# Immunization for NEET PG PSM: India's UIP Schedule (2024), Cold Chain, Open Vial Policy, AEFI and the 2026 HPV Campaign Source: https://tracknation.in/story/immunization-for-neet-pg-psm-india-s-uip-schedule-2024-cold-chain-open-vial-policy-aefi-and-the-2026-hpv-campaign (TrackNation β€” free UPSC notes with PYQs) > NEET PG Community Medicine: the National Immunization Schedule from the 2024 MoHFW Routine Immunization Manual (with a timeline diagram) including the fIPV-3 dose, doses, routes and sites, the history of UIP vaccine introductions, cold-chain equipment and temperatures, VVM, the open vial policy, the 4-hour rule, shake test, AEFI definitions, and the 2026 single-dose HPV campaign β€” with verified MCQs and cards. ## Start Here 🎯 **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)** β€” 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.* | **Vaccine** | **Age** | **Dose Β· route** | **Site** | | BCG | Birth (up to 1 year) | 0.05 ml up to 1 month, 0.1 ml after Β· intradermal | Left upper arm (deltoid) | | Hep B birth dose | Within 24 hours of birth | 0.5 ml Β· IM | Left anterolateral thigh | | bOPV-0; bOPV 1–3 | Birth (within 15 days); 6, 10, 14 weeks | 2 drops Β· oral | Mouth | | Rotavirus 1–3 | 6, 10, 14 weeks (up to 1 year) | 5 drops or 2 ml (by formulation) Β· oral | Mouth | | fIPV 1, 2, 3 | 6 weeks, 14 weeks, 9–11 months | 0.1 ml Β· intradermal | Right upper arm (1, 2); left (3) | | PCV | 6, 14 weeks + booster 9–11 months | 0.5 ml Β· IM | Right anterolateral thigh | | Pentavalent 1–3 | 6, 10, 14 weeks (up to 1 year) | 0.5 ml Β· IM | Left anterolateral thigh | | MR-1; MR-2 | 9–11 months; 16–23 months | 0.5 ml Β· subcutaneous | Right upper arm | | DPT booster-1; booster-2 | 16–23 months; 5–6 years (up to 7 years) | 0.5 ml Β· IM | Thigh (booster-1); left upper arm (booster-2) | | Td | 10 and 16 years; pregnancy | 0.5 ml Β· IM | Upper arm | | Vitamin A | 9 months with MR-1 (1 lakh IU); then 2 lakh IU every 6 months to 5 years | Oral | Mouth | - 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 | **Year** | **Milestone** | | 2011 | Pentavalent vaccine (DPT + Hep B + Hib) introduced in a phased manner | | 2014 | India and the South-East Asia Region certified polio-free; Mission Indradhanush launched | | 2016 | tOPV β†’ bOPV switch (25 April); fractional IPV nationwide; rotavirus vaccine begins in 4 states | | 2017 | MR campaign (9 months–15 years) replacing measles vaccine; PCV in a phased manner | | 2019 | Td replaces TT; rotavirus vaccine nationwide | | 2021 | PCV nationwide | | 2023 | fIPV-3 at 9–11 months; U-WIN digital platform introduced | | 2026 | HPV vaccination campaign: single dose for girls aged 14 (see below) | ## Cold Chain, VVM and the Open Vial Policy | **Equipment** | **Temperature** | **Use** | | Ice-lined refrigerator (ILR) | +2 Β°C to +8 Β°C | Store all UIP vaccines at PHC and district level | | Deep freezer | βˆ’15 Β°C to βˆ’25 Β°C | Prepare and store ice packs (and OPV/freeze-dried vaccine storage at higher levels) | | Walk-in cooler | +2 Β°C to +8 Β°C | Bulk storage; no hold-over time without power | | Cold box, vaccine carrier | +2 Β°C to +8 Β°C | Transport and session sites | - 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. | **Group (MoHFW 2024)** | **Vaccines** | **Heat** | **Freezing** | | Heat-sensitive | OPV; rotavirus (VVM on label) | Sensitive | Not damaged | | Heat- and light-sensitive | MR, BCG | Sensitive | Not damaged | | Freeze-sensitive | IPV, DPT, pentavalent, JE, rotavirus (VVM on cap) | Sensitive | Damaged | | Freeze-sensitive, heat-stable | Hepatitis B, PCV, Td | Relatively stable | Damaged | - 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 β€” 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 β€” 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) β€” 4-hour rule; Penta, PCV, IPV, Hep B, OPV β€” open vial policy (28 days). - The HPV campaign is a single dose for 14-year-old girls. ## Rapid-Revision Cards - BCG, Hep B birth dose (within 24 h), bOPV-0 (within 15 days). - bOPV-1, Penta-1, RVV-1, fIPV-1, PCV-1. - bOPV-2, Penta-2, RVV-2. - bOPV-3, Penta-3, RVV-3, fIPV-2, PCV-2. - MR-1, fIPV-3, PCV booster, JE-1 (endemic), Vitamin A 1 lakh IU. - MR-2, DPT booster-1, bOPV booster, JE-2, Vitamin A 2 lakh IU. - DPT booster-2 / Td. - 0.05 ml up to 1 month; 0.1 ml after; intradermal, left arm. - 0.1 ml intradermal; 6 w, 14 w, 9–11 m (3rd dose since 2023). - DPT + Hep B + Hib. - +2 to +8 Β°C / βˆ’15 to βˆ’25 Β°C. - Eligible multi-dose vials reused up to 28 days. - BCG, MR, JE (live), RVV with VVM on cap β€” 4 hours. - Cumulative heat exposure (shake test checks freezing). - Hepatitis B, PCV, Td. - MR, BCG. - Death, hospitalization, disability, congenital anomaly, cluster. - 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) β€” Ministry of Health & Family Welfare, Government of India, September 2024 (link) - Operational Guidelines for Roll Out of HPV Vaccination Campaign β€” Ministry of Health & Family Welfare / National Health Mission, February 2026 (link) - CBME Curriculum 2024, Vol. II β€” Community Medicine (CM 8, CM 10) β€” 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, βˆ’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 **Answer: (a)** β€” fIPV is given at 6 weeks, 14 weeks and 9–11 months; the third dose was introduced in 2023. **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 **Answer: (b)** β€” fIPV is a fractional 0.1 ml intradermal dose (right upper arm for doses 1 and 2, left for dose 3). **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 **Answer: (c)** β€” BCG is 0.05 ml up to 1 month of age and 0.1 ml from 1 month to 1 year, intradermally in the left upper arm. **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 **Answer: (a)** β€” The MoHFW manual states the birth dose is effective against mother-to-child transmission only within the first 24 hours. **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 **Answer: (a)** β€” PCV: 2 primary doses at 6 and 14 weeks + 1 booster at 9–11 months. **Q6.** Which vaccine replaced TT in India's immunization programme in 2019? - (a) Td - (b) DPT - (c) TdaP - (d) Pentavalent **Answer: (a)** β€” Td (tetanus and adult diphtheria) replaced TT in 2019. **Q7.** The second dose of DPT booster is given at - (a) 9 months - (b) 16–23 months - (c) 10 years - (d) 5–6 years **Answer: (d)** β€” DPT booster-2 is given at 5–6 years (up to 7 years of age). **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 **Answer: (a)** β€” Vitamin A: 1 lakh IU (1 ml) at 9 months with MR-1; then 2 lakh IU every 6 months from 16–23 months up to 5 years. **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 **Answer: (a)** β€” The manual instructs that oral vaccines are given first, followed by injections. **Q10.** The temperature range of an ice-lined refrigerator storing UIP vaccines is - (a) 0 Β°C to +4 Β°C - (b) βˆ’15 Β°C to βˆ’25 Β°C - (c) +2 Β°C to +8 Β°C - (d) +8 Β°C to +15 Β°C **Answer: (c)** β€” An ILR maintains +2 Β°C to +8 Β°C; deep freezers (βˆ’15 Β°C to βˆ’25 Β°C) are for ice packs. **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 **Answer: (d)** β€” Under the open vial policy, eligible multi-dose vials can be reused for up to four weeks (28 days) from opening. **Q12.** The open vial policy does NOT apply to - (a) PCV - (b) pentavalent vaccine - (c) BCG and measles-rubella vaccine - (d) Td **Answer: (c)** β€” OVP excludes BCG, MR, rotavirus with VVM on cap/stem and JE (live); these must be used within 4 hours of opening/reconstitution. **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 **Answer: (d)** β€” Vaccines outside the open vial policy are used for a maximum of 4 hours after reconstitution or opening. **Q14.** The vaccine vial monitor on a vial indicates - (a) freezing - (b) cumulative heat exposure - (c) expiry date - (d) contamination **Answer: (b)** β€” A VVM is a heat-sensitive label that registers cumulative heat exposure; freezing is checked by the shake test. **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 **Answer: (c)** β€” AEFI need not be causally linked to the vaccine; serious AEFI includes death, hospitalization, disability, congenital anomaly or clusters. **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 **Answer: (d)** β€” The 2024 manual groups Hep B, PCV and Td as relatively heat-stable but damaged by freezing; MR and BCG are heat- and light-sensitive but not damaged by freezing. **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 **Answer: (b)** β€” The campaign uses quadrivalent Gardasil as a single 0.5 ml IM dose in the left upper arm for girls aged 14. **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 **Answer: (a)** β€” The global strategy sets elimination at fewer than 4 cases per 100,000 women-years, with 90-70-90 targets by 2030. **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 **Answer: (c)** β€” The tOPV to bOPV switch was on 25 April 2016. ### 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.