Red Flags
- Severe vaccine reaction (anaphylaxis, encephalopathy, severe persistent crying for >3 h) — refer adverse event for assessment; document and report; consult before subsequent doses[1]
- Live vaccine in immunocompromised child or pregnancy — generally contraindicated; review individualised; specialist input[1]
- Significant vaccine delay or refusal — outreach, catch-up schedule, address vaccine hesitancy with evidence-based counselling[1]
- Outbreak setting (measles, polio, diphtheria, JE) — supplementary immunisation activity; expand age range and accelerate catch-up[1]
First-line treatment
Interventions
- UIP schedule (free, government)[1]Birth: BCG, OPV-0, Hep B-0. 6w/10w/14w: Pentavalent (DTP-HepB-Hib), OPV, IPV (selected sites), PCV, Rota. 9 mo: MR-1, JE-1 (endemic), Vitamin A. 16–24 mo: DPT booster, OPV booster, MR-2, JE-2. 5–6 y: DPT-2 booster. 10 y/16 y: Td. Pregnancy: Td/Tdap × 2 doses
- IAP-ACVIP additional schedule[1]Add Typhoid Conjugate Vaccine (TCV) 9–12 mo, Hepatitis A 12 mo (×2 doses), Varicella 12 mo + 4–6 y, HPV girls (and boys per latest update) 9–14 y (2 doses), influenza annually, MMR (1st dose 9 mo + 2nd at 15 mo)
- Catch-up immunisation[1]Use IAP catch-up tables; minimise gaps; combination vaccines reduce injection burden; document carefully on Kalandar/IAP card and digital records (CoWIN-derivative platforms)
- Address vaccine hesitancy and counselling[1]Active listening; address specific concerns; cite local, evidence-based outcomes; tailor communication to caregiver; respect autonomy while reinforcing benefit; mass-campaign participation
First-line drug therapy
| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Pentavalent vaccine (DTP-HepB-Hib)[1] | Combination inactivated/conjugate vaccine | Not applicable — paediatric guideline | 0.5 mL IM (anterolateral thigh in infants) at 6, 10, 14 weeks | Foundation of UIP infant schedule; combines diphtheria, tetanus, pertussis, hepatitis B, Hib; document lot number and site; expect mild fever and injection-site reaction |
| Bacille Calmette-Guérin (BCG)[1] | Live attenuated bacterial vaccine | Not applicable — paediatric guideline | 0.05 mL intradermal at birth (or as soon as possible if delayed) | First dose at birth; left deltoid; small papule then ulcer is expected; contraindicated in known severe immunodeficiency |
| Measles-Rubella (MR) or MMR[1] | Live attenuated viral vaccine | Not applicable — paediatric guideline | MR 1st dose 9 mo, 2nd dose 16–24 mo (UIP). MMR 1st dose 9 mo, 2nd dose 15 mo (IAP) | Critical for measles elimination; 95% coverage to interrupt transmission; live vaccine — defer 4 weeks if MR-1 already given |
| Pneumococcal conjugate vaccine (PCV)[1] | Conjugate bacterial vaccine | Not applicable — paediatric guideline | 0.5 mL IM at 6, 14 weeks + booster 9 months (UIP) — or per IAP/manufacturer schedule | PCV13 or PCV15 per local availability; reduces invasive pneumococcal disease and pneumonia; eligible up to 5 years for catch-up |
| Rotavirus vaccine (oral)[1] | Live oral viral vaccine | Not applicable — paediatric guideline | 5 drops PO at 6, 10, 14 weeks (UIP — Rotavac/Rotasiil); first dose by 15 weeks, last by 32 weeks (intussusception risk) | Strict age windows for first and last dose; defer if intercurrent severe gastroenteritis; live vaccine — caution in primary immunodeficiency household |
| HPV vaccine (Gardasil-9 or Cervavac)[1] | Recombinant subunit vaccine | 0.5 mL IM at 0, 6 months (2-dose) for adolescents 9–14 y; 0.5 mL IM at 0, 1–2, 6 months (3-dose) for ≥15 y | Adolescents 9–14 y: 0.5 mL IM × 2 doses 6 months apart | IAP recommends from age 9; 2-dose schedule under 15; reduces cervical and HPV-related cancers; counsel both girls and boys per latest schedules |
Pentavalent vaccine (DTP-HepB-Hib)[1]
Combination inactivated/conjugate vaccine
- Adult
- Not applicable — paediatric guideline
- Paediatric
- 0.5 mL IM (anterolateral thigh in infants) at 6, 10, 14 weeks
Foundation of UIP infant schedule; combines diphtheria, tetanus, pertussis, hepatitis B, Hib; document lot number and site; expect mild fever and injection-site reaction
Bacille Calmette-Guérin (BCG)[1]
Live attenuated bacterial vaccine
- Adult
- Not applicable — paediatric guideline
- Paediatric
- 0.05 mL intradermal at birth (or as soon as possible if delayed)
First dose at birth; left deltoid; small papule then ulcer is expected; contraindicated in known severe immunodeficiency
Measles-Rubella (MR) or MMR[1]
Live attenuated viral vaccine
- Adult
- Not applicable — paediatric guideline
- Paediatric
- MR 1st dose 9 mo, 2nd dose 16–24 mo (UIP). MMR 1st dose 9 mo, 2nd dose 15 mo (IAP)
Critical for measles elimination; 95% coverage to interrupt transmission; live vaccine — defer 4 weeks if MR-1 already given
Pneumococcal conjugate vaccine (PCV)[1]
Conjugate bacterial vaccine
- Adult
- Not applicable — paediatric guideline
- Paediatric
- 0.5 mL IM at 6, 14 weeks + booster 9 months (UIP) — or per IAP/manufacturer schedule
PCV13 or PCV15 per local availability; reduces invasive pneumococcal disease and pneumonia; eligible up to 5 years for catch-up
Rotavirus vaccine (oral)[1]
Live oral viral vaccine
- Adult
- Not applicable — paediatric guideline
- Paediatric
- 5 drops PO at 6, 10, 14 weeks (UIP — Rotavac/Rotasiil); first dose by 15 weeks, last by 32 weeks (intussusception risk)
Strict age windows for first and last dose; defer if intercurrent severe gastroenteritis; live vaccine — caution in primary immunodeficiency household
HPV vaccine (Gardasil-9 or Cervavac)[1]
Recombinant subunit vaccine
- Adult
- 0.5 mL IM at 0, 6 months (2-dose) for adolescents 9–14 y; 0.5 mL IM at 0, 1–2, 6 months (3-dose) for ≥15 y
- Paediatric
- Adolescents 9–14 y: 0.5 mL IM × 2 doses 6 months apart
IAP recommends from age 9; 2-dose schedule under 15; reduces cervical and HPV-related cancers; counsel both girls and boys per latest schedules
Safety-net
- Bring the immunisation card to every visit; never miss a dose if you can avoid it; mild fever, soreness, and irritability are expected and resolve in 1–2 days[1]
- If your child has a severe reaction (difficulty breathing, swelling of face, persistent severe crying, seizure) — same-day medical review[1]
- Catch-up is possible at any age — do not skip vaccinations even if delayed; speak to your paediatrician about a personalised plan[1]
Referral criteria
- Severe adverse event following immunisationAEFI committee notification; paediatrician for individualised future schedule[1]
- Immunocompromised child (primary, HIV, transplant, on immunosuppression)Paediatric immunology / specialist for live-vaccine eligibility and dose adjustments[1]
- Pre-international travelTravel medicine clinic for itinerary-specific vaccines (yellow fever, typhoid, JE, rabies pre-exposure)[1]
- Outbreak setting (measles, polio, diphtheria, JE)Public health response — supplementary immunisation activity[1]
Clinical summary
Universal Immunisation Programme (UIP) and IAP-ACVIP childhood vaccination schedule in adults and children, including catch-up and special situations.