Last Updated on October 3, 2021 by PAN ADMIN

IMMUNIZATION
HOMEPAGE

PAN recommends complete vaccination of every child born in Nigeria and those immigrating into Nigeria. The vaccine schedules are recommended by experts in PAN, in collaboration with others in UNICEF and the WHO.

See the vaccine schedules here>>

HISTORY OF VACCINES

Smallpox was a most feared disease resulting in 20-30% mortality and the disease left survivors scarred for life. As part of efforts to control the disease, inoculation, a practice of injecting some of the pox materials into healthy individuals was practiced as early as 10th century AD. This practice met with varying success with some getting protected and others contracting the disease and dying. Following observations that milkmaids who caught the cowpox were protected against smallpox, Edward Jenner performed an experiment on James Phipps, inoculating him with cowpox material and then challenging him with smallpox. James Phipps was protected and Edward Jenner was the first to publish his works on vaccination as the practice came to be known in 1796. A hundred years later, Louis Pasteur made the first Rabies vaccine

What are vaccines and how do they work?

To understand how vaccines work we must examine the immune system. Immunity is the ability of the body to recognize and tolerate what is “self” while getting rid of what is “non-self”. The body is equipped with the capacity to resist invasion by materials foreign to the body which are recognized as non-self. Following a first time exposure to foreign materials (antigens) which include microorganisms the cells of the immune system respond by developing antibodies, specific helper, and effector T lymphocytes (including cytokine-producing cells) and killer T cells which will help to get rid of the antigen. This reaction takes time and the organism would have caused disease before the immune system can eventually get rid of the organism.  A few of these immune cells develop a state of immunological memory such that when a similar organism is encountered again they respond with faster production of antibodies that bind with greater avidity and cells that kill faster thus getting rid of the organism before it can cause disease.

Vaccine is any preparation which when administered is able to stimulate the immune system to produce specific responses that inactivate, destroys, or suppresses a given pathogen (microorganism). Thus vaccination is the administration of a vaccine for the prevention of disease while Immunization is the process of inducing immunity artificially. The two words are used interchangeably because vaccination leads to immunization. Vaccination uses the concept of immunity by introducing materials that will induce immune response without causing disease and when an individual subsequently encounters the organism, he/she is able to mount an effective immune response to get rid of the organism without suffering the disease.

Types of immunization

Active immunization is that which induces in the recipient a degree of immunity similar to that achieved from the natural infection and is able to prevent clinical disease. It involves stimulating the immune system to produce antibodies or cell-mediated immunity against an infectious agent. The immunity is produced by the individual’s immune system and is usually long-lasting.

Passive immunization is the administration of exogenously (outside the body of the recipient) preformed antibodies. The immunity produced by this type of immunization is temporary.

Determinants of immune response

Although vaccination should lead to immunization, this is not always the case. The determinants of immune response include

  • Chemical and physical state of the vaccine
  • Route/site of administration
  • Vaccine dose
  • Immunogenicity of the vaccine
  • Host factors- age, sex, nutrition, presence of preexisting antibodies, genetics, immune status, pregnancy

Herd Immunity

This is the resistance of a group to invasion and spread of an infectious agent due to the immunity of a large proportion of the group. To achieve this, high immunization coverage is necessary. When there is herd immunity, the unimmunized in the population are protected because the infection is unable to spread as most people are immune. However when the proportion of those immunized is low then an infection can spread readily. Often a target of 80% immunization coverage can achieve herd immunity but for highly infectious agents, herd immunity may require immunization coverage of up to 90-95%.

All information on immuisation is evidence-based and are reviewed intermittently by the PAN sub-committee on immunisation to ensure that they are scientific, accurate, and based on recommendations by WHO, UNICEF, and the NPI.

Vaccination is one of the most cost-effective interventions in public health.  Smallpox a disease that ravaged and decimated populations was eradicated in 1977 by the use of vaccination. Poliomyelitis a disease which resulted in deaths and caused profound disabilities for millions of children was endemic in 125 countries prior to the global eradication initiative in 1988. There are currently only two endemic countries Afghanistan and Pakistan while Nigeria and indeed Africa was only just declared polio-free on August 25th 2020 having not recorded any case of wild polio in the last 3 years.

At the regional level, the Americas have eliminated congenital rubella. Measles had been eliminated in many developed countries until the recent outbreaks stemming from vaccine hesitancy in their populations. Invasive Haemophilus influenzae type b infections were reduced by 99% following the introduction of a vaccine against the organism in the United States of America.  Vaccines continue to prevent 2-3 million deaths yearly. Vaccines work!

 

Benefits of immunization

  • Immunization is able to prevent 2-3 million deaths globally each year.
  • Immunizations prevent disease
  • Vaccines not only prevent epidemics, but they can also be used to stop the spread of an on-going epidemic
  • Disability is the hallmark of some diseases such as poliomyelitis. These disabilities are prevented by immunizing children.
  • Vaccines help to save scarce economic resources. The billions of dollars used in the Smallpox eradication effort amount is now being saved because the vaccine is no longer being produced and quarantine facilities for Smallpox are no longer necessary.
  • Vaccines prevent suffering. The suffering occasioned by vaccine-preventable diseases is averted by being vaccinated.
  • Immunization helps to keep children healthy. When children suffer from vaccine-preventable diseases, their health and immunity are compromised. Immunization keeps children healthy so that they are able to grow and develop normally. Healthy children become healthy adults and produce a healthy nation.
  • When children are healthy, they are able to benefit maximally from their education
  • Antibiotic resistance is a major global challenge. Vaccines can reduce the development of antibiotic resistance by preventing the occurrence of the infection in the first instance thus precluding the need for antibiotics.  When antibiotics are not used resistance does not occur.
  • Immunizations contribute to sustainable development by enhancing productivity. Lost man-hours from parents having to look after children suffering from vaccine-preventable diseases are prevented. Economic losses from caring for children suffering from vaccine-preventable diseases or their long term effects are also prevented

PAN collaborates with associations in conducting research and other programmes where sponsorship is offered. The study designs, data collection, fieldwork, analyses, interpretations are not influenced by donors. This website is sponsored and sustained by the dues of members of PAN and its contents are reviewed by the communications committee regularly.

 

Vaccines are safe and effective if used correctly. However, no vaccine is completely without risk and adverse events can occasionally result after an immunization. Adverse Event Following Immunization (AEFI) is any medical occurrence which followed immunization and which does not necessarily have a causal relationship with the usage of the vaccine. These events may be any unfavourable or unintended sign, abnormal laboratory finding, symptom or disease.  Such events may present as local reactions (redness, pain or swelling at the injection site), fever, irritability, convulsions, anaphylactic shock, adenopathy and encephalopathy.

Most vaccines will cause no or minor, non-serious adverse events. Serious events are extremely rare and generally do not result in death or long-term disability. These events are often not as deadly as the complications caused by the disease the vaccine is meant to prevent.

Categorization: AEFI can be categorized into two broad categories based specifically on cause, seriousness and frequency:

  1. Cause-specific categorization
  2. Vaccine reactions by seriousness and frequency

Cause – Specific Categorization: WHO has classified AEFI into five groups:

  1. Vaccine product-related reaction – reaction to one or more of the inherent properties of the vaccine itself e.g. limb swelling following DPT (components of Pentavalent vaccine)
  2. Vaccine quality – defect reaction – due to defect in the quality of the vaccine
  • Immunization error related reaction – due to inappropriate vaccine handling, prescription or administration. It is largely preventable.
  1. Immunization anxiety-related reaction – due to anxiety about the immunization e.g. fainting during immunization.
  2. Coincidental event – caused by things other than vaccine product, immunization error or anxiety e.g. developing fever due to malaria shortly after immunization.

Vaccine reactions by seriousness and frequency:

  1. Non – serious AEFI – these are reactions that occur within a few hours of injection, resolve after a short period and do not pose a potential risk to the health of the recipient. Such reactions include mild fever (<38°C), pain and soreness at the injection site.
  2. Serious AEFI – these are events that cause a potential risk to the health or life of the recipient. Such events include death, persistent or significant disability, hospitalization and congenital anomalies

Intensity of AEFI

  1. Mild – reactions that are easily tolerated by recipient, causing minimal discomfort and not interfering with daily activities
  2. Moderate – reactions that are sufficiently discomforting and interfere with daily activities.
  3. Severe – reactions that prevent normal daily activities e.g reaction that prevent school attendance in a young child or that causing parents to seek medical attention.

 

PAN’s policy on immunisation is based on scientific and epidemiologic data in partnership with Government and Non-Government organisations that promote child health and this is updated regularly. PAN is actively involved in immunisation activities in Nigeria. As the chief advocate for Nigerian children, the following is the recommended schedule by PAN and this has been successfully used in advocating for the addition of new vaccines to the national immunization schedule;

AGENAME of  VACCINEROUTEDOSE
AT  BIRTH

BCG

 

HBV0 (birth dose)

OPV0

Intradermal

 

IM or deep SC

Oral

0.05ml for infants <12months, 0.1ml for children ≥12months

0.5ml: if > 2 weeks skip birth dose

2 drops: if>2weeks skip birth dose

6 Weeks

OPV1

PENTA 1

PCV 13 1

Rotavirus1

Oral

IM

IM

Oral

2 drops

0.5ml

0.5ml

2 drops: do not give if child is ≥15 weeks (31/2months)

10 Weeks

OPV2

Rotavirus2

Oral

Oral

2 drops

2 drops: do not give if child is ≥32 weeks (8 months)

14 Weeks

OPV3

PENTA 2

PCV13 2

Oral

Intramuscular

Intramuscular

2 drops

0.5ml

0.5ml

6 Months

PENTA 3

 

PCV13 3

 

Vitamin A

(1st dose)

IM

 

IM

 

Oral

Last dose of Hep B not given earlier than 2 weeks of age and 16 weeks from the 1st dose

3rd dose given at a minimum of 2 months after the 2nd dose

100,000IU for 6 -11 months, 200,000IU for ≥12 months old

9 Months

Measles (1st dose)

Yellow fever

IM or deep SC

IM or deep SC

0.5ml

0.5ml: booster every 10 years

12 – 15 months

Vitamin A

(2nd dose)

DTaP – booster

OPV booster

Oral

 

IM or deep SC

Oral

Repeat every 6 months till 5 years

 

0.5ml

18 months

Hepatitis A

MMRV (or MMR +Var or Measles -2+ Var)

IM

IM

 

0.5ml: 2 doses at 6months interval

0.5ml

2 yearsTyphoid (Vi polysaccharide)IM0.5ml: Revaccinate every 4 years
5 years

OPV

DTaP

MMR

  
 10 – 14 years

Tdap

Yellow fever

HPV (male and female)  3doses at 0, 2 and 6 months interval

IM

IM

Every 10 years

Every 10 years

≥ 15 years5 dose of TT

TT1 – at first contact

TT2 – 4 weeks after first dose (3 years protection)

TT3 – 6  months after 2nd dose (5 years protection)

TT4 – 1 year after 3rd dose (10 years protection)

TT5 – 1 years after 4th dose (protects all through childbearing years )

VACCINES FOR SPECIAL GROUP
12 – 15 monthsMen ACYW135 (conjugated) For children in the meningitis belt only. Polysaccharide is given after 2 years
>1 yearCholera vaccine (Sanchol and Morcvax) During epidemics and at refugee camps. 2 doses 14 days apart and a booster 2 years later
15 yearsTetanus  

 

BCG: Bacillle Calmette Guerin, HBV: Hepatitis B Vaccine, OPV: Oral Polio Vaccine, PENTA: Pentavalent vaccine (comprising diphtheria, pertussis, tetanus, haemophilus influenzae type B, hepatitis B), PCV: pneumococcal conjugate vaccine, Men ACYW135: Quadrivalent meningococcal conjugate vaccine, MMRV: Measles, Mumps, Rubella,  Varicella, HPV: Human papilloma virus

 

 

Vaccines are made from a variety of similar ingredients, although they differ in individual constituents. They may also contain residual by-products from the production process. Knowing the precise content of each vaccine can be helpful when investigating adverse events following vaccination and for choosing alternative products for persons with allergies to certain components.

Active components: This consists of the antigen; which is a form of the virus, bacteria, or toxin causing disease. The antigen is however modified and can no longer replicate or cause disease but it can elicit an immune response.

Adjuvants: Adjuvants are a highly heterogeneous group of compounds that have the ability to enhance the immune response. How they work is not entirely understood, but it is postulated that they help keep antigens near the site of injection, meaning that the immune cells can easily access them. Adjuvants are added to vaccines to stimulate the production of antibodies against the vaccine antigen to make it more effective and have been used for decades most often in inactivated (killed) vaccines. There are several hundred different types of adjuvants that are being used or studied in vaccine technology. For example, Aluminium hydroxide and Aluminium phosphate, and there is no evidence of any serious side effects from using them except for occasional minor reactions near the injection site. Adjuvants are also used to reduce the amount of the active component of vaccines.

Antibiotics: These are used during the manufacturing process to prevent bacterial contamination of the tissue culture cells in which the viruses are grown. Usually, only trace amounts appear in vaccines. Commonly used antibiotics include Neomycin and Gentamycin. Persons with known sensitivity to these drugs should be observed for possible reactions after vaccination.

Stabilizers: Stabilizers are used to help the vaccine remain stable and effective during storage. Vaccine stability is important, especially where the cold chain is unreliable. Factors affecting stability include acidity or alkalinity of the vaccine (PH). Stabilizing agents include inorganic salts such as MgCl2 (for OPV), MgSo(for measles), lactose-sorbitol, and sorbitol –gelatin. Monosodium glutamate and glycine are also sometimes used.

Preservatives and trace components: These are added to multidose and single-dose vaccines to prevent bacterial and fungal growth. They include a variety of substances such as Thiomersal (thimerosal), Formaldehyde or phenol derivatives. Thiomersal is ethyl mercury-containing compound that has generated a lot of debate because of its content, however current evidence shows, there is no evidence of neurotoxicity to Thiomersal (even in trace amounts) in vaccines. Formaldehyde is used to inactivate viruses (IPV) and detoxify bacterial toxins such as those used to make diphtheria and tetanus vaccines.  Although it is purposefully removed during production, the small amounts that remain are too small to cause any harm.

Vaccines are made from a variety of similar ingredients, although they differ in individual constituents. They may also contain residual by-products from the production process. Knowing the precise content of each vaccine can be helpful when investigating adverse events following vaccination and for choosing alternative products for persons with allergies to certain components.

Active components: This consists of the antigen; which is a form of the virus, bacteria, or toxin causing disease. The antigen is however modified and can no longer replicate or cause disease but it can elicit an immune response.

Adjuvants: Adjuvants are a highly heterogeneous group of compounds that have the ability to enhance the immune response. How they work is not entirely understood, but it is postulated that they help keep antigens near the site of injection, meaning that the immune cells can easily access them. Adjuvants are added to vaccines to stimulate the production of antibodies against the vaccine antigen to make it more effective and have been used for decades most often in inactivated (killed) vaccines. There are several hundred different types of adjuvants that are being used or studied in vaccine technology. For example, Aluminium hydroxide and Aluminium phosphate, and there is no evidence of any serious side effects from using them except for occasional minor reactions near the injection site. Adjuvants are also used to reduce the amount of the active component of vaccines.

Antibiotics: These are used during the manufacturing process to prevent bacterial contamination of the tissue culture cells in which the viruses are grown. Usually, only trace amounts appear in vaccines. Commonly used antibiotics include Neomycin and Gentamycin. Persons with known sensitivity to these drugs should be observed for possible reactions after vaccination.

Stabilizers: Stabilizers are used to help the vaccine remain stable and effective during storage. Vaccine stability is important, especially where the cold chain is unreliable. Factors affecting stability include acidity or alkalinity of the vaccine (PH). Stabilizing agents include inorganic salts such as MgCl2 (for OPV), MgSo(for measles), lactose-sorbitol, and sorbitol –gelatin. Monosodium glutamate and glycine are also sometimes used.

Preservatives and trace components: These are added to multidose and single-dose vaccines to prevent bacterial and fungal growth. They include a variety of substances such as Thiomersal (thimerosal), Formaldehyde or phenol derivatives. Thiomersal is ethyl mercury-containing compound that has generated a lot of debate because of its content, however current evidence shows, there is no evidence of neurotoxicity to Thiomersal (even in trace amounts) in vaccines. Formaldehyde is used to inactivate viruses (IPV) and detoxify bacterial toxins such as those used to make diphtheria and tetanus vaccines.  Although it is purposefully removed during production, the small amounts that remain are too small to cause any harm.

Vaccine-preventable diseases are those for which there is a vaccine. These include diseases caused by viruses and those caused by bacteria.

Vaccine-preventable bacterial diseases include tuberculosis, meningococcal disease, pneumonia (due to Streptococcus pneumoniae and Haemophilus influenza type b), pertussis, tetanus, diphtheria, cholera, Typhoid, Lyme disease, tick-borne encephalitis.

Vaccine-preventable viral diseases include Poliomyelitis, Hepatitis B, Hepatitis A, Measles, Yellow fever, Japanese encephalitis, Rabies, Varicella, Diarrhoea due to rotavirus, mumps, rubella, influenza, dengue,  diseases caused by human papillomavirus (cervical cancer, venereal warts)

Although there are many vaccine-preventable diseases, not all of them are recommended in national immunization programmes. Several factors are taken into consideration before vaccines are recommended. These include;

  • Epidemiology of the target disease -incidence, age, sex
  • Age-specific morbidity and mortality
  • Risk of adverse events from the vaccine
  • Cost-effectiveness
  • Age of recommended health care visits
  • Efficacy of the vaccine

Vaccinations are generally recommended at the age;

  • When there is a significant risk of disease and complications
  • When the protective immunologic response is expected to occur
  • Also recommended for special situations e.g. SCA, HIV

Expanded Programme on Immunization

The Expanded Programme on Immunization (EPI) is the World Health Organization’s immunization programme. The programme started in 1974 with the intention of providing vaccines to all the children in the world. It initially addressed six killer diseases in children. These six diseases tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles were responsible for a high proportion of childhood mortality. With the success of the EPI in reducing morbidity and mortality from these diseases over the years, other diseases have been targeted with the addition of pneumococcal conjugate vaccine, hepatitis B, yellow fever and meningococcal vaccines to the schedule.

Most low and middle-income countries subscribe to the EPI schedule and countries are encouraged to add on other vaccines depending on the epidemiology of their diseases. Nigeria also subscribes to the EPI and her immunization programme is called the National Programme on Immunization in which vaccines are provided free to all children.

Bacille Calmett Guerin (BCG) is the vaccine given to children and / or adults to prevent Mycobacterium tuberculosis infection. In infancy, it is given soon after delivery, usually within the first 48 hours, intradermally, and  in the upper arm of the baby. The dose is 0.5 millilitre and this protects against severe forms of tuberculosis for life. The vaccine is very safe.

 

Oral Polio Vaccine is given to prevent infection from Poliomyelitis virus which causes acute flaccid paralysis. The vaccine has helped eradicate polio in Nigeria, a status achieved in 2019 and it is safe. OPV is given orally as 2 drops per dose, and infants receive it at birth (OPV 0), 6 weeks (OPV 1), 10 weeks (OPV 2), and 14 weeks (OPV 3).

 

Hepatitis B is a viral disease that primarily affects the liver causing severe damage to the liver and its functioning. If left untreated, hepatitis B infection can lead to liver cirrhosis and hepatocellular cancer. Hepatitis infection can be contracted following contact with human and bodily fluids, sexually or through blood transfusion. The vaccine is given 3 times at intervals to achieve lifelong immunity against the disease. It is safe and given as intramuscular injection.

 

Pneumococcal vaccine was introduced into the immunisation schedule in 2014, and it is given to induce immunity against the pneumococcal organism that causes respiratory infection and meningitis, which is a major cause of childhood illness and death. The vaccine is safe and is given as an intramuscular injection.

 

Diarrhoeal diseases are one of the commonest causes of death in Nigeria, and the commonest cause of this diarrhoea is rotavirus. This vaccine is given orally and it is safe for all babies. Most babies who receive rotavirus infection do not have any problems but some mothers have reported diarrhoea following administration of the vaccine, and this usually stops within a day.

 

The measles virus causes a constellation of symptoms and signs, fever, rash, cough, runny nose, and red, watery eyes. Complications can include ear infection, diarrhea, pneumonia, brain damage, and death. It is usually given after 6 months of age because maternal immunity transferred to the baby starts waning at that time.

 

Mumps virus infection causes painful swelling in the jaw with fever. However long term complications of Mumps infection include disease of the testes and ovaries causing the possibility of infertility, and some have reported deafness and meningitis. The vaccine is safe and given in combination with measles and rubella.

 

Rubella vaccine gives immunity against rubella virus infection which causes fever, rash, and occasionally, deafness and if a woman is infected with the virus when she is pregnant, she may have a miscarriage, and her baby may be born blind, and have some other defects. The vaccine is safe and provides long term immunity.

 

Yellow fever virus infection is one of the viral haemorrhagic virus diseases that cause bleeding into various organs of the body in its severest form. Adults can also take this vaccine and the immunity lasts for a duration of 10 years.

 

Tetanus was a major killer of newborn children in the early 1980s and beyond until vigorous campaign for immunisation reduced the mortality rate. Tetanus causes high-grade fever, spams of the newborn with the occasional cessation of breath, and death. Mothers and all girls in the reproductive age group are encouraged to receive at least 3 doses of the vaccine before delivery and pregnancy.

 

The vaccine safety net is a WHO-initiated programme aimed at improving the information available to the general public concerning immunisation in children, in terms of content, and context to prevent undue fear about the safety of vaccines.
The VSN is established to provide understandable, evidence-based information on the safety of vaccines for internet users, regardless of their geographic location and language too long ago, some infants were denied vaccines because their parents were misinformed about the intentions behind the immunisation. PAN partners with VSN to provide safe and effective vaccines and information to the general public and medical practitioners.

Despite the proven benefits of immunization, Nigeria still struggles with vaccine-preventable diseases and perennially low immunization coverage. Peculiar challenges have continued to threaten the gains made in the fight against Vaccine-Preventable Diseases. Among these challenges are inadequate funding of health services, religious beliefs and misconceptions regarding vaccines and vaccine safety, and weak access to health services. These factors, singly and in combination, lead to the low immunization coverage in the country.

Health services including immunization services are poorly funded in Nigeria. Significant funding for the country’s vaccination programme comes from external donors. Due to the tenuous funding, many vaccines are not given on demand. In some cases, clients are pooled to a minimum number below which a vial is not opened even though this practice is not in accordance with the National policy. On occasions, vaccines have been reported unavailable to clients due to breaches in the supply system, leading to the postponement of due immunizations. These practices result in missed opportunities.

In the last decade, the Nigerian healthcare landscape has been bedeviled with strikes from health workers; these strikes have had a negative impact on immunization coverage as often clients have been turned away at such periods of strikes which occur rather too often.

Religious and political considerations have also posed challenges to our vaccine programme. In 2003, protests and boycotts followed the introduction of some vaccines in the northern part of Nigeria owing to rumors of population control through such vaccines. This boycott contributed to the persistence of poliomyelitis for many years after. Apart from religion, there have been unfounded misrepresentations about vaccine safety owing to ignorance among the populace. General practice is to refrain from seeking immunization during minor illnesses. In addition, unrelated deaths have been attributed to immunizations thereby reducing confidence in vaccine services.

Another major challenge to immunization is the operations of Boko haram terrorists, bandits, and other forms of insecurity in some parts of the country which has resulted in many children being orphaned or being in internally displaced persons (IDP) camps. Healthcare workers and volunteers providing services to these IDPs are also abducted and sometimes killed. These factors result in a reduction in available healthcare workers, logistic challenges in transportation, and storage of vaccines, and the children are either not vaccinated or are vaccinated late. There is, therefore, an urgent need to curb the insurgencies and insecurity in these parts of the country to improve access to immunization

The current Covid-19 pandemic has not only limited access to immunization services through the lockdowns, but has revived a number of conspiracies regarding vaccine safety. This situation threatens efforts to reduce under-five mortality in Nigeria. The government should, therefore, strive to restore the confidence of the populace in vaccines, as well as provide continuing education of the masses on the proven safety and efficacy of current vaccines. In addition, there should be increased funding of health services to reduce the reliance on foreign support to maintain immunization services in the country.

The presence of a contraindication increases the risk of developing an adverse reaction to a vaccine recipient, in such a case the vaccine should be withheld. Contraindications are rare (and usually temporary) but misperceptions that they occur frequently lead to refusals to take vaccines and poor immunisation coverage.

The only true contraindication to all vaccines is a previous serious allergic reaction (anaphylaxis) to an earlier received vaccine dose or constituent. Non-absolute contraindications include:

  • Severe immunocompromised persons: do not give live vaccines.
  • Pregnancy: do not give live attenuated vaccines.
  • Occurrence of encephalopathy within 7 days of receipt of a pertussis-containing vaccine which cannot be attributed to another identifiable cause: do not give any other dose of a pertussis-containing vaccine.
  • Severe Combined Immunodeficiency (SCID) disease and a history of intussusception: do not give rotavirus vaccines.

Other conditions that can increase the risk of adverse reactions, cause diagnostic challenges, or prevent the production of immunity after vaccination are precautions. The risk from precautions is less than those from contraindications. Where there are precautions, the vaccine should be given if the benefits outweigh the risks but should preferably be deferred until the earliest suitable time. Precautions should be taken in the presence of:

  • moderate or severe acute illness with or without fever.
  • a family or personal history of seizures (for MMRV vaccine).
  • a neurologic disorder
  • development of Guillain-Barre Syndrome within 6 weeks after receiving a previous tetanus toxoid –containing vaccine dose or influenza vaccine.
  • egg allergy (excluding hives) for the influenza vaccine.
  • receipt of antibody-containing blood products within 11 months or less for the varicella vaccine.
  • receipt of specific antiviral drugs (acyclovir, famciclovir, vacyclovir) 24 hours before vaccination and 14 days after vaccination for varicella and zoster vaccine

Note that BCG or yellow fever should not be given to infants with symptoms of HIV/AIDS. Health workers should also be taught to recognise signs of adverse reactions and report such reactions to their superiors immediately.

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  14. National Primary Health Care Development Agency, Nigerian Field Guide on surveillance of adverse events following immunization (AEFI) and response. 2018

Prof Ayebo Sadoh

Dr Chukwuma Onuchukwu

Dr Mariya Mukhtar-Yola

Dr Eno Ekop

Dr Francis Iregbu

Dr Patricia Medupin

Dr Adaobi Bisi-Onyemaechi

Dr Peter Teru

Dr Ogechi Maduka

Dr Iretiola Fajolu

Dr Chris Yilgwan

Dr Oladele Olatunya

Dr Amarachukwu Okafor

Dr Seyi Oniyangi

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