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Immunization

National Immunization Schedule and Principles (Uganda)

Overview of the routine national immunization schedule for children under two years, 10-year-old girls (HPV), and women of childbearing age (Td) in Uganda, along with general principles of vaccine administration, storage, and management of common side effects, based on UNEPI/MOH guidelines.

Also known as: UNEPI Schedule, Vaccination Schedule, Childhood Immunization

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Referral and warning signs

When to refer

Refer for management of severe AEFI. Seek guidance for vaccination of individuals with complex medical conditions or severe immunosuppression.

Red flags

  • Signs of anaphylaxis immediately after vaccination (difficulty breathing, wheezing, stridor, hypotension, urticaria).
  • Seizures following vaccination.
  • High persistent fever unresponsive to paracetamol.
  • Severe local reaction (extensive swelling beyond nearest joint).

Signs and symptoms

  • Common Non-Serious Vaccine Side Effects:
  • - BCG: Local ulcer at injection site (normal reaction).
  • - DPT-HepB-Hib, PCV, IPV, HepB, Yellow Fever, HPV, Td: Mild local reactions (pain, swelling, redness), mild fever.
  • - Oral Polio, Rotavirus: Mild, short-lived GI symptoms (pain, diarrhoea).
  • - Measles/Rubella: Fever and skin rash 5-12 days post-vaccination.
  • AEFI Warning Signs Requiring Return to Facility:
  • - High persistent fever (>2 doses paracetamol ineffective).
  • - Seizures.
  • - Severe rash.
  • - Difficulty breathing / Anaphylaxis signs.

Risk factors

  • Contraindications/Precautions:
  • - BCG: Do NOT give to child with clinical signs/symptoms of immunosuppression (e.g., AIDS).
  • - General: Do not use expired vaccines, vaccines with VVM at discard point, suspected contamination, lost labels, or vaccines that have been frozen if freeze-sensitive (DPT-HepB-Hib, PCV, IPV, HPV, HepB, Td, YF).
  • - Severe illness: Admit and treat first, vaccinate on discharge.
  • - Known severe allergy to previous dose or vaccine component.

Diagnosis

Clinical assessment

Assessment of vaccination status based on age and immunization card/history to determine eligibility for scheduled or catch-up vaccination.

Diagnostic criteria

Eligibility based on age according to the National Immunization Schedule. Minor illness is NOT a contraindication.

Management

Non-pharmacological management

  • Adherence to Schedule: Give vaccines at recommended age or first contact thereafter.
  • Cold Chain Management: Store vaccines between +2°C and +8°C at health units. Polio/MR can be frozen (-20°C) centrally. Do NOT freeze freeze-sensitive vaccines or diluents. Use conditioned ice packs/sponge method for transport. Monitor fridge temperature twice daily.
  • Vaccine Reconstitution & Administration: Use corresponding diluent from same manufacturer. Never use Water for Injection. Avoid direct sunlight. Record every dose (register, tally sheet, child health card).
  • Multi-Dose Vial Policy (MDVP): Adhere to WHO guidelines. OPV/IPV, Penta, HepB, TT/Td, PCV vials opened in facility can be used for up to 4 weeks if VVM okay, not contaminated, stored correctly. BCG, YF, MR vials must be discarded 6 hours after reconstitution or end of session.
  • Tracking: Use child register and health card for follow-up/dropout tracking.
  • Screening: Screen clients at points of care for due vaccines and administer.
  • Waste Management: Proper disposal of sharps and vials.

Pharmacological treatment

  • Routine Childhood Schedule (Key vaccines & timing):
  • - Birth: OPV0, BCG, HepB.
  • - 6 Weeks: OPV1, IPV1, DPT-HepB-Hib1, PCV1, Rota1.
  • - 10 Weeks: OPV2, DPT-HepB-Hib2, PCV2, Rota2.
  • - 14 Weeks: OPV3, IPV2, DPT-HepB-Hib3, PCV3, Rota3.
  • - 6 Months: Malaria Vaccine 1.
  • - 7 Months: Malaria Vaccine 2.
  • - 8 Months: Malaria Vaccine 3.
  • - 9 Months: Measles-Rubella1, Yellow Fever.
  • - 18 Months: Measles-Rubella2, Malaria Vaccine 4.
  • Other Routine Vaccinations:
  • - HPV: 10-year-old girls (single dose mentioned, check current national guidelines for multi-dose schedule if applicable).
  • - Tetanus-Diphtheria (Td) for Women of Childbearing Age (WCBA 15-49yrs): 5-dose schedule (Td1: first contact; Td2: 1m after Td1; Td3: 6m after Td2; Td4: 1yr after Td3; Td5: 1yr after Td4).
  • Hepatitis B (Adolescents/Adults): Recommended for high-risk groups after testing (if possible). Schedule: 0, 1, 6 months. Dose 0.5ml IM deltoid.
  • Tetanus Prophylaxis (Wound Management):
  • - Requires Tetanus Immunoglobulin (TIG) AND TT vaccine dose(s) based on wound severity and prior immunization status.
  • - Unimmunised/Partially immunised: Full course TT.
  • - Fully immunised (>10 yrs since last booster): Give TT booster.
  • - Fully immunised (<10 yrs since last booster): No TT booster needed (TIG may still be needed for severe wounds).
  • COVID-19 Vaccination:
  • - Recommended for ≥12 years (5-12yrs with consent).
  • - Primary series schedule varies by vaccine type (AstraZeneca, Sinovac, Pfizer, Moderna, J&J, Sinopharm).
  • - Booster dose recommended ≥6 months after primary series for high-risk groups (≥50yrs, health workers, teachers, etc.). Heterologous (mix-and-match) boosting permitted.

Monitoring

  • Track completion of schedule using immunization records.
  • Monitor for Adverse Events Following Immunization (AEFI) and report serious AEFI.
  • Evaluate cold chain status regularly.

Complications

  • Serious AEFI (rare): Anaphylaxis, seizures, severe local reactions, vaccine-associated paralytic polio (VAPP - extremely rare with OPV).
  • Complications of vaccine-preventable diseases if immunization fails or is incomplete.

Prevention

  • Vaccination according to the national schedule is the primary prevention strategy for targeted Vaccine-Preventable Diseases (VPDs).

Patient education

  • Importance of completing the full immunization schedule on time.
  • Which vaccines are being given and diseases prevented.
  • Date for next visit/dose.
  • Common mild side effects (fever, local soreness) and simple management (Paracetamol, cool sponge).
  • Warning signs of severe reactions requiring immediate return to facility.
  • Keeping the child health card safe and bringing it for every visit.
  • Importance of Td vaccination for women to prevent neonatal tetanus.

Uganda-specific notes

UNEPI manages the national program. Schedule includes Penta (DPT-HepB-Hib), PCV10, Rotavirus, Malaria vaccine (RTS,S), and Yellow Fever. Use of VVM is standard practice. MDVP guidelines important for efficiency. Emphasis on screening at all contact points.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 18, Sections 18.1.1 - 18.1.4, 18.2.3, 18.2.4

  • UNEPI / MOH Immunization Schedule, 2025

    (As adapted in UCG 2023)

  • WHO Multi-Dose Vial Policy (MDVP)

    (Referenced principle)

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