: 4 weeks between doses (shorter intervals reduce antibody response)
• Catch-up: DPT can be given up to 7 years of age; do NOT restart - pick up where left off
• If child develops encephalopathy or severe allergy after DPT → switch to DTaP (acellular pertussis) for remaining doses (whole-cell pertussis component is usually responsible)
• Shake vial before drawing up (T-series vaccines)
• Do NOT freeze pentavalent vaccine - freeze damage reduces potency (perform "shake test" to detect freeze damage)

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5e. PCV - Pneumococcal Conjugate Vaccine

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5f. RVV - Rotavirus Vaccine (ROTAVAC)

• First dose: must be given before 15 weeks
• Last dose: must be given before 8 months (risk of intussusception if given later)

• 3 drops oral; hold upright position during and after administration
• May cause mild loose stools/vomiting for 1-2 days - reassure parents
• Store in refrigerator at +2 to +8°C; do NOT freeze

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5g. MR Vaccine - Measles-Rubella

• Measles (Rubeola): High fever, cough, coryza, conjunctivitis, Koplik's spots, morbilliform rash; complications - pneumonia, encephalitis, SSPE
• Rubella (German Measles): Mild febrile illness in children; devastating in pregnancy - Congenital Rubella Syndrome (CRS) causing heart defects, cataracts, deafness in newborns

• If missed: can give MR up to 5 years of age
• If measles vaccine received before 9 months (e.g., during outbreak) → still give MR at 9 months and 16-24 months

• Reconstitute with supplied diluent only; use within 4 hours of reconstitution or end of session (whichever is earlier)
• Given with Vitamin A 1st dose at 9 months
• Expected reaction: mild rash and fever at 7-12 days post-vaccination (not immediately) - reassure parents

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5h. Hepatitis B - Birth Dose

• Hepatitis B vaccine given within 24 hours prevents 90% of perinatal (vertical) transmission
• Efficacy drops significantly if given after 24 hours
• Part of pentavalent at 6, 10, 14 weeks (combined with DPT + Hib)
• Hepatitis B vaccine can be given up to 1 year of age

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5i. Vitamin A Supplementation

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6. IAP (Indian Academy of Pediatrics) RECOMMENDED SCHEDULE 2025

• IAP includes MMR (Mumps component) vs. UIP's MR (no mumps)
• IAP includes Varicella, Typhoid conjugate, Hepatitis A, Influenza, HPV
• IAP uses IPV full dose; UIP uses fractional fIPV
• IAP uses DTaP (acellular pertussis); UIP uses whole-cell pertussis

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7. COLD CHAIN MANAGEMENT

7a. Why Cold Chain Matters in Pediatric Nursing

7b. Temperature Requirements

7c. Vaccine Vial Monitor (VVM)

• Inner square starts lighter than the outer circle
• Progressive heat exposure darkens the inner square
• Rule: If inner square = same shade as outer circle or darker → DISCARD, do NOT use
• VVM detects cumulative heat exposure; vial may be within expiry date but still unusable if VVM is triggered

7d. Cold Chain Equipment at Each Level

7e. Critical Cold Chain DO's and DON'Ts

7f. Open Vial Policy

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8. NURSING PROCEDURE - VACCINE ADMINISTRATION (Step-by-Step)

Pre-Administration Assessment

1. Verify child's age and immunization card
2. Identify which vaccines are due at this visit
3. Screen for contraindications (not false contraindications)
4. Check VVM and expiry date on each vial
5. Explain the procedure and expected reactions to the parent/caregiver
6. Obtain informed consent (verbal)

Preparation

1. Wash hands thoroughly
2. Gather correct vaccines, syringes, diluents
3. Reconstitute lyophilized vaccines (BCG, MR) with supplied diluent only - NOT normal saline from another source
4. Draw up the correct dose in a new AD (Auto-Disable) syringe for each injection
5. Never mix two vaccines in one syringe unless they are a fixed combination (e.g., pentavalent)

Administration Technique

• 26G needle, 1 mL syringe, bevel up
• Insert almost parallel to skin (10-15°)
• Inject 0.1 mL - a pale bleb must form
• Do NOT massage after injection
• Never clean site with spirit before injection (kills live vaccine components)

• 23-25G needle; 1 mL syringe
• Site: anterolateral mid-thigh in infants <1 year; deltoid in older children
• 90° insertion; aspirate not required for pediatric IM (CDC/WHO)
• Apply gentle pressure after injection; do NOT massage

• 23-25G needle
• Pinch skin; insert at 45°
• Site: right upper arm

• 2 or 3 drops directly into mouth
• Ensure child does not spit out or vomit within 10 minutes

Post-Administration Care

1. Observe child for 30 minutes at the immunization site
2. Counsel parents: expected reactions, warning signs, when to return urgently
3. Record in immunization card and register
4. Dispose of all used syringes in puncture-proof sharps container (do NOT recap needles)
5. Wash hands

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9. CONTRAINDICATIONS TO VACCINATION

True Contraindications

False Contraindications (Must be Corrected by the Pediatric Nurse)

Park's Textbook states: "Low grade fever, mild respiratory infections or diarrhoea and other minor illnesses should not be considered as contraindications to immunization. These are the very children who are most in need of immunization."

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10. ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI)

Definition

CIOMS/WHO Classification of AEFIs (2012)

Common AEFIs and Pediatric Nursing Management

Recognition of Anaphylaxis Post-Vaccination (MEDICAL EMERGENCY)

1. Call for medical help IMMEDIATELY
2. Lay child flat; elevate legs
3. Administer adrenaline (epinephrine) 0.01 mg/kg IM (anterolateral thigh) - ANMs now authorized to give adrenaline IM under NHM protocol (2017)
4. ABC (Airway, Breathing, Circulation)
5. Transfer to emergency facility
6. Report as AEFI

AEFI Reporting

• All serious AEFIs must be reported within 24 hours to Medical Officer and District Immunization Officer (DIO)
• Use MoHFW AEFI reporting form
• National AEFI surveillance system: MoHFW → NHM → WHO

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11. SPECIAL SITUATIONS IN PEDIATRIC IMMUNIZATION

11a. Preterm / Low Birth Weight Infants

• Give all vaccines at chronological age (from date of birth), NOT corrected gestational age
• BCG: Delay if weight <2 kg until baby gains adequate weight (>2 kg)
• Hepatitis B birth dose: Give within 24 hours regardless of prematurity

11b. HIV-Positive Children

• Asymptomatic HIV: Can receive BCG, OPV, MR
• Symptomatic HIV / severe immunodeficiency: Do NOT give any live vaccines (BCG, OPV, MR)
  • Use IPV instead of OPV
  • Refer for DTaP, pneumococcal vaccine

11c. Child with Fever at Immunization Visit

• Low-grade fever (<38.5°C): Vaccinate - do NOT postpone
• High fever (>38.5°C): Postpone until fever resolves; schedule return visit

11d. Missed / Delayed Doses

• NEVER restart the schedule - continue from where it was left off
• Example: Child received BCG, Hep B-1, DPT-1, OPV-1 at 5 months, comes at 11 months → give DPT-2, Hep B-2, OPV-2, and MR-1
• "Do not penalize the child or restart for late presentation"

11e. Catch-up Age Limits

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12. NURSING PROCESS IN PEDIATRIC IMMUNIZATION

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13. HEALTH EDUCATION FOR PARENTS - PEDIATRIC NURSE'S ROLE

Key Messages

1. Why vaccinate? Vaccines protect your child from serious diseases that can kill, paralyze, or permanently disable
2. Stick to the schedule - vaccines work best when given at the right age; immunity may be incomplete if delayed
3. Bring the immunization card every visit - it is the baby's health passport
4. What to expect after vaccination:
   • Mild fever, fussiness, pain/swelling at injection site - normal, resolves in 1-3 days
   • Give paracetamol syrup (15 mg/kg) for fever and discomfort
   • BCG scar develops over 6-12 weeks - this is expected and normal
   • MR rash/fever may appear 7-12 days later - reassure this is the vaccine working
5. Return urgently if:
   • High-grade fever (>39°C)
   • Convulsions/fits
   • Collapse or unresponsiveness
   • Difficulty breathing
   • Persistent inconsolable crying >3 hours
6. Dispelling myths:
   • Vaccines do NOT cause autism
   • Multiple vaccines in one visit are safe - the immune system can handle them
   • A sick child with mild illness should STILL be vaccinated
   • Breastfeeding should continue before and after vaccination (reduces crying)

Non-Pharmacological Comfort Measures During Vaccination

• Breastfeed during injection (reduces pain and crying duration)
• Skin-to-skin contact (kangaroo care) for neonates
• Oral sucrose (2 mL of 24% sucrose 2 minutes before injection) for neonates and infants
• Distraction techniques for toddlers
• Give oral vaccines (OPV, RVV) before injections
• Use the smallest gauge needle appropriate for the site

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14. PROGRAMME OVERVIEW AND ACHIEVEMENTS

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15. SUMMARY

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REFERENCES

1. Park, K. Park's Textbook of Preventive and Social Medicine, 27th ed. Jabalpur: Banarsidas Bhanot Publishers - Tables 8, 9, 35, 43; pp. 3497-3620
2. Ministry of Health and Family Welfare, Government of India. National Immunization Schedule (NIS) 2025. New Delhi: MoHFW
3. National Health Mission, Himachal Pradesh. NIS Schedule - UIP. NHM India
4. Press Information Bureau, Government of India. India's UIP: 98.4% full immunization coverage, January 2026
5. UNICEF India. Know Your Child's Immunization Schedule
6. Indian Academy of Pediatrics (IAP). IAP ACVIP Immunization Schedule 2025
7. WHO/CIOMS 2012. Causality Assessment of an Adverse Event Following Immunization (AEFI). Geneva: WHO

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Exam Tips for Pediatric Nursing Students:

• Memorize the complete NIS table (vaccine, age, dose, route, exact site)
• Know the 5 CIOMS/WHO AEFI categories with examples
• Know true vs. false contraindications (commonly tested)
• Know the "why" behind each rule: Why antero-lateral thigh? Why NOT spirit before injection? Why BCG before 1 year only? Why Hep B within 24 hours?
• Know catch-up age limits for each vaccine
• Know VVM reading and cold chain do's/don'ts - these are high-yield for practical and theory exams