Is it okay or not okay to swab alcohol prior to injection and take paracetamol before or after vaccination?

Last week I accompanied our PHA Nurse under the DOH-HRH to give immunization to some of the kids who were absent during their School Based Immunization (SBI) which they recently conducted within the vicinity.  The schools were just walking distance from the Rural Health Unit where we were deployed and so I agreed readily when she asked me if I want to go with her.  

So why is there School-based immunization? According to World Health Organization, one of the objectives of Global Vaccine Action Plan is to equitably extend the benefits of immunization to adults, adolescents and children. School-based immunization is then a strategy for reaching older children and adolescents with vaccination services. This is deemed necessary especially for children who have missed their scheduled vaccinations. The increase in school enrollment rates, particularly in low income countries, makes the school a growing interest as a platform for immunization. 

Here in the Philippines, before School-based immunization became a yearly activity it was piloted in selected provinces and cities nationwide in 2013 and it was in 2015 when August was declared School-Based Immunization month. As of this year, 2019, the target populations to be vaccinated are school children from kindergarten to grade 7 (K-7).

The first school where we went is a private school, though school-based immunization targets public schools, private schools can access the vaccines as long as they have letter of intent. I was informed that this private school participates annually with the program.  We went to the faculty office and she talked to one of the teachers luckily, the kid’s adviser was there and so he went to get his student. A handsome boy with a dimpled smile came; his adviser then led us to their clinic.

Our nurse swabbed the injection site with water before administering the vaccine. She injected Mumps Measles Rubella Vaccine and Tetanus Diptheria on the other side after explaining to him in a calm and friendly way why he needed the vaccines. She was quick and the kid didn’t flinch or cry, he just gave us his sweet dimpled smile.  She applied tactile stimulation by rubbing the child’s skin near the injection site where in the mechanism is thought to be that the sensation of touch competes the the feeling of pain from the injection and thereby results in less pain. She didn’t give a dose of paracetamol as well which is right but just advised the kid to take paracetamol when he is going to have fever.

She then asked me if I was the one or was it our physician who informed during our previous meeting that alcohol is not necessary to swab prior to injection and I told her it wasn’t me, what I remember telling was about the use of paracetamol before and after vaccination that it could reduce the potency of vaccine to which she replied, “oh yes, that is why one of the midwives reminded us what you said when we went to the other school to conduct SBI, so we didn’t give the kids paracetamol”. I felt happy and admired more my fellow DOH-HRH NDP’s for going beyond their job description to help other people and the community as a whole. The data they have also been gathering were very helpful.

So why is it not necessary to use alcohol prior to injection? It is mentioned in the Vaccination Practical Guideline to “clean the skin with water if dirty, it is not necessary to use alcohol”. Alcohol could “sterilize/disinfect” the skin only if it is done properly which is not usually the case and most important alcohol can affect the quality of some vaccines like BCG vaccine which is administered intradermic.

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