Vaccination Schedule for Children in Pakistan: Complete Immunization Guide for Parents

*Tikakaari* (vaccination) is the single most powerful tool parents have to protect their children from deadly diseases. Yet Pakistan still sees preventable outbreaks of measles, polio, and typhoid every year — largely because of missed doses or incomplete schedules. Whether you are delivering in a government hospital or a private clinic, this guide tells you exactly which vaccines your child needs and when, so no dose is missed.

Understanding Pakistan's EPI Programme

The Expanded Programme on Immunization was launched in Pakistan in 1978 and is one of the country's most important public health initiatives. EPI vaccines are free of charge at all government Basic Health Units (BHUs), Mother and Child Health (MCH) centres, and district hospitals. The programme is constantly updated by the Ministry of National Health Services in collaboration with WHO and UNICEF.

In 2019, Pakistan added the Typhoid Conjugate Vaccine (TCV) to the EPI schedule — a significant step given Pakistan's ongoing burden of extensively drug-resistant (XDR) typhoid, especially in Sindh and Karachi. The pneumococcal vaccine (PCV) was added in 2012 and has dramatically reduced childhood pneumonia deaths.

Private Vaccines Your Child Should Also Get

The EPI schedule is comprehensive but not complete. Several vaccines available globally are not yet part of Pakistan's free programme. These are available at paediatricians' clinics, private hospitals, and some pharmacies — at a cost, but highly recommended.

• Varicella (Chickenpox) — 1 dose at 12–15 months, second dose at 4–6 years. Chickenpox can cause serious complications including bacterial skin infections and encephalitis in young children.
• Hepatitis A — 2 doses from 12 months, 6 months apart. Hepatitis A is endemic in Pakistan; contaminated food and water are the main routes.
• HPV (Cervical Cancer Vaccine) — for girls 9–14 years; 2 doses 6 months apart. Gardasil or Cervarix are both effective against the strains responsible for >70% of cervical cancer cases.
• Influenza — annual vaccine for children over 6 months, especially those with asthma or heart disease. Pakistan's flu season typically peaks November–February.
• Meningococcal — recommended for children going to international schools or travelling abroad.

What to Expect After Vaccination

Most vaccine side effects are mild and last 1–2 days. Common reactions include redness and swelling at the injection site, low-grade fever, fussiness, and reduced appetite. These are signs that the immune system is responding — not that the vaccine caused harm.

Give paracetamol (15 mg/kg) if the child is clearly uncomfortable or febrile after vaccination. Continued breastfeeding immediately after the injection significantly reduces crying. The BCG vaccine produces a small red papule at the injection site that becomes a scar — this is expected and normal.

Catch-Up Vaccination: What to Do If Your Child Missed Doses

Life in Pakistan is busy — a move to a new city, a family illness, or a flood can disrupt the vaccination schedule. The good news: most vaccines can be caught up at any age, and you do not need to restart a series that was interrupted. A paediatrician or the nearest EPI centre can produce an individualised catch-up schedule.

The general rule is: give the missed vaccine as soon as possible. Space doses by the minimum interval (usually 4 weeks). Vaccines given too close together are not effective. If the child has never received any vaccines, start from the beginning of the schedule regardless of age.

Frequently Asked Questions

Is the EPI vaccination really free?

Yes. All EPI vaccines listed in the national schedule are provided completely free of charge at government health facilities. If a health worker requests payment for EPI vaccines, report this to the district health office.

Can I vaccinate my child at a private clinic instead of EPI?

Yes. Private paediatricians carry the same EPI vaccines plus the additional private vaccines. You will typically pay for the service charge and sometimes for the vaccine itself if it's outside the EPI list.

My child had a cold on vaccination day. Should I postpone?

A mild cold with no fever is not a reason to postpone vaccination. Postponing unnecessarily leaves your child unprotected longer. Only postpone if the child has a fever above 38°C, is severely unwell, or is on certain immunosuppressive medications — ask your doctor.

Does the MMR/MR vaccine cause autism?

No. This claim originated from a 1998 paper that was fully retracted due to fraud. Dozens of large studies covering millions of children have found no link between any vaccine and autism. The original author lost his medical licence.

How many injections can my child receive in one visit?

International guidelines allow multiple vaccines at a single visit — this is routine and safe. Combination vaccines like Pentavalent already contain 5 antigens in one injection, reducing total jabs significantly.

What is the polio drop versus the injectable polio vaccine?

Pakistan's EPI schedule includes both. OPV (oral, drops) is given at birth and multiple early visits. IPV (injectable) is added from 6 weeks. OPV creates gut immunity that blocks transmission; IPV produces strong blood immunity. Both are needed for complete protection in Pakistan's context.

My child received no vaccines at birth — can I still vaccinate them at 2 years?

Absolutely. A paediatrician will design a catch-up schedule appropriate for your child's age. Some vaccines have upper age limits (e.g., Rotavirus is only given up to 24 weeks), but most core vaccines can be given at any age.

Is the typhoid vaccine a single shot or multiple doses?

The new Typhoid Conjugate Vaccine (TCV) in the EPI schedule is a single injection at 9 months. It provides long-lasting protection against typhoid, including the XDR strain. An older typhoid vaccine (Vi polysaccharide) is also available privately from age 2 and requires booster every 3 years.

How do I get a vaccination card if I lost mine?

Visit the EPI centre or hospital where your child was vaccinated — records are usually kept. If records are unavailable, a paediatrician can assess which vaccines may have been received (some have visible signs like the BCG scar) and recommend re-vaccination for any uncertain doses. It is always safer to re-vaccinate than to leave a child unprotected.