BNF for Children 2011-2012

602 14.2 Passive immunity BNFC 2011–201214 Immunological products and vaccinesVaccines and asplenia The following vaccines arerecommended for asplenic children or those with splenicdysfunction:haemophilus influenzae type b; influenza; meningococcalA, C, W135, and Y conjugate; pneumococcal.For antibiotic prophylaxis in asplenia see p. 255.Route of administration Vaccines should not begiven intravenously. Most vaccines are given by theintramuscular route; some vaccines are given by otherroutes—the intradermal route for BCG vaccine, deepsubcutaneous route for Japanese encephalitis and varicellavaccines, and the oral route for cholera, live poliomyelitis,rotavirus, and live typhoid vaccines. The intramuscularroute should not be used in children withbleeding disorders such as haemophilia or thrombocytopenia;vaccines usually given by the intramuscularroute should be given by deep subcutaneous injectioninstead.Note The Department of Health has advised against the use ofjet guns for vaccination owing to the risk of transmitting bloodborneinfections, such as HIV.High-risk groupsFor information on high-risk groups, see section 14.4under individual vaccinesBCG Vaccines, p. 603Hepatitis A Vaccine, p. 607Hepatitis B Vaccine, p. 608Influenza Vaccine, p. 611Pneumococcal Vaccines, p. 616Tetanus Vaccines, p. 619Children with unknown or incompleteimmunisation historyFor children born in the UK who present with aninadequate or unknown immunisation history, investigationinto immunisations received should be carriedout. Outstanding doses should be administered wherethe routine childhood immunisation schedule has notbeen completed.For advice on the immunisation of children coming tothe UK, consult the handbook Immunisation againstInfectious Disease (2006) (available at www.dh.gov.uk)14.2 Passive immunityImmunity with immediate protection against certaininfective organisms can be obtained by injecting preparationsmade from the plasma of immune individualswith adequate levels of antibody to the disease for whichprotection is sought (see under Immunoglobulins, section14.5). The duration of this passive immunity variesaccording to the dose and the type of immunoglobulin.Passive immunity may last only a few weeks; whennecessary, passive immunisation can be repeated.Antibodies of human origin are usually termed immunoglobulins.The term antiserum is applied to materialprepared in animals. Because of serum sickness andother allergic-type reactions that may follow injectionsof antisera, this therapy has been replaced wheneverpossible by the use of immunoglobulins. Reactions aretheoretically possible after injection of human immunoglobulins,but reports of such reactions are very rare.14.3 Storage and useCare must be taken to store all vaccines and otherimmunological products under the conditions recommendedin the product literature, otherwise the preparationmay become ineffective. Refrigerated storage isusually necessary; many vaccines and immunoglobulinsneed to be stored at 2–88C and not allowed to freeze.Vaccines and immunoglobulins should be protectedfrom light. Reconstituted vaccines and opened multidosevials must be used within the period recommendedin the product literature. Unused vaccines should bedisposed of by incineration at a registered disposalcontractor.Particular attention must be paid to instructions on theuse of diluents. Vaccines which are liquid suspensions orare reconstituted before use should be adequatelymixed to ensure uniformity of the material to beinjected.14.4 Vaccines and antiseraAvailability Anthrax and yellow fever vaccines, botulismantitoxin, diphtheria antitoxin, and snake and spidervenom antitoxins are available from local designatedholding centres.For antivenom, see Emergency Treatment of Poisoning,p. 34.Enquiries for vaccines not available commercially canalso be made to:Immunisation Policy, Monitoring and SurveillanceDepartment of HealthWellington House133–155 Waterloo RoadLondon, SE1 8UGvaccine.supply@dh.gsi.gov.ukIn Scotland information about availability of vaccinescan be obtained from a Specialist in PharmaceuticalPublic Health. In Wales enquiries for vaccines notcommercially available should be directed to:Welsh Medicines Information CentreUniversity Hospital of WalesCardiff, CF14 4XWTel: (029) 2074 2979and in Northern Ireland:Pharmacy and Medicines Management CentreBeech HouseAntrim Hospital SiteNorthern Health and Social Care TrustBush RoadAntrim, BT41 2RLrphps.admin@northerntrust.hscni.netFor further details of availability, see under individualvaccines.