Pakistan EPI vaccination schedule 2026: every dose, age and vaccine

Pakistan's Expanded Programme on Immunization (EPI) gives every child protection against 12 potentially fatal diseases across six visits, from birth to 15 months. The schedule has changed meaningfully in recent years — measles vaccine has been replaced by measles-rubella, typhoid conjugate vaccine has been added, and a second IPV dose now sits at 9 months. If you trained more than a few years ago, the card in front of you is not the schedule you memorised.

Here is the current national schedule in full, followed by what changed, what each vaccine covers, and how to handle the child who turns up late.

The complete Pakistan EPI schedule

That is 19 doses in total. This reproduces the Federal Directorate of Immunization's National Vaccination Schedule — the same schedule printed on the EPI card and displayed at every EPI centre.

If you would rather not count weeks by hand, our Pakistan EPI due-date calculator takes a date of birth and the doses already given, and returns exactly what is due, overdue and upcoming with calendar dates.

Three things that have changed

1. Measles is now measles-rubella (MR)

Standalone measles vaccine has been replaced by MR on the routine schedule. Two doses are required — MR-1 at 9 months and MR-2 at 15 months. This matters more than it sounds: a child who has had only MR-1 is not fully protected, and MR-2 is the single most commonly dropped dose on the schedule because it falls after the intensive first-year visits have finished and families have stopped attending.

2. Typhoid conjugate vaccine at 9 months

TCV is given as a single dose at 9 months, alongside MR-1 and IPV-2. Pakistan was the first country in the world to introduce TCV into routine immunisation, following the extensively drug-resistant (XDR) typhoid outbreak that began in Sindh in 2016. Given how much harder XDR typhoid is to treat than the sensitive strains most of us trained on, this is one of the highest-value doses on the card.

3. Two IPV doses, not one

Injectable polio vaccine is given twice — IPV-1 at 14 weeks and IPV-2 at 9 months — in addition to the four oral polio doses at birth, 6, 10 and 14 weeks. Pakistan remains one of the last countries with endemic wild poliovirus transmission, and the schedule reflects that.

What each vaccine covers

One detail worth committing to memory: PCV goes into the opposite thigh from Pentavalent. At the 6, 10 and 14-week visits you are giving two intramuscular injections plus oral drops, and it is easy to assume both IM vaccines share a leg. On the national schedule, Hepatitis B, Pentavalent and TCV go into the right thigh; IPV and PCV into the left.

Two further practical notes. The hepatitis B birth dose is separate from the hepatitis B component inside pentavalent, and works best given as soon as possible after delivery — its whole purpose is blocking perinatal transmission, and its value falls away with every hour of delay. And the national schedule specifies "pneumococcal" without stating the valency, so check which PCV product your centre currently stocks rather than assuming.

The 12 diseases covered

Completing all six visits protects against: childhood tuberculosis, poliomyelitis, hepatitis B, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, pneumococcal disease, rotavirus diarrhoea, measles, rubella and typhoid fever.

The child who turns up late

This is the commonest real-world scenario in a Pakistani OPD, and the commonest source of avoidable error.

The first principle: a missed dose does not mean starting the course again. Continue from where the child left off. Restarting a pentavalent or PCV course from dose 1 because a family missed the 10-week visit wastes doses, wastes the family's time and money, and is one of the reasons children fall further behind.

The second principle is more subtle, and it is where international references can mislead you.

WHO advised in 2009 that the rotavirus course should start by 15 weeks and be completed by 32 weeks, because of a small association with intussusception in older infants. In its January 2013 position paper, WHO removed that universal age restriction for low- and middle-income settings — the modelling showed the lives saved by vaccinating late substantially outnumber the excess intussusception risk. Pakistan is exactly such a setting.

So if you are working from a US-oriented reference that gives a hard "maximum age 14 weeks 6 days" cut-off for rotavirus dose 1, that guidance was written for a different risk-benefit context. Give the doses on time wherever you can — timeliness is still the goal — and follow current national guidance for late presenters rather than reflexively withholding.

For children who are substantially behind, discuss catch-up intervals with your EPI centre. Minimum-interval scheduling is a separate question from the routine schedule and depends on how far behind the child is and which antigens are outstanding.

Practical notes for the OPD

• Check the card, not the memory. Parental recall of which doses were given is unreliable, particularly for the 6/10/14-week visits, which look identical from the outside.
• Ask specifically about MR-2. It is the most commonly missed dose. "Has he had all his vaccines?" gets a yes; "Did he come back at 15 months for the second measles-rubella?" often does not.
• Use every contact. A child brought in for something unrelated is an opportunity to check the card and give what is due — missed opportunities are a bigger driver of under-immunisation than refusal.
• Multiple injections at one visit are safe and correct. The 6, 10 and 14-week visits each involve more than one injection by design. Splitting them across visits to reduce discomfort reliably means some are never given.
• Record what you give. An unrecorded dose is functionally a missed dose at the next encounter.

Common questions

Can vaccines be given to a child with a mild illness?

A mild illness without high fever is not a reason to defer routine immunisation. Deferring for minor coughs and colds is a common cause of drift, and each deferral tends to become a missed visit rather than a delayed one. Apply clinical judgement for the genuinely unwell child.

What if the birth doses were missed entirely?

Children born at home or outside a facility frequently miss BCG, OPV-0 and the hepatitis B birth dose. Give what is still appropriate at first contact and continue the schedule. The hepatitis B birth dose in particular is time-critical for its perinatal purpose, so its value is much reduced once that window has passed — but the pentavalent doses still deliver hepatitis B protection.

Is the schedule the same across all provinces?

The national routine schedule is the reference, but provincial EPI programmes run their own campaigns and supplementary immunisation activities alongside it. Check your provincial guidance for campaign doses, which sit outside the routine card.

Bottom line

Six visits, 19 doses, 12 diseases, all completed by 15 months. The changes worth internalising are MR replacing measles with two required doses, TCV at 9 months, and a second IPV dose. The most common practical errors are restarting interrupted courses, missing MR-2, and applying foreign age cut-offs for rotavirus that WHO has withdrawn for settings like Pakistan.

To check a specific child in seconds, use the EPI due-date calculator — enter the date of birth, tick what has been given, and it returns what is due and overdue with dates. It is free, and so is our paediatric antibiotic dose calculator.

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