No. Though mild fever comes in majority of children who receive injectable vaccines, there are few children in which the immune response elicited by vaccine does not cause rise in body’s temperature. This is normal in some children, and there is no need to re-administer vaccine if fever does not come after vaccination.

In case of injectable vaccines (like Hepatitis B, pentavalent and IPV), infants may have redness, mild pain, and swelling at the injection site. This is mainly due to rupture of some muscle fibres by the needle getting injected into the muscle tissue. In addition, some of the vaccine’s components (e.g. aluminium adjuvant, stabilizers or preservatives) can lead to local inflammatory reactions. These symptoms generally appear on the day after the injection is given and last from 1 to 3 days. Cold compresses can be used to control swelling and redness. You should recommend Paracetamol (syrup or tablet, in divided doses) for providing symptomatic relief to child.

Yes. A sick child suffering from mild illness can be safely vaccinated. Symptoms of mild illness (like cough, cold, mild fever or mild diarrhoea) are not contra- indications to vaccination. However, a child with moderate to severe illness requiring hospitalization (high grade fever, severe diarrhoea, etc.), should not be vaccinated during the acute phase.

Oral vaccines can be given to a child with mild diarrhoea. However, if a child has severe diarrhoea requiring hospitalization, oral vaccines should be given only after diarrhoea is controlled. Oral vaccines should not be given to child who is vomiting recurrently, until vomiting is controlled.

Adverse events are any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. The reported events may be a result of vaccine or immunization process, or they may be coincidental events that are not due to vaccine or immunization process but simply something that occurred soon after immunization. Though, the occurrence is not due to a particular vaccine, but unless there is a thorough investigation to determine the cause, such occurrences are assumed to be due to vaccines and immunization. All cases of serious/severe AEFI should be reported and investigated as per guidelines.

There are a few medical conditions for which vaccines should be delayed or should not be given. These are as follows:

• A child who has had a severe (allergic) reaction to earlier dose of any vaccine should not be given another dose of the same vaccine. This is an absolute contra-indication applicable for all vaccines.
• If a child has allergy to one conjugate vaccine (like DPT), any other conjugated vaccine (like PCV) should not be given (or may be given under medical observations) to the child.
• IPV should not be given to children allergic to streptomycin, neomycin or polymyxin B.
• Vaccination should be given only after medical advice if a child is allergic to egg

proteins.

• Rotavirus vaccine should not be given to children who have history of

intussusception, or abdominal surgery, or intestinal malformation.

• Live vaccines should not be given to immune-compromised children (e.g. HIV, Leukaemia), and those taking steroid therapy or immune-suppressant drugs.
• Vaccines should not be given to hospitalized or unconscious child, or those having convulsions.
• Immunization should also be withheld during moderate to severe acute illness, since vaccines may not elicit immune response in such conditions.

Yes. Vaccination should be provided to all children. It does not matter if:

• They are delivered by surgery or by normal delivery
• They are delivered at a private or government health facility or at home
• They are delivered before completing 9 months of gestation period (premature)
• Mother is suffering from any medical condition
• Has a low birth weight

The immunization schedule should start at birth irrespective of the age of gestation and weight of the child.

As a health worker, you should ensure that the parents/caretakers wait for 30 minutes at the health facility or the session site after vaccination. This is required to ensure that immediate care can be sought if there is any side effect or adverse event. Breastfeeding can be done after vaccination, even after giving oral vaccines. There is no effect of breast milk on efficacy of the vaccines. You should ensure that parents/caretakers do not apply any medicines or herbs at the injection site. In case of redness or swelling at the injection site, cold water compresses (i.e. a pad of clean cloth dipped into cold water) can be used. Please recommend Paracetamol for providing symptomatic relief to the child.

In rare cases, vaccines can lead to an allergic reaction or any other kind of adverse event. These events require early diagnosis and management. Therefore, it is advised that parents/caretakers are asked to stay at the session site for at least 30 minutes after receiving vaccination.

No. The child’s leg does not become weak due to vaccination. However, in some cases the child may avoid leg movement to avoid pain at the injection site. This can be managed by cold compresses at the injection site, or by giving paracetamol tablet or syrup in recommended dose.

No. All vaccines used in Universal Immunization Programme are pre-tested and recommended by WHO. All these vaccines are highly safe and effective, and are being used in many other countries besides India. No vaccine can lead to infertility or impotency, and this, like many other myths related to vaccines, is baseless and wrong.

There is strong scientific evidence that measles/MR vaccination is not linked to autism, or any other conditions like inflammatory bowel disease or permanent neurological sequelae, which have been wrongly associated with this vaccine.9

Vaccines are generally safe. However, some children may be allergic to certain vaccines or a component of vaccine (like antibiotic or preservative), and administration of vaccine in such children can result in allergic reaction, like itching, or appearance of red spots on the body, soon after immunization. These cases need to be managed immediately and in some cases may also require referral. After an allergic reaction, DO NOT repeat or provide subsequent doses of the same vaccine without consultation and advice of medical officer.