Learn — Childhood infections & immunisation

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Expanded Programme on Immunization (EPI) schedule

The Expanded Programme on Immunization is the framework WHO launched in 1974 to protect every child in the world against six killer diseases — tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. India adopted it in 1978 and expanded it in 1985 into the Universal Immunization Programme, whose current National Immunization Schedule is the timetable a staff nurse actually works from at the session table, from the birth doses through to the Td booster at 16 years.

  • At birth, as early as possible and within 24 hours for the hepatitis B dose: BCG 0.1 mL intradermally into the left upper arm (0.05 mL for an infant under 1 month), OPV zero dose 2 drops by mouth, and hepatitis B birth dose 0.5 mL intramuscularly into the anterolateral thigh.
  • Six weeks: OPV-1, pentavalent-1 (DPT with hepatitis B and Hib) 0.5 mL intramuscularly into the left anterolateral thigh, rotavirus-1 5 drops by mouth, fractional IPV-1 0.1 mL intradermally into the right upper arm and PCV-1 0.5 mL intramuscularly into the right anterolateral thigh.
  • Ten weeks: OPV-2, pentavalent-2 and rotavirus-2 only. Fourteen weeks: OPV-3, pentavalent-3, rotavirus-3, fractional IPV-2 and PCV-2 — so fractional IPV and PCV fall at 6 and 14 weeks, while OPV, pentavalent and rotavirus are given at all three visits.
  • Nine to twelve months: measles-rubella first dose 0.5 mL subcutaneously into the right upper arm, the PCV booster, JE-1 in endemic districts, and the first dose of vitamin A, 1 lakh IU by mouth.
  • Sixteen to twenty-four months: DPT booster-1, OPV booster, MR-2, JE-2 in endemic districts and the second dose of vitamin A, 2 lakh IU; vitamin A is then repeated 2 lakh IU every 6 months until 5 years of age, nine doses in all.
  • The later doses are DPT booster-2 at 5 to 6 years and Td at 10 years and again at 16 years; the pregnant woman gets Td-1 at her first contact and Td-2 four weeks later, or one booster dose if she was fully immunised within the last 3 years.
  • Routes worth memorising: BCG and fractional IPV are the two intradermal injections, OPV and rotavirus and vitamin A are oral, measles-rubella and JE are subcutaneous into the upper arm, and hepatitis B, pentavalent, PCV, DPT and Td are intramuscular into the anterolateral thigh or the upper arm in an older child.
  • Cold chain: vaccines are held at +2 to +8 degrees Celsius in the ice-lined refrigerator at the health facility, while OPV and measles-containing vaccine are the heat-sensitive ones kept frozen at the district store; hepatitis B, pentavalent, PCV, IPV, rotavirus and Td are freeze-sensitive, must never be frozen, are kept away from the freezing unit and are checked with the shake test if freezing is suspected.
  • The vaccine vial monitor is a square inside a circle: the vial may be used while the inner square is lighter than the outer circle and must be discarded the moment the square is as dark as or darker than the circle, whatever the printed expiry says.
  • Open vial policy: opened multi-dose vials of OPV, hepatitis B, pentavalent, fractional IPV, PCV, rotavirus and Td may be used for up to 4 weeks if the vial is dated and labelled, the monitor is usable, the expiry has not passed and the vial was never submerged in water, but reconstituted BCG, measles-rubella and JE must be discarded 4 hours after mixing.
  • The only absolute contraindication to a further dose is anaphylaxis to a previous dose of the same vaccine; a runny nose, low-grade fever, diarrhoea, malnutrition, breastfeeding and a course of antibiotics are not contraindications, and sending such a child home is the commonest missed opportunity in the programme.

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