Frequenty Asked Questions

Immunization is the process whereby a child is protected against an infectious disease by administration of one or more doses of a vaccine, either by injection or by drops in the mouth.

Immunization protects children against certain specific and serious diseases, which otherwise would lead to stress, worry and expense of having a child become very ill and possibly die from a disease that could be prevented by administration of a vaccine.

Babies are born with natural protection against some diseases, which they get from their mothers through their shared blood during pregnancy and by breastfeeding in the early days of their life. But as they grow, this protection begins to decrease gradually, making them vulnerable to certain serious diseases.

Immunization by vaccines enhances this declining immunity and protects them from diseases in the age group when they are most vulnerable.

Protection against different infections is due to the presence of some protective substances in the blood, known as antibodies, which kill disease-causing organisms or neutralize their effect when they enter the body.

Vaccines contain a weakened form, killed form or part of the disease-causing agent (bacteria or virus). When introduced into the child's body by the correct route and technique, the vaccine activates a protective response against a targeted pathogen through the generation of specific antibodies.

These specific antibodies further protect a child in case of a subsequent episode of infection.

The protection developed after vaccination usually lasts for many years and can stop the disease in most cases.

Even if the child does get the disease after being vaccinated, the symptoms will generally be much milder than those in a child who was never vaccinated.

For some vaccines, booster doses are given to children at specified ages to further raise the protection up to an optimum level.

Under the Expanded Programme on Immunization (EPI), immunization of children starts as soon as the child is born.

Vaccination against childhood tuberculosis (BCG), polio (OPV) and maternally transmitted Hepatitis B (Hep B vaccine) are given to a child immediately after birth.

After this, specific vaccines are given at recommended ages and through recommended routes as outlined in the National Immunization Schedule.

Vaccines ensure the best protection to children when they are given at the right ages and in the required number of doses. At certain periods of life, there is a maximum incidence of a particular disease. Therefore, to prevent harm caused by the disease, vaccines are provided at that age.

For example, the occurrence of Polio is maximum in children below 5 years of age; hence, vaccination against polio is given through routine immunization as well as in campaigns to children below 5 years of age.

Similarly, the number of doses required is determined by the level of protection required to prevent serious infections.

The National Immunization Schedule clearly mentions different vaccines, the ages at which they are to be given, and the doses required for ensuring full protection from vaccine-preventable diseases.

When children are not vaccinated, or if there is a delay in getting the vaccination, they remain unprotected and have increased chances of getting serious infections.

Ages of administration for different vaccines have been determined by considering the ages at which the vaccine ensures maximum protection against disease-causing organisms, thus reducing the number of cases and deaths caused by the disease.

After reaching a certain age, children may acquire natural protection against some infections, such as childhood tuberculosis, or may have already crossed the age when the disease could have been life-threatening.

Therefore, after a specific age, these children may not require certain vaccinations according to the recommended immunization schedule.

If, due to any reason, there is a delay in receiving a vaccine or any dose of a vaccine requiring more than one dose, the vaccine should be provided as early as possible.

Please contact the ASHA in your area and/or ANM to ensure that your child receives the pending vaccines.

It is important to understand that in case of a delay, there is no need to restart the entire vaccination schedule. Instead, the remaining schedule should be continued as recommended and completed.

Vaccines are costly, and the government spends a significant amount of money on procuring them and storing and transporting them at the correct temperature.

However, all immunization services, including vaccines, syringes, Mother and Child Protection Card and medicines and supplements such as Paracetamol, ORS, Zinc and Vitamin A, are provided to all children free of cost at government health facilities.

Similarly, immunization services for pregnant women are also provided free of cost at government health facilities.

You can visit any government health facility for getting your children vaccinated, including:

• Government Hospitals
• Medical Colleges
• Urban/Corporation Dispensaries
• Civil Dispensaries
• Zila Council Dispensaries
• Rural Dispensaries
• Mother & Child Health Centers
• Basic Health Units (BHUs)
• Rural Health Centers (RHCs)

The government health department has ensured that immunization services are available near you.

It is important to understand that under the National Immunization Schedule, vaccines are generally not provided house-to-house, except during special campaigns and drives such as Polio campaigns.

All vaccines available in the country are licensed by the Drug Regulatory Authority of Pakistan (DRAP) and are therefore safe for use.

Both government and private sectors procure vaccines from government-approved and licensed manufacturers. However, complete immunization services are provided to all children and pregnant women free of cost at government health facilities.

The Expanded Programme on Immunization (EPI) is implemented by the Provincial Health Ministries of all provinces.

The Government of Pakistan has a larger role in ensuring that all children and pregnant women are protected from diseases that infect, disable, or cause death among children and pregnant women.

On the other hand, private providers cater to individual children and parents who approach them for additional services on a chargeable basis.

Under the Expanded Programme on Immunization (EPI) Punjab, 10 different vaccines against 12 diseases are provided to beneficiaries free of cost through the government health system.

These vaccines include:

According to the National Immunization Schedule, one dose each of the following three vaccines is given to a new-born:

• OPV – Oral Polio Vaccine
• BCG – Bacillus Calmette-Guérin
• Hepatitis B – Hepatitis B Birth Dose

One dose each of OPV, BCG and Hepatitis B should be given to the new-born irrespective of the place of delivery.

Vaccines have been used for a long time and have been proven to be effective. However, like any other medicine, no vaccine is 100% effective.

The level of protection generated by a vaccine may vary from one child to another due to differences in the response of the immune system.

Children suffering from malnutrition and repeated episodes of diarrhea may have a diminished protection level after being vaccinated. However, malnutrition and mild diarrhea are not contraindications to vaccination.

Thus, in some children, the disease can occur even if the child has been vaccinated. However, in such cases, the severity of the disease is generally less compared with children who have never been vaccinated.

Yes. Most diseases, such as Diphtheria, Tetanus, Rotavirus diarrhea, Hib pneumonia, Measles and Japanese Encephalitis, may only provide short-term protection even after a full-blown infection and disease.

Therefore, in these cases, a child will still require all recommended doses of the vaccine according to the immunization schedule.

Tetanus Toxoid (TT) vaccine is given to pregnant women to protect them and their newborns against tetanus.

• Two doses of this vaccine should be given to all pregnant women: the first as soon as pregnancy is confirmed and the second 4 weeks after the first dose, or as advised by the health worker.
• If the pregnant woman has not received TT doses during pregnancy, one dose of TT should be given at the time of delivery.
• If the previous pregnancy occurred within 3 years of the current pregnancy and the woman received 2 doses of TT during the previous pregnancy, only 1 dose of TT is required during the current pregnancy.
• If the previous pregnancy occurred more than 3 years before the current pregnancy, 2 doses of TT should be given during the current pregnancy, irrespective of the number of doses received during the previous pregnancy.
• TT vaccine should be given to a woman every time she becomes pregnant or as advised by a health worker.
• Repeat doses enhance the protection level and do not cause harm to the woman or her child.

TT vaccine is given to pregnant women to protect them and their children from tetanus.

Tetanus, also known as lockjaw, is a life-threatening disease of newborns that can cause seizures and severe muscle spasms, potentially leading to death due to respiratory failure.

Yes. Scarring is a normal reaction after BCG vaccination.

Around two weeks after administration of BCG vaccine, the injection site usually becomes red and hard. It then changes to an elevation in the skin, which grows to its maximum size by the fourth week.

The area may later crack and discharge pus, gradually change into a crust during 5–6 weeks, and finally leave a small scar after approximately 8 weeks.

If the child develops significant swelling or fever, visit the nearest health facility.

No. The immune system makes antibodies against a germ, such as the chickenpox virus, whether it encounters it naturally or is exposed to it through a vaccine.

Being vaccinated against one disease does not weaken the immune response to another disease.

It is not possible to get the disease from vaccines made with dead (killed) bacteria or viruses, or from vaccines containing only part of the bacteria or virus.

Some vaccines are made from weakened (attenuated) live viruses, such as the chickenpox (varicella) and measles-mumps-rubella (MMR) vaccines. These may rarely cause a mild form of the disease, but it is almost always much less severe than an infection with the disease-causing virus itself.

For children with weakened immune systems, such as those receiving treatment for cancer, live vaccines may cause problems and should be discussed with a qualified healthcare professional.

The risk of disease from vaccination is extremely small.

Oral polio vaccine (OPV) is a live-virus vaccine. In some countries, including the United States, OPV has been replaced by the inactivated polio vaccine (IPV), which uses a killed virus.

There is no need to re-vaccinate the child even if a scar does not form after BCG vaccination.

In some cases, a scar may not form after BCG vaccination, even though the vaccine has developed protection against the disease.

The pentavalent vaccine has been introduced into the National Immunization Schedule.

A single vaccine provides protection against five serious diseases:

Three doses of this vaccine are given to children at 6, 10 and 14 weeks.

One dose of Hepatitis B vaccine is given at birth to protect the child from possible infection transmitted from the mother during delivery.

In addition, three doses of the pentavalent vaccine, given at 6, 10 and 14 weeks, also provide protection against Hepatitis B infection.

Yes. It is safe to give IPV and OPV together on the same day.

OPV is given orally, while IPV is given by injection.

When both vaccines are used together, they provide additional protection against polio infection.

Rubella is a viral disease. Infection during pregnancy can cause abortion or stillbirth and may also lead to multiple birth defects in newborns.

These birth defects may include:

Rubella vaccines have been used in the private sector for a long time. The vaccine is also included in the immunization program as Measles-Rubella (MR) vaccine to help prevent rubella infection among children and young adults.

In the case of injectable vaccines such as Hepatitis B, Pentavalent, DPT and IPV, infants may experience redness, mild pain and swelling at the injection site.

This is a normal reaction and usually goes away within 1–3 days. It is not related to the quality, safety or effectiveness of the vaccine.

If advised and provided by a health worker, Paracetamol (syrup or tablets in divided doses) may be given to the child.

If the symptoms persist for more than three days, please take your child to the nearest health facility.

Occurrence of mild fever, specifically after Pentavalent and DPT vaccines, is a result of the normal reaction that vaccines have on the body system. This fever is generally mild in nature, self-limiting, and goes away within 1–2 days.

Paracetamol (syrup or tablets in divided doses) provided by the health worker can be given to the child for providing relief.

In some children, fever does not occur after vaccination. This is also normal and there is no need to vaccinate the child again.

A sick child suffering from mild illness, such as cough, cold, mild fever, mild diarrhea or vomiting, can be safely vaccinated with injectable or oral vaccines.

However, a child who has a serious illness or is hospitalized, such as with high-grade fever or severe diarrhea, should not be vaccinated until his or her condition improves.

Following steps should be followed after vaccination:

• You must wait for half an hour at the session site after vaccination to ensure immediate care and response in case there is any minor adverse event.
• Continue breastfeeding or complementary feeding after vaccination, even after oral vaccines.
• Ensure that no medicine or herb is applied to the injection site.

Yes. Your child must be vaccinated according to the National Immunization Schedule. Vaccination should be provided to all children.

It does not matter whether:

• The child was delivered by surgery or through normal delivery.
• The child was delivered at a private or government health facility, or at home.
• The child was delivered before completing 9 months of gestation.
• The mother is suffering from any medical condition.
• The child has low birth weight.

No. All vaccines used in the Expanded Programme on Immunization are tested and recommended for their quality and efficacy, and they are highly safe and effective.

No vaccine leads to impotency or autism.

Some children may be allergic to certain vaccines or components of a vaccine, such as an antibiotic or preservative. Administration of a vaccine in such children can result in an allergic reaction, such as itching or the appearance of red spots on the body soon after vaccination.

If there is any history of allergy, please ensure that you take medical advice from a Medical Officer before vaccination.

Yes. More than one vaccine can be administered to your child safely at the same time. It does not cause any adverse event nor does it affect the effectiveness of individual vaccines.

Administering more than one vaccine according to the schedule during the same immunization session reduces the number of visits and avoids extra travel and time required to get your child vaccinated.

The route of each vaccine is decided after assessing the maximum protection that it will generate in the body.

Each vaccine provides protection against its target pathogen only when it is administered through its specific route. Therefore, different vaccines are given through different routes.

The quality of vaccines is ensured by maintaining the correct temperature for vaccine storage.

At the immunization session site, the health worker keeps vaccines in a foam pad. This helps ensure that the optimum temperature of the vaccines is maintained.

A vaccine carrier is the insulated box that an EPI vaccinator uses to carry vaccines to the session site. It is packed with four cool packs to maintain the correct storage temperature for vaccines for up to 6 hours.

The Vaccine Vial Monitor (VVM), represented by a square within the blue circle on the label or cap of the vial, provides information about heat exposure over a period that may affect vaccine potency.

It helps the health worker or vaccinator determine whether the vaccine is potent enough to be administered.

In addition, health workers mention the date and time of opening the vial to ensure that vaccines are not used beyond the recommended time after opening.

AD or Auto Disabled syringes are specialized plastic syringes introduced in the immunization program for administering injectable vaccines.

Once used, these syringes get locked. This prevents the reuse or misuse of used syringes and helps prevent the transmission of infections from one child or pregnant woman to another.

In such situations, the health worker will give your child all available vaccines for which he or she is eligible and will call you for the remaining vaccination during the next immunization session.

You may also visit a higher-level health facility to receive the scheduled vaccine or wait for the next immunization session day.

You have the right to be made aware of the following by the vaccinator at the session site:

• What vaccines are being given.
• Which diseases the vaccines protect against.
• The schedule of these vaccines.
• What are AEFI (Adverse Events Following Immunization).
• What to do in case of AEFI.
• The next date of vaccination.

To provide full protection against disease, most vaccines are given in a series, meaning they are administered more than once. These repeated doses are known as a primary series.

Some vaccines provide immunity for life after a single dose or after the primary series is completed.

Other vaccines require another dose or doses to boost the immune system back to protective levels because immune memory can weaken over time.

These additional doses are known as booster doses and act as reminders to the immune system.

Routine immunization schedules tell you when and if booster doses are needed and for which vaccines.

There are 18 diseases that have vaccines to help prevent them. These diseases are known as vaccine-preventable diseases and include:

• Chickenpox (Varicella)
• Diphtheria
• Haemophilus influenzae type B (Hib)
• Hepatitis A
• Hepatitis B
• Human Papillomavirus (HPV)
• Influenza (Flu)
• Measles
• Meningococcal disease
• Mumps
• Pertussis (Whooping cough)
• Pneumococcal disease
• Polio
• Rotavirus
• Rubella (German measles)
• Shingles
• Tetanus
• COVID-19

It is true that a single child's chance of catching a disease is lower if everyone else is immunized. However, your child is also exposed to people other than those in school.

If one person thinks about skipping vaccines, others may think the same. Each child who is not immunized gives highly contagious diseases another opportunity to spread.

Babies have strong immune systems and can handle far more germs than those received from vaccines. In fact, the number of germs in vaccines is only a small percentage of the germs that babies' immune systems encounter every day.

Sometimes children can have a reaction to a vaccine, such as mild fever or rash. However, the risk of serious reactions is small compared with the health risks associated with the serious diseases that vaccines prevent.

The immunization schedule has been carefully developed and studied and has been shown to be safe.

Spreading or delaying vaccines can leave a child unprotected for longer and may result in missed vaccines.

Few things in medicine work 100% of the time. However, vaccines are among the most effective tools we have against disease.

Vaccines greatly reduce your child's risk of serious illness and give diseases fewer opportunities to spread in a population.

Although it can be difficult to watch a child receive a shot, the short-term discomfort is much less than the suffering that can result from serious vaccine-preventable diseases.

Vaccinations are intended to help keep healthy children healthy. Vaccines work by protecting the body before disease strikes.

If you wait until your child becomes sick, it will be too late for the vaccine to work against that illness. The best time to immunize children is when they are healthy.

The most common reactions to vaccines are minor and include:

• Redness and swelling where the shot was given.
• Fever.
• Soreness at the injection site.

In rare cases, immunizations can trigger more serious problems, such as seizures or severe allergic reactions.

If your child has a history of allergies to food or medicine, or has had a problem with a vaccine before, inform the doctor before any vaccines are given.

No. Numerous studies have found no link between vaccines and autism.

Likewise, research has found no evidence that thimerosal, an organic mercury compound used as a preservative in some vaccines, causes autism.

Scientific evidence has repeatedly found no causal relationship between vaccination and autism.

Rotavirus is one of the most common causes of diarrhea in young children.

In 1999, a rotavirus vaccine was taken off the market because it was linked to an increased risk of intussusception, a type of bowel obstruction in babies.

Newer rotavirus vaccines are available and have been shown to be safe and effective. Studies indicate that the risk of intussusception is very small.

Rotavirus vaccines help prevent most cases of rotavirus infection and almost all severe cases.

There are concerns, many of which circulate on the Internet, linking some vaccines to multiple sclerosis, sudden infant death syndrome (SIDS), and other problems.

To date, studies have failed to show a connection between immunizations and these conditions.

The duration of immunity varies depending on the vaccine. Some vaccines may provide long-lasting or lifelong protection after the recommended doses.

Other vaccines, such as tetanus, provide protection for many years but require periodic booster doses for continued protection.

The pertussis (whooping cough) vaccine also does not provide lifelong immunity, which is one reason outbreaks can still occur.

It is important to keep a record of vaccinations so that you know when booster doses are due.