Childhood Vaccination in Sri Lanka: Schedule Overview, Side Effects and Common Questions

Vaccination is one of the most effective ways to protect children from serious and sometimes deadly diseases. Sri Lanka's National Immunization Programme, run by the Ministry of Health through Public Health Midwives (PHMs), Medical Officers of Health and clinics, has achieved high coverage and has eliminated or controlled many diseases. This article gives a general overview. Schedules change from time to time, so always follow the latest schedule in your child's Child Health Development Record (the "green book") and confirm with your PHM or doctor.

Approximate national schedule

The programme has generally included the following vaccines:

• At birth: BCG (protects against severe forms of tuberculosis in children)
• 2, 4 and 6 months: pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b) and oral polio vaccine, with injectable polio vaccine at 2 and 4 months. Some vaccines, such as pneumococcal vaccine, have been added or planned in recent years.
• 9 months: MMR (measles, mumps and rubella)
• 12 months: live Japanese encephalitis vaccine
• 18 months: DPT (diphtheria, tetanus, pertussis) booster and oral polio
• 3 years: second MMR dose
• 5 years: DT (diphtheria and tetanus) and oral polio booster
• Around 11-12 years (school-based): adult-type tetanus and diphtheria (aTd), and HPV vaccine for girls to prevent cervical cancer
• Women: tetanus vaccines during pregnancy, and rubella vaccine before pregnancy if not immune

Ask your clinic for the current schedule, as vaccines are updated periodically.

What the vaccines protect against

• Tuberculosis: BCG protects babies from the most serious forms such as TB meningitis.
• Diphtheria, tetanus, whooping cough: dangerous bacterial diseases causing breathing obstruction, muscle spasm and fatal coughing in infants.
• Hepatitis B: virus that can cause lifelong liver infection and liver cancer.
• Haemophilus influenzae type b (Hib): cause of meningitis and pneumonia in young children.
• Polio: causes paralysis.
• Measles, mumps, rubella: measles can cause pneumonia, brain damage and death; rubella in pregnancy damages the baby.
• Japanese encephalitis: mosquito-borne brain infection.
• HPV: causes cervical and other cancers.

Other vaccines you may want to discuss

Some vaccines may be available through private clinics or may not yet be part of the national programme in all areas. Ask your paediatrician about:

• Pneumococcal vaccine (pneumonia, meningitis, ear infections)
• Rotavirus vaccine (severe diarrhoea). See diarrhoea in children
• Chickenpox (varicella)
• Hepatitis A
• Typhoid
• Influenza yearly, especially for children with asthma or chronic illness
• Dengue vaccine, depending on availability and age and exposure criteria
• COVID-19 vaccine, following current advice

What to expect after vaccination

Common, mild reactions usually last one to two days:

• Soreness, redness or swelling at the injection site
• Low-grade fever, fussiness, sleepiness, reduced appetite
• A small lump after BCG that becomes a scab and heals into a scar over weeks, which is normal
• A mild fever and rash 7-12 days after MMR

How to help: offer extra breast milk or fluids, dress lightly, use a cool damp cloth on the site, and give paracetamol if the child is uncomfortable, using the weight-based dose. Use our paracetamol dose calculator. Do not apply herbal pastes or ointments to the injection site.

When to seek medical help after a vaccine

Seek urgent care if a child has:

• Difficulty breathing, swelling of the face or lips, or widespread hives within minutes to hours (allergic reaction)
• A fit, floppy or unresponsive state, or persistent inconsolable crying for more than 3 hours
• A very high fever (39.5 °C or higher), or fever lasting more than 2-3 days
• A swelling at the injection site that grows or has pus

Serious reactions are extremely rare, and the risk from the diseases is far greater than the risk from the vaccines.

Who should delay or check first

Tell the health worker if your child:

• Has a high fever or moderate to severe illness on the day
• Has had a severe allergic reaction to a previous dose or a vaccine ingredient
• Has a weak immune system, is on high-dose steroids, chemotherapy or has HIV, since live vaccines such as BCG, MMR and JE may be unsafe
• Has a history of seizures or neurological illness (the doctor will advise)

Minor illnesses such as a cold, mild diarrhoea, or taking antibiotics are not reasons to postpone vaccination.

Myths and facts

• "Too many vaccines overload the immune system." Children's immune systems handle thousands of germs each day. Combined vaccines are safe.
• "Natural infection is better than vaccination." Natural infections can cause deaths and lifelong harm.
• "Vaccines cause autism." This has been disproved by large studies.
• "My child doesn't need vaccines if no one around is sick." Diseases can return quickly when coverage drops.

Keep your child's vaccine records

Keep the green book safe, and take it to every clinic or hospital visit. It is also needed for school admission and travel. If you lose it, ask your PHM or clinic for a replacement.

Missed doses and catch-up

Do not restart a series if doses were delayed. Visit your PHM, clinic or hospital to arrange catch-up, and ask about vaccines for older children or adults who missed them. Track your child's growth at the same visits with our child growth calculator.

When to see a doctor

Speak to your doctor or PHM if you are unsure about the schedule, your child has a medical condition, you are travelling, or you have had a vaccine reaction. For general illness, see fever in children.

References

• Sri Lanka Ministry of Health, Epidemiology Unit: national immunization programme schedule and guidelines
• World Health Organization: immunization schedules and vaccine safety
• Sri Lanka Ministry of Health, Family Health Bureau: child health development record
• UNICEF Sri Lanka: immunisation