A 6-month-old male infant presents to the immunisation clinic for routine vaccination. The mother reports that the child received BCG and OPV (oral polio vaccine) at birth, and DPT1 + IPV1 + Hepatitis B1 + PCV1 at 6 weeks of age. On examination, the child is afebrile, alert, and weighs 6.2 kg. According to the National Immunisation Schedule (NIS) of India, which of the following vaccine(s) should be administered at this 6-month visit?

Explanation

## National Immunisation Schedule — 6-Month Milestone **Key Point:** At 6 months of age, the second dose of primary series vaccines is administered according to the NIS (India 2023). ### Vaccine Schedule at 6 Months | Vaccine | Dose | Route | Notes | |---------|------|-------|-------| | DPT (Diphtheria, Pertussis, Tetanus) | 2nd dose | IM | Part of pentavalent or separate | | IPV (Inactivated Polio Vaccine) | 2nd dose | IM | Replaces OPV at 6 weeks and 6 months | | Hepatitis B | 2nd dose | IM | Birth, 6 weeks, 6 months, 14 months | | PCV (Pneumococcal Conjugate Vaccine) | 2nd dose | IM | 6 weeks, 6 months, 12-15 months | | Rotavirus | 2nd dose | Oral | 6 weeks, 10 weeks, 14 weeks (NOT at 6 months) | | OPV (Oral Polio Vaccine) | 2nd dose | Oral | Booster doses only after primary series | **High-Yield:** The current NIS recommends **IPV (inactivated polio vaccine) at 6 weeks and 6 months**, not OPV. OPV is given as booster doses (at 9–12 months and 16–24 months) after the primary IPV series is complete. **Clinical Pearl:** Rotavirus vaccine is given at 6, 10, and 14 weeks (not 6 months). The second dose at 6 months would be outside the recommended window. ### Correct Vaccine Bundle at 6 Months 1. **DPT2** — second dose of diphtheria, pertussis, tetanus 2. **IPV2** — second dose of inactivated polio vaccine 3. **Hepatitis B2** — second dose of hepatitis B 4. **PCV2** — second dose of pneumococcal conjugate vaccine 5. **OPV2** — second booster dose of oral polio vaccine (booster phase) **Mnemonic:** **"DIP-PCV-HepB-OPV at 6M"** — Remember that at 6 months, you give DPT, IPV, PCV, Hepatitis B, and OPV (booster), but NOT Rotavirus (which ends by 14 weeks). **Warning:** Do NOT confuse the primary series (IPV at 6 weeks and 6 months) with the booster series (OPV at 9–12 months and 16–24 months). Both IPV and OPV appear in the schedule but at different phases.