BNF for Children 2011-2012

618 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinesrabies and rapid access to post-exposure prophylaxis islikely to be limited.Up-to-date country-by-country information on the incidenceof rabies can be obtained from the NationalTravel Health Network and Centre (www.nathnac.org)and, in Scotland, from Health Protection Scotland(www.hps.scot.nhs.uk).Immunisation against rabies requires 3 doses of rabiesvaccine, with further booster doses for those whoremain at continued risk.Post-exposure management Following potentialexposure to rabies, the wound or site of exposure (e.g.mucous membrane) should be cleansed under runningwater and washed for several minutes with soapy wateras soon as possible after exposure. Disinfectant and asimple dressing can be applied, but suturing should bedelayed because it may increase the risk of introducingrabies virus into the nerves.Post-exposure prophylaxis against rabies depends onthe level of risk in the country, the nature of exposure,and the individual’s immunity. In each case, expert riskassessment and advice on appropriate managementshould be obtained from the Health Protection AgencyVirus Reference Department, Colindale, London (tel.(020) 8200 4400) or the Centre for Infections (tel.(020) 8200 6868), in Scotland from Health ProtectionScotland (tel. (0141) 300 1100), in Northern Ireland fromthe Public Health Laboratory, Belfast City Hospital (tel.(028) 9032 9241).There are no specific contra-indications to the use ofrabies vaccine for post-exposure prophylaxis and its useshould be considered whenever a child has beenattacked by an animal in a country where rabies isenzootic, even if there is no direct evidence of rabiesin the attacking animal. Because of the potential consequencesof untreated rabies exposure and becauserabies vaccination has not been associated with fetalabnormalities, pregnancy is not considered a contraindicationto post-exposure prophylaxis.For post-exposure prophylaxis of fully immunised individuals(who have previously received pre-exposure orpost-exposure prophylaxis with cell-derived rabiesvaccine), 2 doses of cell-derived vaccine, given on day0 and day 3, are likely to be sufficient. Rabies immunoglobulinis not necessary in such cases.Post-exposure treatment for unimmunised individuals(or those whose prophylaxis is possibly incomplete)comprises 5 doses of rabies vaccine given over 1month (on days 0, 3, 7, 14, and 30); also, dependingon the level of risk (determined by factors such as thenature of the bite and the country where it was sustained),rabies immunoglobulin (section 14.5.2) is givenon day 0. The immunisation course can be discontinuedif it is proved that the child was not at risk.RABIES VACCINECautions see section 14.1Contra-indications see section 14.1; but see also PostexposureManagement in notes abovePregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1; also reported paresisIndication and dosePre-exposure immunisation against rabies. By intramuscular injection in deltoid region oranterolateral thigh in infantsChild 1 month–18 years 1 mL on days 0, 7, and21 or 28; for those at continued risk give a singlereinforcing dose 1 year after the primary course iscompleted and booster doses every 3–5 years; forthose at intermittent risk give booster doses every2–5 yearsPost-exposure immunisation against rabies. By intramuscular injection in deltoid region oranterolateral thigh in infantsChild 1 month–18 years 1 mL (see notes above)Rabies Vaccine (Sanofi Pasteur) ARabInjection, powder for reconstitution, freeze-driedinactivated Wistar rabies virus strain PM/WI 38 1503-3M cultivated in human diploid cells, net price singledosevial with syringe containing diluent = £31.90Excipients include neomycinRabipur c (Novartis Vaccines) AInjection, powder for reconstitution, freeze-driedinactivated Flury LEP rabies virus strain cultivated inchick embryo cells, net price single-dose vial = £28.80Excipients include neomycinRotavirus vaccineRotavirus vaccine is a live, oral vaccine licensed forimmunisation of infants over 6 weeks of age for protectionagainst gastro-enteritis caused by rotavirus infection.The vaccine is not included in the childhoodimmunisation schedule.The rotavirus vaccine virus is excreted in the stool andmay be transmitted to close contacts; the vaccineshould be used with caution in those with immunosuppressedclose contacts. Carers of a recently vaccinatedbaby should be advised of the need to wash their handsafter changing the baby’s nappies.ROTAVIRUS VACCINECautions see section 14.1; also diarrhoea or vomiting(postpone vaccination); immunosuppressed closecontacts (see notes above); interactions: Appendix 1(vaccines)Contra-indications see section 14.1; also predispositionto, or history of, intussusceptionSide-effects see section 14.1Indication and doseImmunisation against gastro-enteritis causedby rotavirus infection. By mouthChild over 6 weeks 2 doses of 1.5 mL, separatedby an interval of at least 4 weeks; course should becompleted before 24 weeks of age (preferablybefore 16 weeks)Rotarix c (GSK) TAOral suspension, live attenuated rotavirus (RIX4414strain), net price 1.5 mL prefilled oral syringe = £41.38