BNF for Children 2011-2012

606 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinesDiphtheria-containing vaccines for children over10 yearsA low dose of diphtheria toxoid is sufficient to recallimmunity in older children previously immunisedagainst diphtheria but whose immunity may havediminished with time; it is insufficient to cause seriousreactions in a child who is already immune. Preparationscontaining low dose diphtheria should be usedfor children over 10 years, both for primary immunisationand booster doses.Adsorbed Diphtheria [low dose], Tetanus andPoliomyelitis (Inactivated) Vaccine AInjection, suspension of diphtheria toxoid [low dose],tetanus toxoid and inactivated poliomyelitis vaccinecomponents adsorbed on a mineral carrier, net price0.5-mL prefilled syringe = £6.35Excipients may include neomycin, polymyxin B and streptomycinDosePrimary immunisation. By intramuscular injectionChild 10–18 years 3 doses each of 0.5 mL separated byintervals of 1 month; second booster dose, 0.5 mL given10 years after first booster dose (may also be used as firstbooster dose in those over 10 years who have receivedonly 3 previous doses of a diphtheria-containingvaccine); see also notes on booster doses, aboveAvailable as part of childhood schedule, from health organisationsor ImmFormBrands include Revaxis cDiphtheria antitoxinDiphtheria antitoxin is used for passive immunisationin suspected cases of diphtheria only (withoutwaiting for bacteriological confirmation); tests forhypersensitivity should be first carried out. It isderived from horse serum, and reactions are commonafter administration; resuscitation facilities should beavailable immediately.It is no longer used for prophylaxis because of the riskof hypersensitivity; unimmunised contacts should bepromptly investigated and given antibacterial prophylaxis(Table 2, section 5.1) and vaccine (see Contactsabove, p. 605).Diphtheria Antitoxin ADip/SerDoseProphylaxisNot recommended therefore no dose stated (see notesabove)Immunisation schedule, section 14.1). For infantsunder 1 year, the course consists of 3 doses of a vaccinecontaining haemophilus influenzae type b component,with an interval of 1 month between doses. A boosterdose of haemophilus influenzae type b vaccine (combinedwith meningococcal group C conjugate vaccine)should be given at around 12–13 months of age.Children 1–10 years who have not been immunisedagainst Haemophilus influenzae type b need to receiveonly 1 dose of the vaccine (combined with meningococcalgroup C conjugate vaccine). However, if a primarycourse of immunisation has not been completed,these children should be given 3 doses of diphtheria,tetanus, pertussis (acellular, component), poliomyelitis(inactivated) and haemophilus type b conjugate vaccine(adsorbed). The risk of infection falls sharply in olderchildren and the vaccine is not normally required forchildren over 10 years.Haemophilus influenzae type b vaccine may be given tothose over 10 years who are considered to be atincreased risk of invasive H. influenzae type b disease(such as those with sickle-cell disease or complementdeficiency, or those receiving treatment for malignancy).For use of rifampicin in the prevention of secondarycases of Haemophilus influenza type b disease, seeTable 2, section 5.1Asplenia, splenic dysfunction, or complementdeficiency Children diagnosed with asplenia, splenicdysfunction, or complement deficiency at:. under 2 years of age should be vaccinated accordingto the Immunisation Schedule (section 14.1).The booster dose of haemophilus influenzae type bvaccine (combined with meningococcal group Cconjugate vaccine), given at 12–13 months of age,should be followed at least 1 month later by onedose of meningococcal A, C, W135, and Y conjugatevaccine. An additional dose of haemophilusinfluenzae type b vaccine (combined with meningococcalgroup C conjugate vaccine) should be givenafter the second birthday;. over 2 years of age should receive one dose ofhaemophilus influenzae type b vaccine (combinedwith meningococcal group C conjugate vaccine),followed 1 month later by one dose of meningococcalA, C, W135, and Y conjugate vaccine.TreatmentConsult product literatureAvailable from Centre for Infections (Tel (020) 8200 6868) or inNorthern Ireland from Public Health Laboratory, Belfast CityHospital (Tel (028) 9032 9241).Haemophilus type B conjugate vaccineHaemophilus influenzae type b (Hib) vaccine is madefrom capsular polysaccharide; it is conjugated with aprotein such as tetanus toxoid to increase immunogenicity,especially in young children. Haemophilus influenzaetype b vaccine is given in combination with diphtheria,tetanus, pertussis (acellular, component) andpoliomyelitis (inactivated) vaccine, (see under Diphtheriacontaining Vaccines) as a component of theprimary course of childhood immunisation (seeHAEMOPHILUS TYPE B CONJUGATEVACCINECautions see section 14.1Contra-indications see section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1; also, atopic dermatitis,hypotoniaLicensed use Menitorix c is not licensed for use inchildren over 2 yearsIndication and doseSee notes above and under preparationPrimary immunisation, see under Diphtheriacontainingvaccines