Indications and contraindications for vaccines used in the Expanded Programme on Immunization.

The aim of the Expanded Programme on Immunization is to reduce morbidity and mortality from six diseases that can be prevented by immunization. In many countries the immunization coverage is still less than optimal; one of the reasons for this is the fact that frequently health workers are faced with long lists of contraindications to immunization.The present review discusses the risks of adverse reactions after immunization and compares these risks with the complication rates following natural disease. It is concluded that the decision to withhold the benefits of immunization from an eligible child should not be taken lightly, particularly in areas where access to immunization services is limited and the incidence of the vaccine-preventable diseases is still high.Malnutrition should be a prime indication for immunization. Low-grade fever, mild respiratory infection, or diarrhoea should not be considered a contraindication to immunization. Measles immunization of children who have to be admitted to hospital has been shown to reduce the overall mortality rates in paediatric wards. It is recommended that all countries should formulate their own national policy, carefully considering the risks of disease as well as the benefits and potential risks of immunization.