Can a vaccine be given when a child is sick?
Minor illness like mild cough, cold, loose stools, vomiting or even mild fever is not a contraindication for vaccination. However if a child is suffering from severe diseases, high fever, severe loose stools, pneumonia or any other illness needing investigation or admission to a hospital, vaccination should be postponed till full recovery. OPV dose can be given during diarrhea but should not be counted & an extra dose in the schedule should be given.

What precautions should one take before vaccination?
Foremost is to complete the schedule in time. Do tell the doctor about any adverse effects seen to previous immunization. Understand properly the implications of giving or not giving the vaccine under optional category. One can feed the child including breast feeds before & after any vaccination.
There is no need to starve the child before vaccination. Maintain properly the vaccination card & take it along during each vaccination for the doctor to see record.

What precautions should be taken after vaccination?
Keep firm pressure for few minutes at the injection site with a spirit swab. Do not massage or rub at the injection site. Wait in the consulting room for another 30 minutes should any reaction develop following vaccination. Note down carefully when to come back for next vaccination. Inform the doctor immediately if the child develops any reaction or abnormal behavior or habits following vaccination in the next few days.

What are the common side effects of vaccination?
Most of the vaccines are very safe. Patient can get pain, redness, swelling at the injection site. It is less common with subcutaneous injections. Rarely a nodule may form which remains for few weeks especially following DPT. Patient can develop mild to moderate fever, which usually responds to paracetamol. Never give aspirin for pain or fever following vaccination especially after varicella vaccine.
Rarely child can develop fussiness, irritability, anorexia, vomiting, diarrhea, excessive crying etc. especially after DTP injection. Lastly there could develop severe reaction like convulsion, depressed responsiveness, altered consciousness, shock, hyperpyrexia (fever>1050C) with DPT, which must be reported immediately to the doctor.
Not all the vaccines lead to reactions. Not all the children develop reaction nor does it develop with each dose of vaccine. Equally important is the fact that development of some reaction like fever or pain is not a prerequisite of good action of vaccine.

What are contraindications to vaccination?
Patients with severe reactions to previous immunization should not receive same vaccine again. Patients will severe egg allergies should not be given measles or MMR vaccine. Patients with immune compromised state like symptomatic HIV or AIDS should by and large not receive live vaccines especially if a killed vaccine substitute is available. Of course there are some exceptions to this rule & for details refer to individual vaccines.

What should be minimum gap between 2 vaccines?
As discussed before, any number of vaccines can be given on same day at separate sites but if not given on same day there should be gap of 4 weeks between two vaccines in general. One should not give one vaccine today, second 7 day & 3rd vaccine after another 7 days. Extra doses of OPV like in pulse immunization or ring immunization is notable exemption to this rule. Some vaccines like rabies vaccine have schedule where 5 doses are given in 1 month’s time. Again rabies vaccine or tetanus toxoid when indicated should be started as soon as possible irrespective of vaccines received in recent past

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