Baby vaccination schedule protects against 12 life-threatening diseases in Pakistan through EPI (Expanded Programme on Immunization). Learn complete timeline birth to 2 years: BCG/OPV/Hepatitis B at birth, Pentavalent/PCV/Rotavirus at 6/10/14 weeks, Measles-Rubella at 9 months, Typhoid at 12 months, boosters at 15 months. Includes free vs paid vaccines, where to get vaccines (BHU, RHC, DHQ, private), side effects management, missed vaccine catch-up, and addressing vaccine hesitancy in Pakistan.
Baby Vaccination Schedule: Complete Guide From Birth to 2 Years (Pakistan EPI)
Baby vaccination schedule protects against 12 life-threatening diseases in Pakistan through EPI (Expanded Programme on Immunization). Learn complete timeline birth to 2 years: BCG/OPV/Hepatitis B at birth, Pentavalent/PCV/Rotavirus at 6/10/14 weeks, Measles-Rubella at 9 months, Typhoid at 12 months, boosters at 15 months. Includes free vs paid vaccines, where to get vaccines (BHU, RHC, DHQ, private), side effects management, missed vaccine catch-up, and addressing vaccine hesitancy in Pakistan.
Quick Reference: When Are Vaccines Due?
| Age | Vaccines Due | Protects Against |
|---|---|---|
| AT BIRTH | • BCG • OPV-0 • Hepatitis B-1 |
Tuberculosis, Polio, Hepatitis B |
| 6 WEEKS | • Pentavalent-1 • PCV-1 • OPV-1 • Rotavirus-1 |
Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib, Pneumonia, Polio, Diarrhea |
| 10 WEEKS | • Pentavalent-2 • PCV-2 • OPV-2 • Rotavirus-2 |
(Same as 6 weeks - dose 2) |
| 14 WEEKS | • Pentavalent-3 • PCV-3 • OPV-3 |
(Same as 6 weeks - dose 3, no Rotavirus) |
| 9 MONTHS | • Measles-Rubella (MR) | Measles, Rubella (German measles) |
| 12 MONTHS | • Typhoid Conjugate Vaccine (TCV) | Typhoid fever |
| 15 MONTHS | • Measles-Rubella (MR-2) • DTP Booster |
Measles, Rubella, Diphtheria, Tetanus, Pertussis (booster doses) |
Total visits needed: 7 visits from birth to 2 years to complete full immunization schedule.
What Is Pakistan EPI? (Expanded Programme on Immunization)
According to Federal Directorate of Immunization Pakistan:
"EPI aims to vaccinate children aged 0-15 months against 12 Vaccine Preventable Diseases (VPDs)."
— Federal Directorate of Immunization, Pakistan
The 12 diseases EPI protects against:
- Tuberculosis (TB)
- Poliomyelitis (Polio)
- Diphtheria
- Pertussis (Whooping cough)
- Tetanus
- Hepatitis B
- Haemophilus influenzae type b (Hib) - causes meningitis
- Pneumococcal disease (Pneumonia)
- Rotavirus diarrhea
- Measles
- Rubella (German measles)
- Typhoid fever
EPI in Pakistan - key facts:
- Launched in 1978 (46 years of protecting Pakistani children)
- ALL vaccines are FREE at government health facilities
- Aims to immunize 3.39 million children (0-23 months) annually
- Uses WHO pre-qualified vaccines (quality assured)
- Available at: Basic Health Units (BHU), Rural Health Centers (RHC), District Headquarters (DHQ) hospitals, Tehsil Headquarters (THQ) hospitals, and through outreach workers
Complete Pakistan EPI Schedule: Birth to 2 Years (Detailed)
AT BIRTH (Within 24 Hours)
1. BCG (Bacille Calmette-Guérin) - Tuberculosis Vaccine
- What it protects against: Tuberculosis (TB) - serious lung infection
- How it's given: Injection in upper left arm
- Important note: Leaves small scar on arm (this is normal and expected)
- Side effects: Small bump forms, turns into blister, heals in 2-5 months leaving scar. Do NOT cover or apply cream.
2. OPV-0 (Oral Polio Vaccine - Birth Dose)
- What it protects against: Polio (causes permanent paralysis)
- How it's given: 2 drops by mouth
- Why at birth: Pakistan is one of only 2 countries where polio still exists. Early protection is critical.
- Side effects: Usually none
3. Hepatitis B-1 (Birth Dose)
- What it protects against: Hepatitis B virus (causes liver disease)
- How it's given: Injection in thigh
- Why at birth: Mother may unknowingly have Hepatitis B. Birth dose protects baby immediately.
- Side effects: Mild soreness at injection site
6 WEEKS OLD
1. Pentavalent Vaccine - Dose 1 (5-in-1 Vaccine)
- What it contains: DTP (Diphtheria, Tetanus, Pertussis) + Hepatitis B + Hib
- Protects against 5 diseases in single injection
- How it's given: Injection in thigh
- Side effects: Fever, fussiness, soreness. Normal for 1-2 days.
2. PCV-1 (Pneumococcal Conjugate Vaccine) - Dose 1
- What it protects against: Pneumococcal bacteria (causes pneumonia, meningitis, ear infections)
- How it's given: Injection in thigh
- Important: Pneumonia is leading cause of death in Pakistani children under 5. This vaccine is CRITICAL.
- Side effects: Mild fever, redness at injection site
3. OPV-1 (Oral Polio Vaccine) - Dose 1
- How it's given: 2 drops by mouth
- Side effects: Usually none
4. Rotavirus-1 (Oral Vaccine) - Dose 1
- What it protects against: Rotavirus diarrhea (severe, life-threatening diarrhea in babies)
- How it's given: Liquid by mouth
- Introduced: 2017 in Pakistan EPI
- Side effects: Mild diarrhea or vomiting (rare)
10 WEEKS OLD
Same vaccines as 6 weeks - Dose 2:
- Pentavalent-2
- PCV-2
- OPV-2
- Rotavirus-2
Why multiple doses: Building immunity takes several doses. Each dose strengthens protection.
14 WEEKS OLD
Final doses (Dose 3):
- Pentavalent-3
- PCV-3
- OPV-3
- Note: NO Rotavirus at 14 weeks (only 2 doses needed)
After 14 weeks: Baby has completed primary series! Next vaccine at 9 months.
9 MONTHS OLD
Measles-Rubella Vaccine (MR-1)
- What it protects against: Measles (highly contagious, can be fatal) and Rubella (German measles)
- How it's given: Injection in arm or thigh
- Introduced: 2021 in Pakistan (replaced single Measles vaccine)
- Side effects: Mild fever, rash 7-10 days after vaccine (normal immune response)
- Important: Do NOT give before 9 months - won't work properly if given too early
12 MONTHS OLD (1 Year)
Typhoid Conjugate Vaccine (TCV)
- What it protects against: Typhoid fever (serious bacterial infection spread through contaminated food/water)
- How it's given: Injection in arm
- Introduced: 2021 in Pakistan EPI (newest vaccine)
- Why it's important: Pakistan has high burden of typhoid. Many strains are drug-resistant (XDR typhoid).
- Side effects: Mild soreness, fever
15 MONTHS OLD (1 Year 3 Months)
Booster Doses:
- Measles-Rubella (MR-2): Second dose for lifelong protection
- DTP Booster: Strengthens protection against Diphtheria, Tetanus, Pertussis
Why boosters are needed: Immunity from earlier doses fades over time. Boosters restore full protection.
After 15 months: Child has completed ALL EPI vaccines! Next doses at school entry (4-6 years).
Free EPI Vaccines vs Private/Paid Vaccines in Pakistan
FREE Government EPI Vaccines
What's included (ALL FREE at government centers):
- BCG
- OPV (4 doses)
- Hepatitis B (4 doses - birth + 3 in Pentavalent)
- Pentavalent/DTP (3 doses + 1 booster)
- PCV (3 doses)
- Rotavirus (2 doses)
- Measles-Rubella (2 doses)
- Typhoid (1 dose)
Brands used in government EPI:
- Pentavalent: Various WHO-prequalified brands
- PCV: Synflorix (PCV-10) - protects against 10 pneumococcal types
- Rotavirus: Rotarix (2-dose schedule)
Private/Paid Vaccines (Available at Private Clinics)
Additional vaccines NOT in government EPI:
| Vaccine | Protects Against | Schedule | Approx Cost (PKR) |
|---|---|---|---|
| MMR | Measles, Mumps, Rubella | 12 months, 15 months | Rs. 1,500-2,500 per dose |
| Varicella (Chickenpox) | Chickenpox | 12 months, 4-6 years | Rs. 3,000-4,000 per dose |
| Hepatitis A | Hepatitis A virus | 12 months, 18 months | Rs. 2,000-3,000 per dose |
| Meningococcal | Meningococcal meningitis | 9 months or 12 months | Rs. 3,000-5,000 |
| Flu (Influenza) | Seasonal flu | 6 months onwards, yearly | Rs. 1,000-1,500 per dose |
Upgraded private options (same diseases, different brands):
- Hexavalent vaccine (6-in-1): Pentavalent + IPV (Inactivated Polio Vaccine). Cost: Rs. 3,000-4,000 per dose
- Prevenar-13 (PCV-13): Covers 13 pneumococcal types (vs government's 10 types). Cost: Rs. 4,000-5,000 per dose
Should I Get Private Vaccines?
Government EPI vaccines are SUFFICIENT for full protection. However, private vaccines offer:
- ✅ Protection against additional diseases (MMR includes Mumps, Varicella prevents chickenpox)
- ✅ Broader coverage (PCV-13 vs PCV-10, Hexavalent includes IPV)
- ✅ Convenience (fewer injections with combination vaccines)
- ❌ Significant cost (Rs. 15,000-30,000 total for private schedule)
Bottom line: If budget allows, private vaccines add extra protection. If not, government EPI provides EXCELLENT core protection for FREE.
Where to Get Vaccines in Pakistan
1. Government/Free EPI Centers
Basic Health Units (BHU):
- Located in rural areas, Union Councils
- Offer ALL EPI vaccines FREE
- Fixed vaccination days (usually 2-3 days per week)
- Staffed by vaccinators, Lady Health Workers (LHWs)
Rural Health Centers (RHC):
- Larger than BHUs, cover multiple Union Councils
- Daily vaccination services
- All EPI vaccines available FREE
District Headquarters (DHQ) & Tehsil Headquarters (THQ) Hospitals:
- Major government hospitals in every district
- Immunization departments with daily services
- Walk-in vaccination (no appointment needed)
- All EPI vaccines FREE
Outreach Vaccination:
- Lady Health Workers (LHWs) visit homes
- Mobile vaccination teams in remote areas
- Check with local LHW for schedule
2. Private Clinics & Hospitals
Examples:
- Aga Khan University Hospital (AKUH) - Karachi, Karachi
- Shifa International Hospital - Islamabad
- Services Hospital - Lahore
- Local pediatric clinics
Advantages:
- More convenient timing
- Additional vaccines available (MMR, Varicella, Hepatitis A)
- Upgraded vaccine options (Hexavalent, PCV-13)
- Appointment-based (less waiting)
Cost: Rs. 500-1,500 per visit (doctor fee) + vaccine costs
How to Find Nearest EPI Center
Sehat Tahaffuz Helpline: 1166
- FREE helpline by Federal Directorate of Immunization
- Call to find nearest vaccination center
- Ask about vaccine availability
- Available nationwide
Common Vaccine Side Effects & How to Manage at Home
According to Federal Directorate of Immunization Pakistan: "Vaccines may induce mild symptoms such as localized soreness at the injection site, irritability, or a low-grade fever. These are normal and show the immune system is working."
Expected Side Effects (Normal Reactions)
| Side Effect | When It Happens | How to Manage |
|---|---|---|
| Mild Fever (100-101°F / 37.7-38.3°C) |
Within 24 hours after vaccine | • Give paracetamol (acetaminophen) - age-appropriate dose • Keep baby cool (light clothing) • Offer extra breastfeeding/fluids • Lasts 1-2 days |
| Redness, Swelling at Injection Site | Within 24 hours | • Apply cool (not cold) compress • Do NOT rub or massage • Move baby's leg/arm gently • Goes away in 2-3 days |
| Fussiness, Irritability | Day 1-2 after vaccine | • Offer extra comfort, cuddle more • Breastfeed on demand • Gentle rocking • Normal activity within 24-48 hours |
| Mild Diarrhea (Rotavirus vaccine) |
Within 1 week | • Continue breastfeeding • Ensure hydration • Should resolve in 2-3 days |
| Rash 7-10 Days Later (Measles vaccine) |
7-10 days after MR vaccine | • This is NORMAL immune response • Not contagious • Goes away on its own • No treatment needed |
When to Call Doctor (Serious Reactions - Rare)
🚨 Call Doctor IMMEDIATELY If:
- High fever over 102°F (38.9°C)
- Fever lasting more than 2 days
- Baby has seizure or fits
- Difficulty breathing, wheezing
- Severe swelling at injection site (larger than 2 inches)
- Baby extremely lethargic (won't wake for feeding)
- Severe allergic reaction (rash all over body, face swelling)
Important: Serious reactions are EXTREMELY RARE (1 in 100,000 doses). Benefits of vaccination FAR outweigh risks.
What If I Missed the Vaccination Schedule?
Don't panic! Vaccines can be caught up.
General Catch-Up Principles
- Start where you left off. You don't restart the entire series - just continue from where you stopped.
-
Minimum intervals between doses:
- Pentavalent/PCV/OPV doses: Minimum 4 weeks apart
- Measles-Rubella doses: Minimum 4 weeks apart
-
Age limits for certain vaccines:
- Rotavirus: Can ONLY be given up to 24 weeks (6 months) age. After 6 months, skip it.
- All other vaccines: No maximum age limit - can catch up at any age
Common Catch-Up Scenarios
Scenario 1: Missed 6-week vaccines, baby now 3 months old
- Action: Start immediately with dose 1 of Pentavalent, PCV, OPV, Rotavirus
- Give dose 2 after 4 weeks
- Give dose 3 after another 4 weeks
- Continue with 9-month vaccines at 9 months
Scenario 2: Missed 9-month Measles vaccine, baby now 15 months
- Action: Give MR-1 now
- Give MR-2 (second dose) 4 weeks later
- Give DTP booster along with MR-2
Scenario 3: Baby 8 months old, never received ANY vaccines
- Action: Visit EPI center or pediatrician for complete catch-up plan
- Will need: BCG, Hepatitis B, 3 doses Pentavalent, 3 doses PCV, OPV doses, skip Rotavirus (too old)
- Vaccinator will create custom schedule
Where to Get Catch-Up Vaccines
- EPI centers: Will provide catch-up schedule FREE
- Call Sehat Tahaffuz helpline: 1166 for guidance
- Private pediatrician: Can create catch-up plan
Important: Better late than never! Even if severely delayed, catching up provides protection.
Addressing Vaccine Hesitancy in Pakistan: Common Concerns Answered
Pakistan has one of the highest rates of unvaccinated children globally. According to WHO: "Pakistan reported 1.2 million children under 1 year who missed first vaccine dose in 2017."
Common Concern 1: "Polio drops are harmful / make children sick"
FACT: Polio vaccine is SAFE. According to Federal Directorate of Immunization:
- Over 10 BILLION doses given worldwide since 1988
- Pakistan is one of only 2 countries where polio still paralyzes children
- Every child needs polio vaccine to be protected
- Side effects are extremely rare (less than 1 in 2.4 million doses)
- NOT giving polio drops puts child at risk of permanent paralysis
Common Concern 2: "Too many vaccines at once will overwhelm baby's immune system"
FACT: Babies' immune systems can handle multiple vaccines safely.
- Babies encounter thousands of germs daily (from air, food, environment)
- Vaccines contain tiny amounts of weakened/killed germs
- Combination vaccines (like Pentavalent) are SAFER than separate injections (fewer needle pokes, less pain)
- Schedule is scientifically designed for maximum protection with minimum visits
Common Concern 3: "Vaccines cause autism"
FACT: Multiple large scientific studies prove vaccines do NOT cause autism.
- Original study claiming link was FRAUDULENT and retracted
- Doctor who published it lost medical license
- Studies of millions of children show NO link between vaccines and autism
- Autism is genetic condition that develops before birth
Common Concern 4: "Natural immunity is better than vaccine immunity"
FACT: Vaccines provide immunity WITHOUT the risk of disease complications.
- Measles can cause brain damage and death
- Diphtheria can cause heart failure
- Pertussis (whooping cough) can cause babies to stop breathing
- Getting "natural" immunity means child must survive the disease first
- Vaccines provide protection WITHOUT the suffering
Common Concern 5: "These diseases don't exist anymore, so vaccines aren't needed"
FACT: Diseases are rare BECAUSE of vaccines. They will return if we stop vaccinating.
- Polio still paralyzes children in Pakistan (34 cases in 2024)
- Measles outbreaks occur in areas with low vaccination (Sindh outbreak 2023)
- Diphtheria cases reported in KPK (2022-2023)
- Typhoid is extremely common in Pakistan (XDR strains spreading)
- Only vaccination keeps these diseases controlled
The Bottom Line: Complete Vaccination Protects Your Child's Life
According to Federal Directorate of Immunization Pakistan: "Immunization is believed to be the most cost-effective public health intervention. Vaccination significantly reduces childhood mortality."
Key takeaways:
- Complete schedule: 7 visits from birth to 15 months protects against 12 life-threatening diseases
- FREE in Pakistan: All EPI vaccines available free at BHU, RHC, DHQ hospitals
- Critical vaccines: BCG at birth, Pentavalent at 6/10/14 weeks, PCV, Rotavirus, Measles-Rubella, Typhoid
- Side effects: Mild and temporary (fever, soreness 1-2 days). Serious reactions extremely rare.
- Missed vaccines: Can catch up - don't restart, continue from where you left off
- Vaccine hesitancy: Concerns based on myths. Scientific evidence proves vaccines are safe and effective.
- Private options: Additional vaccines (MMR, Varicella) available for extra protection
Where to start:
- Vaccinate baby at birth (BCG, OPV, Hepatitis B) before leaving hospital
- Schedule 6-week vaccines on calendar
- Keep immunization card safe (needed for school admission)
- Call Sehat Tahaffuz helpline 1166 for nearest EPI center
- Complete ALL doses on time for full protection
Remember: Vaccines save lives. Pakistan loses thousands of children annually to vaccine-preventable diseases. Don't let your child be one of them. Complete the EPI schedule - it's FREE, it's SAFE, and it WORKS. Your child deserves full protection. 💉
About Newbornsy Team
Senior Medical Advisor • Pediatric Specialist
Dr. Newbornsy Team has dedicated over 15 years to pediatric care and parental education. Their research focuses on early development and child comfort during essential care routines.
