A 14-month-old girl from urban Delhi is brought to the paediatrician for a catch-up immunisation visit. The mother states the child received all vaccines on time until 12 months but has missed the 12-month booster doses due to family relocation. The child is clinically well with no contraindications to vaccination. According to the IAP (Indian Academy of Paediatrics) schedule, which of the following is the MOST appropriate vaccination plan for this child?

Explanation

## IAP Immunisation Schedule at 14 Months — Catch-up Strategy **Key Point:** At 14 months, the child has missed the 12-month booster vaccines. All missed vaccines can be administered simultaneously without waiting periods (except live vaccines, which require 4-week spacing if given on different days). ### Vaccines Due at 12 Months (Now Overdue at 14 Months) | Vaccine | Dose | Route | Notes | |---------|------|-------|-------| | DPT | 1st booster | IM | Can be given immediately | | IPV | 1st booster | IM | Can be given immediately | | MMR | 1st dose | SC | Live vaccine; if given with other live vaccines, must be same day or 4 weeks apart | | Hepatitis A | 1st dose | IM | IAP recommends at 12 months | | Varicella | 1st dose | SC | IAP recommends at 12 months | **High-Yield:** The IAP schedule includes Hepatitis A and Varicella as recommended vaccines (not part of the National Immunisation Schedule but part of IAP's comprehensive schedule). ### Catch-up Immunisation Principles 1. **No need to restart series** — If primary series is complete, give the next dose in sequence. 2. **Simultaneous administration** — Multiple vaccines can be given at the same visit in different sites. 3. **Live vaccine spacing** — If two live vaccines are not given on the same day, space them ≥4 weeks apart. 4. **No maximum interval** — There is no need to restart a series if the interval between doses exceeds the recommended interval. **Clinical Pearl:** At 14 months, the child can receive all overdue vaccines at once. DPT booster (inactivated) and IPV booster (inactivated) can be given together. MMR and Varicella (both live) can be given on the same day in different sites, or if given on different days, must be spaced 4 weeks apart. **Mnemonic:** **DIVE** — DPT booster, IPV booster, Varicella, and Hepatitis A at 12 months (IAP schedule). ### Why Option 1 Is Correct Option 1 includes DPT booster, IPV booster, MMR, and Varicella — all appropriate at 14 months. Hepatitis A is also due at 12 months per IAP but can be given at 15 months if not available immediately. [cite:Park 26e Ch 6; IAP Immunisation Schedule 2023]