13Immunization and other public health measures

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The following chapters are directed at the authority in charge of administering and managing public health measures for the population affected by the emergency situation and not for the health worker at the health center / clinic / post.

Public health measures

Prevention of child morbidity and mortality is critical to the care of children in emergencies. Preventive measures can sometimes be implemented during each encounter with a sick child, but often require community-based interventions such as:

  • Provision of clean water and clean containers
  • Proper sanitation including ensuring proper disposal of human waste
  • Public education on hygiene behaviour and respiratory etiquette
  • Provision of adequate nutrition
  • Promotion of breast feeding
  • Provision of means for safe food preparation and storage
  • Vitamin A supplementation
  • Vaccination, particularly against measles, diphtheria-tetanus-pertussis (DTP)
  • Use of insecticide-treated bed nets (ITNs), preferably long-lasting insecticidal nets (LLINs)
  • Indoor residual spraying of shelters with insecticide (IRS)
  • Prevention of overcrowding.

Immunization schedule

Prevention of measles

Prevention of measles can be achieved by vaccination of all children from 6 months through 14 years of age if possible, with a minimum acceptable age range of 6 months through 4 years of age. Ideally, measles vaccination should happen within the first days of the emergency. Children vaccinated at the age of 6 to 9 months should be revaccinated as soon as they reach 9 months of age. All children aged 6 months to 5 years should receive vitamin A to decrease mortality and prevent complications of measles.

Routine deworming

Give every child mebendazole or albendazole every 6 months from the age of one year. Record the dose on the child's card.

Give 500 mg mebendazole as a single dose in clinic if:

  • hookworm/ whipworm is a problem in your area
  • the child is 1 year of age or older, and
  • has not had a dose in the previous 6 months

In addition to the public health measures mentioned above, specific measures can be taken to prevent morbidity and mortality as shown below.

Prevention of diarrhea and dehydration

In addition to the general preventive measures described above, specific care must be taken by caregivers to personal hygiene such as hand washing after toileting and bathing, and before preparing food and feeding children.

Counsel mother or caretaker to start rehydration right at the onset of diarrhoea to prevent dehydration.

Prevention of acute respiratory infection (ARI)

The additional measures required to prevent respiratory infections are to minimize exposure to smoke, particularly cigarette smoke, and other air pollutants, to improve ventilation in households, respiratory etiquette (for example, covering mouth and nose with tissue when coughing or sneezing, or coughing/sneezing into your sleeve) and avoiding close contact (<1 metre) with people with respiratory illnesses (people who are coughing or sneezing), and to promote hand hygiene.

Prevention of malaria

Malaria prevention can be achieved by mosquito control. The use of insecticide-treated bed nets when sleeping are important in preventing bites. Indoor residual spraying of shelters may be indicated if the shelters are suitable for spraying. The drainage and elimination of small breeding sites, as well as environmental sanitation will also help prevent malaria control.

Prevention of severe bacterial infections

Prevention of severe bacterial infections can be achieved by vaccinating against the two most common causes of serious bacterial infections in children: Streptococcus pneumonia (pneumococcal vaccine) and Haemophilus influenzae type b (Hib vaccine). However, these vaccines are not often available during emergencies.

Prevention of illness in the young infant age up to 2 months

The most common causes of newborn and young infant death are serious bacterial infection, premature delivery and birth asphyxia (lack of oxygen). Most newborn deaths occur in low birth weight babies. Disease in the young infant can be prevented by:

  • Good antenatal care
  • Clean delivery
  • Clean sectioning of the umbilical cord and good umbilical stump and skin care
  • Keeping the newborn warm and prevention of hypothermia through:
    • placing the newborn on the mother's chest
    • wrapping and capping to keep the baby warm
  • Early and exclusive breastfeeding regularly (upon demand by the infant)
  • Early recognition and treatment of illness
  • Immunization (see generic schedule above for adaptation to national guidelines).

Prevention of anaemia

Anaemia can be prevented by:

  • Good nutrition
  • Regular de-worming starting from the age of one year
  • Prevention and early treatment of malaria
  • Supplemental iron.

Prevention of malnutrition and micronutrient deficiencies

Malnutrition and micronutrient deficiencies can be prevented by:

  • Early and exclusive breast feeding up to 6 months of age
  • Promotion of breast feeding up to 2 years at least and appropriate complementary foods
  • Access to locally-available nutrient dense foods
  • Education to the mother/caregiver on the preparation of nutritious meals from locally available foods.

Vitamin A supplementation

Young infants and children should be given a dose of vitamin A every 6 months from the age of 6 months up to 5 years. It is best that the Vitamin A doses are synchronised with immunization visits or campaigns.


  • Give Vitamin A to all children to prevent severe illness:
    • First dose at 6 weeks in a child that is not being breastfed
    • First dose in breastfed children to be given any time after 6 months of age
    • Thereafter Vitamin A should be given every six months to ALL CHILDREN up to 5 years.


  • Give an extra dose of Vitamin A (same dose) for treatment if the child has measles or PERSISTENT DIARRHOEA. If the child has had a dose of Vitamin A within the past month, DO NOT GIVE VITAMIN A.
  • Always chart the dose of Vitamin A given on the child's chart.