BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 613school at 3–5 years of age (see Immunisation schedule,section 14.1).When protection against measles is required urgently(e.g. during a measles outbreak), the second dose ofMMR vaccine can be given 1 month after the first dose;if the second dose is given before 18 months of age, thenchildren should still receive the routine dose beforestarting school at 3–5 years of age.Children presenting for pre-school booster who havenot received the first dose of MMR vaccine should begiven a dose of MMR vaccine followed 3 months later bya second dose. At school-leaving age or at entry intofurther education, MMR immunisation should beoffered to individuals of both sexes who have notreceived 2 doses during childhood. In a young adultwho has received only a single dose of MMR in childhood,a second dose is recommended to achieve fullprotection. If 2 doses of MMR vaccine are required, thesecond dose should be given one month after the initialdose.MMR vaccine should be used to protect against rubellain seronegative females of child-bearing age (seeImmunisation schedule, section 14.1). MMR vaccinemay also be offered to previously unimmunised andseronegative post-partum mothers—vaccination a fewdays after delivery is important because about 60% ofcongenital abnormalities from rubella infection occur inbabies of mothers who have borne more than one child.Immigrants arriving after the age of school immunisationare particularly likely to require immunisation.Contacts MMR vaccine may also be used in thecontrol of outbreaks of measles and should be offeredto susceptible children including babies aged over 6months who are contacts of a case, within 3 days ofexposure to infection; these children should still receiveroutine MMR vaccinations at the recommended ages.Children aged under 9 months for whom avoidance ofmeasles infection is particularly important (such asthose with history of recent severe illness) can begiven normal immunoglobulin (section 14.5, p. 622)after exposure to measles; routine MMR immunisationshould then be given after at least 3 months at theappropriate age.MMR vaccine is not suitable for prophylaxis followingexposure to mumps or rubella since the antibodyresponse to the mumps and rubella components is tooslow for effective prophylaxis.Children with impaired immune response should notreceive live vaccines (for advice on HIV see section14.1). If they have been exposed to measles infectionthey should be given normal immunoglobulin (section14.5).Travel Unimmunised children over 6 months of agetravelling to areas where measles is endemic or epidemicshould receive MMR vaccine. Children immunisedbefore 12 months of age should still receive twodoses of MMR at the recommended ages. If one dose ofMMR has already been given to a child, then the seconddose should be brought forward to at least one monthafter the first, to ensure complete protection. If the childis under 18 months of age and the second dose is givenwithin 3 months of the first, then the routine dose,before starting school at 3–5 years, should still be given.Side-effects See section 14.1. Also malaise, fever, or arash can occur after the first dose of MMR vaccine, mostcommonly about a week after vaccination and lastingabout 2 to 3 days. Leaflets are available for parents onadvice for reducing fever (including the use of paracetamol).Febrile seizures occur rarely 6 to 11 days afterMMR vaccination; the incidence of febrile seizures islower than that following measles infection. Parotidswelling occurs occasionally, usually in the third week,and rarely, arthropathy 2 to 3 weeks after immunisation.Adverse reactions are considerably less frequent afterthe second dose of MMR vaccine than after the firstdose.Idiopathic thrombocytopenic purpura has occurredrarely following MMR vaccination, usually within 6weeks of the first dose. The risk of idiopathic thrombocytopenicpurpura after MMR vaccine is much less thanthe risk after infection with wild measles or rubella virus.Children who develop idiopathic thrombocytopenicpurpura within 6 weeks of the first dose of MMR shouldundergo serological testing before the second dose isdue; if the results suggest incomplete immunity againstmeasles, mumps or rubella then a second dose of MMRis recommended. The Specialist and Reference MicrobiologyDivision, Health Protection Agency offers freeserological testing for children who develop idiopathicthrombocytopenic purpura within 6 weeks of the firstdose of MMR.Post-vaccination aseptic meningitis was reported (rarelyand with complete recovery) following vaccination withMMR vaccine containing Urabe mumps vaccine, whichhas now been discontinued; no cases have been confirmedin association with the currently used Jeryl Lynnmumps vaccine. Children with post-vaccination symptomsare not infectious.Reviews undertaken on behalf of the CSM, theMedical Research Council, and the Cochrane Collabaration,have not found any evidence of a linkbetween MMR vaccination and bowel disease orautism. The Chief Medical Officers have advisedthat the MMR vaccine is the safest and best way toprotect children against measles, mumps, and rubella.Information (including fact sheets and a list ofreferences) may be obtained from:www.dh.gov.uk/immunisationMEASLES, MUMPS AND RUBELLAVACCINE, LIVECautions see section 14.1; also after immunoglobulinadministration or blood transfusion, leave an intervalof at least 3 months before MMR immunisation asantibody response to measles component may bereduced; interactions: Appendix 1 (vaccines)Hypersensitivity to egg There is increasing evidence thatMMR vaccine can be given safely even when the child hashad an anaphylactic reaction to food containing egg (dislikeof egg or refusal to eat egg is not a contra-indication). Forchildren with a confirmed anaphylactic reaction to eggcontainingfood, MMR vaccine may be administered in ahospital setting.Contra-indications see section 14.1Pregnancy avoid pregnancy for at least 1 month aftervaccination; see also, p. 600Breast-feeding see p. 60014 Immunological products and vaccines