Neobook — clinical reference

The contents of this chapter are based on the current recommendations from the National Advisory Group on Immunisation (NAGI).

Any medical incident that takes place after immunisation and may be potentially related to immunisation should be reported (See: Adverse Events Following Immunisation (AEFI)).

Every clinic day is an immunisation day.
Never miss a chance to immunise – never turn a child away if an immunisation is needed, even if it means opening a multi-dose vial for just one person.
Check the Road to Health Booklet every time the child visits the clinic and give missed immunisations. These should be given according to the catch-up schedule which is shown in the table on Childhood Immunisation Schedule.
Mild illnesses are not a contra-indication to immunisation – most children who are well enough to be sent home, are well enough to be immunised. Do not immunise a sick child if the mother seriously objects but encourage her to bring the child for immunisation on recovery.
Give an extra dose if in doubt whether a child has had a certain dose or not, as extra doses are not harmful.
The measles/rubella vaccine must not be given with other childhood vaccines when administered at 6 months of age. The measles/rubella vaccine can be co-administered with other vaccines from 9 months of age. All other vaccines listed in the table below can be given safely at the same time but should not be given in the same syringe or at the same site.
Serious adverse events following immunisation are uncommon. All adverse events should be reported.
For management of anaphylaxis associated with vaccinations, See: Anaphylaxis.
As COVID vaccination recommendations are being updated regularly as new evidence emerges, please consult the latest National Department of Health vaccine policy recommendations.

Note:
COVID-19 vaccines may be administered without regard to timing of other vaccines. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day. If multiple vaccines are administered at a single visit, administer each injection in a different injection site (different arm), with the COVID-19 vaccine administered on the LEFT arm.

Adverse events following immunisation (AEFI) definition

Any untoward medical occurrence which follows immunisation, irrespective of whether there is a causal relationship with the vaccine. The adverse event may be any unfavourable or unintended sign, abnormal laboratory finding, symptom or disease. All AEFI should be reported. Serious and severe AEFI or cluster of events are investigated, and causality assessed by the National Immunisation Safety Expert Committee (NISEC) which is an independent committee appointed by the Minister of Health. Further information is available in the vaccine safety surveillance in South Africa - Manual for Surveillance and Response to Adverse Events Following Immunisation.

Conditions that are not contraindications to any of the standard EPI vaccines

There are very few contra-indications, but many missed opportunities.

Family history of any adverse reactions following vaccination.
Family history of convulsions.
Previous convulsions.
Egg allergy.
Previous measles, mumps, rubella, or pertussis-like illness.
Preterm birth.
History of jaundice after birth.
Stable neurological conditions such as cerebral palsy or trisomy 21.
Contact with an infectious disease.
Minor illness (without systemic illness and with a temperature below 38.5°C).
Treatment with antibiotics.
Asthma, eczema, hay fever or ‘snuffles’.
Treatment with locally acting (inhaled or low-dose topical) steroids.
Child’s mother is pregnant.
Child being breastfed.
Underweight, but otherwise healthy child.
Over the age recommended in vaccination schedule but not above the allowable upper age limit per manufacturer's recommendations.
Recent or imminent surgery.

LoE: IVb¹

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version1.1_6 December 2024

Chapter 13: Immunisation_13.1 Immunisation Schedule