BNF for Children 2011-2012

610 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinesand booster doses may need to be adjusted in those withlow antibody concentrationChild 16–18 years 4 doses of 40 micrograms, the second1 month, the third 2 months and the fourth 6 monthsafter the first dose; immunisation schedule and boosterdoses may need to be adjusted in those with low antibodyconcentrationNote Deltoid muscle is preferred site of injection in olderchildren; anterolateral thigh is preferred site in neonates,infants and young children; not to be injected into thebuttock (vaccine efficacy reduced)Fendrix c (GSK) AInjection, suspension of hepatitis B surface antigen(prepared from yeast cells by recombinant DNAtechnique) 40 micrograms/mL adsorbed onto aluminiumphosphate, net price 0.5-mL prefilled syringe= £38.10Excipients include traces of thiomersalDoseRenal insufficiency patients (including pre-haemodialysisand haemodialysis patients). By intramuscular injection(see note below)Child 15–18 years 4 doses of 20 micrograms, the second1 month, the third 2 months and the fourth 6 monthsafter the first dose; immunisation schedule and boosterdoses may need to be adjusted in those with low antibodyconcentrationNote Deltoid muscle is preferred site of injection; not tobe injected into the buttock (vaccine efficacy reduced)HBvaxPRO c (Sanofi Pasteur) AInjection, suspension of hepatitis B surface antigen(prepared from yeast cells by recombinant DNAtechnique) 10 micrograms/mL adsorbed onto aluminiumhydroxyphosphate sulphate, net price 0.5-mL(5-microgram) prefilled syringe = £8.95, 1-mL (10-microgram) prefilled syringe = £12.20; 40 micrograms/mL,1-mL (40-microgram) vial = £27.60Dose. By intramuscular injection(see note below)Neonate (except if born to hepatitis B surface antigenpositivemother, see below), 3 doses of 5 micrograms,second dose 1 month and third dose 6 months after firstdoseChild 1 month–16 years 3 doses of 5 micrograms,second dose 1 month and third dose 6 months after firstdoseChild 16–18 years 3 doses of 10 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 dosewith fourth dose at 12 monthsBooster doses may be required in immunocompromisedpatients with low antibody concentrationInfant born to hepatitis B surface antigen-positivemother (see also notes above). By intramuscular injection(see note below)Neonate 5 micrograms, first dose at birth with hepatitis Bimmunoglobulin injection (separate site), the second 1month, the third 2 months and the fourth 12 months afterthe first doseChronic haemodialysis patients. By intramuscular injection(see note below)Child 16–18 years 3 doses of 40 micrograms, seconddose 1 month and third dose 6 months after first dose;booster doses may be required in those with low antibodyconcentrationNote Deltoid muscle is preferred site of injection in olderchildren; anterolateral thigh is preferred site in neonates andinfants; not to be injected into the buttock (vaccine efficacyreduced)With hepatitis A vaccineSee Hepatitis A VaccineHuman papilloma virus vaccinesHuman papilloma virus vaccine is available as abivalent vaccine (Cervarix c ) or a quadrivalent vaccine(Gardasil c ). Cervarix c is licensed for use in females forthe prevention of cervical cancer and other precancerouslesions caused by human papilloma virustypes 16 and 18. Gardasil c is licensed for use in femalesfor the prevention of cervical cancer, genital warts andpre-cancerous lesions caused by human papilloma virustypes 6, 11, 16 and 18. The vaccines may also providelimited protection against disease caused by other typesof human papilloma virus. The two vaccines are notinterchangeable and one vaccine product should beused for an entire course. However, the Department ofHealth (November 2008) states for individuals withprevious incomplete vaccination with Gardasil c , whoare eligible for HPV vaccination under the nationalprogramme, Cervarix c can be used to complete thevaccination course if necessary; the individual must beinformed that Cervarix c does not protect againstgenital warts.Human papilloma virus vaccine will be most effective ifgiven before sexual activity starts. The first dose is givento females aged 12 to 13 years, the second and thirddoses are given 1–2 and 6 months after the first dose(see Immunisation schedule, section 14.1); all 3 dosesshould be given within a 12-month period. If the courseis interrupted, it should be resumed but not repeated,allowing the appropriate interval between the remainingdoses. Where there are significant challenges in schedulingvaccination, or a high likelihood that the thirddose will not be given, the third dose of Cervarix c canbe given 3 months after the second dose; if this is notpossible and the second dose was given late, inexceptional circumstances, the third dose can be givenat least 1 month after the second dose. Under thenational programme in England, females remain eligibleto receive the vaccine up to the age of 18 years if theydid not receive the vaccine when scheduled. Whereappropriate, immunisation with human papillomavirusvaccine should be offered to females coming into theUK as they may not have been offered protection intheir country of origin. The duration of protection hasnot been established, but current studies suggest thatprotection is maintained for at least 6 years aftercompletion of the primary course.HUMAN PAPILLOMA VIRUSVACCINESCautions see section 14.1Contra-indications see section 14.1Pregnancy not known to be harmful, but vaccinationshould be postponed until completion of pregnancyBreast-feeding see p. 600Side-effects see section 14.1