General instructions for vaccination

BOX 1: General instructions on immunization

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 GENERAL INSTRUCTIONS FOR VACCINATION

There are many things we forget much time in the routine practice of vaccination like the timing, minimum age, gap, site, etc..
What should be the minimum gap of vaccines and what to do if any dose is missed due to some reason? Can we give the vaccine before the recommended age and should a child be vaccinated if he has crossed the age of any vaccine? 
Here is a rapid reminder of the useful points we should keep in mind while vaccinating the child.

1-Vaccination at birth means as early as possible within 24–72 hours after birth (vaccinate the baby with BCG/OPV-O/HepB-1 before mother is discharged from the hospital in case of the hospital delivery) or at least not later than 1 week after birth. 

Give vaccination cards also with proper documentation, many times parents get confused with vit -K for vaccination. tell them clearly that vit -k is not a vaccine.
Documentation with the brand of vaccine, batch number, and expiry date should be written in the vaccine card.
A doctor can paste the vaccine vial label on vaccine cards also this is very useful in future visits.

2- Whenever multiple vaccinations are to be given simultaneously, they should be given within 24 hours if simultaneous administration is not feasible due to some reasons. Many babies get vaccinated in gov hospital under UIP and later on come to Pvt clinic for PCV and another vaccine which is not available in govt hospital, in that case, consider the proper timing and gap.
When a baby comes to the doctor for the first visit of the vaccine these points should be cleared to parents so that all the vaccines can be given to the baby without any delay. 

 GENERAL INSTRUCTIONS FOR VACCINATION

3-The recommended age in weeks/months/years means completed weeks/months /years, this age is the minimum required age for any particular vaccine. Baby should not be vaccinated before the recommended age. If given less then 4 weeks apart, the vaccine given should be repeated.

For catchup vaccine instructions click -
Catch-up vaccination/Adolescent vaccination

4- If any vaccine is not administered at the recommended age should be administered at a subsequent visit when indicated and feasible. this will not disturb the other vaccine schedule.

5-There should be the use of a combination vaccine over separate injections of its equivalent component vaccines. This will be easy and convenient for babies and parents. Babies will not get afraid of multiple pricks of syringes. 

6-When two or more live parenteral/intranasal vaccines are not administered on the same day, they should be given at least 28 days (4 weeks) apart.
This rule does not apply to live oral vaccines. (parents ask you much time about OPV vaccine given in India in the govt program, assure them they can take it anytime and this will not disturb their other routine vaccination schedules.

7-The minimum interval between 2 doses of inactivated vaccines should be 4 weeks (the only exception for this rule is rabies vaccine).

8- Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid (exception rabies). If the vaccine is administered more then 5 days before a minimum period, it is counted as an invalid dose.

9-Any number of antigens (vaccine) can be given on the same day.

10-Changing needles between drawing vaccine into the syringe and injecting it into the child are not necessary.

11-Different vaccines should not be mixed in the same syringe unless specifically licensed and labeled for such use by the manufacturer of that vaccine.

12- Patients should be observed for any allergic reaction (anaphylaxis) for 15–20 minutes after receiving immunization(s).awake the child before injecting the vaccine if he is sleeping, because many times children become more afraid while giving an injection in a sleeping state and become more irritated.

13-When necessary, two vaccines can be given in the same limb (1–2 inches apart) at a single visit.

14-The anterolateral aspect of the thigh is the preferred site for two simultaneous intramuscular (IM) injections because of its greater muscle mass.

15-The distance separating the two injections site should be at least 1 inch so that local reactions are unlikely to overlap.

16-Although most experts recommend “aspiration” by gently pulling back on the syringe before the injection is given, there are no data to document the necessity for this procedure. If blood appears after negative pressure, the needle should be withdrawn and another site should be selected using a new needle.

17-A previous immunization with a dose that was less than the standard dose or one administered by a nonstandard route should not be counted, and the person should be re-immunized as appropriate for the age.

18-Keep your self updated with latest vaccine schedule updated by IAP
For more info click the link ⇒VACCINATION GUIDELINE 2019-2020 -IAP