The EPI policy recommends that health workers should use every opportunity to check whether eligible children have been immunized, and to immunize them if they have not received all scheduled doses of all the EPI vaccines at the correct age. However, as you already know from Study Sessions 2 and 3, sometimes a child may be temporarily or permanently unfit to receive a specific vaccine. This is called a contraindication to immunization.

Minor illnesses such as upper respiratory tract infections or diarrhoea, with low-grade fever below 38.5^oC, are not contraindications for immunizing children with EPI vaccines. Infants with a moderate or severe fever (above 38.5ºC) should be considered as temporarily unfit for vaccination until their condition improves. A good rule to follow is that:

However, there are some absolute contraindications to immunization, which mean that a child should not be immunized (Box 7.2). You need to be aware of these conditions, because they may seriously affect a child if he or she is immunized.

The contraindications for individual vaccines were explained in Study Sessions 2 and 3 of this Module.

Box 7.2 Absolute contraindications to immunization with EPI vaccines

Do not give another dose of pentavalent or PCV10 vaccine to a child who developed convulsions or a severe allergic reaction soon after, or within three days, of receiving the previous dose. Severe acute allergic reactions include generalized skin itching, skin rash, difficulty in breathing, swelling of the mouth and throat, and signs of shock (low blood pressure and rapid pulse rate); the symptoms quickly get worse (this is what ‘acute’ means).
Do not give any doses of pentavalent PCV10 vaccine to a child with recurrent convulsions, or another active neurological disease of the central nervous system (brain and spinal cord).
Do not give BCG or PCV10 vaccines to HIV-positive infants with AIDS, or symptoms of HIV infection including chronic lung infections, tuberculosis and persistent serious diarrhoea.

Note that HIV-positive asymptomatic infants (without symptoms) should receive all EPI vaccines at the earliest age possible, according to the nationally recommended EPI schedule.

Why do you think symptomatic HIV infection (with symptoms) is an absolute contraindication for BCG vaccination? Think back to what you learned about BCG vaccine in Study Session 2, and the effect of HIV on the immune system (Communicable Diseases Module, Part 3.)

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BCG vaccine contains live-attenuated TB bacteria. The defence against infection in people with symptomatic HIV infection is very low, because HIV has damaged their immune system. If they are given BCG vaccine, they can develop tuberculosis.