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Pediatrics/spacing between two different combination vaccines


QUESTION: Dear Doctor,
My daughter (born 28 Jan 2013)had received 1st dose of DTAP (Pentaxim)on 24 march and Penumococcal and rotavirus vaccine (Prevaner 13 and Rotarix) on 26 March as per PED. Next doses given on 24 & 26 th April. Is it wright schedule? someone told me that there should be 21 days gap in between. When I should give the 3rd doses of these (though scheduled on 24 & 26 May)? Plz answer ASAP.


ANSWER: Hi Manas,

There is no problem as such in this schedule. It is a common misconception (even among some doctors!) that there has to be a gap (of four weeks) between two different vaccines. It is not true.

However, practically, it is better if different vaccines are given on the same day (but on different sites). This reduces visits to the doctor, and number of "uncomfortable days" for the baby. Hence, my personal advice would be to take the 3rd dose  of both vaccines (Pentaxim and Prevenar 13) on 26th May. There is no problem if you take these on 24th and 26th May, if you (or your Pediatrician) so desire..

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India


---------- FOLLOW-UP ----------

Thanks again for ur opinion. One more question I forgot to ask for my daughter. DOB of her is 28.01.2013, As I already told u, we hav already given pentaxim (24 march & 24 April) and Prevenar13 & Rotarix (26th March & 26 April). Hosp had given OPV also with the 26 April dose of Prevenar13 & Rotarix. Is this a wright dosing of giving two live vaccines together.
her OPV schedule till now is 0, 25 days, 3 months. What should be the opv schedule as she is already taking Pentaxim.
Please suggest me.

Hi Manas,

There is no "problem" if OPV is also given along with IPV (pentaxim). Till July 2012, this was the standard recommendation to give OPV along with IPV. However, as per the latest recommendations (issued in July 2012), OPV is to be given at birth, 6 month, 9 months and at 5 tears of age (4 doses). In addition, OPV must be given at every pulse polio round ("Polio Ravivars"). IPV is recommended at 6, 10, 14 weeks.

You can see the latest immunzation schedue at:

In your baby's case, I would recommed OPV at 6 month, 9 month, 5 years and all Pulse polio rounds.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India



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Dr. Puneet Kumar


I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query that requires diagnosing, since it is not possible to examine a child online.


I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 17 years of experience in the field.

Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (

(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. (f) Regular column, “How do I treat” in Pediascene ( (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 ( ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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