Three vaccines are due at birth — BCG, oral polio and hepatitis B, with the hepatitis B dose given within 24 hours of birth, and the next three visits fall at 6, 10 and 14 weeks. That is the IAP-ACVIP schedule (2025 revision, published in Indian Pediatrics 2026;63:311-324), and most of those first-year doses are free at government centres in Tamil Nadu.
Written by Dr. A. Muhammed Shadique, Consultant Pediatrician, AJSMC, Egmore, Chennai (TNMC 111008). This page is about routine, planned immunisation. It is not a page for a child who is unwell right now: AJSMC has no casualty or trauma unit, so anything sudden or severe means calling 108 or going straight to the nearest hospital with a 24-hour emergency department.
Which vaccine is due at which age in 2026?
The chart below is the IAP-ACVIP Recommended Immunization Schedule 2025 revision, finalised at the IAP office in Navi Mumbai on 22-23 November 2025 and published in Indian Pediatrics 2026;63:311-324. It replaced the 2023 schedule. The right-hand column tells you what the government programme in Tamil Nadu provides free at the same age, because the two schedules do not line up dose for dose.
| Age | Vaccines due on the IAP-ACVIP schedule (2025 revision) | Free under the government programme in Tamil Nadu? |
|---|---|---|
| Birth | BCG (before discharge), OPV zero dose, Hepatitis B-1 within 24 hours | Yes — all three, free (MoHFW, 2024) |
| 6 weeks | DTwP or DTaP-1, IPV-1, Hib-1, Hep B-2, Rotavirus-1, PCV-1 | Yes — as pentavalent-1 (DPT + hepatitis B + Hib), bOPV-1, rotavirus-1, fractional IPV-1 (0.1 mL intradermal) and PCV-1. DTaP is not in the programme |
| 10 weeks | DTwP/DTaP-2, IPV-2, Hib-2, Hep B-3, Rotavirus-2, PCV-2 | Partly — pentavalent-2, bOPV-2 and rotavirus-2 are free. The programme gives no IPV and no PCV dose at 10 weeks |
| 14 weeks | DTwP/DTaP-3, IPV-3, Hib-3, Hep B-4, Rotavirus-3, PCV-3 | Yes — pentavalent-3, bOPV-3, rotavirus-3, fractional IPV-2 and PCV-2 (the programme's second PCV dose) |
| 6 months | Influenza (IIV) dose 1 | No — influenza vaccine is not in the government programme |
| 6-9 months | Typhoid conjugate vaccine — a single 0.5 mL intramuscular dose from 6 months of age, scheduled at 6-9 months. No booster dose is recommended (IAP-ACVIP 2025, Indian Pediatrics 2026;63:311-324, Table 2) | Ask at the government immunisation centre whether typhoid conjugate vaccine is offered there |
| 7 months | Influenza (IIV) dose 2, four weeks after dose 1 | No |
| 9 months | MMR-1 | Partly — the programme gives MR-1 (measles and rubella, no mumps) at 9-12 months, free, along with fractional IPV-3, the PCV booster and Vitamin A dose 1. Japanese encephalitis dose 1 is free only in 13 endemic Tamil Nadu districts, and Chennai is not one of them (TN DPH, accessed 2026) |
| 12 months | Hepatitis A dose 1 (single dose only if the live attenuated vaccine is used) | No |
| 15 months | MMR-2, Varicella-1, PCV booster | Partly — the PCV booster is free but is given at 9-12 months in the programme, and MR-2 is free but is given at 16-24 months. Varicella is not in the programme |
| 16-18 months | DTwP/DTaP booster-1, Hib booster-1, IPV booster-1 | Partly — DPT booster-1 and the bOPV booster are free at 16-24 months, along with MR-2. The Hib booster and the intramuscular IPV booster are not in the programme |
| 18-19 months | Hepatitis A dose 2 (inactivated vaccine only), Varicella-2 (3-6 months after dose 1) | No |
| 4-6 years | DTwP/DTaP booster-2, IPV booster-2, MMR-3 | Partly — DPT booster-2 is free at 5-6 years. The programme has no third measles-containing dose and no IPV booster at this age |
| 9 to under 15 years | HPV — immunocompetent girls: a single 0.5 mL intramuscular dose. Boys: two doses at 0 and 6 months, with a gap of not less than 5 months | Free for girls aged 14, as a single dose of the quadrivalent vaccine at government health facilities, on routine immunisation days (MoHFW reply in Rajya Sabha, PIB, 17 March 2026). Not free for boys, nor for girls outside the 14-year target age |
| 10 years | Tdap | Partly — Td is free at 10 years. Tdap is not in the programme, and Td may be substituted if Tdap is unavailable |
| 15-18 years | HPV three-dose schedule (0, 2 and 6 months) from the 15th year onward, and for immunocompromised children of any age | No |
| 16-18 years | Td or Tdap | Partly — Td is free at 16 years |
| Every year, 6 months to 5 years | Influenza, annually, usually pre-monsoon; continued to 18 years and beyond if the child is at high risk of influenza complications | No |
| 9 months to 5 years | Not a vaccine, but given at the same visits: Vitamin A, nine doses in all | Yes — dose 1 at 9 months with MR-1, dose 2 at 16-18 months, then one dose every six months to the age of 5 (MoHFW, 2024) |
One change in the 2025 revision is easy to miss and appears wrongly on many charts still online: quadrivalent influenza vaccines are to be replaced with trivalent vaccines (A/H1N1, A/H3N2, B/Victoria), because the B/Yamagata lineage has shown no sustained community transmission since 2020 (Indian Pediatrics 2026;63:311-324). If a chart you are reading says quadrivalent, it predates this revision.
Which of these are free at the government centre, and which are not?
The government programme and the IAP-ACVIP chart do not line up dose for dose, so it is worth knowing which of the doses due at a given age the programme provides. The government list below is the National Immunization Schedule in the MoHFW Routine Immunization Manual for Health Workers, 2024.
| Vaccine | Free under the government programme? | What a parent in Egmore, Chennai should know |
|---|---|---|
| BCG, hepatitis B, bOPV, pentavalent, rotavirus, PCV | Yes | These cover the whole first-year core. Pentavalent carries DPT, hepatitis B and Hib in one 0.5 mL intramuscular injection |
| Injectable polio | Yes, as fractional IPV — 0.1 mL intradermal at 6 weeks, 14 weeks and 9-12 months | The IAP schedule uses full-dose intramuscular IPV at 6, 10 and 14 weeks. A child who completed all three fractional IPV doses of the government series does not need an additional intramuscular IPV dose at 16-18 months, but does still need an intramuscular IPV booster at 4-6 years (IAP-ACVIP 2023, Indian Pediatrics 2024;61:113-125, page 118). A child who received only two fractional doses is not covered by that reconciliation and should have the remaining doses worked out with the paediatrician |
| Measles and rubella | Yes, as MR, two doses | The mumps component is not in the government programme. IAP-ACVIP 2025 lists three MMR doses, at 9 months, 15 months and 4-6 years |
| Vitamin A | Yes, nine doses to age 5 | Dose 1 at 9 months with MR-1, dose 2 at 16-18 months, then one dose every six months to the age of 5 |
| Td at 10 and 16 years | Yes | IAP-ACVIP 2025 recommends Tdap at 10 years, which adds the pertussis component |
| HPV | Yes, for girls aged 14, single dose, at government facilities | The national programme launched on 28 February 2026 with registration through U-WIN. Its 90-day launch drive, which also covered girls turning 15 within that window, has since closed, and the vaccine now continues on routine immunisation days for the 14-year age group (MoHFW reply in Rajya Sabha, PIB, 17 March 2026). Not available free to boys or to girls outside the 14-year group, and not repeated for girls already vaccinated with any HPV vaccine |
| Typhoid conjugate | Ask at the government immunisation centre | It is on the IAP-ACVIP 2025 schedule as a single dose at 6-9 months. Whether it is offered at your local government session is the question to put to that centre |
| Japanese encephalitis | Only in 13 endemic Tamil Nadu districts | Chennai is not one of them. The 13 are Tiruvallur, Tiruvannamalai, Villupuram, Cuddalore, Perambalur, Ariyalur, Thiruvarur, Thanjavur, Pudukottai, Tiruchirapalli, Madurai, Virudhunagar and Karur (TN DPH, accessed 2026) |
| Influenza, hepatitis A, varicella | No | All three are on the IAP-ACVIP 2025 schedule and none is part of the national routine programme |
| Meningococcal, cholera, PPSV23, yellow fever | No | Special situations and travel only, not routine childhood immunisation |
Delivery arrangements in Tamil Nadu can differ in detail from the national programme, so the government immunisation centre is the place to confirm what is being offered locally and on which days.
How is HPV dosing decided?
The bound that matters is the 15th birthday. A girl who is still under 15 gets one dose; a girl who has turned 15 gets three (IAP-ACVIP 2025, Indian Pediatrics 2026;63:311-324, Table 2 and Fig. 1 footnote j).
| Who | Doses on the IAP-ACVIP 2025 schedule | Interval |
|---|---|---|
| Immunocompetent girls, 9 to under 15 years | Single 0.5 mL intramuscular dose | Not applicable |
| Boys, 9 to under 15 years | Two doses | 0 and 6 months; the gap between dose 1 and dose 2 must not be less than 5 months |
| Anyone starting from the 15th year onward | Three doses | 0, 2 and 6 months — dose 2 at least 1 month after dose 1, dose 3 at least 3 months after dose 2 |
| Immunocompromised children, any age | Three doses | Same 0-2-6 month schedule |
What if we missed a dose — do we have to start again?
No. The rule is explicit in MoHFW guidance for health workers (2024): if a vaccine is delayed, the schedule is not restarted. The next dose in the series is given, and you are given an appointment for the dose after that at the normal interval. The same instruction appears in the older MoHFW Immunization Handbook for Medical Officers (2008).
What a delay does change is the deadline. Several government doses have a maximum age past which they are no longer given, so a long gap can close the door on a particular dose even though it does not undo the ones already received.
| Vaccine | Latest age the government dose can still be given |
|---|---|
| BCG | Before the 1st birthday |
| bOPV zero dose | Within the first 15 days of life |
| bOPV 1, 2, 3 and booster | 5 years |
| Pentavalent | 1 year |
| Rotavirus | 1 year |
| Fractional IPV | 1 year |
| PCV | 1 year |
| MR dose 1 and dose 2 | 5 years |
| Japanese encephalitis (endemic districts) | 2 years |
| DPT booster-1 and booster-2 | 7 years |
| Vitamin A | 5 years |
| Td | 16 years |
Two catch-up rules from the IAP-ACVIP general instructions decide how quickly the missed doses can then be given. The minimum interval between two doses of the same inactivated vaccine is usually 4 weeks, rabies excepted. A dose given up to 4 days before that minimum interval or minimum age still counts as valid; a dose given 5 or more days early is invalid and has to be repeated. Bring the immunisation card to the appointment so the actual dates, not a recollection, decide what is given.
Some rules are about spacing rather than lateness. Two or more live injected or intranasal vaccines, if they are not given on the same day, must be at least 28 days apart. Live oral vaccines are exempt. Inactivated vaccines can be given at any interval relative to each other or to live vaccines, and any number of antigens can be given on the same day (IAP-ACVIP general instructions, accessed 2026).
Children who move from the government programme onto the IAP schedule need the two lists reconciled dose by dose, because the measles-containing vaccine differs between them — MR in the programme, MMR on the IAP chart. Take the card to the paediatrician and have the remaining measles-containing doses worked out against what is already recorded.
When should a vaccination be postponed?
Far less often than parents expect. A runny nose is not a reason to skip the visit, and a small or underweight child is a reason to be more careful about keeping the schedule, not less. MoHFW states plainly that mild illness is not a contraindication, and that malnourished children should be vaccinated on schedule because they are more prone to vaccine-preventable diseases (MoHFW Routine Immunization Manual for Health Workers, 2024).
| Situation | What happens |
|---|---|
| Severely sick child | Postpone; come back after recovery |
| Fever above 38.5 C on the day of the appointment, before the dose is given | Postpone, and give the dose once the fever has settled |
| Mild illness — cough, cold, mild loose motion, low-grade fever | Not a contraindication; vaccinate |
| Malnutrition | Not a contraindication; vaccinate on schedule |
| Anaphylaxis or another severe reaction to a previous dose or to a vaccine component | That vaccine is not given again |
| Immunoglobulin or a blood product received recently | Live vaccine at least 3 months later; the exact interval depends on the product |
| Vaccine given first, immunoglobulin needed after | The antibody product is given after a gap of at least 2 weeks |
| Known immunocompromise — HIV, steroids, chemotherapy | Vaccinate only in consultation with the treating physician |
| Known pregnancy (relevant for adolescent girls) | No live vaccines |
| Egg allergy | Only yellow fever vaccine is contraindicated. A history of anaphylaxis to any vaccine component must still be told to the doctor before the dose |
| Breastfeeding | Only yellow fever vaccine is contraindicated |
| Two live injected vaccines not given the same day | Space them at least 28 days apart |
| Oral vaccine spat out or vomited | The full dose is repeated in the same session |
Sources for this table: MoHFW Routine Immunization Manual for Health Workers, 2024; IAP-ACVIP general instructions, accessed 2026; WHO measles vaccines position paper, April 2017, which also states that mild concurrent infection is not a contraindication to a measles-containing vaccine and that the minimum interval between the first and second measles doses is 4 weeks.
Is fever after a vaccine normal, and what do we do at home?
Usually yes. Local reactions — pain, swelling or redness at the injection site, and fever can be expected in about 1 in 10 children, rising to as many as 1 in 2 after a DPT or Td booster. Measles-rubella vaccine causes fever, rash or red eyes in 5-15% of children, and that one appears about a week after the dose rather than the same evening (MoHFW Routine Immunization Manual for Health Workers, 2024).
| Expected and self-limiting | How common | What to do at home |
|---|---|---|
| Pain, swelling or redness at the injection site | About 1 in 10; up to 1 in 2 after DPT or Td boosters | Cold cloth on the site; paracetamol if there is fever |
| Fever | About 1 in 10; up to 1 in 2 after DPT or Td boosters | Extra fluids, tepid sponging, paracetamol if needed |
| Fever, rash or red eyes after measles-rubella vaccine | 5-15% of children | Same as above; appears about a week after the dose |
| A BCG papule that ulcerates and then heals with a scar | Expected | Starts 2 or more weeks after the dose and heals over several months. Keep it clean and dry. It is not an infection and does not need antibiotic ointment |
| Irritability, off feeds, out of sorts | Common | Extra fluids and comfort; tell the doctor if it is severe or unlike your child |
On paracetamol, MoHFW advises 10-15 mg per kg of body weight every 4-6 hours, a maximum of four doses in 24 hours with at least four hours between doses, given only when there is fever, not routinely after every vaccine. It is not recommended for a child weighing under 2 kg (MoHFW, 2024).
Two different temperatures appear in MoHFW's manual and they answer two different questions, so read each with its context attached. The first, 38.5 C on the day of the appointment and before the dose is given, is the threshold for deciding whether to vaccinate that day: above it, the dose is postponed. The second, an axillary temperature of 38 C (100.4 F) after the dose, or a child who feels hot to touch, is the caregiver-advice threshold for having the child looked at, not an emergency number. Fever after a vaccine is common and is normally managed at home; what needs same-day attention is set out below.
IAP-ACVIP advises that a child be observed for 15-20 minutes after immunisation before leaving, because immediate allergic reactions declare themselves in that window. Plan the visit around that, and do not leave the premises as soon as the injection is over.
Which reactions need a doctor the same day?
A small number of reactions are not part of the normal picture and are not something to watch at home overnight.
| Reaction | What it looks like |
|---|---|
| Anaphylaxis — a medical emergency | Sudden and fast-worsening, with signs in any two of three systems: swelling of the lips, tongue or throat, difficulty breathing, noisy or whistling breathing, grunting or blue lips; fainting, dizziness, drowsiness or collapse; widespread hives, widespread redness or generalised itching with a rash |
| A fit (seizure) | Any convulsion after a vaccine |
| Hypotonic hyporesponsive episode | Sudden limpness with reduced responsiveness and pallor or blueness, within 48 hours and usually within 12. It is transient and self-limiting, needs no specific treatment, and is not a reason to stop further doses — but it must be seen and recorded |
| Persistent inconsolable screaming | Prolonged high-pitched crying that will not settle |
| Abscess at the injection site | A fluid-filled or draining swelling |
| Fever that is out of the ordinary rather than fever in itself | Any fever in an infant under 3 months; a temperature above 40 C; fever that starts more than 48 hours after the dose or is still going beyond 48-72 hours; or fever together with drowsiness, poor feeding, breathing difficulty or a fit |
Anaphylaxis and post-vaccination seizures need a hospital with a 24-hour emergency department. AJSMC in Egmore, Chennai runs an outpatient service and has no casualty or trauma unit. If your child collapses, has difficulty breathing, turns blue or has a fit, call 108 or go directly to the nearest hospital with a 24-hour emergency department — do not spend time travelling to an outpatient clinic. Immediate intramuscular adrenaline followed by immediate transport is what MoHFW specifies for anaphylaxis (MoHFW Routine Immunization Manual for Health Workers, 2024).
Reactions that MoHFW classes as serious. Those causing death, hospitalisation, persistent or significant disability, congenital anomaly, or occurring in clusters — are reportable events, so tell whoever gave the dose even after the child has been treated elsewhere.
When are outpatient services in Egmore?
AJSMC runs outpatient services Monday to Saturday, 10am to 9pm, at Police Commissioner Office Road, Egmore, Chennai 600008. The hospital number is 044 2532 2021.
Book around the child rather than the calendar where you can. If a child is running a fever on the planned morning, the dose is deferred and the schedule resumes. It is not restarted, so there is nothing lost by moving the visit by a few days.
What do we bring, and how long does the visit take?
- The immunisation card, every time. It is the record that decides which dose is next and whether a dose given early counts.
- Any hospital discharge summary from birth, which is where the BCG and birth-dose hepatitis B entries usually sit.
- The child's weight if it was measured recently, and a note of any reaction to a previous dose — what happened, how soon after, and how long it lasted.
- Details of any recent immunoglobulin or blood product, and of any ongoing steroid or chemotherapy treatment, since both change what can be given that day.
- If the child has had doses at a government centre, bring that card too rather than a list written from memory.
Plan for the visit to run past the injection itself — IAP-ACVIP advises 15-20 minutes of observation afterwards.
What about vaccines that are not on the routine chart?
Nirsevimab, the RSV monoclonal antibody, is not a routine vaccine and IAP-ACVIP 2025 does not recommend it for all infants. Until good Indian epidemiological data on RSV are available, its use is restricted to high-risk infants after discussion with parents (Indian Pediatrics 2026;63:311-324). It does not belong on a routine chart and should not be expected at a standard visit.
An animal bite is not an outpatient scheduling matter. IAP-ACVIP 2025 follows the NCDC five-dose intramuscular post-exposure schedule on days 0, 3, 7, 14 and 28, given together with rabies immunoglobulin or monoclonal antibody according to the category of exposure. A bite or scratch needs same-day assessment at a centre equipped to give immunoglobulin — go to a hospital with a 24-hour emergency department or an anti-rabies clinic the same day, not to a routine clinic session.
When should you see a doctor about the schedule itself?
Book a paediatric review, rather than waiting for the next due date, if any of the following applies. Your child had a reaction to a previous dose that involved a fit, limpness, prolonged screaming or breathing difficulty. Your child is immunocompromised, is on steroids or chemotherapy, or has received immunoglobulin or a blood transfusion in the past few months. Your child has moved between the government programme and a private schedule and you cannot tell which doses are still owed. Or the card has doses recorded at ages that do not match either schedule, since a dose given 5 or more days before its minimum interval does not count and needs repeating.
And if a child is genuinely unwell right now — breathing difficulty, a fit, collapse, or drowsiness that is not like them. That is not a question about the vaccination chart. Call 108 or go to the nearest hospital with a 24-hour emergency department. AJSMC, Egmore, Chennai does not run a casualty unit.
Written by Dr. A. Muhammed Shadique, Consultant Pediatrician, TNMC 111008.
Independently reviewed by Dr. Ashutosh Kumar Singh, Consultant General Physician, TNMC 126451.
Primary sources: IAP-ACVIP Recommended Immunization Schedule 2025, Indian Pediatrics 2026;63:311-324; IAP-ACVIP Recommended Immunization Schedule 2023, Indian Pediatrics 2024;61:113-125; IAP-ACVIP general instructions, accessed 2026; MoHFW Routine Immunization Manual for Health Workers, 2024; MoHFW Immunization Handbook for Medical Officers, 2008; PIB, Government of India, 28 February 2026 and 17 March 2026; Tamil Nadu Directorate of Public Health, accessed 2026; WHO measles vaccines position paper, April 2017.
