BNF for Children 2011-2012

604 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinesTwo interferon gamma release assay (IGRA) tests arealso available as an aid in the diagnosis of tuberculosisinfection: QuantiFERON c -TB Gold and T-SPOT c .TB.Both tests measure T-cell mediated immune response tosynthetic antigens. For further information on the use ofinterferon gamma release assay tests for tuberculosis,see www.hpa.org.uk.Tuberculin Purified Protein Derivative A(Tuberculin PPD)Injection, heat-treated products of growth and lysis ofappropriate Mycobacterium spp. 20 units/mL(2 units/0.1-mL dose) (for routine use), 1.5-mL vial;100 units/mL (10 units/0.1-mL dose), 1.5-mL vialDoseMantoux test. By intradermal injection2 units (0.1 mL of 20 units/mL strength) for routineMantoux test; if first test is negative and a further test isconsidered appropriate 10 units (0.1 mL of 100 units/mLstrength)Available from ImmForm (SSI brand)Important The strength of tuberculin PPD in this productmay be different to the strengths of products used previouslyfor the Mantoux test; care is required to select the correctstrengthBotulism antitoxinA polyvalent botulism antitoxin is available for the postexposureprophylaxis of botulism and for the treatmentof children thought to be suffering from botulism. Itspecifically neutralises the toxins produced by Clostridiumbotulinum types A, B, and E. It is not effectiveagainst infantile botulism as the toxin (type A) is seldom,if ever, found in the blood in this type of infection.Hypersensitivity reactions are a problem. It is essentialto read the contra-indications, warnings, and details ofsensitivity tests on the package insert. Prior to treatmentchecks should be made regarding previous administrationof any antitoxin and history of any allergic condition,e.g. asthma, hay fever, etc. All children should betested for sensitivity (diluting the antitoxin if history ofallergy).Botulism Antitoxin AA preparation containing the specific antitoxic globulinsthat have the power of neutralising the toxinsformed by types A, B, and E of Clostridium botulinum.Note The BP title Botulinum Antitoxin is not used becausethe preparation currently in use may have a different specificationDoseProphylaxisConsult product literatureAvailable from local designated centres, for details see TOXBASE(requires registration) www.toxbase.org. For supplies outsideworking hours apply to other designated centres or to the dutydoctor at the Health Protection Agency (Tel (020) 8200 6868). Formajor incidents, obtain supplies from the local blood bankCholera vaccineCholera vaccine (oral) contains inactivated Inaba(including El-Tor biotype) and Ogawa strains of Vibriocholerae, serotype O1 together with recombinant B-subunit of the cholera toxin produced in Inaba strainsof V.cholerae, serotype O1.Oral cholera vaccine is licensed for travellers to endemicor epidemic areas on the basis of current recommendations(see also section 14.6). Immunisationshould be completed at least 1 week before potentialexposure. However, there is no requirement for choleravaccination for international travel.Immunisation with cholera vaccine does not providecomplete protection and all travellers to a countrywhere cholera exists should be warned that scrupulousattention to food, water, and personal hygiene is essential.Injectable cholera vaccine provides unreliable protectionand is no longer available in the UK.CHOLERA VACCINECautions see section 14.1 and notes aboveContra-indications see section 14.1; also acute gastro-intestinalillnessPregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1; also rarely respiratorysymptoms such as rhinitis and cough; very rarely sorethroat, insomniaIndication and doseSee notes above. By mouthChild 2–6 years 3 doses each separated by aninterval of 1–6 weeksChild 6–18 years 2 doses separated by an intervalof 1–6 weeksNote If more than 6 weeks have elapsed between doses,the primary course should be restartedA single booster dose can be given 2 years afterprimary course for children 6–18 years, and 6months after primary course for children 2–6 years.If more than 2 years have elapsed since the lastvaccination, the primary course should be repeatedAdministration Dissolve effervescent sodium bicarbonategranules in a glassful of water (approximately150 mL). For child over 6 years, add vaccine suspensionto make one dose. For child 2–6 years, discardhalf (approximately 75 mL) of the solution, then addvaccine suspension to make one dose. Drink within 2hours. Food, drink and other oral medicines should beavoided for 1 hour before and after vaccinationDukoral c (Crucell) AOral suspension, for dilution with solution of effervescentsodium bicarbonate granules, heat- andformaldehyde-inactivated Inaba (including El-Torbiotype) and Ogawa strains of Vibrio cholerae bacteriaand recombinant cholera toxin B-subunit producedin V. cholerae, net price 2-dose pack = £23.42.Counselling, administrationDiphtheria VaccinesDiphtheria vaccines are prepared from the toxin ofCorynebacterium diphtheriae and adsorption on aluminiumhydroxide or aluminium phosphate improvesantigenicity. The vaccine stimulates the production ofthe protective antitoxin. The quantity of diphtheria