Introduction
In routine outpatient departments and pediatric wards, children commonly present with fever, cough, diarrhea, and other infectious conditions. A significant proportion of these illnesses are caused by vaccine-preventable diseases (VPDs). These diseases not only contribute to avoidable morbidity and mortality but also impose a heavy burden on families and the health system.
Immunization is one of the most cost-effective public health interventions, capable of preventing disease, disability, and death. Recognizing this, India has implemented a comprehensive national programme to protect children and pregnant women from major VPDs through free vaccination services.
UIP – Universal Immunization Programme
The Universal Immunization Programme (UIP) is a national programme of immunization that provides free vaccines against selected vaccine-preventable diseases to all eligible beneficiaries, including infants, children, adolescents, and pregnant women.
India’s UIP is among the largest immunization programmes in the world, both in terms of beneficiaries covered and vaccines administered annually. It forms the backbone of India’s child survival strategy and is a critical component of primary health care.
History of UIP
The evolution of immunization services in India reflects growing public health priorities:
- 1978 – Expanded Programme on Immunization (EPI) introduced
- 1985 – Universal Immunization Programme launched
- 1992 – UIP became part of the Child Survival and Safe Motherhood Programme
- 1997 – Integrated into the National Reproductive and Child Health (RCH) Programme
- 2014 – Launch of Mission Indradhanush to improve coverage
- 2017 – Intensified Mission Indradhanush to target low-coverage districts
These initiatives aimed to close immunization gaps and ensure equitable access.
Why UIP
The Universal Immunization Programme was introduced to:
- Reduce morbidity, mortality, and disability due to VPDs
- Achieve ≥90% full immunization coverage
- Reduce Infant Mortality Rate (IMR) and Under-5 Mortality Rate (U5MR)
- Eliminate, eradicate, or control selected diseases such as neonatal tetanus, polio, measles, and rubella
Diseases Covered under UIP
UIP currently protects against multiple VPDs, including:
- Tuberculosis
- Poliomyelitis
- Diphtheria
- Pertussis
- Tetanus
- Hepatitis B
- Haemophilus influenzae type b
- Measles
- Rubella
- Rotavirus diarrhea
- Pneumococcal disease
- Japanese Encephalitis (in endemic areas)
Why Only These Diseases
These diseases were selected because:
- They are of major public health importance
- They cause high morbidity and mortality, especially in children
- Safe and effective vaccines are available
- Disease burden reduction significantly improves child survival indicators
UIP Schedule
| Age | Vaccines given |
| Pregnant woman | Td-1, Td-2 or Td Booster** |
| At Birth | Bacillus Calmette–Guérin (BCG), Oral Polio Vaccine (OPV) – 0 dose, Hepatitis B birth dose |
| 6 weeks | OPV-1, Pentavalent-1, Rotavirus Vaccine (RVV)-1, Fractional dose of Inactivated Polio Vaccine (fIPV)-1, Pneumococcal Conjugate Vaccine (PCV)-1 |
| 10 weeks | OPV-2, Pentavalent-2, RVV-2 |
| 14 weeks | OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2 |
| 9–12 months | Measles & Rubella (MR)-1, Japanese Encephalitis (JE)-1*, PCV Booster |
| 16–24 months | MR-2, JE-2*, Diphtheria–Pertussis–Tetanus (DPT) Booster-1, OPV Booster |
| Age | Vaccines given |
| 5–6 years | DPT Booster-2 |
| 10 years | Tetanus & adult Diphtheria (Td) |
| 16 years | Td |
•JE vaccine is given only in endemic districts
•** Td booster is given if the woman was adequately immunized in a previous pregnancy within the last 3 years
Td Vaccine in Pregnancy
- Protects both mother and newborn against tetanus
- Prevents neonatal tetanus, a fatal but preventable disease
- Given as Td-1 and Td-2, or booster depending on prior immunization history
BCG Vaccine
- Given at birth or as early as possible
- Protects against severe forms of childhood tuberculosis such as TB meningitis and miliary TB
OPV Vaccine
- Oral Polio Vaccine provides intestinal immunity
- Plays a critical role in polio eradication
- Administered at birth and during infancy
IPV Vaccine
- Inactivated Polio Vaccine induces systemic immunity
- Used along with OPV to prevent vaccine-derived poliovirus
Hepatitis B Vaccine
- Prevents chronic hepatitis, cirrhosis, and hepatocellular carcinoma
- Birth dose is crucial to prevent perinatal transmission
Pentavalent Vaccine
- Protects against five diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B, and Hib
- Reduces injection burden and improves compliance
Rotavirus Vaccine
- Prevents severe rotavirus diarrhea
- Significantly reduces hospitalizations and deaths due to diarrhea
PCV Vaccine
- Protects against pneumococcal pneumonia, meningitis, and sepsis
- Important for reducing under-5 mortality
MR Vaccine
- Measles-Rubella vaccine aims to eliminate measles and control rubella
- Prevents Congenital Rubella Syndrome (CRS)
JE Vaccine
- Administered in JE-endemic districts
- Prevents a disease with high fatality and neurological sequelae
DPT Vaccine
- Provides booster protection against diphtheria, pertussis, and tetanus
- Maintains long-term immunity
Td Vaccine in Children
- Given during adolescence
- Replaces TT to provide additional diphtheria protection
Vitamin A Solution
- Prevents vitamin A deficiency
- Reduces severity of measles and diarrhea
- Lowers child mortality
AD Syringes
Auto-disable (AD) syringes are single-use syringes that lock or break after one injection.
Purpose:
- Prevent syringe reuse
- Reduce transmission of HIV, Hepatitis B, and Hepatitis C
- Mandatory under UIP for all injectable vaccines
Hub Cutter
A hub cutter is a needle-destroying device used immediately after injection.
Function:
- Cuts and separates the needle
- Prevents reuse
- Ensures safe biomedical waste disposal
Vaccine Vial Monitor (VVM)
A Vaccine Vial Monitor is a time-temperature-sensitive label attached to vaccine vials.
Purpose:
- Indicates cumulative heat exposure
- Ensures vaccine potency and safety
Structure:
- Light-colored outer circle
- Heat-sensitive inner square
Vaccine Vial Monitor Interpretation
- Inner square lighter than outer circle → Vaccine usable
- Inner square same or darker → Vaccine to be discarded
Open Vial Policy
The Open Vial Policy allows reuse of certain opened multi-dose liquid vaccine vials.
Conditions:
- Vaccine within expiry date
- Proper cold chain maintained
- No contamination
Benefits:
- Reduces vaccine wastage
- Improves cost-effectiveness
Opened vials can be used for up to 28 days.
AEFI (Adverse Events Following Immunization)
AEFI is defined as any untoward medical occurrence following immunization, not necessarily causally related to the vaccine.
Purpose of AEFI Surveillance
- Ensure vaccine safety
- Maintain public confidence
- Detect programmatic errors early
AEFI Classification
- Vaccine reaction
- Programmatic error
- Coincidental event
- Injection reaction
- Unknown
AEFI Reporting
- All serious AEFIs (death, hospitalization, anaphylaxis) must be reported within 24 hours
- Reporting is mandatory under UIP
- Minor AEFIs are reported periodically
- Reporting is non-punitive and aimed at programme improvement
Who Will Implement
- Ministry of Health and Family Welfare
- State and district health authorities
- Medical officers, ANMs, ASHAs, Anganwadi workers
Session Monitoring
- Ensures quality, safety, and adherence to guidelines
- Identifies gaps in service delivery
Four Key Messages to Parents
- Complete immunization protects the child from serious diseases
- Vaccines are safe and effective
- Mild fever or pain is normal after vaccination
- Keep and bring the immunization card every visit
Immunization Card
- Legal and medical record of vaccination
- Helps track due doses
- Essential for school admission and travel
Summary
The Universal Immunization Programme is a cornerstone of India’s public health system, providing free vaccines to prevent major VPDs. It aims to reduce morbidity, mortality, disability, and IMR, while achieving ≥90% full immunization coverage. A well-defined schedule, safe injection practices, effective surveillance of AEFI, and strong communication with parents are essential for the programme’s success.
Applied MCQs – Universal Immunization Programme (UIP)
Q1.
A 6-week-old infant presents to an immunization clinic for the first time. Which of the following vaccines should be administered as per UIP?
A. BCG, OPV, Hepatitis B
B. OPV, Pentavalent, Rotavirus, IPV
C. BCG, MR, OPV
D. OPV, DPT booster, Vitamin A
Correct answer: B
Q2.
A pregnant woman received two doses of Td vaccine during her last pregnancy 2 years ago. She is now pregnant again. What is the correct immunization strategy?
A. Td-1 and Td-2
B. Single Td booster
C. No Td required
D. TT booster only
Correct answer: B
Q3.
Japanese Encephalitis (JE) vaccine under UIP is given:
A. To all children nationwide
B. Only during outbreaks
C. Only in endemic districts
D. Only to children below 1 year
Correct answer: C
Q4.
A vaccine vial monitor (VVM) shows the inner square darker than the outer circle. What should be done?
A. Use vaccine immediately
B. Shake well and use
C. Discard the vaccine
D. Keep in cold chain and reuse later
Correct answer: C
Q5.
Which of the following vaccines is included in the Pentavalent vaccine?
A. Measles
B. Hepatitis A
C. Haemophilus influenzae type b
D. Rotavirus
Correct answer: C
Q6.
A 9-month-old child presents with incomplete immunization and has not received MR vaccine. What is the major public health concern?
A. Risk of neonatal tetanus
B. Risk of congenital rubella syndrome in community
C. Risk of poliomyelitis
D. Risk of hepatitis B carrier state
Correct answer: B
Q7.
Which vaccine under UIP is most effective in preventing severe forms of childhood tuberculosis?
A. OPV
B. BCG
C. Pentavalent
D. MR
Correct answer: B
Q8.
An opened vial of DPT vaccine was stored properly in cold chain and used 10 days later. This practice is allowed due to:
A. Cold chain maintenance
B. Vaccine vial monitor
C. Open vial policy
D. Multi-dose vial policy
Correct answer: C
Q9.
What is the maximum duration an opened eligible vaccine vial can be used under the Open Vial Policy?
A. 7 days
B. 14 days
C. 21 days
D. 28 days
Correct answer: D
Q10.
Which of the following adverse events must be reported within 24 hours under UIP?
A. Fever <38°C
B. Local swelling
C. Anaphylaxis
D. Mild pain at injection site
Correct answer: C
Q11.
Which vaccine is primarily responsible for reduction in severe diarrheal deaths under UIP?
A. MR vaccine
B. Vitamin A
C. Rotavirus vaccine
D. PCV
Correct answer: C
Q12.
A child receives OPV at birth. The primary purpose of OPV is to induce:
A. Only systemic immunity
B. Only humoral immunity
C. Intestinal and community immunity
D. Cell-mediated immunity
Correct answer: C
Q13.
Which device is mandatory under UIP to prevent reuse of syringes and transmission of blood-borne infections?
A. Disposable syringe
B. AD syringe
C. Glass syringe
D. Insulin syringe
Correct answer: B
Q14.
What is the primary function of a hub cutter in immunization sessions?
A. Sterilization of needles
B. Disposal of vaccine vials
C. Cutting needle immediately after use
D. Cold chain maintenance
Correct answer: C
Q15.
Which vitamin supplementation under UIP reduces child mortality and severity of measles?
A. Vitamin D
B. Vitamin C
C. Vitamin A
D. Vitamin K
Correct answer: C
Q16.
A serious AEFI occurs following vaccination. The main purpose of AEFI surveillance is:
A. Punish health workers
B. Stop immunization sessions
C. Ensure vaccine safety and public confidence
D. Withdraw vaccines immediately
Correct answer: C
Q17.
Which of the following is NOT a classification of AEFI?
A. Vaccine reaction
B. Programmatic error
C. Genetic reaction
D. Coincidental event
Correct answer: C
Q18.
Replacement of TT with Td vaccine in children primarily helps in prevention of:
A. Only tetanus
B. Only diphtheria
C. Tetanus and diphtheria
D. Tetanus and pertussis
Correct answer: C
Q19.
Which of the following vaccines under UIP helps in preventing pneumonia and meningitis?
A. Rotavirus
B. MR
C. PCV
D. OPV
Correct answer: C
Q20.
The most important document for tracking child immunization status is:
A. Birth certificate
B. OPD slip
C. Immunization card
D. School record
Correct answer: C
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