BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 609. close family contacts of an individual with chronichepatitis B infection;. babies whose mothers have had acute hepatitis Bduring pregnancy or are positive for hepatitis Bsurface antigen (regardless of e-antigen markers);hepatitis B vaccination is started immediately ondelivery and hepatitis B immunoglobulin (seep. 624) given at the same time (but at a differentsite). Babies whose mothers are positive for hepatitisB surface antigen and for e-antigen antibodyshould receive the vaccine only (but babies weighing1.5 kg or less should also receive the immunoglobulinregardless of the mother’s e-antigen antibodystatus);. children with haemophilia, those receiving regularblood transfusions or blood products, and carersresponsible for the administration of such products;. children with chronic renal failure including thoseon haemodialysis. Children receiving haemodialysisshould be monitored for antibodies annually and reimmunisedif necessary. Home carers (of dialysispatients) should be vaccinated;. children with chronic liver disease;. patients of day-care or residential accommodationfor those with severe learning difficulties;. children in custodial institutions;. children travelling to areas of high or intermediateprevalence who are at increased risk or who plan toremain there for lengthy periods (see p. 626);. families adopting children from countries with ahigh or intermediate prevalence of hepatitis B;. foster carers and their families.Different immunisation schedules for hepatitis Bvaccine are recommended for specific circumstances(see under individual preparations); an ‘acceleratedschedule’ is recommended for pre-exposure prophylaxisin high–risk groups where rapid protection is required,and for post-exposure prophylaxis (see below). Generally,three or four doses are required for primaryimmunisation. Immunisation may take up to 6 monthsto confer adequate protection; the duration of immunityis not known precisely, but a single booster 5 years afterthe primary course may be sufficient to maintain immunityfor those who continue to be at risk.Immunisation does not eliminate the need for commonsenseprecautions for avoiding the risk of infection fromknown carriers by the routes of infection which havebeen clearly established, consult Guidance for ClinicalHealth Care Workers: Protection against Infection withBlood-borne Viruses (available at www.dh.gov.uk). Accidentalinoculation of hepatitis B virus-infected bloodinto a wound, incision, needle-prick, or abrasion maylead to infection, whereas it is unlikely that indirectexposure to a carrier will do so.Following significant exposure to hepatits B, an acceleratedschedule, with the second dose given 1 month,and the third dose 2 months after the initial dose, isrecommended. For those at continued risk, a fourthdose should be given 12 months after the first dose.More detailed guidance is given in the Immunisationagainst Infectious Disease handbook, see p. 599Specific hepatitis B immunoglobulin (‘HBIG’) is availablefor use with the vaccine in those accidentallyinoculated and in neonates at special risk of infection(section 14.5.2).A combined hepatitis A and hepatitis B vaccine is alsoavailable.HEPATITIS B VACCINECautions section 14.1Contra-indications section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects section 14.1Indication and doseImmunisation against hepatitis B infectionFor dose see under preparationsSingle componentEngerix B c (GSK) AInjection, suspension of hepatitis B surface antigen(prepared from yeast cells by recombinant DNAtechnique) 20 micrograms/mL adsorbed onto aluminiumhydroxide, net price 0.5-mL (paediatric) prefilledsyringe = £9.67, 1-mL vial = £12.34, 1-mLprefilled syringe = £12.99Dose. By intramuscular injection(see note below)Neonate (except if born to hepatitis B surface antigenpositivemother, see below), 3 doses of 10 micrograms,second dose 1 month and third dose 6 months after firstdoseChild 1 month–16 years 3 doses of 10 micrograms,second dose 1 month and third dose 6 months after firstdoseChild 16–18 years 3 doses of 20 micrograms, seconddose 1 month and third dose 6 months after first doseAccelerated schedule (all age groups), second dose 1month after first dose, third dose 2 months after first doseand fourth dose 12 months after first doseAlternative schedule for Child 11–15 years, 2 doses of20 micrograms, the second dose 6 months after the firstdose (this schedule not suitable if high risk of infectionbetween doses or if compliance with second doseuncertain)Infant born to hepatitis B surface antigen-positivemother (see also notes above). By intramuscular injection(see note below)Neonate 4 doses of 10 micrograms, first dose at birthwith hepatitis B immunoglobulin injection (separate site)the second 1 month, the third 2 months and the fourth 12months after first doseRenal insufficiency (including haemodialysispatients). By intramuscular injection(see note below)Neonate (except if born to hepatitis B surface antigenpositive mother, see above), 3 doses of 10 micrograms,second dose 1 month and third dose 6 months after firstdose or accelerated schedule, 4 doses of 10 micrograms,second dose 1 month, third dose 2 months, and fourthdose 12 months after first dose; immunisation scheduleand booster doses may need to be adjusted in those withlow antibody concentrationChild 1 month–16 years 3 doses of 10 micrograms,second dose 1 month and third dose 6 months after firstdose or accelerated schedule, 4 doses of 10 micrograms,second dose 1 month, third dose 2 months, and fourthdose 12 months after first dose; immunisation schedule14 Immunological products and vaccines