“A comprehensive overview of the key milestones of the Expanded Program on Immunization (EPI) and its impact on child health in India.”

Expanded Program on Immunization (EPI)

Introduction:

Smallpox Eradication: Showed the effectiveness of immunization in India.

• EPI Launch: The World Health Organization (WHO) started the “Expanded Program on Immunization” to protect children from six major diseases: diphtheria, pertussis (whooping cough), tetanus, poliomyelitis (polio), tuberculosis, and measles.
• Support: UNICEF has continuously supported this program.

Key Points:

• “Expanded” Meaning: Adding more vaccines and ensuring the program reaches all parts of the country, especially underserved areas.
• Alma-Ata Conference (1978): Highlighted immunization as vital to achieving health for everyone by 2000.

Milestones:

1. 1978: India began the Expanded Program on Immunization (EPI), mainly in urban areas.
2. 1983: Introduced Tetanus Toxoid (TT) immunization for pregnant women.
3. 1985: EPI was renamed the “Universal Immunization Program” (UIP) by UNICEF, aiming to reduce deaths and illnesses from six vaccine-preventable diseases.

• Indigenous Vaccine Production: Increased to meet the program’s needs.
• Cold Chain System: Set up to ensure vaccines stay effective.
• 1989-90: All districts in India were covered.

1. 1986: Technology mission on immunization started, monitored under the Prime Minister’s 20-point program.
2. 1992: Child Survival and Safe Motherhood (CSSM) program began, including UIP and safe motherhood initiatives.
3. 1995: Pulse Polio Immunization Program started, targeting children under five with additional polio doses during December and January.
4. 2005: National Rural Health Mission (NRHM) launched.
5. 2010-11: Hepatitis B vaccine added, given at 6, 10, and 14 weeks with DPT and OPV.
6. 2006: Japanese Encephalitis vaccine introduced in high-risk areas.
7. 2011: India introduced the pentavalent vaccine (DPT, Hepatitis B, Hib) in Kerala and Tamil Nadu.
8. 2013: Multi-dose vial policy and two doses of Japanese Encephalitis vaccine in endemic areas introduced.
9. 2014: Mission Indradhanush launched to vaccinate all children under five by 2020, with support from WHO, UNICEF, and Rotary International.
10. 2015: Inactivated Polio Vaccine (IPV) introduced in six states, expanded nationwide in 2016.
11. 2016: Rotavirus vaccine introduced in four states.

Components of Universal Child Immunization (UCI)

Overview:

• Two Main Components:

1. Immunization of Pregnant Women: Protects against tetanus with two doses of tetanus toxoid (TT) or a booster dose.
2. Immunization of Children: Targets diseases like diphtheria, pertussis (whooping cough), tetanus (DPT), polio (OPV), tuberculosis (BCG), and measles within the first year of life.

Goals:

• Pregnant Women: Achieve 100% coverage with two TT doses or a booster.
• Children: Reach 85% coverage with three doses of DPT, OPV, one dose of BCG, and one dose of measles by 1990.

Implementation:

• Initial Phase (1985): Began in 30 selected districts and 50 medical college catchment areas.
• Current Phase: Expanded to all districts and medical colleges, integrated with Maternal and Child Health (MCH) services, without additional staffing.

Program Implementation Plan (PIP) to Strengthen Routine Immunization

Key Strategies:

• Vaccine Delivery: Ensures smooth transportation of vaccines from Primary Health Centers (PHC) to sub-centers and outreach areas.
• Retired Manpower: Utilized in underserved slum areas to support immunization efforts.
• Mobility Support: Provided to district immunization officers for better supervision.
• Review Meetings: Held at the state level to monitor district progress.
• Community Mobilization: Assisted by ASHA workers, women’s self-help groups, and others to bring children to immunization clinics.
• Materials Support: Includes printing immunization cards, monitoring sheets, etc.
• Central Government Assistance:
• Auto-disposable syringes.
• Downsizing BCG ampoules from 20 to 10 doses.
• Cold chain maintenance to ensure vaccine potency.

Immunization Schedule 2020

Mandatory Vaccines:

• Administered to all children in India under the Universal Immunization Program (UIP) as per the latest guidelines by the Government of India and the Indian Academy of Pediatrics (IAP), following WHO recommendations.

Schedule Overview:

• Weeks (W), Months (M), and Years (Y): The schedule specifies when each vaccine should be given, tailored to the child’s age and health history.

National Immunization Schedule (NIS) – India 2020

For Infants and Children

Vaccine	When to Give	Dose
BCG	At birth or as early as possible till 1 year of age	0.1 ml (0.05 ml for infants under 1 month)
Hepatitis B (Birth dose)	At birth or as early as possible within 24 hours	0.5 ml
OPV (zero dose)	At birth or as early as possible within the first 15 days	2 drops
Hepatitis B (1st dose)	6 weeks	0.5 ml
DPT (1st dose)	6 weeks	0.5 ml
OPV (1st dose)	6 weeks	2 drops
Hib (1st dose)	6 weeks	0.5 ml
Rotavirus (1st dose)	6 weeks	2.5 ml (liquid) or 1.5 ml (lyophilized)
IPV (1st dose)	6 weeks	0.5 ml
Hepatitis B (2nd dose)	10 weeks	0.5 ml
DPT (2nd dose)	10 weeks	0.5 ml
OPV (2nd dose)	10 weeks	2 drops
Hib (2nd dose)	10 weeks	0.5 ml
Rotavirus (2nd dose)	10 weeks	2.5 ml (liquid) or 1.5 ml (lyophilized)
IPV (2nd dose)	10 weeks	0.5 ml
Hepatitis B (3rd dose)	14 weeks	0.5 ml
DPT (3rd dose)	14 weeks	0.5 ml
OPV (3rd dose)	14 weeks	2 drops
Hib (3rd dose)	14 weeks	0.5 ml
Rotavirus (3rd dose)	14 weeks	2.5 ml (liquid) or 1.5 ml (lyophilized)
Measles/MR (1st dose)	9 completed months-12 months	0.5 ml
JE-I (1st dose)	9 completed months-12 months	0.5 ml
Vitamin A (1st dose)	9 completed months-12 months	1 ml (100,000 IU)
DPT (1st booster)	16-24 months	0.5 ml
OPV (1st booster)	16-24 months	2 drops
IPV (booster dose)	16-24 months	0.5 ml
Hib (booster dose)	16-24 months	0.5 ml
Measles/MR (2nd dose)	16-24 months	0.5 ml
JE-II (2nd dose)	16-24 months	0.5 ml
Vitamin A (2nd dose)	16-24 months	2 ml (200,000 IU)
Vitamin A (3rd to 9th dose)	Every 6 months from 2 years to 5 years	2 ml (200,000 IU) each
DPT (2nd booster)	5-6 years	0.5 ml

For Pregnant Women

Vaccine	When to Give	Dose
TT-1	Early in pregnancy	0.5 ml
TT-2	4 weeks after TT-1	0.5 ml
TT Booster	If previously vaccinated within 3 years	0.5 ml

Note: This table is based on the immunization schedule as recommended by the Ministry of Health and Family Welfare, Government of India

Routine and Catch-Up Dose Schedule for Vaccines

Hepatitis B

• Routine Dose:
• Birth dose within 24 hours.
• 1st dose at 6 weeks, 2nd dose at 10 weeks, and 3rd dose at 14 weeks.
• Catch-Up Dose:
• If missed, start with a dose as soon as possible, followed by 2 more doses at 1-month intervals.

Oral Polio Vaccine (OPV)

• Routine Dose:
• Birth dose, followed by doses at 6, 10, and 14 weeks.
• Booster at 4-6 years.
• Catch-Up Dose:
• Can be given up to 5 years of age.

Inactivated Polio Vaccine (IPV)

• Routine Dose:
• 3 primary doses at 6, 10, and 14 weeks.
• Booster dose at 12-18 months.
• Catch-Up Dose:
• If missed, give at least one dose along with OPV. Complete the primary doses as soon as possible.

DTP (Diphtheria, Tetanus, Pertussis)

• Routine Dose:
• 3 primary doses at 6, 10, and 14 weeks.
• 1st booster at 16-24 months.
• 2nd booster at 4-6 years.
• Catch-Up Dose:
• Missed doses can be completed up to 7 years of age.

Hib (Haemophilus influenzae type b)

• Routine Dose:
• 3 doses at 6, 10, and 14 weeks.
• Booster at 12-18 months.
• Catch-Up Dose:
• For children aged 1-5 years, 1-2 doses can be given based on age and previous doses.

Pneumococcal Conjugate Vaccine (PCV)

• Routine Dose:
• 3 primary doses at 6, 10, and 14 weeks.
• Booster at 15 months.
• Catch-Up Dose:
• For children 12-23 months, 2 doses at 4-week intervals.
• For children 2-5 years, 1 dose.

Rotavirus

• Routine Dose:
• 3 doses at 6, 10, and 14 weeks.
• Catch-Up Dose:
• Missed doses can be given before 8 months of age.

Influenza

• Routine Dose:
• 2 doses at 6 months of age (4 weeks apart).
• Annual dose thereafter.
• Catch-Up Dose:
• 2 doses can be given at any time for children under 9 years.

MMR (Measles, Mumps, Rubella)

• Routine Dose:
• 1st dose at 9-12 months.
• 2nd dose at 15-18 months or 4-6 years.
• Catch-Up Dose:
• 2 doses at 4-week intervals for children and adolescents.

Typhoid (Vi PS Conjugate)

• Routine Dose:
• Primary dose at 9-12 months.
• Booster at 2 years.
• Catch-Up Dose:
• Can be given up to 18 years of age.

Hepatitis A

• Routine Dose:
• 1 dose at 12-23 months (live vaccine) or 2 doses (killed vaccine) with a 6-month interval.
• Catch-Up Dose:
• Can be given up to 18 years of age.

Chickenpox (Varicella)

• Routine Dose:
• 1st dose at 12-15 months.
• 2nd dose at 4-6 years.
• Catch-Up Dose:
• 2 doses at a 3-month interval for children aged 7-12 years; 4-week interval for those 13 years and older.

Tdap (Tetanus, Diphtheria, Pertussis)

• Routine Dose:
• 1 dose at 11-12 years.
• Catch-Up Dose:
• Can be given to children aged 7-10 years if not fully immunized.

HPV (Human Papillomavirus)

Can be given up to 25 years, maintaining minimum intervals.

Routine Dose:

2 doses for girls aged 9-14 years, with a 6-month interval.

3 doses for girls 15 years and older (0, 1-2, 6 months).

Catch-Up Dose:

Can be given up to 25 years, maintaining minimum intervals.

Read more: “Expanded Program on Immunization (EPI): 14 Key Milestones that Transformed Child Health”

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