BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 619Rubella vaccineA combined measles, mumps and rubella vaccine (MMRvaccine) aims to eliminate rubella (German measles)and congenital rubella syndrome. MMR vaccine is usedfor childhood vaccination as well as for vaccinatingadults (including women of child-bearing age) who donot have immunity against rubella the combined livemeasles, mumps and rubella vaccine is a suitable alternative.Single antigen vaccineNo longer available in the UK; see MMR vaccine,p. 612Combined vaccinessee MMR vaccineSmallpox vaccineLimited supplies of smallpox vaccine are held at theSpecialist and Reference Microbiology Division, HealthProtection Agency (Tel. (020) 8200 4400) for the exclusiveuse of workers in laboratories where pox viruses(such as vaccinia) are handled.If a wider use of the vaccine is being considered, Guidelinesfor smallpox response and management in thepost-eradication era should be consulted atwww.dh.gov.ukTetanus vaccinesTetanus vaccine contains a cell-free purified toxin ofClostridium tetani adsorbed on aluminium hydroxide oraluminium phosphate to improve antigenicity.Primary immunisation for children under 10 years consistsof 3 doses of a combined preparation containingadsorbed tetanus vaccine (see Diphtheria-containingVaccines), with an interval of 1 month between doses.Following routine childhood vaccination, 2 boosterdoses of a preparation containing adsorbed tetanusvaccine are recommended, the first before schoolentry and the second before leaving school. (seeImmunisation schedule, section 14.1).The recommended schedule of tetanus vaccination notonly gives protection against tetanus in childhood butalso gives the basic immunity for subsequent boosterdoses. In most circumstances, a total number of 5 dosesof tetanus vaccine is considered sufficient for long-termprotection.For primary immunisation of children over 10 yearspreviously unimmunised against tetanus, 3 doses ofadsorbed diphtheria [low dose], tetanus and poliomyelitis(inactivated) vaccine are given with an intervalof 1 month between doses (see Diphtheria-containingVaccines).Cautions See also Section 14.1. When a child presentsfor a booster dose but has been vaccinated following atetanus-prone wound, the vaccine preparation administeredat the time of injury should be determined. If thisis not possible, the booster should still be given toensure adequate protection against all antigens in thebooster vaccine.Very rarely, tetanus has developed after abdominalsurgery; carers of children awaiting elective surgeryshould be asked about the child’s tetanus immunisationstatus and the child should be immunised if necessary.Parenteral drug abuse is also associated with tetanus;those abusing drugs by injection should be vaccinated ifunimmunised—booster doses should be given if there isany doubt about their immunisation status.Travel recommendations see section 14.6.Contra-indications See section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects See section 14.1Wounds Wounds are considered to be tetanus-prone ifthey are sustained more than 6 hours before surgicaltreatment or at any interval after injury and are puncture-type(particularly if contaminated with soil or manure)or show much devitalised tissue or are septic or arecompound fractures or contain foreign bodies. Allwounds should receive thorough cleansing.. For clean wounds: fully immunised individuals(those who have received a total of 5 doses of atetanus-containing vaccine at appropriate intervals)and those whose primary immunisation is complete(with boosters up to date), do not require tetanusvaccine; individuals whose primary immunisation isincomplete or whose boosters are not up to daterequire a reinforcing dose of a tetanus-containingvaccine (followed by further doses as required tocomplete the schedule); non-immunised individuals(or those whose immunisation status is not knownor who have been fully immunised but are nowimmunocompromised) should be given a dose ofthe appropriate tetanus-containing vaccine immediately(followed by completion of the full course ofthe vaccine if records confirm the need).. For tetanus-prone wounds: management is as forclean wounds with the addition of a dose of tetanusimmunoglobulin (section 14.5.2) given at a differentsite; in fully immunised individuals and those whoseprimary immunisation is complete (with boostersup to date) the immunoglobulin is needed only if therisk of infection is especially high (e.g. contaminationwith manure). Antibacterial prophylaxis (withbenzylpenicillin, co-amoxiclav, or metronidazole)may also be required for tetanus-prone wounds.Combined vaccinesSee Diphtheria-containing VaccinesTick-borne encephalitis vaccineTick-borne encephalitis vaccine contains inactivatedtick-borne encephalitis virus cultivated in chick embyrocells. It is recommended for immunisation of thoseliving in or visiting high-risk areas (see InternationalTravel, section 14.6). Children walking or camping inwarm forested areas of Central and Eastern Europe,Scandinavia, Northern and Eastern China, and someparts of Japan, particularly from April to Novemberwhen ticks are most prevalent, are at greatest risk of14 Immunological products and vaccines