Guidelines for vaccinations of a normal child in India

The Expanded Program of Immunization (EPI) was introduced globally in 1974. The initial EPI program in India was limited to Bacillus Calmette Guerin (BCG), diphtheria, tetanus toxoids, whole cell pertussis (DTwP), oral poliomyelitis, and typhoid vaccines, and chiefly covered urban areas. The Universal Immunization Program (UIP), introduced in 1985, improved immunization coverage and extended the focus beyond infancy. Typhoid vaccine was excluded from the schedule, and measles vaccine was added. Vitamin A supplementation was added in 1990, and the Polio National Immunization Days introduced in 1995. Some states introduced hepatitis B vaccine in 2002 and a pentavalent vaccine (Haemophilus influenzae [b-HiB] and hepatitis B with DTwP) in 2011. UIP is an essential part of the Child Survival and Safe Motherhood Program since 1992, the Reproductive and Child Health Program (RCH-I) from 1997, and the RCH-II and National Rural Health Mission since 2005.[1]

Indian Academy of Pediatrics 2014 Guidelines

The Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices recommended immunization of children until the age of 18 years based on the recent evidence of the licensed vaccines in the country [Table 2]. The major changes introduced in 2014 included[2] the following:

Table 2.

Comparison of vaccines included in the National Immunization Program and the 2014 recommendation of the Indian Academy of Pediatrics

• Two doses of measles mumps rubella at 9 and 15 months of age, and no standalone measles vaccine at 9 months

• Single dose administration of live attenuated H2 strain hepatitis A vaccine, or two doses of inactivated (killed) hepatitis A vaccine

• New slot at 9-12 months for typhoid conjugate vaccine for primary immunization

• Two doses of human papillomavirus vaccines with a minimum interval of 6 months between doses of primary schedule of adolescent/preadolescent girls aged 9-14 years.

Special Circumstances

High-risk groups

The Indian Academy of Pediatrics recommends additional vaccines for children with high-risk conditions [Table 3].

Table 3.

High-risk conditions where certain added vaccines may be necessary

Corticosteroids and immunosuppressive therapy

Children receiving high-dose (HD) steroids (prednisolone >2 mg/kg/day or for those more than 10 kg, 20 mg/day or equivalent) for >2 weeks should not receive live vaccines until the steroids have been discontinued for at least 1 month. Killed vaccines are safe but may be less efficacious.

Lapsed immunization

Table 4 outlines the suggested schedules for children who have missed routine immunizations. There is no need to restart a vaccine series regardless of the time that has relapsed between the individual doses due to the immune memory.

Table 4.

Vaccinations in case of a previously unimmunized child

Solid Organ Transplantation

Children requiring transplantation require immunization due to the immunosuppressive nature of the underlying disease and the need for immunosuppression for the graft survival. In general, standard vaccination should be followed for such children. The recipients should complete all immunizations before the transplant in an accelerated schedule if needed. Live vaccines should be completed at least 2 weeks before the transplant. It will be desirable if the seroconversion is documented.

Posttransplantation, all live vaccines are contraindicated. Vaccination with killed vaccines may be commenced 6 months posttransplantation when the immunosuppression is at the lowest possible. Table 5 summarizes vaccines before and after solid organ transplant in children.

Table 5.

Suggested vaccines before and after solid organ transplant in children