BNF for Children 2011-2012

616 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinesSide effects See also section 14.1. The incidence oflocal and systemic effects is generally lower with vaccinescontaining acellular pertussis components thanwith the whole-cell pertussis vaccine used. However,compared with primary vaccination, booster doses withvaccines containing acellular pertussis are reported toincrease the risk of injection-site reactions (some ofwhich affect the entire limb); local reactions do notcontra-indicate further doses (see below).The vaccine should not be withheld from children with ahistory to a preceding dose of:. fever, irrespective of severity;. persistent crying or screaming for more than 3hours;. severe local reaction, irrespective of extent.Combined vaccinesCombined vaccines, see under Diphtheria vaccinesPneumococcal vaccinesPneumococcal vaccines protect against infection withStreptococcus pneumoniae (pneumococcus); the vaccinescontain polysaccharide from capsular pneumococci,Pneumococcal polysaccharide vaccine containspurified polysaccharide from 23 capsular types ofpneumococci, whereas pneumococcal polysaccharideconjugate vaccine (adsorbed) contains polysaccharidefrom either 10 capsular types (Synflorix c ) or 13capsular types (Prevenar 13 c ) with the polysaccharidebeing conjugated to protein.The 13-valent conjugate vaccine is used for childhoodimmunisation. The recommended schedule consists of 3doses, the first at 2 months of age, the second at 4months, and the third at 12–13 months (see ImmunisationSchedule, section 14.1).Pneumococcal vaccination is recommended for individualsat increased risk of pneumococcal infection asfollows:. child under 5 years with a history of invasivepneumococcal disease;. asplenia or splenic dysfunction (including homozygoussickle cell disease and coeliac disease whichcould lead to splenic dysfunction);. chronic respiratory disease (includes asthma treatedwith continuous or frequent use of a systemiccorticosteroid);. chronic heart disease;. chronic renal disease;. chronic liver disease;. diabetes mellitus;. immune deficiency because of disease (e.g. HIVinfection) or treatment (including prolonged systemiccorticosteroid treatment);. presence of cochlear implant;. conditions where leakage of cerebrospinal fluidcould occur.Where possible, the vaccine should be given at least 2weeks before splenectomy, cochlear implant surgery,and chemotherapy; children and carers should begiven advice about increased risk of pneumococcalinfection. Prophylactic antibacterial therapy againstpneumococcal infection (Table 2, section 5.1, p. 255)should not be stopped after immunisation. A patientcard and information leaflet for patients with aspleniaare available from the Department of Health or in Scotlandfrom the Scottish Executive, Public Health Division1 (Tel (0131) 244 2501).Choice of vaccine Children under 2 years at increasedrisk of pneumococcal infection (see list above) shouldreceive the 13-valent pneumococcal polysaccharideconjugate vaccine (adsorbed) at the recommendedages, followed by a single dose of the 23-valent pneumococcalpolysaccharide vaccine after their second birthday(see below). Children at increased risk of pneumococcalinfection presenting late for vaccination shouldreceive 2 doses (separated by at least 1 month) of the13-valent pneumococcal polysaccharide conjugatevaccine (adsorbed) before the age of 12 months, and athird dose at 12–13 months. Children over 12 monthsand under 5 years (who have not been vaccinated or notcompleted the primary course) should receive a singledose of 13-valent pneumococcal polysaccharide conjugatevaccine (adsorbed) (2 doses separated by an intervalof 2 months in the immunocompromised or thosewith asplenia or splenic dysfunction). All children under5 years at increased risk of pneumococcal infectionshould receive a single dose of the 23-valent pneumococcalpolysaccharide vaccine after their second birthdayand at least 2 months after the final dose of the 13-valent pneumococcal polysaccharide conjugate vaccine(adsorbed).Children over 5 years who are at increased risk ofpneumococcal disease should receive a single dose ofthe 23-valent unconjugated pneumococcal polysaccharidevaccine.Revaccination In individuals with higher concentrationsof antibodies to pneumococcal polysaccharides,revaccination with the 23-valent pneumococcal polysaccharidevaccine more commonly produces adversereactions. Revaccination is therefore not recommended,except every 5 years in individuals in whom the antibodyconcentration is likely to decline rapidly (e.g.asplenia, splenic dysfunction and nephrotic syndrome).If there is doubt, the need for revaccination should bediscussed with a haematologist, immunologist, ormicrobiologist.PNEUMOCOCCAL VACCINESCautions see section 14.1Contra-indications see section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1; also Revaccination,aboveIndication and doseImmunisation against pneumococcal infectionFor dose see under preparationsPneumococcal polysaccharide vaccinesPneumovax c II (Sanofi Pasteur) AInjection, polysaccharide from each of 23 capsulartypes of pneumococcus, net price 0.5-mL vial = £8.32Dose. By subcutaneous or intramuscular injectionChild 2–18 years 0.5 mL; revaccination, see notes above