A 14-month-old girl from Delhi is brought to the immunisation clinic by her mother. The child has received all vaccines on schedule up to 12 months of age, including Measles at 9 months. The mother reports that the child had a mild fever (38.5°C) 2 days ago, which resolved spontaneously. On examination, the child is afebrile, playful, and has no signs of acute illness. What is the most appropriate action regarding immunisation at this visit?

Question

Accepted Answer

B. Administer DPT-B and OPV-B as scheduled; mild fever in the past is not a contraindication. ## Immunisation in Presence of Recent Mild Illness

**Key Point:** A history of mild fever that has resolved is **NOT a contraindication** to immunisation. The child is currently afebrile and clinically well, making her eligible for scheduled vaccines.

### Contraindications to Immunisation

| Contraindication Type | Status | Action |
|---|---|---|
| **Mild fever (resolved)** | Not a contraindication | Proceed with immunisation |
| **Acute severe illness** | True contraindication | Defer until recovery |
| **Severe allergic reaction to prior dose** | True contraindication | Avoid that vaccine |
| **Immunosuppression** | True contraindication | Assess before live vaccines |
| **Recent live vaccine** | Relative (spacing required) | Space by 4 weeks if different live vaccine |

**Clinical Pearl:** The WHO and Indian Academy of Pediatrics (IAP) guidelines clearly state that **minor illnesses with or without low-grade fever are NOT reasons to postpone immunisation**. Deferring vaccines in such cases leads to missed opportunities for protection and incomplete immunisation coverage.

### Vaccines Due at 14 Months (16–24 Month Booster Window)

At 14 months, the child is due for:
- **DPT-B** (DPT booster — 1st booster)
- **OPV-B** (OPV booster — 1st booster)

These are typically given between 16–24 months, but can be given at 14 months if the child is due.

**High-Yield:** **"Mild illness ≠ contraindication"** — This is a high-yield concept frequently tested. Students often incorrectly defer vaccines for minor febrile illnesses, which is a major cause of incomplete immunisation.

**Mnemonic:** **"AAFI"** (Adverse events following immunisation) — Only true medical contraindications (anaphylaxis, encephalitis, thrombocytopenia) warrant deferral. Mild fever is **NOT** AAFI.

**Warning:** Do not confuse:
- ~~Mild fever (resolved) = contraindication~~ ✗
- Mild fever (resolved) = safe to immunise ✓

Answer

A. Administer Hepatitis A vaccine instead of DPT-B and OPV-B

Answer

C. Defer all vaccines until the fever completely resolves and wait 4 weeks

Answer

D. Give only OPV-B and defer DPT-B due to recent fever history

Explanation

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