1. Live vaccines (BCG, Polio, MMR, Measles, and Oral Typhoid) are contraindicated in malignancies, immunosuppressed patients, patients on chronic steroid therapy or on chemotherapeutic agents. In AIDS, BCG & Measles are recommended, as the benefits outweigh the risk, but not oral polio drops. Instead dead polio vaccine (i.m.) can be given.
2. BCG: A nodule appears 3-4 weeks after the injection, which softens and ulcerates, in another 2-4 weeks. This heals, leaving behind a scar, indicating successful Immunisation. If this does not happen, the child should be re-vaccinated.
3. Oral polio can be given in cases of mild diarrhea. Breast feeds can be given immediately after oral polio vaccine, though warm liquids should be withheld for half- hour.
4. DTP: This causes pain and swelling at the local site with fever. Give Crocin drops (2 drops/kg) stat and prn (dose should be at least 4 hours apart) and cold fomentation at the local site. A small, painless lump may remain for a few weeks, which is of no concern.
5. Measles/MMR may also cause fever but 5-7 days after the vaccine and may be associated with a mild rash. Treatment is same as above.
6. Immunisation can be safely given in the presence of minor illnesses like cough, cold, diarrhoea & low- grade fever.
7. After 6 years of age, the child can be given oral typhoid vaccine (1 capsule every alternate day for 3 days with booster dose every 5 years). For 2-6 years, i.m. vaccine is recommended with boosters every 3 years.
8. After the age of 5 years, only DT is given, i.e. P (pertusssis) is not required. DT is again recommended at the age of 10 year, then at 16 years and thereafter every 10 years. Practically, however, it is seen that the vast majority of children are regularly and routinely immunized till the age of 5 years. After that the recommendation of DT is hardly followed. Not much emphasis is given because DT chiefly prevents against tetanus, and a person is given a tetanus shot whenever he / she gets any injury, so the protection against tetanus is by and large ensured anyhow.
9. Anyone at any age can be immunised, if not immunised before. The same schedule is followed. However after the age of 5 years, only DT and not DTP should be given. HiB is not required after 5 years and if the patient is > 15 months, a single dose only is required.
10. It is not necessary to restart an interrupted schedule from the beginning or give extra doses. Instead, continue as if nO interruption has occurred.
11. Multiple vaccines can be given together on the same visit without any problem.
12. Measles vaccine can interfere with tuberculin testing. Therefore the test should be dohe on the day of immunisation ox 6 weeks later. Measles vaccine can also flare up T.B. and so if the child is having active T.B., he/she should be on Anti-T.B. drugs while receiving it.
13. For preterm b&bies, the exact schedule and dosage /as for term babies is followed anxl no adjustments for prematurity ire made.
14. ROUTE OF ADMINISTRATION
• Intradermal : BCG (in deltoid area).
• Subcutaneous : Measles, MMR and chickenpox.
• Orally : Polio and Oral Typhoid.
• Intramuscular : Rest all vaccines.
15. Efficacy of no vaccine is 100%. Vaccinating the child doesn’t mean that he cannot get the disease. Most vaccines have efficacy of over 95%, except BCG (efficacy 50%).
16. Though vaccines are very safe, yet very rarely there may be a serious allergic reaction called anaphylaxis which if not treated in time may sometimes cause even death. A previous hypersensitivity reaction to a particular vaccine is an absolute contraindication for further doses of the same vaccine.
17. Rubella vaccine is used primarily not to protect the recipient (as other vaccines are), but to protect the baby of a pregnant woman from congenital rubella. Ideally all women of child-bearing age should be immunised by it pre-pregnancy (rubella vaccination is contraindicated during pregnancy). As it is practical difficult to achieve this goal, both males & females are normally vaccinated at the age of 15 months, males are vaccinated to decrease them as being the reservoir of infection.
18. Rabies and Hepatitis – B are perhaps the only vaccines, which are effective postexposure and recommended urgently along with the respective immune globulin on exposure. They can also, of course, be used pre-exposure i.e. like other vaccines. Hepatitis-B is nowadays routinely given preexposure, though not so rabies.
19. For persons at high risk of rabies, the vaccine is recommended pre-exposure as a-3-dose schedule (1-ml i.m. at 0, 7 and 28 days) with boosters every 3 years. If exposure to rabies occurs, then he/she has to take only 2 doses of the vaccine at 0 and 3 days + RIG (rabies immunoglobulin) with the 1st dose. For others, it is recommended only postexposure as 5 doses at 0,3, 7,14 and 28 days (6th dose at 90 days being optional) + RIG with the 1st dose (20U/kg, half at the site of bite and half i.m. in the gluteal region).
DTP vaccine (due to the pertussis component) can rarely cause neurological side effects like encephalopathy, convulsions, prolonged inconsolable crying or prolonged somnolescence. It may also cause fever >105°F and sometimes may result in a collapsed, hypotensive shock like state. If such adverse reactions are observed, consult the doctor, who will usually advise to give only DT instead of DTP in future.