Summary
There are many ways to protect your child against childhood diseases as they grow up, but when it comes to protection against certain childhood diseases, we strongly recommend vaccination.
It is therefore very important that children are vaccinated against these dangerous and preventable diseases. The vaccines on the EPI programme are provided free of charge by the South African Government at government and municipal clinics. Private clinics (such as clinics in pharmacies) and private nurses and doctors also provide these vaccines for free, but require a consultation fee; this usually includes a counselling session that monitors, among other things, the growth and development of the baby.
In South Africa, vaccines are available to prevent the following common childhood diseases:
- Tuberculosis
- Poliomyelitis
- Diphtheria
- Hepatitis A and B
- Mumps
- Varicella (Chickenpox)
- Rotavirus (Gastro)
- Pneumococcal infection (meningitis, infection of the lung, blood infections and infection of the middle ear)
- Tetanus
- Pertussis (Whooping Cough)
- Haemophilus Influenzae type B (Hib)
- Measles
- Rubella (German measles)
- Influenza (Flu)
How is a vaccine made?
Most vaccines contain purified fragments, taken from dead bacteria or viruses (germs). Some vaccines contain live viruses, but in a very weak form that will not bring about the disease.
How do vaccines work?
Vaccines “teach” the immune system how to recognize and fight certain germs, bacteria and viruses before a particular disease can gain a foothold. By giving the body a small “sample” of the germ, it can develop resistance, without actually contracting the disease.
Why give babies and children vaccines?
Certain vaccine-preventable diseases can infect babies within the first few months of life. Vaccinating these babies helps provide them with protection when it is needed. Some of these immunisations have to be repeated to make sure the baby/child remains protected.
The safety of vaccines
In the last decade, numerous changes in vaccine production and administration have reduced the number of side-effects and resulted in safer vaccines. This process never stops, and research continues to develop improved vaccines.
Side effects of vaccines
The different vaccinations’ side effects will be discussed with each vaccine. The most typical side-effects include a slight fever, drowsiness and soreness at the injection site. Although extremely rare, vaccines can cause other side-effects, e.g. very high temperatures. If your child develops a highfever (more than 39º C), or appears to be in severe pain, seek medical attention immediately.
The flu injection
A paediatric (child) flu vaccine is available. This is not part of the EPI immunization programme in South Africa. There are lots of different opinions about giving it to children under the age of 6 months. Discuss this with your healthcare provider.
The road to health chart
If you gave birth in a hospital maternity ward, you will be given a “road to heath” chart. These charts don't all look the same, as each hospital and the state have their own. Make sure you receive a chart before leaving the hospital. If the baby was born at home, you can get a chart from your nearest clinic. Make sure you take the baby’s birth certificate with you.
All the details about your baby’s health will be entered on the chart by the doctor or clinic sister. Vaccination information also has to be filled in on the chart. Remember to keep the chart in a safe place, because you will need it when your child goes to school. Always take it with you to the clinic, doctor or hospital; most clinics will not immunize your child without it.
National routine immunisation schedule
Age of child | Which vaccine? | How and where is it given? |
At birth | BCG (vaccine against TB) Polio vaccine | vaccination in upper right arm drops by mouth |
6 weeks old | Polio vaccine DTP* vaccine Hib*** vaccine Hepatitis B vaccine | drops by mouth injection in left thigh injection in left thigh injection in right thigh |
10 weeks old | Polio vaccine DTP* vaccine Hib*** vaccine Hepatitis B vaccine | drops by mouth injection in left thigh injection in left thigh injection in right thigh |
14 weeks old | Polio vaccine DTP* vaccine Hib*** vaccine Hepatitis B vaccine | drops by mouth injection in left thigh injection in left thigh injection in right thigh |
9 months old | Measles vaccine | injection in right thigh |
18 months old | Polio vaccine DTP* vaccine Measles vaccine | drops by mouth injection in left arm injection in right arm |
6 years old | Polio vaccine Td** vaccine | drops by mouth injection in left arm |
DTP* = vaccine against diptheria, whooping cough and tetanus (lock-jaw)
Td** = vaccine against diphteria and tetanus only
Hib*** = vaccine against Haemophilus influenzae type b
All the above vaccines are freely available at state and private clinics. (You only pay for the “well baby consultation”, as mentioned.)
Discussion of the EPI immunisation vaccines
OPV-Merieux Polio vaccine protects against the following: Poliomyelitis
- Used exclusively via the oral route: 2 drops, which, with the aid of a dropper, provided with the vaccine, can be administered directly into the mouth.
- First dosage at birth, then at six weeks, and a booster at 6 years
Side effects
- Rigors (shivering)
- Asthenia (weakness)
- Myalgia (pain in the muscles)
- Arthralgia (severe pain in joints)
When to be worried
- Inconsolable crying
- Muscle weakness
When to take baby to doctor or casualty ward
- Persistent, inconsolable crying
Vaccination should be postponed in case of
- Acute illness
- Within 3 months of prior administration of immunoglobulins
Treatment
- People in contact with recently immunized babies should be advised of the need for strict personal hygiene, particularly hand washing after nappy changes for 3-4 days after vaccination.
- Put soiled nappies in a plastic bag before discarding for 3-4 days after vaccination.
BCG vaccine SSI Tuberculosis vaccine protects against the following: Tuberculosis
- Babies should be immunised as soon as possible after birth.
- Children under 1 should receive 0.05 ml of the reconstituted vaccine intradermally.
- Children older than 1 year should receive 0.1 ml.
- The injection is to be given slowly, strictly intradermally, into the upper layer of skin of the right arm in the region over the distal insertion of the deltoid muscle.
Side effects
- Small, red area after 3 weeks
- Small papule, with scaling and scabbing, after 6 weeks
- Formation of a small vesicle
- Ulcer, 2-4 weeks after vaccination
- Healing taking from 2-5 months.
- Small flat scar forming after 1 year
When to be worried
- Enlargement of auxiliary lymph nodes
Take the baby to a doctor or casualty ward
- Enlargement of auxiliary lymph node
Vaccination should be postponed in case of
- Acute illness
- High fever
- Serious skin disease
Treatment
- Do not open vesicle or ulcer.
- Do not apply any ointment directly onto injection site.
- It is advisable to watch for any side effects.
- Remain at clinic for at least 20 minutes after injection.
If in doubt, contact your clinic/clinic sister immediately.
Pentaxim injection, also called the 5-in-one injection, protects against the following: Diphtheria, Tetanus, Pertussis, Poliomylitis, Haemophilus influenzae type B
- Injection in right upper thigh, 0, 5 ml intramuscularly
- After 1 year, in the right upper arm
Side effects
- Redness at the injection site
- Fever
- Diarrhoea/vomiting
- Feeding/sleeping disturbances
- Irritability
When to be worried
- Redness and swelling > 5 cm at injection site
- Fever > than 39º C
- Drowsiness
- Inconsolable crying
Take baby to doctor or casualty ward
- Fever > 40º C
- Convulsions, with or without fever, within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Rash
- Persistent ,inconsolable crying lasting > 3 hours and occurring within 48 hours of vaccination
Vaccination should be postponed in case of
- Fever > 39º C
- Acute illness
- Hypersensitivity to any components of the vaccine
- Severe reaction to previous injections
Treatment
- Only administer Panado syrup if temperature is higher than 38º C
- 6 and 8 week old babies: Panado Infant drops, 0,6 ml, 4-6 hourly x 2 for fever
- 10 and14 week old babies: Panado syrup, 2.5 ml, 4-6 hourly x 2 for fever
- Older babies: Panado syrup 5 ml, 4-6 hourly x 2 for fever
- Nurofen can also be used as indicated on the instruction pamphlet.
- Apply hot face cloth (tested on mother’s forearm for correct temperature before applying to baby) on the injection spot every time you change the nappy, for 2 days.
- Do not apply any ointment directly on injection site.
- It is advisable to observe for any side effects.
- Remain at clinic for at least 20 minutes after injection.
- If in doubt, contact your clinic/clinic sister immediately for advice.
Prevenar injection is a Pneumococcal infection vaccine that protects against the following: Pneumonia and Otitis media, caused by Streptococcus pneumoniae, Meningitis, Bacteremia
- Injection in right upper thigh, 0, 5 ml intramuscularly
- After 1 year in the right upper arm
Side effects
- Swelling, pain and tenderness
- Fever
- Diarrhoea/Vomiting
- Decreased appetite
- Drowsiness/restless sleep
- Irritability
- Crying
When to be worried
- Redness and swelling > 2,4 cm at injection site, interfering with movement
- Fever > than 39º C
- Seizures, hypotonic-hypo responsive episode
- Rash
- Lymphadenopathy, localized to the region of injection site
Take baby to doctor or casualty ward
- Fever > 40º C
- Convulsions with or without fever within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Hypersensitivity reaction, including face oedema dyspnoea, bronchospasm (struggling to breathe)
- Injection site pruritis (swelling, red and very sore)
- Lymphadeopathy, localized to the region of injection site
- Wheezing
Vaccination should be postponed in case of
- Fever > 39º C
- Acute illness
- Hypersensitivity to the vaccine including Diphtheria toxoid
- Not be given to infants with thrombocytopenia or any coagulation disorders
- Sickle cell disease
Treatment
- Only give Panado syrup if temperature is higher than 38º C
- 6 and 8 week old babies: Panado Infant drops, 0,6 ml, 4-6 hourly x 2 for fever
- 10 and 14 week old babies: Panado syrup, 2.5 ml 4-6 hourly x 2 for fever
- Older babies: Panado syrup, 5 ml 4-6 hourly x 2 for fever
- Nurofen can also be used as indicated on the instruction pamphlet.
- Apply hot face cloth (tested on mother’s forearm for correct temperature before applying to baby) on the injection spot, every time you change the nappy, for 2 days.
- Do not apply ointment directly on injection site.
- It is advisable to observe for any side effects.
- Stay at clinic for at least 20 min after injection.
- If in doubt, contact your clinic/clinic sister immediately for advice.
Herberbiovac HB is a Hepatitis B vaccine: Hepatitis B virus
- Injection in right upper thigh, 0, 5 ml intramuscularly
Side effects
- Redness at the injection site
- Fever
- Diarrhoea/Vomiting
- Feeding/Sleeping disturbances
- Irritability
When to be worried
- Redness and swelling > 5 cm at injection site
- Fever > than 39º C
- Drowsiness
- Inconsolable crying
Take baby to doctor or casualty ward
- Fever > 40º C
- Convulsions with or without fever within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Rash
- Persistent inconsolable crying lasting > 3 hours, occurring within 48 hours of vaccination
Vaccination should be postponed in case of
- Fever > 39º C
- Acute illness
- Hypersensitivity to any components of the vaccine
- Severe reaction to previous injections
Treatment
- Only give Panado syrup if temperature is higher than 38º C
- 6 and 8 week old babies: Panado Infant drops, 0,6 ml 4-6 hourly x 2 for fever
- 10 and14 week old babies: Panado syrup, 2.5 ml 4-6 hourly x 2 for fever
- Nurofen can also be used as indicated on the instruction pamphlet
- Apply hot face cloth (tested on mother’s forearm for correct temperature before applying to baby) on the injection spot every time you change the nappy, for 2 days.
- Do not apply any ointment directly on injection site.
- It is advisable to observe for any side effects.
- Remain at clinic for at least 20 minutes after injection.
- If in doubt, contact your clinic/clinic sister immediately for advice.
Rotarix is a Rotavirus gastro vaccine and protects against the following: Gastroenteritis caused by rotavirus
- The vaccination course consists of 2 doses.
- First doses should be given between 6 and 14 weeks.
- Second doses between 14 and 24 weeks
- Interval between doses: 4 weeks
- Method of administration: oral only
- Repeat if infant vomits, spits it out or regurgitates.
- Not to be given after 24 weeks
Side effects
- Irritability
- Loss of appetite
- Diarrhoea
- Vomiting
- Flatulence
- Abdominal pain
- Fever
- Fatigue
When to be worried
- Fever > than 39º C
- Drowsiness
- Inconsolable crying
Take baby to doctor or casualty ward
- Fever > 40 º C
- Convulsions with or without fever within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Persistent, inconsolable crying lasting > 3 hours, occurring within 48 hours of vaccination
Vaccination should be postponed in case of
- History of chronic gastrointestinal disease
- Uncorrected congenital malformation of the gastrointestinal tract
- Diarrhoea or vomiting
Treatment
- People in contact with recently immunised babies should be advised of the need for strict personal hygiene, particularly hand-washing after nappy changes for 3-4 days after the event.
- Put soiled nappies in plastic bag before discarding for 3-4 days after immunisation.
- It is advisable to observe for any side effects.
- Stay at clinic for at least 20 minutes after injection.
- If in doubt, contact your clinic /clinic sister immediately for advice.
Rouvax protects against the following: Measles
- Injection in right upper thigh 0, 5 ml intramuscularly
- After 1 year in the right upper arm
Side effects
- Malaise (general feeling of unwellness)
- Fever
- Cough
- Coryza (inflammation of the mucous membrane of the nose)
- Rash
- Pharyngitis
- Headache
When to be worried
- Fever > than 39º C
- Drowsiness
- Inconsolable crying
Take baby to doctor or casualty ward
- Fever > 40º C
- Convulsions with or without fever within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Persistent, inconsolable crying lasting > 3 hours, occurring within 48 hours of vaccination
Vaccination should be postponed in case of
- Acute respiratory infection
- Immuno-compromised patients
- Immune deficiency syndrome
- Human gabba globulin: for 3 months afterward
- Egg protein and neomycin allergy
Treatment
- Only give Panado syrup if temperature is higher than 38º C
- Panado syrup: 5 ml, 4-6 hourly x 2 for fever
- Nurofen can also be used as indicated on the instruction pamphlet.
- Apply hot face cloth (tested on mother’s forearm for correct temperature before applying to baby) on the injection spot, every time you change the nappy, for 2 days afterwards.
- Do not apply any ointment directly onto injection site.
- After 5 to 10 days it might look as if your baby has measles, a runny nose, a cough, red and watery eyes, mild fever and a rash on the face and upper neck. These are not infections and only last for 2-3 days.
- Put Calamine lotion on rash.
- It is advisable to observe for any side effects.
- Stay at clinic for at least 20 minutes after injection.
- If in doubt, contact your clinic/clinic sister immediately for advice.
Diftavax injection is a Td (tetanus, diphtheria) vaccine and protects against the following: Diphtheria (reduced dosage) and Tetanus Toxiod vaccine adsorbed on aluminum hydroxine
- Injection in right upper arm, 0, 5 ml intramuscularly
Side effects
- Redness at the injection site
- Fever
When to be worried
- Redness and swelling > 5 cm at injection site
- Fever > than 39º C
- Drowsiness
- Inconsolable crying
Take child to doctor or casualty ward
- Fever > 40º C
- Convulsions with or without fever within 3 days of vaccination
- Hypotonic reactions (collapse or shock-like state)
- Rash
- Persistent, inconsolable crying lasting > 3 hours, occurring within 48 hours of vaccination
Vaccination should be postponed in case of
- Fever > 39º C
- Acute illness
- Hypersensitivity to any components of the vaccine
- Severe reaction to previous injections
Treatment
- Only give Panado syrup if temperature is higher than 38º C
- Panado syrup: 10 ml, twice 6 hourly
- Nurofen can also be used as indicated on the instruction pamphlet
- Apply hot face cloth (tested on mother’s forearm for correct temperature before applying to the injection site) 4 times a day.
- Do not apply ointment directly onto injection site.
Other vaccines not provided by the state
Infanrix Hexa | Given at: 8, 12 and 16 weeks,18 months | Diphtheria Tetanus A cellular Pertussis Haemophilis influenza type B Hepatitis B Polio (Inactivated Polio Vaccine) |
Varilrix | Given from: 9 months | Chickenpox |
Havrix Junior or Avaxim
| Given at: 12 and 18 months | Hepatitis A |
Havarix
| Given at: over 16 years | Hepatitis A |
Engerix B | Given at: 6,10 and 14 weeks and to children up to, and including,15 years | Hepatitis B |
Twinrix | Given at: 1-15 years | Hepatitis A & B |
Priorix or Trimovax | Given at: 15 months and 4-6 years | Measles, Mumps, Rubella |
Infanrix | Given at: 4-6 years | Diphtheria |
Adacel Quadra | Given at: 6 and 11-18 years | Tetanus Pertussis |
Cervarix Mencevax | Given to: females 10 years and older | Cervical cancer protection |
Typherix | Given to: children age 2 years and older and adults | Typhoid |
Find out from your medical aid if they will pay for any of these vaccines. |
Reviewed October 2010 by Lizelle Prinsloo, registered nurse (M. Cur Verpleegkunde), part-time lecturer at the