A contraindication is one or more conditions which makes administration of vaccines inadvisable due to some potential side effects. Common illnesses are not contraindications for immunization, so no sick child, including the malnourished child, should miss immunization, unless there is a clear contraindication.

There are only three situations which are considered to be contraindications to immunization:

• Do not give BCG to a child known to have AIDS
• Do not give DPT2-HepB2-Hib2 or DPT3-HepB3-Hib3 to a child who has had convulsions or shock within three days of the last dose of the vaccine
• Do not give any doses of DPT-HepB-Hib to a child with recurrent convulsions or another active neurological disease of the central nervous system.

In all other situations, here is a good rule to follow:

• There are no contraindications to immunization of a sick child if the child is well enough to go home
• If you are referring a child, you do not need to give him or her a vaccine before referral. The staff at the referral site should make the decision about immunizing the child when the child is admitted. This will avoid delaying referral.

As you read earlier, children with diarrhoea who are due for OPV should still receive this during their visit to the health post. However, the dose should not be counted and you should tell the mother to return with the child in four weeks for an additional dose of OPV.

You should also advise the mother to be sure the other children in the family are immunized.