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3. If the chiId has had clinical Whooping Cough before Triple Immunisation is started, theprocedure should
be:-
Visit 1 O.P.V. only
2 DT/Vacc/PTAH + O.P.V.
3 DT/Vacc/PTAH + O.P.V.
5 DT/Vacc/PTAH + O.P.V.
4. The age or Smallpox Vaccination has been left open between 1 - 2 years. In practice, if the other
immunisation due in the first year has been completed, it is often desirable to do the Vaccination
when the child is seen for the 1 year old R.M.I. at the clinic. At the times of the VA year and 2year
old R.M.I.'s the doctor should check to see whether the vaccination has been done. When the chiId
attends for the Booster Triple and Polio at eighteen months the doctor or nurse should enquire if the
Smallpox Vaccination has been done, if not, on ALL these occasions a definite DATE should be written
on the immunisation card for the Smallpox Vaccination appointment.
5. Immunisation against Whooping Cough should not be given after the age of 2 years unless there is a
sibling under 1 year of age in the family or the mother is pregnant. (In these circumstances immunisation
may be considered justified in order to prevent the child bringing home infection to the infant). This
isalsotrueifvisit5takes place after the age of 2 years when DT/Vacc/PTAH should begiven instead
of D.T.P.
6. If child at 5 years old has had Diphtheria Immunisation as an infant but not Tetanus, the parents should
be strongly advised that the child should be actively immunised against Tetanus, and the child should
be given:-
(a) 1. T(PTAH) 0.5ml I.M.
after 6/52 2. D.T(PTAH) 0.5ml I.M.
after 6/12 3. T(PTAH) 0.5ml I.M.
(b) If the offer of Tetanus Immunisation is refused D/PTAH 0.5 ml I.M. should be given.
T.A.F. should NOT be given due to the risk of subsequent sensitisation to horse serum - in a child
who might be given A.T.S. in the absence of active protection against Tetanus.
7. If a child at school age has had NO immunisation e.g. Immigrant Child, Suggested course:-
1. D.T(PTAH) 0.5ml I.M. + O.P.V. (3 drops)
after 4/52 2. D.T(PTAH) 0.5ml I.M. + O.P.V. (3 drops)
after 4/52 3. O.P.V. (3 drops)
after 5/12 4. D.T(PTAH) 0.5ml I.M.
8. A chiId over the age of 12 years who is to have primary immunisation against Diphtheria, should have a
SchickTest. If the result ispositiveafter2-4 days the child should be immunised, preferably combined
with Tetanus as in 6a.
9. Children who have commenced a course of primary immunisation should complete this, but receive
re-inforcing and booster injections according to the revised schedule.
CONTRA INDICATIONS
1. To Triple Immunisation - If there is history or family history of convulsions or allergy DT/PTAH should
be given instead of D.T.P. If there is a strong reaction to the first injection of D.T.P., the DT/PTAH
should be given instead, probably in half dosage. If the reaction to the D.T.P. is really severe,
immunisation may have to be discontinued.
Minor respiratory infections need NOT be contra-indications to immunisation, but postpone if the
temperature is raised.
2. To Polio Immunisation - Diarrhoea is a contra-indication as it may interfere with the desired
establishment of "gut immunity".
3. To Smallpox Vaccination - If there is a history of active eczema vaccination should certainly be
postponed until the skin is clear, and even then is probably better avoided except in special
circumstances. It is also contra-indicated if another child in the household has eczema.
4. Live Virus Vaccines (Oral Polio, B.C. G. or Smallpox) are all contra-indicated in cases receiving Corticosteroid
therapy, convalescent from specific fevers, or during the first four months of pregnancy.
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