Uttar Pradesh has more than 0.5 million zero-dose (ZD) children and over 1.2 million under-immunized children, contributing to 28% of India’s ZD and under-immunized cohort.

Vaccines are safe and protect an individual against several diseases. Nevertheless, they can cause mild side effects, such as a low-grade fever, pain, or redness at the injection site. Mild reactions go away within a few days on their own.

An adverse event following immunization(AEFI) is defined as any untoward medical occurrence that follows immunization and does not necessarily have a causal relationship with the usage of the vaccine.

Apprehensions stemming from the AEFI have been identified as a primary cause for drop-outs in children, particularly after receiving pentavalent or Diphtheria Pertussis Tetanus (DPT)-containing vaccines.

Fever and Pain Management Following Immunization

Paracetamol, an analgesic and antipyretic drug, is the preferred medication for treating fever and pain following immunization. The recommended dose of paracetamol is 10-15mg/kg body weight every 8 hours, with a maximum of four doses within 24 hours. It is considered safe and well-tolerated, with a low occurrence of side effects.

The Challenge

3 in 4 children develop fever and pain post-vaccination with DPT-containing vaccine. The health workers suggest using fractional doses like 1/4th, 1/6th, or 1/8th of a 500 mg tablet to manage postvaccination fever. This practice raised concerns about inaccurate dosing, particularly overdoses in infants, as splitting paracetamol tablets precisely is hard.

In 2020, Uttar Pradesh mandated Syrup Paracetamol after vaccinations (following GoI guidelines). However, COVID-19 disrupted implementation, and CiVHSND observations revealed limited 125mg/5ml syrup availability.

The role of UPTSU is supporting GoUP


The availability of Syrup Paracetamol increased from ~51% of the 3,073 CiVHSNDs observed in June 2022 to ~91% of the 2,590 CiVHSNDs observed in October 2023. The utilization has also seen marked improvement, with ~56% of the children receiving Penta/DPT being provided Syrup Paracetamol in October 2023, compared to ~24% in June 2022.


“Parents find it easier to administer syrup to their young children. Previously, post-vaccination, we provided paracetamol tablets for AEFI. Since giving tablets to children was inconvenient, parents used to purchase syrup, incurring additional expenses. Now, our provision of Syrup Paracetamol has increased parental trust and reduced dropouts caused by children experiencing fever and excessive crying after vaccination.”

Suman, ANM, Narkhori Subcentre, Chetara Block, Sonbhadra District, Uttar Pradesh

“After my child developed a fever following vaccination, I administered Paracetamol syrup as suggested by ANM didi. Administering Paracetamol syrup to the child is easy with a measuring cap. Now, I am not afraid of vaccinations and will go for the next scheduled vaccination as well.”

Tanu, Mother, Imali Village, Nevada Block, Kaushambi District, Uttar Pradesh

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