BNF for Children 2011-2012

620 14.4 Vaccines and antisera BNFC 2011–201214 Immunological products and vaccinestick-borne encephalitis. For full protection, 3 doses ofthe vaccine are required; booster doses are requiredevery 3–5 years for those still at risk. Ideally, immunisationshould be completed at least one month beforetravel.TICK-BORNE ENCEPHALITISVACCINE, INACTIVATEDCautions see section 14.1Contra-indications see section 14.1Pregnancy see p. 600Breast-feeding see p. 600Side-effects see section 14.1Indication and doseImmunisation against tick-borne encephalitis. By intramuscular injection in deltoid region oranterolateral thigh in infantsChild 1–16 years initial immunisation, 3 doses of0.25 mL, second dose after 1–3 months and thirddose after a further 5–12 monthsChild 16–18 years 3 doses each of 0.5 mL, seconddose after 1–3 months and third dose afterfurther 5–12 monthsImmunocompromised (including those receivingimmunosuppressants), antibody concentrationmay be measured 4 weeks after second dose anddose repeated if protective levels not achievedNote To achieve more rapid protection, second dose maybe given 14 days after first dose.Booster doses, give first dose within 3 years afterinitial course, then every 3–5 yearsTicoVac c (MASTA) AInjection, suspension, formaldehyde-inactivatedNeudörfl tick-borne encephalitis virus strain, (cultivatedin chick embryo cells) adsorbed onto hydratedaluminium hydroxide, net price 0.25-mL prefilledsyringe (TicoVac Junior c ) = £28.00, 0.5-mL prefilledsyringe = £32.00Excipients include gentamicin and neomycinTyphoid vaccinesTyphoid vaccine is available as Vi capsular polysaccharideinjectable vaccine (from Salmonella typhi) forinjection; and as live attenuated Salmonella typhivaccine for oral use.Typhoid immunisation is advised for children travellingto:. areas where typhoid is endemic, especially if stayingwith or visiting local people. endemic areas where frequent or prolonged exposureto poor sanitation and poor food hygiene islikelyTyphoid vaccination is not a substitute for scrupulouspersonal hygiene (see p. 627).Capsular polysaccharide typhoid vaccine is usuallygiven by intramuscular injection. Children under 2years may respond suboptimally to the vaccine, butchildren aged between 1–2 years should be immunisedif the risk of typhoid fever is considered high (immunisationis not recommended for infants under 12months). Booster doses are needed every 3 years oncontinued exposure.Oral typhoid vaccine is a live attenuated vaccinecontained in an enteric-coated capsule. One capsuletaken on alternate days for a total of 3 doses, providesprotection 7–10 days after the last dose. Protection maypersist for up to 3 years in those constantly (or repeatedly)exposed to Salmonella typhi, but occasional travellersrequire further courses at intervals of 1 year.interactions Oral typhoid vaccine is inactivated byconcomitant administration of antibacterials or antimalarials:. Antibacterials should be avoided for 3 days beforeand after oral typhoid vaccination;. Mefloquine should be avoided for at least 12 hoursbefore or after oral typhoid;. For other antimalarials, vaccination with oral typhoidvaccine should be completed at least 3 daysbefore the first dose of the antimalarial (exceptproguanil hydrochloride with atovaquone, whichmay be given concomitantly).TYPHOID VACCINECautions section 14.1; interactions: see above andAppendix 1 (vaccines)Contra-indications section 14.1; also for oral vaccine,acute gastro-intestinal illnessPregnancy see p. 600Breast-feeding see p. 600Side-effects section 14.1Indication and doseImmunisation against typhoid feverFor dose see under preparationsTyphoid polysaccharide vaccine for injectionTypherix c (GSK) AInjection, Vi capsular polysaccharide typhoidvaccine, 50 micrograms/mL virulence polysaccharideantigen of Salmonella typhi, net price 0.5-mL prefilledsyringe = £9.93Dose. By intramuscular injectionChild under 2 years [unlicensed use], 0.5 mL, at least 2weeks before potential exposure to typhoid infection;response may be suboptimal (see notes above)Child 2–18 years 0.5 mL, at least 2 weeks beforepotential exposure to typhoid infectionTyphim Vi c (Sanofi Pasteur) AInjection, Vi capsular polysaccharide typhoidvaccine, 50 micrograms/mL virulence polysaccharideantigen of formaldehyde-inactivated Salmonellatyphi, net price 0.5-mL prefilled syringe = £9.00Dose. By intramuscular injectionChild under 2 years [unlicensed use], 0.5 mL, at least 2weeks before potential exposure to typhoid infection;response may be suboptimal (see notes above)Child 2–18 years 0.5 mL, at least 2 weeks beforepotential exposure to typhoid infectionPolysaccharide vaccine with hepatitis A vaccineSee Hepatitis A Vaccine