BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 605toxoid in a preparation determines whether the vaccineis defined as ‘high dose’ or ‘low dose’. Vaccines containingthe higher dose of diphtheria toxoid are used forprimary immunisation of children under 10 years of age.Vaccines containing the lower dose of diphtheria toxoidare used for primary immunisation in children over 10years. Single-antigen diphtheria vaccine is not availableand adsorbed diphtheria vaccine is given as a combinationproduct containing other vaccines.For primary immunisation of children aged between 2months and 10 years vaccination is recommendedusually in the form of 3 doses (separated by 1-monthintervals) of diphtheria, tetanus, pertussis (acellular,component), poliomyelitis (inactivated) and haemophilustype b conjugate vaccine (adsorbed) (seeImmunisation schedule, section 14.1). In unimmunisedchildren aged over 10 years the primary course comprisesof 3 doses of adsorbed diphtheria [low dose],tetanus and poliomyelitis (inactivated) vaccine.A booster dose should be given 3 years after the primarycourse (this interval can be reduced to a minimum of 1year if the primary course was delayed). Children under10 years should receive either adsorbed diphtheria,tetanus, pertussis (acellular, component) and poliomyelitis(inactivated) vaccine or adsorbed diphtheria[low dose], tetanus, pertussis (acellular, component)and poliomyelitis (inactivated) vaccine. Childrenaged over 10 years should receive adsorbed diphtheria[low dose], tetanus, and poliomyelitis (inactivated)vaccine.A second booster dose, of adsorbed diphtheria [lowdose], tetanus and poliomyelitis (inactivated) vaccine,should be given 10 years after the previous booster dose(this interval can be reduced to a minimum of 5 years ifprevious doses were delayed). For children who havebeen vaccinated following a tetanus-prone wound, seeTetanus vaccines, p. 619.Travel Children travelling to areas with a risk of diphtheriainfection should be fully immunised according tothe UK schedule (see also section 14.6). If more than 10years have lapsed since completion of the UK schedule,a dose of adsorbed diphtheria [low dose], tetanus andpoliomyelitis (inactivated) vaccine should be administered.Contacts Advice on the management of cases ofdiphtheria, carriers, contacts and outbreaks must besought from health protection units. The immunisationhistory of infected children and their contacts should bedetermined; those who have been incompletely immunisedshould complete their immunisation and fullyimmunised individuals should receive a reinforcingdose. For advice on antibacterial treatment to preventa secondary case of diphtheria in a non-immune child,see Table 2, section 5.1.DIPHTHERIA-CONTAINING VACCINESCautions see section 14.1; see also individual componentsof vaccinesContra-indications see section 14.1; see also individualcomponents of vaccinesPregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1; also restlessness, sleepdisturbances, and unusual crying in infants;Licensed use Infanrix-IPV + Hib c not licensed foruse in children over 36 months; Pediacel c notlicensed in children over 4 years but Department ofHealth recommends that these be used for childrenup to 10 yearsIndication and doseSee notes above and under preparationsDiphtheria-containing vaccines for childrenunder 10 yearsImportant Not recommended for children aged 10 years orover (see Diphtheria vaccines for children over 10)Diphtheria, Tetanus, Pertussis (Acellular, Component),Poliomyelitis (Inactivated) and HaemophilusType b Conjugate Vaccine (Adsorbed) AInjection, suspension of diphtheria toxoid, tetanustoxoid, acellular pertussis, inactivated poliomyelitisand Haemophilus influenzae type b (conjugated totetanus protein), net price 0.5-mL prefilled syringe =£19.94Excipients may include neomycin, polymyxin B and streptomycinDosePrimary immunisation. By intramuscular injectionChild 2 months–10 years 3 doses each of 0.5 mLseparated by intervals of 1 month; see also notes onbooster doses, aboveAvailable as part of childhood immunisation schedule, from healthorganisations or ImmFormBrands include Pediacel cAdsorbed Diphtheria, Tetanus, Pertussis (Acellular,Component) and Poliomyelitis (Inactivated)Vaccine AInjection, suspension of diphtheria toxoid, tetanustoxoid, acellular pertussis and inactivated poliomyelitisvaccine components adsorbed on a mineral carrier,net price 0.5-mL prefilled syringe = £17.56Excipients may include neomycin and polymyxin BDoseFirst booster dose. By intramuscular injectionChild 3–10 years 0.5 mL 3 years after primaryimmunisation; see also notes on booster doses, aboveAvailable as part of childhood immunisation schedule, from healthorganisations or ImmFormBrands include Infanrix-IPV cAdsorbed Diphtheria [low dose], Tetanus, Pertussis(Acellular, Component) and Poliomyelitis(Inactivated) Vaccine AInjection, suspension of diphtheria toxoid [low dose],tetanus toxoid, acellular pertussis and inactivatedpoliomyelitis vaccine components adsorbed on amineral carrier, net price 0.5-mL prefilled syringe =£11.98Excipients may include neomycin, polymyxin B and streptomycinDoseFirst booster dose. By intramuscular injectionChild 3–10 years 0.5 mL 3 years after primaryimmunisation; see also notes on booster doses, aboveAvailable as part of childhood immunisation schedule, from healthorganisations or ImmFormBrands include Repevax c14 Immunological products and vaccines