BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 603Anthrax vaccineAnthrax vaccine is rarely required for children. Forfurther information see BNF section 14.4.BCG vaccinesBCG (Bacillus Calmette-Guérin) is a live attenuatedstrain derived from Mycobacterium bovis which stimulatesthe development of hypersensitivity to M. tuberculosis.BCG vaccine should be given intradermally byoperators skilled in the technique (see below).The expected reaction to successful BCG vaccination isinduration at the site of injection followed by a locallesion which starts as a papule 2 or more weeks aftervaccination; the lesion may ulcerate then subside overseveral weeks or months, leaving a small flat scar. A drydressing may be used if the ulcer discharges, but airshould not be excluded.All children of 6 years and over being considered forBCG immunisation must first be given a skin test forhypersensitivity to tuberculoprotein (see under Diagnosticagents, below). A skin test is not necessary fora child under 6 years, provided that the child has notstayed for longer than 3 months in a country with anincidence 1 of tuberculosis greater than 40 per 100 000,the child has not had contact with a person with tuberculosis,and there is no family history of tuberculosiswithin the last 5 years.BCG is recommended for the following groups of childrenif BCG immunisation has not previously beencarried out and they are negative for tuberculoproteinhypersensitivity:. neonates with a family history of tuberculosis in thelast 5 years;. all neonates and infants (0–12 months) born in areaswhere the incidence 1 of tuberculosis is greater than40 per 100 000;. neonates, infants, and children under 16 years witha parent or grandparent born in a country with anincidence 1 of tuberculosis greater than 40 per100 000;. new immigrants aged under 16 years who wereborn in, or lived for more than 3 months in acountry with an incidence 1 of tuberculosis greaterthan 40 per 100 000;. new immigrants aged 16–18 years from Sub-SaharanAfrica or a country 1 with an incidence of tuberculosisgreater than 500 per 100 000;. contacts of those with active respiratory tuberculosis;. children under 16 years intending to live with localpeople for more than 3 months in a country with anincidence 1 of tuberculosis greater than 40 per100 000 (section 14.6).BCG vaccine can be given simultaneously with anotherlive vaccine (see also section 14.1), but if they are notgiven at the same time, an interval of 4 weeks shouldnormally be allowed between them. When BCG is givento infants, there is no need to delay routine primaryimmunisations. No further vaccination should be given1. List of countries or primary care trusts where the incidenceof tuberculosis is greater than 40 cases per 100 000 isavailable at www.hpa.org.ukin the arm used for BCG vaccination for at least 3months because of the risk of regional lymphadenitis.For advice on chemoprophylaxis against tuberculosis,see section 5.1.9; for treatment of infection followingvaccination, seek expert advice.BACILLUS CALMETTE-GUÉRINVACCINEBCG vaccineCautions see section 14.1; interactions: Appendix 1(vaccines)Contra-indications see section 14.1; also neonate inhousehold contact with known or suspected case ofactive tuberculosis; generalised septic skin conditions(for children with eczema, lesion-free site should beused)Pregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1 and notes above; also atthe injection-site, subcutaneous abscess, prolongedulceration; rarely disseminated complications such asosteitis or osteomyelitisIndication and doseImmunisation against tuberculosis. By intradermal injectionNeonate 0.05 mLChild 1 month–1 year 0.05 mLChild 1–18 years 0.1 mLIntradermal injection technique Skin is stretched betweenthumb and forefinger and needle (size 25G or 26G) inserted(bevel upwards) for about 3 mm into superficial layers ofdermis (almost parallel with surface). Needle should be shortwith short bevel (can usually be seen through epidermisduring insertion). Tense raised blanched bleb showing tips ofhair follicles is sign of correct injection; 7 mm bleb : 0.1 mLinjection, 3 mm bleb : 0.05 mL injection; if considerableresistance not felt, needle is too deep and should be removedand reinserted before giving more vaccine.To be injected at insertion of deltoid muscle onto humerus(keloid formation more likely with sites higher on arm); tip ofshoulder should be avoided.IntradermalBacillus Calmette-Guérin Vaccine ABCG Vaccine, Dried/Tub/BCGInjection, (powder for suspension), freeze-dried preparationof live bacteria of a strain derived from thebacillus of Calmette and GuérinAvailable from health organisations or from ImmForm (SSI brand,multidose vial with diluent)Diagnostic agentsThe Mantoux test is recommended for tuberculin skintesting, but no licensed preparation is currently available.Guidance for healthcare professionals is availableat www.dh.gov.uk/immunisation.In the Mantoux test, the diagnostic dose is administeredby intradermal injection of Tuberculin Purified ProteinDerivative (PPD).The Heaf test (involving the use of multiple-punctureapparatus) is no longer available.Note Response to tuberculin may be suppressed by live viralvaccines, viral infection, sarcoidosis, corticosteroid therapy, orimmunosuppression due to disease or treatment. Tuberculintesting should not be carried out within 4 weeks of receiving alive viral vaccine14 Immunological products and vaccines