BNF for Children 2011-2012

BNFC 2011–2012 59914 Immunological productsand vaccines14.1 Active immunity 59914.2 Passive immunity 60214.3 Storage and use 60214.4 Vaccines and antisera 60214.5 Immunoglobulins 62214.5.1 Normal Immunoglobulin 62214.5.2 Disease-specific immunoglobulins62414.5.3 Anti-D (Rh 0 ) immunoglobulin 62614.6 International travel 62614.1 Active immunityActive immunity can be acquired by natural disease orby vaccination. Vaccines stimulate production of antibodiesand other components of the immune mechanism;they consist of either:1. a live attenuated form of a virus (e.g. measles,mumps, and rubella vaccine) or bacteria (e.g. BCGvaccine), or2. inactivated preparations of a virus (e.g. influenzavaccine) or bacteria, or3. detoxified exotoxins produced by a micro-organism(e.g. tetanus vaccine), or4. extracts of a micro-organism, which may be derivedfrom the organism (e.g. pneumococcal vaccine) orproduced by recombinant DNA technology (e.g.hepatitis B vaccine).Live attenuated vaccines usually produce durableimmunity but not always as long-lasting as that resultingfrom natural infection.Inactivated vaccines may require a primary series ofinjections of vaccine to produce an adequate antibodyresponse, and in most cases booster (reinforcing) injectionsare required; the duration of immunity varies frommonths to many years. Some inactivated vaccines areadsorbed onto an adjuvant (such as aluminium hydroxide)to enhance the antibody response.Advice in this chapter reflects that in the handbookImmunisation against Infectious Disease (2006),which in turn reflects the guidance of the JointCommittee on Vaccination and Immunisation(JCVI).Chapters from the handbook are available atwww.dh.gov.uk/immunisationThe advice in this chapter also incorporates changesannounced by the Chief Medical Officer and HealthDepartment Updates.Cautions Most children can safely receive the majorityof vaccines. Vaccination may be postponed if the child issuffering from an acute illness; however, it is not necessaryto postpone immunisation in children with minorillnesses without fever or systemic upset. See also Predispositionto Neurological Problems, below. For individualswith bleeding disorders, see Route of Administration,below. If alcohol or disinfectant is used forcleansing the skin it should be allowed to evaporatebefore vaccination to prevent possible inactivation oflive vaccines.When 2 or more vaccines are required (and are notavailable as a combined preparation), they should begiven simultaneously at different sites, preferably in adifferent limb; if more than one injection is to be given inthe same limb, they should be administered at least2.5 cm apart (but see also BCG Vaccines, p. 603).When 2 live vaccines cannot be given at the sametime, they should be separated by an interval of atleast 4 weeks. For interactions see Appendix I (vaccines).See also Cautions under individual vaccines.Contra-indications Vaccines are contra-indicated inchildren who have a confirmed anaphylactic reaction toa preceding dose of a vaccine containing the sameantigens or vaccine component (such as antibacterialsin viral vaccines). The presence of the following excipientsin vaccines and immunological products has beennoted under the relevant entries:GelatinGentamicinKanamycinNeomycinPenicillinsPolymyxin BStreptomycinThiomersalHypersensitivity to egg with evidence of previous anaphylacticreaction, contra-indicates influenza vaccine(prepared in hens’ eggs), tick-borne encephalitisvaccine, and yellow fever vaccine. See also Cautionsunder MMR vaccine.See also Vaccines and HIV infection, below.Live vaccines may be contra-indicated temporarily inchildren who are:. immunosuppressed (see Impaired ImmuneResponse, below);. pregnant (see Pregnancy and Breast-feeding,below).See also Contra-indications under individual vaccines.Impaired immune response Immune response to vaccinesmay be reduced in immunosuppressed childrenand there is also a risk of generalised infection with livevaccines. Severely immunosuppressed children shouldnot be given live vaccines (including those with severeprimary immunodeficiency). Specialist advice should besought for children being treated with high doses ofcorticosteroids (dose equivalents of prednisolone: children,2 mg/kg (or more than 40 mg) daily for at least 1week or 1 mg/kg daily for 1 month), or other immuno-14 Immunological products and vaccines