BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 617Pneumococcal polysaccharide conjugate vaccine(adsorbed)Prevenar 13 c (Wyeth) TAInjection, polysaccharide from each of 13 capsulartypes of pneumococcus (conjugated to carrier protein)adsorbed onto aluminium phosphate, net price0.5-mL prefilled syringe = £49.10Dose. By intramuscular injectionChild 2 months–5 years 0.5 mL (see notes above andImmunisation schedule, section 14.1)Note Deltoid muscle is preferred site of injection inyoung children; anterolateral thigh is preferred site ininfantsThe dose in BNF for Children may differ from that inproduct literatureAvailable as part of childhood immunisation schedule fromImmFormSynflorix c (GSK) TAInjection, polysaccharide from each of 10 capsulartypes of pneumococcus (conjugated to carrier proteins)adsorbed onto aluminium phosphate, net price0.5-mL prefilled syringe = £27.60Dose. By intramuscular injectionChild 6 weeks–2 years consult product literatureNote Deltoid muscle is preferred site of injection in youngchildren; anterolateral thigh is preferred site in infantsPoliomyelitis vaccinesTwo types of poliomyelitis vaccine (containing strains ofpoliovirus types 1, 2, and 3) are available, inactivatedpoliomyelitis vaccine (for injection) and live (oral) poliomyelitisvaccine. Inactivated poliomyelitis vaccine,only available in combined preparation (see under Diphtheriavaccines, combined), is recommended for routineimmunisation; it is given by injection and containsinactivated strains of human poliovirus types 1, 2 and 3.A course of primary immunisation consists of 3 doses ofa combined preparation containing inactivated poliomyelitisvaccine starting at 2 months of age with intervalsof 1 month between doses (see Immunisationschedule, section 14.1). A course of 3 doses shouldalso be given to all unimmunised children; no childshould remain unimmunised against poliomyelitis.Two booster doses of a preparation containing inactivatedpoliomyelitis vaccine are recommended, the firstbefore school entry and the second before leavingschool (see Immunisation schedule, section 14.1).Further booster doses should be given every 10 yearsonly to individuals at special risk.Preparations containing inactivated poliomyelitisvaccine can be used to complete an immunisationcourse initiated with the live (oral) poliomyelitis vaccine.Live (oral) poliomyelitis vaccine is available only foruse during outbreaks. The live (oral) vaccine poses avery rare risk of vaccine-associated paralytic poliobecause the attenuated strain of the virus can revertto a virulent form. For this reason the live (oral) vaccinemust not be used for immunosuppressed individuals ortheir household contacts. The use of inactivated poliomyelitisvaccine removes the risk of vaccine-associatedparalytic polio altogether.Travel Unimmunised travellers to areas with a highincidence of poliomyelitis should receive a full 3–dosecourse of a preparation containing inactivated poliomyelitisvaccine. Those who have not been vaccinatedin the last 10 years should receive a booster dose ofadsorbed diphtheria [low dose], tetanus and poliomyelitis(inactivated) vaccine. Information aboutcountries with a high incidence of poliomyelitis can beobtained from www.travax.nhs.uk or from the NationalTravel Health Network and Centre, p. 627(www.nathnac.org).POLIOMYELITIS VACCINESCautions see section 14.1; also for live vaccine,interactions: Appendix 1 (vaccines)Contra-indications see notes above and section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects see notes above and section 14.1Indication and doseSee under preparationsCombined vaccinesSee under Diphtheria-containing VaccinesInactivated (Salk) VaccineSee under Diphtheria-containing VaccinesLive (oral) (Sabin) vaccinePoliomyelitis Vaccine, Live (Oral) (GSK) AOPVA suspension of suitable live attenuated strains ofpoliomyelitis virus, types 1, 2, and 3. Available insingle-dose and 10-dose containersExcipients include neomycin and polymyxin BDoseControl of outbreaks. By mouthChild 1 month–18 years 3 drops; may be given on alump of sugar; not to be given with foods which containpreservativesNote Live poliomyelitis vaccine loses potency once thecontainer has been opened—any vaccine remaining at theend of an immunisation session should be discarded;whenever possible sessions should be arranged to avoidundue wastage.Rabies vaccineRabies vaccine contains inactivated rabies virus cultivatedin either human diploid cells or purified chickembryo cells; vaccines are used for pre- and postexposureprophylaxis.Pre-exposure prophylaxis Immunisation should beoffered to children at high risk of exposure to rabies—where there is limited access to prompt medical care forthose living in areas where rabies is enzootic, for thosetravelling to such areas for longer than 1 month, and forthose on shorter visits who may be exposed to unusualrisk. Transmission of rabies by humans has not beenrecorded but it is advised that those caring for childrenwith the disease should be vaccinated.Immunisation against rabies is indicated duringpregnancy if there is substantial risk of exposure to14 Immunological products and vaccines