The IAP vaccine schedule explained for parents

The Indian Academy of Pediatrics (IAP) schedule starts at birth, has three main visits at 6, 10 and 14 weeks, then boosters through childhood. The free government programme (UIP) covers the most dangerous diseases. The IAP schedule adds a few more. Giving each vaccine on time matters more than which clinic gives it.

How do vaccines work?

A vaccine shows the immune system a harmless piece or weakened form of a germ, so the body learns to fight it before meeting the real infection.

The body makes antibodies (proteins that lock onto a germ) and memory cells that remember it for years. When the real germ arrives, the response is fast and strong, and the child either does not get ill or gets a much milder illness.

Some vaccines need several doses to build full protection, and some need boosters later because protection fades. That is why the schedule has repeat visits.

What is the IAP vaccine schedule for babies?

The IAP's 2023 schedule gives vaccines at birth, 6 weeks, 10 weeks and 14 weeks, then at 6 months, 9 months, and through the second year.¹

• Birth: BCG (against severe tuberculosis), oral polio drops, and hepatitis B within 24 hours.¹
• 6, 10 and 14 weeks: DTP (diphtheria, tetanus, whooping cough), injectable polio (IPV), Hib, hepatitis B, rotavirus and pneumococcal vaccine (PCV).¹
• 6 and 7 months: two doses of flu vaccine, then yearly until age 5.¹
• 6 to 9 months: typhoid conjugate vaccine.¹
• 9 months: MMR (measles, mumps, rubella).¹

Several of these come as one combined injection. One brand of rotavirus vaccine needs only 2 doses, the others 3.¹

Which vaccines are due after the first birthday?

The second year has hepatitis A, more MMR, chickenpox and the first set of boosters.¹

• 12 months: hepatitis A.
• 15 months: MMR second dose, chickenpox (varicella) first dose, PCV booster.
• 16 to 18 months: boosters of DTP, Hib and polio.
• 18 to 19 months: second chickenpox dose, and second hepatitis A dose if the inactivated type was used.
• 4 to 6 years: DTP, polio and MMR boosters.
• 9 to 14 years: HPV vaccine, 2 doses 6 months apart, now advised for boys as well as girls.
• 10 years: Tdap, and 16 to 18 years: Td.

All of this is from the IAP 2023 timetable.¹ Schedules are updated every few years, so treat this as a map and follow your paediatrician's card.

What is the difference between the UIP and IAP schedules?

The UIP (Universal Immunisation Programme) gives free vaccines at government centres. The IAP schedule, followed by most private paediatricians, includes those diseases plus a few extra vaccines.

One example is polio. The IAP advises 5 full doses of injectable polio vaccine. The government programme uses smaller doses injected into the skin at 6 weeks, 14 weeks and 9 months, along with oral polio drops.¹ Both approaches protect.

The UIP vaccines are not second-rate. They are the same proven vaccines that drove polio out of India. If a family cannot afford the IAP's combined injection, the IAP itself advises going to a government centre for the primary doses.¹

You can mix the two. Many families take the free UIP vaccines and pay only for the extras. Tell both providers what has been given and keep one card.

Are "optional" vaccines really needed?

Dr Dutta would call them additional rather than optional. They protect against real diseases that put many Kolkata children in hospital.

Vaccines often outside the government card include flu, typhoid conjugate, hepatitis A, chickenpox and the mumps part of MMR. What the UIP covers changes over time and differs by state, so ask your local centre.

Typhoid is a good example. In a trial of 20,019 children in Nepal, one dose of typhoid conjugate vaccine cut blood-proven typhoid by 79% over 2 years.² Given how common typhoid is in our city, and how hard it has become to treat, Dr Dutta considers it well worth it.

If cost is a problem, finish the basic schedule on time first. Then add extras as you can.

Is the painless vaccine better than the normal one?

Both protect well. The "painless" vaccine (acellular, DTaP) causes less fever and swelling than the whole-cell type (DTwP), but it is still an injection.³

A Cochrane review found that most side effects were less common with acellular vaccines. It also found that good acellular vaccines work about as well as many whole-cell ones, though the best whole-cell vaccines may protect slightly better.³ The IAP allows either for the baby doses.¹

So the whole-cell vaccine, used in the government programme, is a perfectly good choice if cost matters. Expect a fussier day or two afterwards. If your child had a serious reaction to an earlier dose, your doctor will advise which to use next.

Why does my baby need so many vaccines so early?

Because the diseases they prevent are most dangerous in the first months of life. Each vaccine is timed to protect a baby as early as her immune system can respond.

• Whooping cough can make a young baby stop breathing.
• Pneumococcus and Hib cause meningitis and pneumonia, worst in infancy.
• Rotavirus is a leading cause of severe dehydrating diarrhoea in countries like India.⁴ An Indian-made rotavirus vaccine roughly halved severe rotavirus diarrhoea in Indian babies in its first year.⁴
• Measles can cause pneumonia and brain swelling, and weakens the body's defence against other infections for 2 to 3 years afterwards.⁵

Every week of delay is a week without protection at the age of greatest risk.

Is it safe to give several vaccines at one visit?

Yes. Giving several vaccines together is safe, and babies respond well to vaccines given in combination.⁶

A baby's immune system meets a huge number of new germs and proteins every day from milk, skin, hands and the gut. A review of the evidence showed that vaccines take up a tiny part of its capacity, that combined vaccines work as well as separate ones, and that vaccinated children do not get more other infections.⁶ Today's vaccines also contain fewer antigens (the parts the immune system reacts to) than older vaccines did.⁶

Spreading doses over extra visits means more pricks, more trips and longer gaps without protection.

Can we follow a slower or alternative schedule?

Dr Dutta does not recommend it. Slower schedules have no proven benefit, and they leave babies unprotected during the riskiest months.

The IAP schedule sets a recommended age for every dose.¹ A homemade spread-out plan is not tested for either safety or protection. It also adds visits and injections.

If you have a worry about a particular vaccine, bring it to Dr Dutta. She would rather talk it through than have you quietly skip a dose.

Are vaccines safe for my baby?

Yes. Serious reactions are rare, and the diseases are far more dangerous than the vaccines.

Severe allergic reaction (anaphylaxis) is the reaction parents fear most. In a US study of over 25 million doses, it happened about 1 time in every million doses.⁷ Clinics still ask you to wait after the injection, because most such reactions start within minutes to hours.⁷

Vaccines also do not cause sudden infant death. Babies who are vaccinated have about half the risk of SIDS of babies who are not.⁸

Can my baby be vaccinated if she has a cold or was born early?

Yes. A mild illness, a runny nose, loose stools, teething, or being on antibiotics are not reasons to delay. Mild illness does not stop the vaccine from working.⁶

Babies born preterm get their vaccines on the same schedule as other babies, counted from their actual date of birth, not their due date.⁹ This matters, because infections hit preterm babies harder, and delays in this group are common.⁹

There are only a few true reasons to postpone, such as a high fever with a significant illness, or specific immune problems for live vaccines. Your doctor will decide.

What should I do if my baby missed a vaccine?

Go as soon as you can. In most cases the series does not need to restart; your doctor simply continues from where you left off.

For example, if the birth dose of hepatitis B was missed, the IAP says it can be given at the first contact with a health facility.¹ Your doctor will plan a catch-up schedule with the right gaps between doses.

Some vaccines, such as rotavirus, have age limits, so a long delay can mean losing the chance to give them. Bring every card and record you have, from every clinic, to that visit.

What side effects are normal after vaccines?

Mild fever, fussiness, sleepiness and a sore, red or swollen spot at the injection site are common in the first day or two, and they settle on their own.

In one trial, about two in three babies had a temperature of 38 degrees C or more after their first vaccines, but fever above 39.5 degrees C was uncommon.¹⁰ A small, firm lump at the injection site can last a few weeks and is harmless.

Fever after the 6-week vaccines usually starts within a day. A fever that begins several days later, or lasts more than 2 days, is probably something else and needs a check.

Should I give paracetamol before vaccines?

No, not routinely. Giving paracetamol at the time of the vaccine lowered fever in a trial, but it also lowered the baby's antibody response.¹⁰

The trial authors concluded that fever medicine should not be routinely given at vaccination.¹⁰ If your baby is uncomfortable or feverish afterwards, ask your doctor whether a dose of paracetamol is right, and use the exact dose for her weight.

How can I comfort my baby during and after the injection?

Breastfeed her during or straight after the injection. It reduces crying and pain.¹¹

A Cochrane review found that breastfeeding during vaccination cut crying time and lowered pain scores compared with no treatment, water, or cuddling alone.¹¹

• Hold her upright and close against you, not lying flat on the table.
• If she is not breastfed, a sweet solution offered by the clinic, or swaddling, shushing and sucking, can help.¹²
• Stay calm and talk to her. Babies read our faces.
• At home, extra feeds and cuddles are the main treatment.

When should I call a doctor after a vaccine?

Get emergency help at once if, within minutes to hours of a vaccine, your baby has swelling of the face or lips, noisy breathing, difficulty breathing, widespread hives, or collapse.⁷ Go to hospital straight away too if she has a fit (convulsion), becomes floppy, unusually pale or hard to wake, or is under 3 months and has a temperature of 38 degrees C or more that started a day or more after the vaccine.

Call your doctor the same day if your baby:

• cries without stopping for 3 hours or more
• has fever above 39 degrees C, or fever lasting more than 2 days
• has a spreading red, hot swelling at the injection site

And please call if you are simply unsure whether a symptom is a vaccine reaction or a separate illness. That is a reasonable question to ask.