BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 611Indication and doseSee notes above and under preparationsNote To avoid confusion, prescribers should specify thebrand to be dispensedCervarix c (GSK) AInjection, suspension of virus-like particles of humanpapilloma virus type 16 (40 micrograms/mL), type 18(40 micrograms/mL) capsid protein (prepared byrecombinant DNA technique using a Baculovirusexpression system) in monophosphoryl lipid A adjuvantadsorbed onto aluminium hydroxide, net price0.5-mL prefilled syringe = £80.50Note To avoid confusion, prescribers should specify the brandto be dispensedDosePrevention of premalignant genital lesions and cervicalcancer (see notes above). By intramuscular injection into deltoid regionChild 10–18 years 3 doses of 0.5 mL, the second 1month and the third 6 months after the first doseAlternative schedule for Child 10–18 years, 3 doses of0.5 mL, the second 1–2.5 months, and the third 5–12months after the first doseGardasil c (Sanofi Pasteur) TAInjection, suspension of virus-like particles of humanpapilloma virus type 6 (40 micrograms/mL), type 11(80 micrograms/mL), type 16 (80 micrograms/mL),type 18 (40 micrograms/mL) capsid protein (preparedfrom yeast cells by recombinant DNA technique)adsorbed onto aluminium hydroxyphosphate sulphate,net price 0.5-mL prefilled syringe = £86.50Note To avoid confusion, prescribers should specify the brandto be dispensedDosePrevention of premalignant genital lesions, cervicalcancer and genital warts (see notes above). By intramuscular injection preferably into deltoidregion or higher anterolateral thighChild 9–18 years 3 doses of 0.5 mL, the second 2months and the third 6 months after the first doseAlternative schedule for Child 9–18 years, 3 doses of0.5 mL, the second at least 1 month and the third at least4 months after the first dose; schedule should be completedwithin 12 months. chronic liver disease;. chronic renal disease;. chronic neurological disease;. diabetes mellitus;. immunosuppression because of disease (includingasplenia or splenic dysfunction) or treatment(including prolonged corticosteroid treatment [forover 1 month at dose equivalents of prednisolone:1 mg/kg or more daily or 20 mg or more daily] andchemotherapy);. HIV infection (regardless of immune status).Seasonal influenza vaccine is also recommended for allpregnant women, for children living in long-stay facilities,and for carers of children whose welfare may be atrisk if the carer falls ill. Influenza immunisation shouldalso be considered for household contacts of immunocompromisedindividuals.Monovalent influenza A(H1N1)v vaccinesPandemrix c and Celvapan c are monovalent vaccineslicensed against the influenza A(H1N1)v (swine flu)strain.Pandemrix c is recommended for children aged 6months–5 years who have not received the monovalentvaccine previously and who are in the risk groupsprioritised for seasonal influenza vaccine. Pandemrix cis also recommended for all immunocompromisedpatients over 6 months of age who have not receivedthe monovalent vaccine previously. Seasonal influenzavaccine should continue to be offered as normal.Pandemrix c can be given at the same time as the firstdose of seasonal influenza vaccine; however,Pandemrix c should be given 4 weeks before theseasonal influenza vaccine to immunocompromisedpatients who only require one dose of seasonal influenzavaccine.Further information on pandemic influenza, avian influenzaand swine influenza may be found atwww.dh.gov.uk/pandemicflu and at www.hpa.org.uk.Influenza vaccineWhile most viruses are antigenically stable, the influenzaviruses A and B (especially A) are constantlyaltering their antigenic structure as indicated bychanges in the haemagglutinins (H) and neuraminidases(N) on the surface of the viruses. It is essential thatinfluenza vaccines in use contain the H and N componentsof the prevalent strain or strains recommendedeach year by the World Health Organization.Seasonal influenza vaccines Seasonal influenzavaccines will not control epidemics — immunisation isrecommended only for persons at high risk. Annualimmunisation is strongly recommended for children(including infants that were preterm or low birth-weight)aged over 6 months with the following conditions:. chronic respiratory disease (includes asthma treatedwith continuous or repeated use of inhaled orsystemic corticosteroids or asthma with previousexacerbations requiring hospital admission);. chronic heart disease;INFLUENZA VACCINESCautions see section 14.1; interactions: Appendix 1(vaccines)Contra-indications see section 14.1; avoid Enzira c orpreparations marketed by Pfizer, Wyeth or CSLBiotherapies in child under 5 years—increased risk offebrile convulsionsPregnancy not known to be harmfulBreast-feeding not known to be harmfulSide-effects see section 14.1; also reported, febrileconvulsions and transient thrombocytopeniaLicensed use Inactivated Influenza Vaccine (SurfaceAntigen) and Fluvirin c are not licensed for use inchildren under 4 yearsIndication and doseAnnual immunisation against seasonal influenza. By intramuscular injectionChild 6 months–3 years 0.25–0.5 mL (repeatedafter 4–6 weeks in children who have not receivedseasonal influenza vaccine previously)14 Immunological products and vaccines