ROUTINE CHILDHOOD VACCINATION

National Immunization Schedule

Adapted from the UNEPI/MOH Immunization Schedule,
2016.

VACCINE OR
ANTIGEN
AGE DOSE & MODE OF
ADMINISTRATION
SITE OF
ADMINISTRATION
BCG At birth
(or first
contact)
0-11 months:
0.05 mL
Above 11
months:
0.1 mL
Intradermally
in Right
Upper Arm
Oral Polio 4 doses:
at birth, 6,
10, and 14
weeks
2 drops orally Mouth
Injectable
Polio
Vaccine
(IPV)
At 14
weeks
0.5 mL IM Outer aspect
of right thigh;
2.5 cm away
from PCV site
DPT-HepB
+ Hib 1
3 doses:
at 6, 10 and
14 weeks
0.5 mL IM Outer aspect
of left thigh
PCV 3 doses: at
6, 10 and
14 weeks
0.5 mL IM Outer aspect
of right thigh
Rota 2 doses: at
6 and
10 weeks
2 drops orally Slow admin
on inner
aspect of
cheek
9 months Measles 0.5 mL SC Left Upper
Arm
All girls in
primary 4
or 10 year
old girls
outside
school
HPV Give 2 doses
IM 6 months
apart
Left Upper
Arm

General principles of routine childhood immunization

  • The aim is to ensure that all target age groups complete their immunization schedule as above
  • Age for vaccinations: Give each vaccine at the recommended age or if this is not possible, at first contact
    with the child after this age
  • BCG vaccination
    • Give this as early as possible in life, preferably at birth
    • Do NOT give BCG vaccine to any child with clinical signs and symptoms of immunosuppression, e.g. AIDS
  • Use each vaccine with its corresponding pre-cooled diluent from the same manufacturer
  • Polio 0 vaccination (= ‘zero dose’): This is a primer dose of oral polio vaccine (OPV), which should be given ideally at birth but otherwise in the first 2 weeks of life
  • DPT-HepB-Hib vaccine
    • Is a combination of DPT vaccine + hepatitis B vaccine (HepB) + haemophilus influenzae type b (Hib) vaccine
    • Minimum interval between each of the doses is 4 weeks
  • Measles vaccination
    • Normally given at 9 months of age or first contact after this age
    • Can also be given to any unimmunised child of 6-9 months old who has been exposed to measles patients. Children vaccinated in this way must have the vaccination repeated at 9 months of age
  • Vaccination of sick children
    • Admit and treat any child who is severely ill, and vaccinate at the time of discharge
    • Minor illness is not a contraindication to vaccination

Administration and storage of vaccines

Storage and transport

  • At health units, vaccines should be stored between +2°C to +8°C
  • At the district and central vaccine stores (static units) where freezers exist, polio and measles vaccines may be
    stored for prolonged periods at -20°C
  • Do not freeze DPT-HepB-Hib, PCV, IPV, HPV and TT vaccines
  • Never freeze the diluents for BCG and measles vaccines
  • Use conditioned ice packs and sponge method for transport
  • Carefully follow recommended procedures to maintain the cold chain for all vaccines, e.g.:
    • Ensure continuous supply of power/gas
    • Record fridge temperature twice daily (morning and evening, including weekends/public holidays)
    • Use sponge method during each immunization session

Reconstitution and administration

  • Never use the diluents provided for vaccines to mix other injectable medicines
  • Never use water for injection as a diluent for vaccine reconstitution
  • Do not vaccinate in direct sunlight (always carry out immunization in a building or under a shade)
  • Record every vaccination in the child register and on a tally sheet until child has completed all the antigens
  • Use the child register and child health card for tracking drop outs
  • A child who received any immunization dose during national immunization campaigns should still get the
    routine vaccination dose
  • Never use any vaccine:
    • After its expiry date
    • When the vaccine vial monitor (VVM) has changed to discard point (stage 3 and 4)
    • If there has been contamination, or contamination is suspected in open vials
    • If the vial labels are lost
    • DPT-HepB-Hib, HebB, PCV, IPV, HPV, TT that have been frozen

Adhere to the WHO recommended Multi-Dose Vial Policy (MDVP) as below:

TYPE OF
VACCINE
MDVP GUIDELINE
OPV and IPV Do not use vaccine if:

  • Contaminated or has no label
  • The VVM at or beyond discard point
    (stage 3 & 4)
  • Vials have been opened for 4 weeks
  • Vials opened during outreach
  • Vaccines have not been stored under cold
    chain conditions
DPT-HepBHib,
Hep B,
TT,
Do not use vaccine if:

  • Contaminated or has no label
  • The VVM is at or beyond discard point
  • Frozen
  • Vials have been opened for 4 weeks or
    more
  • Vials opened during out- reach
  • Vaccines have not been stored under cold
    chain conditions
BCG, PCV,
and Measles
  • Discard remaining doses in the opened
    vials of these vaccines after 6 hours
    of reconstitution or at the end of the
    immunization session, whichever comes
    first

Common side effects of vaccines and patient advice

VACCINE AND SIDE
EFFECTS
PATIENT ADVICE
BCG

  • Pain at injection
    site
  • The ulcer that forms at the
    injection site is a normal and
    expected reaction that heals by
    itself and leaves a permanent
    scar. It should not be covered
    with anything
DPT-HepB-Hib, PCV

  • Mild reactions
    at injection site:
    swelling, pain,
    redness
  • Fever within
    24 hours of the
    injection
  • Anaphylactic
    reactions
  • Seizures
  • Do not apply anything to the
    injection site
  • Take paracetamol if necessary.
    • If fever continues after 2 doses
      of paracetamol, report to
      health facility
  • Wiping the child with a cool
    sponge or cloth (with water at
    room temperature) is also good
    for reducing fever
  • If seizures or severe rash/
    difficulty in breathing occurs,
    return to health facilty
    immediately
Oral Polio and Rota

  • Short-lived
    gastrointestinal
    symptoms
    (pain, diarrhoea,
    irritation)
  • Dispose of the child’s faeces
    properly as the virus spreads
    through the oral-faecal route
  • Wash hands thoroughly after
    changing the baby’s nappies
Injectable Polio

  • Pain, redness
    and swelling at
    injection site
  • Fever, headache,
    drowsiness,
  • Irritability in
    infants
  • Diarrhoea, nausea,
    vomiting
  • Side effects usually mild and
    should not cause worry
  • Take paracetamol if necessary
  • If fever continues after 2 doses
    of paracetamol, report to health
    facility
  • Report any severe reaction to
    health worker immediately
Measles

  • Pain, swelling,
    redness at injection
    site
  • Fever and skin rash
    5-12 days after the
    vaccine
  • Child may get a mild skin rash
    and fever after few days; do not
    worry
  • Do not apply anything to the
    injection site
HPV

  • Injection site
    reactions: pain,
    redness, itching,
    bruising or swelling
  • Headaches
  • General body aches,
    nausea
  • Side effects usually mild and
    should not cause worry
  • Report to health worker
    immediately any severe
    reaction
Tetanus Toxoid (TT)

  • Irritation at
    injection site
  • Fever, malaise
  • Side effects may occur within
    1–2 days of immunization; they
    are usually mild and should not
    cause worry
  • Report to health worker
    immediately any severe
    reaction
Hep B Vaccine

  • Pain, redness
    and swelling at
    injection site
  • Fatigue
  • Fever
  • If fever develops, give a single
    dose of paracetamol