Immunization for NEET PG PSM: India's UIP Schedule (2024), Cold Chain, Open Vial Policy, AEFI and the 2026 HPV Campaign

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🎯 Exam priority: High-yield (Tier 1). Recent papers regularly ask the schedule, new vaccines, and catch-up or cold-chain scenarios. Everything here comes from the Ministry of Health's Routine Immunization Manual for Medical Officers (September 2024) and the HPV campaign guidelines (February 2026) — not from older handbooks, which miss the 2023 third fIPV dose.

CBME mapping: CM 8, CM 10.

The National Immunization Schedule

India's National Immunization Schedule as given in the 2024 Routine Immunization Manual (Table 3.1). Ages are in completed weeks, months or years.

• At any visit, give oral vaccines first, then injections.

• The Hep B birth dose prevents mother-to-child transmission only if given within the first 24 hours.

• BCG and MR need reconstitution, always with the diluent supplied by the same manufacturer.

• Pregnant women: Td-1 early in pregnancy and Td-2 four weeks later; a single Td booster if two doses were received in a pregnancy within the last three years.

How the Programme Grew

Cold Chain, VVM and the Open Vial Policy

• Inside the ILR, keep freeze-sensitive vaccines in the upper part of the basket, never touching a cooling surface or ice packs. A shake test shows whether a vaccine has been damaged by freezing.

• The vaccine vial monitor (VVM) is a heat-sensitive label that records cumulative heat exposure; a vial past its discard point must not be used.

• Open vial policy: opened multi-dose vials of Hep B, OPV, IPV, PCV, DPT, Td, JE (killed), pentavalent and rotavirus (VVM on label) can be reused in later sessions for up to 28 days, if within expiry with a usable VVM.

• It does not apply to BCG, MR, JE (live) or rotavirus with VVM on the cap: these are used for at most 4 hours after reconstitution or opening.

Adverse Events Following Immunization (AEFI)

• An AEFI is any untoward medical occurrence after immunization that does not necessarily have a causal relationship with the vaccine.

• Serious AEFI: death, hospitalization, persistent or significant disability, congenital anomaly, or events occurring in a cluster. Any hospitalization is reported as serious, whatever its clinical severity.

• ANMs carry intramuscular adrenaline at every session for anaphylaxis (part of UIP since 2017).

HPV Vaccination Campaign, 2026

• Who: girls aged 14 — those who have had their 14th birthday but not their 15th.

• What: the quadrivalent HPV vaccine (Gardasil), a single 0.5 ml intramuscular dose in the left upper arm. India chose a single-dose schedule because evidence shows efficacy and duration of protection comparable to two doses.

• Why: WHO's global strategy aims to eliminate cervical cancer as a public-health problem (fewer than 4 cases per 100,000 women-years), with the 90-70-90 targets to be met by 2030.

Traps the Examiner Sets

• fIPV now has three doses: 6 weeks, 14 weeks and 9–11 months (since 2023).

• PCV is 2 primary doses (6 and 14 weeks) + a booster at 9–11 months — not at 10 weeks.

• Td replaced TT in 2019; the 10- and 16-year doses are Td.

• BCG dose is 0.05 ml up to 1 month of age, 0.1 ml after.

• BCG and MR (reconstituted) — 4-hour rule; Penta, PCV, IPV, Hep B, OPV — open vial policy (28 days).

• The HPV campaign is a single dose for 14-year-old girls.

Rapid-Revision Cards

• Birth vaccines

  BCG, Hep B birth dose (within 24 h), bOPV-0 (within 15 days).

• 6 weeks

  bOPV-1, Penta-1, RVV-1, fIPV-1, PCV-1.

• 10 weeks

  bOPV-2, Penta-2, RVV-2.

• 14 weeks

  bOPV-3, Penta-3, RVV-3, fIPV-2, PCV-2.

• 9–11 months

  MR-1, fIPV-3, PCV booster, JE-1 (endemic), Vitamin A 1 lakh IU.

• 16–23 months

  MR-2, DPT booster-1, bOPV booster, JE-2, Vitamin A 2 lakh IU.

• 5–6 years / 10 & 16 years

  DPT booster-2 / Td.

• BCG dose

  0.05 ml up to 1 month; 0.1 ml after; intradermal, left arm.

• fIPV

  0.1 ml intradermal; 6 w, 14 w, 9–11 m (3rd dose since 2023).

• Pentavalent contains

  DPT + Hep B + Hib.

• ILR / deep freezer temperature

  +2 to +8 °C / −15 to −25 °C.

• Open vial policy

  Eligible multi-dose vials reused up to 28 days.

• Not under open vial policy

  BCG, MR, JE (live), RVV with VVM on cap — 4 hours.

• VVM shows

  Cumulative heat exposure (shake test checks freezing).

• Heat-stable but freeze-damaged vaccines

  Hepatitis B, PCV, Td.

• Heat/light-sensitive, not freeze-damaged

  MR, BCG.

• Serious AEFI

  Death, hospitalization, disability, congenital anomaly, cluster.

• HPV campaign 2026

  Girls aged 14; single 0.5 ml IM dose quadrivalent; left arm.

Sources

Sources

Facts in this article were checked against these documents.

• Routine Immunization Manual for Medical Officers (Table 3.1 NIS; cold chain; AEFI; FAQs) — Ministry of Health & Family Welfare, Government of India, September 2024 (link)

• Operational Guidelines for Roll Out of HPV Vaccination Campaign — Ministry of Health & Family Welfare / National Health Mission, February 2026 (link)

• CBME Curriculum 2024, Vol. II — Community Medicine (CM 8, CM 10) — National Medical Commission, 2024

Test Yourself: Practice Questions

Eighteen questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. Under India's 2024 National Immunization Schedule, the third dose of fractional IPV is given at

• (a) 9–11 months

• (b) 10 weeks

• (c) 5–6 years

• (d) 16–23 months

Q2. The route and dose of fractional IPV are

• (a) 0.5 ml subcutaneous

• (b) 0.1 ml intradermal

• (c) 2 drops oral

• (d) 0.5 ml intramuscular

Q3. A 3-week-old baby comes for a missed BCG. The correct dose is

• (a) 0.5 ml subcutaneous

• (b) 0.1 ml intradermal

• (c) 0.05 ml intradermal

• (d) BCG cannot be given after birth

Q4. The hepatitis B birth dose prevents perinatal transmission only if it is given

• (a) within 24 hours of birth

• (b) before 1 year

• (c) at 6 weeks

• (d) within 15 days

Q5. Pneumococcal conjugate vaccine under UIP is given at

• (a) 6 and 14 weeks, with a booster at 9–11 months

• (b) birth and 6 weeks

• (c) 6, 10 and 14 weeks

• (d) 9 months and 16 months

Q6. Which vaccine replaced TT in India's immunization programme in 2019?

• (a) Td

• (b) DPT

• (c) TdaP

• (d) Pentavalent

Q7. The second dose of DPT booster is given at

• (a) 9 months

• (b) 16–23 months

• (c) 10 years

• (d) 5–6 years

Q8. The first dose of vitamin A under the schedule is

• (a) 1 lakh IU at 9 months with MR-1

• (b) 2 lakh IU at 9 months

• (c) 2 lakh IU at birth

• (d) 1 lakh IU at 6 weeks

Q9. At a session where several vaccines are due, the correct order is

• (a) oral vaccines first, then injections

• (b) injections first, then oral

• (c) live vaccines last

• (d) any order

Q10. The temperature range of an ice-lined refrigerator storing UIP vaccines is

• (a) 0 °C to +4 °C

• (b) −15 °C to −25 °C

• (c) +2 °C to +8 °C

• (d) +8 °C to +15 °C

Q11. A partially used vial of pentavalent vaccine from today's session may be used in later sessions for up to

• (a) 4 hours

• (b) it must be discarded at the end of the session

• (c) 7 days

• (d) 28 days, if within expiry and VVM usable

Q12. The open vial policy does NOT apply to

• (a) PCV

• (b) pentavalent vaccine

• (c) BCG and measles-rubella vaccine

• (d) Td

Q13. A reconstituted vial of MR vaccine must be discarded after a maximum of

• (a) 28 days

• (b) 24 hours

• (c) 1 hour

• (d) 4 hours

Q14. The vaccine vial monitor on a vial indicates

• (a) freezing

• (b) cumulative heat exposure

• (c) expiry date

• (d) contamination

Q15. Which statement about AEFI is correct?

• (a) Clusters are not reported

• (b) Only deaths count as serious AEFI

• (c) Any hospitalization after immunization is reported as a serious AEFI

• (d) An AEFI must be caused by the vaccine

Q16. Which group of vaccines is relatively heat-stable but damaged by freezing?

• (a) OPV and rotavirus

• (b) BCG and JE (live)

• (c) MR and BCG

• (d) Hepatitis B, PCV and Td

Q17. In India's 2026 HPV vaccination campaign, the vaccine schedule is

• (a) a single dose for boys and girls aged 9

• (b) a single 0.5 ml IM dose of quadrivalent vaccine for girls aged 14

• (c) two doses for girls aged 9–14

• (d) three doses for women up to 26

Q18. WHO's threshold for eliminating cervical cancer as a public-health problem is fewer than

• (a) 4 cases per 100,000 women-years

• (b) 40 cases per million

• (c) 10 cases per 100,000 women-years

• (d) 1 case per 1,000 women

Q19. India switched from trivalent to bivalent OPV on

• (a) 14 July 2016

• (b) 1 January 2023

• (c) 25 April 2016

• (d) 27 March 2014

Active Recall

Write the National Immunization Schedule from birth to 16 years from memory, with the 2023 fIPV-3 dose; then list which vaccines fall under the open vial policy and which follow the 4-hour rule, give the ILR temperature, define AEFI and serious AEFI, and state the 2026 HPV campaign's target and dose.